Durability and Decay of Treatment Benefit of Cognitive Behavioral Therapy for Irritable Bowel Syndrome: 12-Month Follow-Up

Lackner JM1, Jaccard J2, Radziwon CD3, Firth RS3, Gudleski GD3, Hamilton F4, Katz LA3, Keefer L5, Krasner SS3,6, Ma CX7, Sitrin MD3, Brenner DM8. Am J Gastroenterol. 2018 Nov 14. doi: 10.1038/s41395-018-0396-x. [Epub ahead of print]

Author information

1 Department of Medicine, Jacobs School of Medicine, Divisions of Behavioral Medicine and Gastroenterology, University at Buffalo, Buffalo, NY, USA. lackner@buffalo.edu.

2 School of Social Work, New York University, New York, NY, USA.

3 Department of Medicine, Jacobs School of Medicine, Divisions of Behavioral Medicine and Gastroenterology, University at Buffalo, Buffalo, NY, USA.

4 Division of Digestive Disease and Nutrition, NIDDK, Bethesda, MD, USA.

5 Department of Medicine, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

6 Departments of Anesthesiology, Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA.

7 Department of Biostatistics, University at Buffalo SUNY, Buffalo, NY, USA.

8 Department of Medicine, Feinberg School of Medicine, Division of Gastroenterology, Northwestern University, Chicago, IL, USA.


BACKGROUND: There is a need for safe and effective IBS treatments that provide immediate and sustained improvement of IBS symptoms, particularly among more severe patients. The aim was to assess long-term clinical response of cognitive behavioral therapy (CBT) with reference to IBS education.

METHODS: A total of 436 Rome III-diagnosed IBS patients (80% F, M age = 41 years) were randomized to: 4 session home-based CBT (minimal contact (MC-CBT)), 10 session clinic-based CBT (standard (S-CBT)), or 4 session IBS education (EDU). Follow-up occurred at 2 weeks and 3, 6, 9, and 12 months following treatment completion. Treatment response was based a priori on the Clinical Global Improvement Scale (global IBS symptom improvement) and IBS Symptom Severity Scale (IBS-SSS).

RESULTS: Post-treatment CGI gains were generally maintained by MC-CBT patients at quarterly intervals through 12-month follow-up with negligible decay. For MC-CBT and S-CBT, 39 and 33% of respondents maintained treatment response at every follow-up assessment. The corresponding percent for EDU was 19%, which was significantly lower (p < 0.05) than for the CBT groups. On the IBS-SSS, therapeutic gains also showed a pattern of maintenance with trends towards increased efficacy over time in all conditions, with the mean unit reductions between baseline and follows-up being approximately -76 at immediate and approximately -94 at 12 months (-50 = clinically significant).

CONCLUSION: For treatment-refractory IBS patients, home- and clinic-based CBT resulted in substantial and enduring relief of multiple IBS symptoms that generally extended to 12-month post treatment.

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