Online Therapy Shows Promise for Irritable Bowel

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NEW YORK (Reuters Health) - Behavioral therapy delivered over the Web might help soothe 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 is a form of psychological counseling that tries to address the unhealthy thinking patterns and behaviors that contribute to various health problems. It's one option for treating IBS.

People with IBS have repeated bouts of abdominal cramps, bloating, constipation and diarrhea. The exact cause is unknown, but anxiety and less-than-ideal coping strategies -- like avoiding going out because of your 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 an obstacle to people actually trying the therapy is that it's not widely available. Many people live nowhere near a therapist; or if they do, the time commitment of meeting with a therapist, or the price tag, may be too much.

So for the new study, published 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."

In the end, a majority of patients in each group said they were having "adequate relief" of IBS pain and discomfort. But six months later, the cognitive behavioral group was faring better: 65 percent still thought their symptoms were under control, versus 44 percent 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," lead researcher Brjann Ljotsson, of the Karolinska Institute in Stockholm, told Reuters Health in an email.

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

"We need to develop effective and efficient ways to treat IBS, and that's what this study was aimed at," said Lackner, who has studied cognitive behavioral therapy for managing the condition.

In his own work, 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.

But there are still questions, according to Lackner.

One is the fact that there are different forms of cognitive behavioral therapy. "We don't really know whether one form is better than others for IBS," 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 explained.

So his team used a type of therapy that involves "graded exposure." They 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 things like stress management and relaxation exercises -- similar to the comparison therapy used in this study. Ljotsson said the findings suggest that graded exposure works better.

However, Lackner pointed out that different people may respond to different tactics.

And 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, Lackner said. The same might be true of people with less education.

A limit of the current study, 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: American Journal of Gastroenterology, online May 3, 2011.

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