Changes in illness-related cognitions rather than distress mediate improvements in irritable bowel syndrome (IBS) symptoms and disability following a brief cognitive behavioural therapy intervention

• Published in: Behaviour research and therapy 2013-10, Vol.51 (10), p.690-695
• Main Authors: Chilcot, Joseph, Moss-Morris, Rona
• Format: Article
• Language: English
• Subjects: Adaptation, Psychological; Adult; Affect; Anxiety; Anxiety-Depression; Behavior therapy. Cognitive therapy; Biological and medical sciences; Clinical trials; Cognition; Cognitive behaviour therapy; Cognitive behavioural therapy (CBT); Cognitive therapy; Cognitive Therapy - methods; Disability; Female; Humans; Illness perception; Irritable bowel syndrome; Irritable bowel syndrome (IBS); Irritable Bowel Syndrome - complications; Irritable Bowel Syndrome - psychology; Irritable Bowel Syndrome - therapy; Male; Mediation; Medical sciences; Mental depression; Mental health care; Middle Aged; Path analysis; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychotherapy, Brief; Self-Management; Social Control, Informal; Stress, Psychological - complications; Stress, Psychological - psychology; Stress, Psychological - therapy; Symptoms; Treatments
• ISSN: 0005-7967; 1873-622X
• DOI: 10.1016/j.brat.2013.07.007

A previous randomised controlled trial demonstrated that a cognitive behavioural therapy (CBT) self-management intervention significantly improved irritable bowel syndrome (IBS) symptoms and disability compared to treatment as usual (TAU). The current study analysed additional data to establish whether; 1) cognitive, behavioural and emotional factors hypothesized to perpetuate IBS symptoms and disability changed following CBT and, 2) ascertain if changes in these factors over the intervention period mediated treatment effects 6-months later. IBS patients (CBT = 31, TAU = 33) completed measures pre-and-post intervention including: Brief Illness Perception Questionnaire, Hospital Anxiety & Depression Scale and Cognitive and Behavioural Responses to Symptoms Questionnaire. Path models were evaluated to determine whether changes in cognitive and behavioural factors over the treatment period mediated treatment effects. Compared to TAU, CBT patients showed significant positive changes on several cognitive variables but not anxiety and depression following intervention. Positive change in illness perceptions following intervention mediated the treatment effect on improved IBS symptom severity and social adjustment six months later. Changes in damaging beliefs mediated the effect on social adjustment. Change in cognition rather than mood mediated treatment related improvements. Changing negative perceptions of IBS appears to be a particularly important treatment mechanism. •A self-management CBT intervention for IBS altered cognitive factors hypothesized to perpetuate symptoms and disability.•Mood and anxiety did not improve following treatment.•Change in negative illness perceptions over the intervention period mediated treatment effects observed at follow up.