Comprehensive Self-Management for Irritable Bowel Syndrome: Randomized Trial of In-Person vs. Combined In-Person and Telephone Sessions
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OBJECTIVES: Psychological and behavioral therapies are being increasingly used for symptom management in patients with irritable bowel syndrome (IBS). The aims of this study were to compare two delivery modes for a comprehensive self-management (CSM) intervention, primarily by telephone vs. entirely in person, and to compare each with usual care (UC). METHODS: Adults with IBS were recruited through community advertisement. Subjects (N=188) were randomly assigned to three groups: one in which all nine weekly CSM sessions were delivered in person, one in which six of the nine sessions were conducted over telephone, and one in which subjects received UC. Primary outcome measures were a gastrointestinal (GI) symptom score based on six symptoms from a daily diary and disease-specific quality of life (QOL). These and other outcomes were assessed at baseline and at 3, 6, and 12 months after randomization. Mixed model analyses tested for differences between the three groups in each outcome variable at the three follow-up occasions, controlling for the baseline level of each outcome. RESULTS: Both GI symptom score and QOL showed significantly greater improvement in the two CSM groups than in the UC group (P<0.001), with the magnitude of this difference being quite similar for the three follow-up time points. The two CSM groups experienced a very similar degree of improvement, and there were no statistically significant differences between the two. CONCLUSIONS: A CSM program is efficacious whether delivered primarily by telephone or totally in person, and there is no evidence that replacing six of the in-person sessions by telephone sessions reduces the efficacy of the intervention.
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Like Morris et al. and Jarrett et al. CBT interventions, this study demonstrated improved self-management skills among IBS patients.
“Similar to both Morris et al. (2010)(48) and Jarrett et al. (2009)(46) CBT based interventions, we were also able to demonstrate improved self-management skills among IBS patients.”
From Randomised clinical trial: Symptoms of the irritable bowel syndrome are improved by a psycho-education group intervention (2013) · cites this paper as [48]
The Methods (Treatment Phase; page unavailable) describe teaching IBS patients diet, relaxation, and cognitive-behavioral self-management strategies. The Results (Primary and Secondary Outcomes; page unavailable) report improved symptoms, quality of life, and cognitive beliefs, but do not establish that patients’ self-management skills improved. (LLM, conf=0.82)
Experimental — accuracy not yet measuredSeveral modifications to traditional CBT have been evaluated and shown that CBT-based interventions can be delivered in different, more cost-effective formats.
“As a result of these limitations, several modifications to the traditional CBT format have been evaluated (e.g. patient administered, group based and Internet focused), and these studies have shown that CBT based interventions can be delivered in different, more cost effective formats(33, 46, 48).”
From Randomised clinical trial: Symptoms of the irritable bowel syndrome are improved by a psycho-education group intervention (2013) · cites this paper as [48]
The Discussion reports that the CBT-based self-management program was effective with either primarily telephone or entirely in-person delivery. But it says the telephone format was not designed to be cheaper in therapist time, and calls for further research on cost-effectiveness. This source supports an alternative delivery format, not a demonstrated more cost-effective one. (LLM, conf=0.90)
Experimental — accuracy not yet measuredThe generalizability of studies investigating CBT for IBS with reduced therapist time is limited by the fact that study participants have mostly been recruited by referral and self-referral.
“However, the generalizability of our studies and other studies investigating CBT for IBS with reduced therapist time [19-22] is limited by the fact that study participants have mostly been recruited by referral and self-referral.”
From Acceptability, effectiveness, and cost-effectiveness of internet-based exposure treatment for irritable bowel syndrome in a clinical sample: A randomized controlled trial (2011) · cites this paper as [20]
The Methods (Recruitment and Eligibility; page unavailable) say volunteers were recruited through community advertisements and a mailing to gastroenterology patients, consistent with self-selection, though they do not establish that participants were mostly recruited by referral and self-referral. The Discussion also says the telephone intervention was not designed to reduce therapist time: sessions lasted approximately 60 minutes in both delivery modes. The paper therefore supports a concern about recruitment only in part, not the characterization of this study as using reduced therapist time. (LLM, conf=0.83)
Experimental — accuracy not yet measuredThe study results are similar to landmark studies using CBT to improve IBS symptoms and quality of life.
“The results from our study are similar to landmark studies published in the field, on utilizing cognitive behavior therapy (CBT) to improve IBS symptoms and improve quality of life(33, 46, 48).”
From Randomised clinical trial: Symptoms of the irritable bowel syndrome are improved by a psycho-education group intervention (2013) · cites this paper as [48]
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Self-citation
- Authors
- Jarrett, M. E., Cain, K. C., Burr, R. L., Hertig, V. L., Rosen, S. N., & Heitkemper, M. M.
- Affiliations
- University of Washington (US)
- Group Health Cooperative (US)
- Corresponding author
- Jarrett, Monica E.
- Venue
- American Journal of Gastroenterology
- Published
- 2009-12
- Volume
- 104
- Issue
- 12
- Pages
- 3004-3014
- ISSN
- 0002-9270 (ISSN-L)
- PMC
- PMC2804069
- OpenAlex
- W1978372360
- Cited by
- 89
- References
- 37
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 7 · 2023: 3 · 2022: 6 · 2021: 6 · 2020: 8 · 2019: 4 · 2018: 6 · 2017: 5 · 2016: 3 · 2015: 5 · 2014: 8 · 2013: 7 · 2012: 7
- FWCI
- 5.67
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The American Journal of Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Nursing Research (P30NR004001, R01NR004142, P30-NR04001)
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Health Professions › Pharmacy › Infant Health and Development
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Keywords
- irritable bowel syndrome, telephone-delivered intervention, in-person intervention, psychotherapy, behavior therapy, gastrointestinal symptoms, quality of life, usual care comparison
- MeSH terms
- Adult, Analysis of Variance, Counseling, Female, Follow-Up Studies, Humans, Male, Middle Aged, Quality of Life, Surveys and Questionnaires, Self Care, Stress, Psychological, Telephone, Cognitive Behavioral Therapy, Chi-Square Distribution, Treatment Outcome, Irritable Bowel Syndrome
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