A combination of cognitive behavioral therapy, relaxation, and dietary strategies reduced symptoms and increased quality of life in patients with irritable bowel syndrome (IBS), compared with usual care, researchers report in the February issue of Clinical Gastroenterology and Hepatology. The program produced sustainable behavioral changes in almost all participants after 1 year of follow up.
Psychological therapies such as cognitive behavioral therapy, relaxation therapies, and dietary management, have each been reported to reduce symptoms of IBS.
Jasmine K. Zia et al combined these strategies, developing a comprehensive self-management (CSM) program with cognitive behavioral therapy and relaxation and dietary strategies. In a clinical trial, the program was delivered in 9 sessions, each lasting 1 hour, within a 13-week period by trained psychiatric nurse therapists. CSM sessions covered 3 main themes: diet, relaxation, and alternative thoughts.
Zia et al followed 81 of the participants for 12 months after the CSM program began to determine its long-term effects.
Completion of the CSM program resulted in sustainable behavioral changes. Of the 81 participants, 40% had at least a 50% improvement in their gastrointestinal symptom scores at 12 months, and 84% of participants demonstrated at least some improvement in symptom scores.
At the 12 month timepoint, 94% of the participants were still using at least 6 strategies, and 79% were using all of them. This level of adherence was higher than that reported in other patient populations.
At the end of the CSM sessions, the participants were asked to write a comprehensive plan that specified which strategies they found the most helpful and planned on using over the next year in managing their IBS symptoms.
Specific relaxation strategies were selected by 95% of the patients, closer attention to dietary composition by 90%, and thought distortion by 90%.
The individual CSM strategies most frequently selected in the comprehensive plan were “eat small, frequent meals” (70%), the “quieting response” (66%), and “alter fiber to tolerable amount” (64%). For CSM strategies such as trigger foods, vitamins and supplements, exercise, time for self, participants provided specific examples.
Zia et al credit the high rate of adherence to the structure of their program, which offered flexibility, individualization, practice, and personal feedback. The program gave participants the freedom to pick and choose their strategies. By trial and error, participants could assess, with the guidance of the nurse therapist, which strategies most affected their personal IBS symptoms and could be integrated into their daily routines. Zia et al believe that personal contact with the nurse therapist might have also contributed to the high adherence rates.
The authors admit that the CSM program is not realistically accessible to all patients with IBS. However, Zia et al say that the results can guide clinicians as to which CSM strategies to strategically focus on, given their limited time and resources.