Do Symptoms of Irritable Bowel Syndrome Improve when Patients Receive Cognitive Behavioural Therapy for Co-morbid Anxiety Disorders in a Primary Care Psychological Therapy (IAPT) Service?

Abstract

Background: Irritable bowel syndrome (IBS) is a common co-morbid condition with anxiety disorders, and patients often report a fear of incontinence in public places. This type of bowel control anxiety (BCA) can be conceptualized as a phobic syndrome. Yet little evidence exists on the prevalence or outcomes of these co-morbidities in routine primary care psychological therapy (Improving Access to Psychological Therapies, IAPT) services. Aims: To examine the prevalence and outcomes of IBS and BCA patients treated with cognitive behavioural therapy (CBT) for anxiety disorders within a routine IAPT service. Method: An observational cohort study screened 2322 referrals to an IAPT service over 12 months for the presence of IBS. Patients with co-morbid anxiety disorders and IBS were grouped into those with, and without BCA. Patients completed the IBS symptom severity scale and the IAPT minimum data set. Diagnoses and outcomes were examined for all groups up to 6 months follow-up. Results: A greater proportion of BCA patients had a primary diagnosis of phobic disorder. After receiving CBT, patients made clinically significant improvement in both anxiety and IBS symptoms at 6 months follow-up. Patients with BCA made greater improvement in phobia scales and IBS symptoms than non-BCA patients. Conclusions: Anxiety disorders with comorbid IBS improved significantly in a routine IAPT service. A significant proportion of comorbid IBS sufferers had a fear of incontinence in public places (BCA). Directly addressing and modifying these fears with CBT appeared to enhance improvement in both phobic anxiety and IBS symptoms.

Improving Access to Psychological Therapies (IAPT) in the United Kingdom: A systematic review and meta‐analysis of 10‐years of practice‐based evidence

“…The number of studies and number of ES reported in each analysis will be reported for clarity. A limited number of studies reporting pre‐post outcomes also included follow‐up data ( n = 4; Clark et al ., 2009; Kenwright, McDonald, Talbot, & Janjua, 2017; Meadows & Kellett, 2017; Pack & Condren, 2014). Due to the small number of these studies, follow‐up outcomes have not been included within this meta‐analysis.…”

Psychotherapy for Irritable Bowel Syndrome: A Systematic Review

“…Several studies have solely evaluated the impact of CBT on IBS, with primary outcomes ranging from the Gastrointestinal Symptoms Rating Scale (GSRS), the IBS-Symptom Severity Score (IBS-SSS), symptom frequency, the Behavioral Response Questionnaire (BRQ), the Pain Catastrophizing Scale (PCS), QoL, depression, and anxiety. Cognitive behavioral therapy significantly improved GSRS and IBS-SSS, which include somatic symptoms like diarrhea, bloating, and constipation, with one study reporting that 69.2% of subjects showed >70% improvement from baseline, which was in range for other studies [13][14][15][16][17][18][19][20]. Cognitive behavioral therapy done specifically for anxiety with bowel control anxiety techniques also had a significant improvement in IBS symptoms [18].…”

“…With CBT, there was a significant change at two months concerning gastrointestinal-specific anxiety, gastrointestinalfocused cognitions, and safety behaviors decreased except for unhelpful IBS avoidance behaviors; however, there was no clinical significance [20]. Depressive and anxiety symptoms improved significantly according to improvements in the Patient Health Questionnaire-9 (PHQ-9), Trait Anxiety Inventory Score (TAIS), State Anxiety Inventory Scores (SAIS), and the Depression Anxiety Stress Scale (DASS) in most studies [15,[17][18][19][20][21]23]. Hunt et al, however, observed that the DASS anxiety subscale did not show significant improvement following CBT [17].…”

“…Cognitive behavioral therapy significantly improved GSRS and IBS-SSS, which include somatic symptoms like diarrhea, bloating, and constipation, with one study reporting that 69.2% of subjects showed >70% improvement from baseline, which was in range for other studies [ 13 - 20 ]. Cognitive behavioral therapy done specifically for anxiety with bowel control anxiety techniques also had a significant improvement in IBS symptoms [ 18 ]. Lee et al observed that significant improvements were observed until 18 weeks into their study, and both expressive writing and internet-delivered CBT showed significant improvements in symptoms [ 19 ].…”