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Adolescents with IBS benefit from internet therapy
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Exposure-based cognitive behavior therapy delivered via the internet improved gastrointestinal symptoms and quality of life in adolescents with irritable bowel syndrome, according to randomized controlled trial results.
“The main findings in our study are a steady improvement in gastrointestinal symptoms, along with a width of improvements seen across almost all secondary outcomes such as pain intensity, school absence, fear and worry about symptoms and quality of life,” Marianne Bonnert, MSc, of the department of clinical neuroscience, division of psychology at Karolinska Institutet in Stockholm, Sweden, told Healio Gastroenterology. “The study shows that exposure for symptoms (to reduce avoidance and even provoke symptoms) is effective to improve symptoms.”
Marianne Bonnert
Previous studies have shown cognitive behavior therapy (CBT) that focuses on exposure exercises to reduce fear and avoidance behaviors is beneficial for IBS patients, but access to CBT is limited for children and adolescents with IBS. Therefore, a promising alternative is CBT delivered via the internet, which relies on texts, images and videos to deliver treatment.
To evaluate the effectiveness of exposure-based internet-CBT in adolescents with IBS, Bonnert and colleagues randomly assigned 101 IBS patients aged 13 to 17 years to a 10-week internet-CBT intervention (n = 47) or a wait-list control (n = 54).
“The main principle of the treatment was to use exposure exercises to reduce symptom-fear and avoidance, eg, eating symptom-provoking foods and avoiding symptom-reducing behavior, eg, resting,” Bonnert and colleagues wrote. “Parent modules mainly emphasized that parents should encourage their adolescent to engage in the challenging exposure exercises.” The families also received online support from a psychologist throughout treatment.
Adherence to treatment was high, and the mean therapist time per family was 188.79 minutes for the whole treatment period.
After 10 weeks, the CBT group showed significant improvements in Gastrointestinal Symptoms Rating Scale for IBS scores compared with controls (P = .006), and in nearly all secondary outcomes, which included adolescent- and parent-rated quality of life and parent-rated gastrointestinal symptoms. These results remained stable or improved significantly after 6 months.
Patient satisfaction with treatment was also high, with 83% reporting the treatment was good or excellent, 91% reporting good or excellent support from the therapist, and 81% reporting they were satisfied or very satisfied with the treatment overall.
The investigators concluded that exposure-based internet-CBT results in long-term symptomatic and functional improvements among adolescents with IBS.
“Our results can contribute to increased access to effective treatment for the many adolescents who suffer from IBS,” Bonnert said. – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.
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