Online Therapy Shows Promise for Irritable Bowel

By Amy Norton

NEW YORK (Reuters Health) May 27 - Behavioral therapy delivered over the internet might help ease symptoms in some people with irritable bowel syndrome (IBS), a new study suggests.

The online approach is not yet available outside of studies. But researchers say that the current findings are a step in the right direction toward making cognitive behavioral therapy more accessible to people with IBS.

Cognitive behavioral therapy tries to address the unhealthy thinking patterns and behaviors that contribute to various health problems. Anxiety and less-than-ideal coping strategies -- like avoiding going out because of symptoms - are thought to make IBS worse for many people. Studies have suggested that cognitive behavioral therapy can ease IBS symptoms in at least some people.

But many people don't live near a therapist; or the time commitment or the price tag of therapy may be too high.

For the new study, published online May 3rd in the American Journal of Gastroenterology, Swedish researchers tested a Web-based program they developed.

They randomly assigned 195 adults with IBS to either cognitive behavioral therapy or a stress management program, both of which were delivered online over 10 weeks. Patients in both groups read self-help texts and sent messages back and forth with an "online therapist."

At the end of the 10 weeks, the majority in each group was having "adequate relief" of IBS pain and discomfort. But six months later, the cognitive behavioral group was faring better: 65% still thought their symptoms were under control, versus 44% of the stress management group.

The findings suggest that "patients can be guided by an online psychologist in their work and do not need to schedule weekly visits at a psychologist's office," said lead researcher Brjann Ljotsson, of the Karolinska Institute in Stockholm, in email to Reuters Health.

The study is a "step in the right direction" to making cognitive behavioral therapy more accessible, said Dr. Jeffrey M. Lackner of the State University of New York at Buffalo, who was not involved in the work.

In his own work, Dr. Lackner has found that both traditional face-to-face counseling and therapy that relies mostly on at-home, self-help materials can help some people with IBS.

There are different forms of cognitive behavioral therapy, however, and "we don't really know whether one form is better than others for IBS," Dr. Lackner said.

The therapy used in the current study is based on the idea that people with IBS often become fearful about developing symptoms and then avoid things, like a certain food or physical activity, they think could trigger symptoms. But that anxiety, itself, can lead to symptoms.

Ljotsson's team had patients gradually expose themselves to the things they feared would cause symptoms, and also taught them "mindfulness" techniques to help them deal with their emotional reactions to their symptoms.

"By exposing themselves to IBS symptoms," Ljotsson said, "the patients become less afraid of them, and the vicious cycle between fear and symptoms is broken."

But there are other approaches, including therapies that involve stress management and relaxation exercises. Ljotsson said the findings suggest that graded exposure works better.

However, he admits, different people may respond to different tactics.

As for online therapy, that too might work for some but not others. Older adults without much tech-savvy, for example, might not do well with it, Dr. Lackner said.

A limit of the current study, Dr. Lackner said, is that all of the participants were self-referred. So they may have been particularly motivated, and their success rates may not necessarily represent what would be seen in the real world.

SOURCE: http://bit.ly/iNfK3I

Am J Gastroenterol 2011.