What is the role of cognitive behavioral therapy in IBS?
Cognitive-behavioral therapy is the best-studied psychological treatment for IBS. Cognitive techniques (typically administered over 4 to 15 sessions) are aimed at changing catastrophic or maladaptive thinking patterns underlying the perception of somatic symptoms. Behavioral techniques aim to modify dysfunctional behaviors through relaxation techniques, contingency management (rewarding healthy behaviors), or assertion training. Some randomized, controlled trials have also shown reductions in IBS symptoms with the use of gut-directed hypnosis (aimed at improving gut function), which involves relaxation, change in beliefs, and self-management.
A metaanalysis of 17 randomized trials of cognitive treatments, behavioral treatments, or both for IBS (including hypnosis), as compared with control treatments (including waiting list, symptom monitoring, and usual medical treatment), found patients treated with cognitive-behavioral therapy were significantly more likely to have a reduction in GI symptoms of at least 50% (odds ratio, 12; 95% CI, 6 to 260) with an NNT of 2.
Recently, a Swedish group developed an Internet-delivered cognitive behavioral treatment for IBS that includes 10 weeks of intervention, including contact with an online therapist. When compared with Internet-delivered stress management that emphasized symptom control through relaxation techniques, dietary adjustments, and problem-solving skills, the Internet-delivered cognitive behavioral treatment showed significant differences at posttreatment and 6-month follow-up as compared with Internet-delivered stress management (difference on GSRS-IBS of 4.8 at posttreatment and 5.9 at 6 months).