Online cognitive behavioral therapy may be cost-effective for IBS; quality studies lacking
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Internet-delivered cognitive behavioral therapy may be a cost-effective solution to improve symptoms and quality of life in patients with irritable bowel syndrome, according to a systematic review in Journal of Medical Internet Research.
However, due to the limited number of clinical trials analyzing this intervention, the researchers noted that “more well-designed” clinical trials are required to verify its long-term effects and sustain its benefits.
“Based on a cognitive-behavioral model in which situation, thoughts, emotions, behaviors, and physiological responses interact with each other, cognitive behavioral therapy (CBT)
has been considered as a treatment choice for IBS,” Hyunjung Kim, PhD, of the Research Institute of Nursing Science at Hallym University in Korea, and colleagues wrote. “However, it is difficult for most patients to access CBT due to a shortage of trained therapists, especially in rural areas. ... Internet-delivered CBT (ICBT) can compensate for the treatment limitations of CBT.”
Kim and colleagues searched six databases for publications related to the use of ICBT in adult IBS patients to assess its efficacy in improving symptom severity, quality of life, psychological status and cost-effectiveness. Databases included PubMed, Cochrane Library, PsycINFO, Korean Studies Information Service System, Korean Medical Database and Research Information Sharing Service.
Researchers identified nine randomized controlled trials published between 2009 and 2019 that involved various ICBT interventions, including five studies on exposure-based cognitive behavioral therapy, three on cognitive behavioral therapy for self-management and one on cognitive behavioral therapy for stress management. All therapies were provided in five to 13 sessions for 5 to 10 weeks.
Researchers evaluated the effect of ICBT on IBS symptom severity using the IBS-Symptom Severity Scale, the Gastrointestinal Symptom Rating Scale and the Bowel Symptom Severity Scale and conducted assessments at postintervention and short-term (4-6 months) and long-term (12-24 months) follow-ups. Patients on a waiting list to receive intervention and standard care, psychological treatment or routine medical treatment served as controls.
At postintervention, ICBT had medium-to-large effects on symptom severity (standardized mean difference [SMD] = –0.633; 95% CI,
–0.861 to –0.4304). Small-to-medium effects were still present at short-term (SMD = –0.391; 95% CI, –0.560 to –0.221) and long-term follow-ups (SMD = –0.357; 95% CI –0.541 to –0.172).
Researchers also reported significant effects on quality of life (SMD = 0.582; 95% CI, 0.396-0.769), and cost-effectiveness (–0.372; 95% CI, –0.704 to –0.039) compared with the control group, although only two studies evaluated cost-effectiveness.
However, ICBT did not have a significant effect on depression or anxiety at postintervention compared with controls.
Study limitations included few relevant, randomized control trials on ICBT for IBS patients IBS and lack of diversity within participant groups. Researchers acknowledged that since the studies were heterogenous, it could be “difficult to definitively determine” the results of their analysis and recommended further, high-quality studies.
“This meta-analysis demonstrated that ICBT was superior to standard care or being on a waiting list with regard to improving IBS symptom severity, [quality of life] and cost-effectiveness,” Kim and colleagues concluded. “The effects on IBS symptom severity persisted for a long time after the intervention; that is, ICBT can be considered an effective intervention that can be provided to patients with IBS regardless of location and time.”
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Kim H, et al. J Med Internet Res. 2022:doi:10.2196/35260.
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