Internet-delivered exposure and mindfulness based therapy for irritable bowel syndrome--a randomized controlled trial.

The aim of this study was to investigate if cognitive behavior therapy (CBT) based on exposure and mindfulness exercises delivered via the Internet would be effective in treating participants with irritable bowel syndrome (IBS). Participants were recruited through self-referral. Eighty-six participants were included in the study and randomized to treatment or control condition (an online discussion forum). One participant was excluded after randomization. The main outcome measure was IBS-symptom severity and secondary measures included IBS-related quality of life, GI-specific anxiety, depression and general functioning. Participants were assessed at pre-treatment, post-treatment and 3 month follow-up (treatment condition only). Four participants (5% of total sample) in the treatment condition did not participate in post-treatment assessment. Participants in the treatment condition reported a 42% decrease and participants in the control group reported a 12% increase in primary IBS-symptoms. Compared to the control condition, participants in the treatment group improved on all secondary outcome measures with a large between group effect size on quality of life (Cohen's d = 1.21). We conclude that CBT-based on exposure and mindfulness delivered via the Internet can be effective in treating IBS-patients, alleviating the total burden of symptoms and increasing quality of life.

[1]  L. Aabakken,et al.  Diagnosing irritable bowel syndrome: poor agreement between general practitioners and the Rome II criteria , 2004, Scandinavian journal of gastroenterology.

[2]  D. Sheehan,et al.  The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. , 1998, The Journal of clinical psychiatry.

[3]  A. H. Berman,et al.  Evaluation of the Drug Use Disorders Identification Test (DUDIT) in Criminal Justice and Detoxification Settings and in a Swedish Population Sample , 2004, European Addiction Research.

[4]  A R Zinsmeister,et al.  Medical costs in community subjects with irritable bowel syndrome. , 1995, Gastroenterology.

[5]  S. Morley,et al.  Psychological treatments for irritable bowel syndrome: a systematic review and meta-analysis. , 2004, Journal of consulting and clinical psychology.

[6]  N. Talley,et al.  A randomized controlled trial of cognitive behavior therapy, relaxation training, and routine clinical care for the irritable bowel syndrome , 2003, American Journal of Gastroenterology.

[7]  I. Wiklund,et al.  The Visceral Sensitivity Index: development and validation of a gastrointestinal symptom‐specific anxiety scale , 2004, Alimentary pharmacology & therapeutics.

[8]  Gregory T. Smith,et al.  Construct Validity of the Five Facet Mindfulness Questionnaire in Meditating and Nonmeditating Samples , 2008, Assessment.

[9]  B. Naliboff,et al.  Stress and the gastrointestinal tract. V. Stress and irritable bowel syndrome , 2001 .

[10]  G. Andersson,et al.  Exposure and mindfulness based therapy for irritable bowel syndrome--an open pilot study. , 2010, Journal of behavior therapy and experimental psychiatry.

[11]  D. Drossman,et al.  Quality of Life in Persons with Irritable Bowel Syndrome (Development and Validation of a New Measure) , 1998, Digestive Diseases and Sciences.

[12]  P. Moayyedi,et al.  Efficacy of antidepressants and psychological therapies in irritable bowel syndrome: systematic review and meta-analysis , 2008, Gut.

[13]  P. Whorwell,et al.  Design of treatment trials for functional gastrointestinal disorders , 1999, Gut.

[14]  Heleen Riper,et al.  Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis , 2006, Psychological Medicine.

[15]  C. B. Taylor,et al.  Evaluation of an internet support group for women with primary breast cancer , 2003, Cancer.

[16]  B. Lacy,et al.  Irritable bowel syndrome: a syndrome in evolution. , 2005, Journal of clinical gastroenterology.

[17]  Andrew C. Leon,et al.  Assessing Psychiatric Impairment in Primary Care with the Sheehan Disability Scale , 1997, International journal of psychiatry in medicine.

[18]  G. Koch,et al.  Cognitive-behavioral therapy versus education and desipramine versus placebo for moderate to severe functional bowel disorders. , 2003, Gastroenterology.

[19]  S. Hayes Acceptance and Commitment Therapy, Relational Frame Theory, and the Third Wave of Behavioral and Cognitive Therapies. , 2004 .

[20]  G. Devilly,et al.  Psychometric properties of the credibility/expectancy questionnaire. , 2000, Journal of behavior therapy and experimental psychiatry.

[21]  Margaret M Heitkemper,et al.  Self-management for women with irritable bowel syndrome. , 2004, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[22]  Jacob Cohen,et al.  A power primer. , 1992, Psychological bulletin.

[23]  E. Blanchard,et al.  Comparison of Treatment Outcome Measures for Irritable Bowel Syndrome , 1997, Applied psychophysiology and biofeedback.

[24]  Lin Chang,et al.  The Central Role of Gastrointestinal-Specific Anxiety in Irritable Bowel Syndrome: Further Validation of the Visceral Sensitivity Index , 2007, Psychosomatic medicine.

[25]  G. Andersson,et al.  Internet-delivered treatments with or without therapist input: does the therapist factor have implications for efficacy and cost? , 2007, Expert review of pharmacoeconomics & outcomes research.

[26]  J. Jaccard,et al.  Self-administered cognitive behavior therapy for moderate to severe irritable bowel syndrome: clinical efficacy, tolerability, feasibility. , 2008, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[27]  M. Åsberg,et al.  A New Depression Scale Designed to be Sensitive to Change , 1979, British Journal of Psychiatry.

[28]  I. Wiklund,et al.  Well-being and gastrointestinal symptoms among patients referred to endoscopy owing to suspected duodenal ulcer. , 1995, Scandinavian journal of gastroenterology.

[29]  G. Andersson Using the Internet to provide cognitive behaviour therapy. , 2009, Behaviour research and therapy.

[30]  D. W. Goodwin The Anxiety Disease and How to Overcome It , 1984 .

[31]  F. Mearin,et al.  Bowel Habit Subtypes and Temporal Patterns in Irritable Bowel Syndrome: Systematic Review , 2005, The American Journal of Gastroenterology.

[32]  Kate Lorig,et al.  Internet Versus Mailed Questionnaires: A Randomized Comparison , 2004, Journal of medical Internet research.

[33]  E. Blanchard,et al.  A controlled evaluation of group cognitive therapy in the treatment of irritable bowel syndrome. , 2007, Behaviour research and therapy.

[34]  A. Kennedy,et al.  A randomised controlled trial of self-help interventions in patients with a primary care diagnosis of irritable bowel syndrome , 2005, Gut.

[35]  T. Borkovec Effects of expectancy on the outcome of systematic desensitization and implosive treatments for analogue anxiety. , 1972 .

[36]  P. Svanborg,et al.  A new self‐rating scale for depression and anxiety states based on the Comprehensive Psychopathological Rating Scale , 1994, Acta psychiatrica Scandinavica.

[37]  David Thompson,et al.  Functional bowel disorders , 2005, Digestive Diseases and Sciences.

[38]  O. Aasland,et al.  Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption--II. , 1993, Addiction.

[39]  A. Hungin Self-help interventions in irritable bowel syndrome , 2006, Gut.

[40]  R Jones,et al.  Guidelines on the irritable bowel syndrome: mechanisms and practical management , 2007, Gut.

[41]  Per Carlbring,et al.  Internet vs. paper and pencil administration of questionnaires commonly used in panic/agoraphobia research , 2007, Comput. Hum. Behav..

[42]  T. Kaptchuk,et al.  The placebo effect in irritable bowel syndrome trials: a meta‐analysis 1 , 2005, Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society.

[43]  T. Hergueta,et al.  The mini international neuropsychiatric interview , 1998, European Psychiatry.

[44]  A. Zinsmeister,et al.  Impact of functional gastrointestinal disorders on health‐related quality of life: a population‐based case–control study , 2004, Alimentary pharmacology & therapeutics.

[45]  E. Blanchard,et al.  Preliminary Study of a Self-Administered Treatment for Irritable Bowel Syndrome: Comparison to a Wait List Control Group , 2007, Applied psychophysiology and biofeedback.

[46]  Nicholas J. Talley,et al.  U. S. Householder survey of functional gastrointestinal disorders , 1993, Digestive Diseases and Sciences.

[47]  I. Wiklund,et al.  An irritable bowel syndrome-specific symptom questionnaire: development and validation. , 2003, Scandinavian journal of gastroenterology.

[48]  G. Clum,et al.  Handbook of Self-Help Therapies , 2007 .

[49]  A R Zinsmeister,et al.  esign of Treatment Trials for Functional Gastrointestinal isorders esign of Treatment Trials Committee : , 2006 .

[50]  E. Blanchard Irritable Bowel Syndrome: Psychosocial Assessment and Treatment , 2001 .

[51]  N. Talley,et al.  The Irritable Bowel Syndrome: Long-Term Prognosis and the Physician-Patient Interaction , 1995, Annals of Internal Medicine.

[52]  W. Whitehead,et al.  Mindfulness for irritable bowel syndrome: protocol development for a controlled clinical trial , 2009, BMC complementary and alternative medicine.

[53]  M. Milonova,et al.  Brief cognitive-behavioral internet therapy for irritable bowel syndrome. , 2009, Behaviour research and therapy.

[54]  T. Borkovec,et al.  Credibility of analogue therapy rationales , 1972 .

[55]  B. Naliboff,et al.  Mind/Body Psychological Treatments for Irritable Bowel Syndrome , 2007, Evidence-based complementary and alternative medicine : eCAM.