ACTIB trial (Assessing Cognitive behavioural Therapy in Irritable Bowel): a multicentre randomised controlled trial, 2015, Chalder et al

Sly Saint · Jun 5, 2018

From 2015 but to be presented in a talk in July at the Society for Academic Primary Care conference:
https://sapc.ac.uk/conference/2018

Approach
ACTIB is a National institute for Health Research (NIHR) multicentre randomised controlled trial. Participants: Adults (≥18 yrs) with refractory IBS who had been offered first-line therapies (eg, antispasmodics, antidepressants or fibre-based medications) and had continuing IBS symptoms ≥12 months, were recruited over 23 months from primary and secondary care in the south of England and London. The interventions were therapist telephone delivered CBT (TCBT) (8 hours therapist time) with a patient CBT manual and homework tasks, or Web-based CBT self-management with minimal therapist support (WCBT) (2 ½ hours therapist time) versus treatment as usual (TAU). Main outcome measures: IBS Symptom Severity Score (IBS SSS) and Work and Social Adjustment Scale (WSAS). Baseline and follow up data was patient reported and collected on-line at 3, 6 and 12 months. Analysis was Intention-to-treat with multiple imputation at 12 months.

Consequences
Both CBT arms showed significant improvements in IBS outcomes compared to TAU, which were sustained at 12 months. TCBT had larger effects than WCBT. We believe this is the largest trial of CBT for IBS worldwide. The results suggest that CBT for IBS could be effectively delivered to a broad range of NHS patients with refractory IBS.
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https://sapc.ac.uk/conference/2018/...cognitive-behavioural-therapy-irritable-bowel

one of the co-authors is Susan Windgassen (!)

alktipping · Jun 5, 2018

more self report forms after brainwashing by therapist mmm so much space for bias/bs

Arnie Pye · Jun 5, 2018

IBS - yet another medical condition that the medical profession can't (be bothered to) find real reasons for, so blame the patients' mental health. It is also a really good diagnosis for any doctor with any patient with a pain vaguely in the gut region. I'm sure it reduces the work load substantially.

Sly Saint · Sep 3, 2018

Think this is might be a 'spin off' :
Patients’ perspectives on GP interactions after cognitive behavioural therapy for refractory IBS: a qualitative study in UK primary and secondary care

Alice Sibelli, Rona Moss-Morris, Trudie Chalder, Felicity L Bishop, Sula Windgassen and Hazel Everitt

Abstract
Background Previous studies have identified issues with the doctor–patient relationship in irritable bowel syndrome (IBS) that negatively impact symptom management. Despite this, little research has explored interactions between GPs and patients with refractory IBS. National guidelines suggest cognitive behavioural therapy (CBT) as a treatment option for refractory symptoms.

Aim To explore perceptions of interactions with GPs in individuals with refractory IBS after receiving CBT for IBS or treatment as usual (TAU).

Design and setting This qualitative study was embedded within a trial assessing CBT in refractory IBS. Fifty-two participants took part in semi-structured interviews post-treatment in UK primary and secondary care.

Method Inductive and/or data-driven thematic analysis was conducted to identify themes in the interview data.
Results Two key themes were identified: perceived paucity of GPs’ IBS knowledge and lack of empathy from GPs, but with acknowledgement that this has improved in recent years. These perceptions were described through three main stages of care: reaching a ‘last-resort diagnosis’; searching for the right treatment through a trial-and-error process, which lacked patient involvement; and unsatisfactory long-term management. Only CBT participants reported a shared responsibility with their doctors concerning symptom management and an intention to reduce health-seeking behaviour.

Conclusion In this refractory IBS group, specific doctor–patient communication issues were identified. Increased explanation of the process of reaching a positive diagnosis, more involvement of patients in treatment options (including a realistic appraisal of potential benefit), and further validation of symptoms could help. This study supports a role for CBT-based IBS self-management programmes to help address these areas and a suggestion that earlier access to these programmes may be beneficial.
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https://bjgp.org/content/68/674/e654

CBT, the solution to the staff shortage in the NHS(?)

"Only CBT participants reported a shared responsibility with their doctors concerning symptom management and an intention to reduce health-seeking behaviour."

Trish · Sep 3, 2018

Only CBT participants reported a shared responsibility with their doctors concerning symptom management and an intention to reduce health-seeking behaviour.
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Does this mean what it seems to mean. My translation: Only CBT participants had started blaming themselves if they didn't improve, and reported they would give up bothering the doctor and trying to get better.

Is this supposed to be a good outcome?

rvallee · Sep 3, 2018

Trish said: ↑

Does this mean what it seems to mean. My translation: Only CBT participants had started blaming themselves if they didn't improve, and reported they would give up bothering the doctor and trying to get better.

Is this supposed to be a good outcome?

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When this whole IAPT project is understood as a cost-cutting measure by providing cheap alternative to medical care, it is definitely a good outcome according to them and everything they say and do starts to make sense.

There ain't no cheaper patients for a health care system than those who have stopped seeking care. Massively more expensive overall for society, but on the single balance sheet of medical services, it definitely gives the illusion that it is a bargain.

Arnie Pye · Sep 3, 2018

Sly Saint said: ↑

"Only CBT participants reported a shared responsibility with their doctors concerning symptom management and an intention to reduce health-seeking behaviour."
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God forbid that patients might seek ways of getting healthy!

Hutan · Sep 4, 2018

Sly Saint said: ↑

Patients’ perspectives on GP interactions after cognitive behavioural therapy for refractory IBS: a qualitative study in UK primary and secondary care
Click to expand...

This study has a thread here:
https://www.s4me.info/threads/patie...tory-ibs-moss-morris-chalder.5238/#post-94310

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ACTIB trial (Assessing Cognitive behavioural Therapy in Irritable Bowel): a multicentre randomised controlled trial, 2015, Chalder et al

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ACTIB trial (Assessing Cognitive behavioural Therapy in Irritable Bowel): a multicentre randomised controlled trial, 2015, Chalder et al

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