BMJ, doi: 10.1136/bmj.38545.505764.06, (Published 10 August 2005)

PRIMARY CARE

Cognitive behaviour therapy in addition to antispasmodic treatment for irritable bowel syndrome in primary care: randomised controlled trial

Tom Kennedy ¹, Roger Jones ^1*, Simon Darnley ¹, Paul Seed ¹, Simon Wessely ², Trudie Chalder ²

¹ Department of General Practice and Primary Care, Guy's, King's, and St Thomas' School of Medicine, King's College, London SE11 6SP
² Institute of Psychiatry, King's College, London

^* Correspondence to: roger.jones{at}kcl.ac.uk.

Objective To assess the efficacy of cognitive behaviour therapy delivered in primary care for treating irritable bowel syndrome.

Design Randomised controlled trial.

Setting 10 general practices in London.

Participants 149 patients with moderate or severe irritable bowel syndrome resistant to the antispasmodic mebeverine.

Interventions Cognitive behaviour therapy delivered by trained primary care nurses plus 270 mg mebeverine taken thrice daily compared with mebeverine treatment alone.

Main outcome measures Primary measures were patients' scores on the irritable bowel syndrome symptom severity scale. Secondary measures were scores on the work and social adjustment scale and the hospital anxiety and depression scale.

Results Of 334 referred patients, 72 were randomised to mebeverine plus cognitive behaviour therapy and 77 to mebeverine alone. Cognitive behaviour therapy had considerable initial benefit on symptom severity compared with mebeverine alone, with a mean reduction in score of 68 points (95% confidence interval 103 to 33), with the benefit persisting at three months and six months after therapy (mean reductions 71 points (109 to 32) and 11 points (20 to 3)) but not later. Cognitive behaviour therapy also showed significant benefit on the work and social adjustment scale that was still present 12 months after therapy (mean reduction 2.8 points (5.2 to 0.4)), but had an inconsistent effect on the hospital anxiety and depression scale.

Conclusion Cognitive behaviour therapy delivered by primary care nurses offered additional benefit over mebeverine alone up to six months, although the effect had waned by 12 months. Such therapy may be useful for certain patients with irritable bowel syndrome in primary care.

---

(Accepted 6 July 2005)
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Articles

Psychological approach to managing irritable bowel syndrome

Bu'Hussain Hayee and Ian Forgacs
BMJ 2007 334: 1105-1109. [Extract] [Full Text] [PDF]

Coeliac disease in primary care

Roger Jones
BMJ 2007 334: 704-705. [Extract] [Full Text] [PDF]

Cognitive behaviour therapy reduces symptom severity of irritable bowel syndrome
BMJ 2005 331: 0. [Full Text]

Related external webpages:

NHS Health Technology Assessment Programme

This article has been cited by other articles:

• Spiller, R, Aziz, Q, Creed, F, Emmanuel, A, Houghton, L, Hungin, P, Jones, R, Kumar, D, Rubin, G, Trudgill, N, Whorwell, P (2007). Guidelines on the irritable bowel syndrome: mechanisms and practical management. Gut 56: 1770-1798 [Abstract] [Full text]  
• Hayee, B., Forgacs, I. (2007). Psychological approach to managing irritable bowel syndrome. BMJ 334: 1105-1109 [Full text]  
• Jones, R. (2007). Coeliac disease in primary care. BMJ 334: 704-705 [Full text]  
• Jones, M. P., Crowell, M. D., Olden, K. W., Creed, F. (2007). Functional Gastrointestinal Disorders: An Update for the Psychiatrist. Psychosomatics 48: 93-102 [Abstract] [Full text]  
• Hungin, P. (2007). Functional disorders--a cause of increasing work absence?. Occup Med (Lond) 57: 2-3 [Full text]  
• Wearden, A. J., Chew-Graham, C. (2006). Managing chronic fatigue syndrome in UK primary care: challenges and opportunities. Chronic Illness 2: 143-153 [Abstract]  
• Hungin, A P S (2006). Self-help interventions in irritable bowel syndrome. Gut 55: 603-604 [Full text]  
• (2005). Adjunctive Cognitive-Behavioral Therapy for IBS. JWatch Psychiatry 2005: 9-9 [Full text]  
• (2005). Adjunctive Cognitive-Behavioral Therapy for IBS. JWatch General 2005: 3-3 [Full text]  

Rapid Responses:

Read all Rapid Responses

Gut feelings

Chris L. Manning
bmj.com, 20 Aug 2005 [Full text]

C.B.T and Hypnotherapy to treat refractory Irritable bowel syndrome

James Paul Pandarakalam
bmj.com, 24 Aug 2005 [Full text]

Premature conclusion?

Bart van Pinxteren
bmj.com, 6 Sep 2005 [Full text]

Primary care cognitive behavioural therapy for irritable bowel syndrome: a placebo response only?

Mark E McAlindon, et al.
bmj.com, 13 Sep 2005 [Full text]