Patients with irritable bowel syndrome who receive cognitive-behavioral therapy seem to derive long-lasting benefits from the treatment, researchers have found.

The gains can last a year or longer regardless of whether CBT is administered in the clinic or at home, according to long-term follow-up of a randomized clinical trial. The effectiveness of either approach was significantly better than a control treatment at the one-year mark.

“We can say from these results that the benefit was not due to a placebo response because placebo response erodes after treatment, but we saw a stable and robust treatment response that is relatively rare in this difficult-to-treat population,” reported Jeffrey M. Lackner, PsyD, the chief of the Division of Behavioral Medicine at the University at Buffalo School of Medicine, in New York. The durable responses were documented both by between-group comparisons for outcome at 12 months and with patient-centered analyses that evaluated the proportion of patients who had improvement in gastrointestinal symptoms immediately and maintained these gains over time.

Dr. Lackner’s group presented the findings at the 2018 Digestive Disease Week (abstract 455). His group has published results from the six-month mark of this prospective multicenter study (Gastroenterology 2018;155[1]:47-57), which randomly assigned 436 patients with IBS based on Rome III diagnostic criteria, to treatment.

In the standard CBT arm, the therapy was delivered in 10 hour-long sessions that emphasized understanding the brain–gut interaction, recognizing triggers of IBS symptoms, and developing flexible approaches to problem solving and preventing relapses.

In a second arm, CBT was delivered in four sessions using home-based study materials. Patients assigned to the control arm received education about IBS, including the role of dietary triggers and minimizing stress, but no therapy.

At the one-year mark, global improvement in IBS symptoms, as assessed by both patients and gastroenterologists blinded to treatment assignment, was significantly better (P<0.05) for CBT than education at every time point—as they were at two weeks and three and six months, according to the investigators. In general, the proportion of patients much or very much improved by patient global ratings at every time point was about 60% in the standard CBT arm, 55% in the minimal contact arm and 43% in the control arm.

One-third of patients treated with CBT and 19% of control patients were complete responders, meaning they had improved when evaluated two weeks after completion of therapy, and they remained improved for the subsequent 12 months of follow-up.

The rate of partial response, defined as improvement by at least three of the five time points, was 67% in patients treated with CBT and 51% in the control group. The rate of nonresponse, meaning no improvement at any point in time, was 14% in the CBT group and 22% in the control group.

Of psychological therapies for IBS, CBT is among the best validated, according to Dr. Lackner. Several practice guidelines, including those issued by the American College of Gastroenterology and the National Institute for Clinical Excellence in the United Kingdom, now include CBT under treatment options. The new data reinforce the clinical value of behavioral treatment, particularly given apprehension about safety issues associated with pharmacologic therapies for pain, he said.

Megan E. Riehl, PsyD, a clinical health psychologist in the Division of Gastroenterology and Hepatology at the University of Michigan, in Ann Arbor, said the findings confirm the efficacy of CBT for IBS and highlight the effectiveness of relatively short-term treatment.

“Given the current shortage of providers who specialize in GI-specific CBT, short-term treatment may allow more patients to be seen,” Dr. Riehl said. CBT may be particularly attractive “for patients who have failed other medical therapy or who are interested in nonpharmaceutical options,” she added.

—Ted Bosworth

Drs. Lackner and Riehl reported no relevant financial conflicts of interest.