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Primary Care

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

BMJ 2005; 331 doi: (Published 18 August 2005) Cite this as: BMJ 2005;331:435
  1. Tom Kennedy, lecturer in general practice1,
  2. Roger Jones, Wolfson professor of general practice (roger.jones{at},
  3. Simon Darnley, research associate1,
  4. Paul Seed, statistician1,
  5. Simon Wessely, professor of epidemiological and liaison psychiatry2,
  6. Trudie Chalder, professor of cognitive behavioural psychotherapy2
  1. 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. 2 Institute of Psychiatry, King's College, London
  1. Correspondence to: R Jones
  • Accepted 6 July 2005


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.


  • Contributors TK,RJ, SW, and TC had the initial idea for the study and wrote the research grant application. SD trained the nurses and acted as the trial research coordinator. PS provided statistical advice. TK, TC, and RJ wrote the early drafts of the manuscript, to which all authors contributed. RJ is guarantor for the study.

  • Funding This study was funded by a grant from the NHS Health Technology Assessment Programme.

  • Competing interests RJ has acted as a consultant for pharmaceutical companies Novartis, Boots, and Solvay. TK has acted as a consultant for Boots.

  • Ethical approval Approval was received from St Thomas' Hospital Research Ethics Committee, Guy's Hospital Research Ethics Committee, and Barnet, Enfield and Haringey LREC.

  • Accepted 6 July 2005
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