Dr Roger Jones and colleagues assessed the efficacy of cognitive behavior therapy delivered in primary care for treating irritable bowel syndrome.
The investigators conducted a randomized controlled trial in 10 general practices in London.
The investigative team included 149 patients with moderate or severe irritable bowel syndrome resistant to the antispasmodic mebeverine.
Cognitive behavior therapy was delivered by trained primary care nurses.
The team also gave participants 270 mg mebeverine taken 3 times daily compared with mebeverine treatment alone.
The investagators' main outcome measures were patients' scores on the irritable bowel syndrome symptom severity scale.
| Cognitive therapy with mebeverine gave a mean reduction in score of 68 points|
|British Medical Journal|
Secondary measures were scores on the work and social adjustment scale and the hospital anxiety and depression scale.
Of 334 referred patients, the investigators randomized 72 to mebeverine plus cognitive behavior therapy and 77 to mebeverine alone.
The team found that cognitive behavior therapy had considerable initial benefit on symptom severity compared with mebeverine alone.
Cognitive therapy with mebeverine gave a mean reduction in score of 68 points.
The investigators noted that the benefit persisted at 3 months and 6 months after therapy with mean reductions of 71 points and 11 points, but not later.
Cognitive behavior therapy also showed significant benefit on the work and social adjustment scale that was still present 12 months after therapy.
The investigative team noted that cognitive behavior therapy had an inconsistent effect on the hospital anxiety and depression scale.
Dr Jones's team concluded, “Cognitive behavior therapy delivered by primary care nurses offered additional benefit over mebeverine alone up to 6 months, although the effect had waned by 12 months.”
“Such therapy may be useful for certain patients with irritable bowel syndrome in primary care.”