Intended for healthcare professionals

Rapid response to:

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

Rapid Response:

Gut feelings

Dear Sir

An interesting paper that adds to the evidence-base for the
effectiveness of CBT across many areas of practice. Evidence from use of
CORE-PC shows that the intervener effect may be as important as the
intervention and results from CBT may not be generalisable from one unit
to another, dependent on levels of clinical expertise and unit

This issue heavily underlines the importance of the placebo effect,
especially in the treatment of those with
conditions that respond to psychological interventions (and it would be
hard to find many that don't?), as has also been clearly debated recently
in the issues concerning RCTs and SSRI antidepressants.

Alongside other studies that show limitation of effect duration,
those who strongly advocate CBT as the "only fruit" psychological
intervention in the NHS need to bear in mind that topping up "boosters"
may be required and that NHS (and other)units and that provider units and
professionals differ in their levels of ability to engage and competence.
This may be increasingly important as primary care becomes open-ground for
competition amongst providers, especially the voluntary and private

The other reminder in this paper, aside from the fact that we are all
"hard wired", is that of the need for the more wholistic assessment of
patients, and that the HAD, and other measurements, do not pick up all
intervention effects because they are not designed to do so - and that
other instruments are. This should serve as a timely reminder for NICE to
be considering all aspects of quality of life and values, especially
social ones, in the thorough assessment of any intervention. This is
further re-iterated in the current issue in Minerva:

"Sick leave for people with chronic lung conditions relates more to
psychosocial and work issues than the state of their lungs, according to a
Dutch study ( Respiratory Medicine 2005;99: 1022-31[CrossRef][Medline]).
The authors asked 189 people with asthma or chronic obstructive pulmonary
disease about their sick leave during the previous 12 months—along with
other questions about their health, work, and psychosocial issues—and
measured their lung function. Sick leave was associated with low job
satisfaction, low job control, and having a new employer but not with lung

Yours Faithfully

Dr Chris Manning
CEO Primhe (Primary care mental health and education)
Mental Health Taskforce (England)

Competing interests:
None declared

Competing interests: No competing interests

20 August 2005
Chris L. Manning
CEO Primhe