Irritable bowel or irritable brain? Cognitive behavioural therapy for irritable bowel syndrome: A review and recommendations for clinical practice.

Abstract

Irritable Bowel Syndrome (IBS) is a chronic gastrointestinal disorder commonly seen in general practice. IBS has been described as a disturbance of the brain-gut axis where psychological stressors, such as stressful life events and anxiety, may affect the onset and development of this condition. Despite the availability of different management options, current treatments for IBS are unsatisfactory. Pharmacological treatments have been shown to reduce symptoms for only a small proportion of IBS patients and can cause unwanted side effects. Given the recent shift in increased attention to the brain gut axis, psychological treatments, such as Cognitive Behavioural Therapy (CBT), have demonstrated improvements in IBS-related symptom severity, psychological distress and quality of life. The purpose of this paper is to undertake a review of the evidence for CBT in patients with IBS. Further discussion on future implications and clinically-relevant recommendations relating to CBT for researchers, clinicians and patients with IBS are also made. A comprehensive literature search was conducted in three databases (Medline, Embase and Web of Science) to identify relevant data from CBT studies conducted in adults with IBS. There is a large body of research to support the delivery of CBT for adults with IBS. However, the usefulness of these results is potentially limited by poor methodological quality within the literature, including small sample sizes and poor control conditions. Despite evidence supporting the efficacy of CBT in IBS, the therapy is associated with barriers to access including limited availability of services, lack of appropriately-trained clinicians, high costs and time demands. Future research directions should concentrate on increasing CBT accessibility for patients with IBS and improving training resources to allow more healthcare providers to deliver this intervention competently