Efficacy of behavioural therapies for irritable bowel syndrome: a systematic review and network meta-analysis 2025 Ford et al

Sly Saint

Sly Saint

Senior Member (Voting Rights)
Elyse R Thakur, PhD<a>a</a>,<a>b</a>,<a>*</a> ∙ Mais Khasawneh, MBBS<a>c</a>,<a>d</a>,<a>*</a> ∙ Prof Paul Moayyedi, PhD<a>e</a> ∙ Christopher J Black, PhD<a>c</a>,<a>d</a>,<a>†</a> ∙ Prof Alexander C Ford, MD<a>c</a>,<a>d</a>,<a>†</a>
aSection of Gastroenterology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
bDivision of Gastroenterology and Hepatology, Atrium Health, Charlotte, NC, USA
cLeeds Gastroenterology Institute, St James's University Hospital, Leeds, UK
dLeeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
eFarncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
*
Joint first author
†
Joint last author

Summary​

Background​

Irritable bowel syndrome (IBS) management guidelines recommend that behavioural therapies, particularly brain–gut behaviour therapies, should be considered as a treatment. Some, such as IBS-specific cognitive behavioural therapy (CBT) or gut-directed hypnotherapy, have specific techniques and, therefore, are in their own class of brain–gut behaviour therapy, while others, such as stress management or relaxation training, are common or universal techniques that are present in most classes of brain–gut behaviour therapy. In addition, there are other behavioural therapies or treatment options, including digital therapies, which are not classed as brain–gut behaviour therapies. We aimed to evaluate relative efficacy of the available behavioural therapies in IBS.

Methods​

For this systematic review and network meta-analysis we searched MEDLINE, EMBASE, EMBASE Classic, PsychINFO, and the Cochrane Central Register of Controlled Trials from inception to April 23, 2025, to identify randomised controlled trials (RCTs) comparing the efficacy of behavioural therapies for adults with IBS with each other, or a control intervention. We judged efficacy using dichotomous assessments of improvement in global IBS symptoms. We pooled data with a random effects model, with efficacy of each intervention reported as pooled relative risks (RRs) with 95% CIs. We ranked behavioural therapies according to their P score, which is the mean extent of certainty that one treatment is better than another, averaged over all competing behavioural therapies.

Findings​

We identified 67 eligible RCTs, comprising 7441 participants. After completion of treatment, and compared with waiting list control, behavioural therapies with the largest numbers of trials, and patients recruited, that showed efficacy were: minimal contact CBT (RR for global IBS symptoms not improving at first point of follow-up post-treatment 0·55 [95% CI 0·39–0·76], P score 0·78; two RCTs, 511 patients), telephone disease self-management (0·57 [0·41–0·80], P score 0·75; two trials, 746 patients), dynamic psychotherapy (0·59 [0·43–0·80], P score 0·72; three RCTs, 303 patients), CBT (0·65 [0·53–0·80], P score 0·64; nine trials, 1150 patients), disease self-management (0·68 [0·50–0·92], P score 0·58; three RCTs, 375 patients), internet-based minimal contact CBT (0·77 [0·61–0·96], P score 0·43; five RCTs, 705 patients), and gut-directed hypnotherapy (0·79 [0·66–0·95], P score 0·39; 12 trials, 1507 patients). After completion of treatment, among trials recruiting only patients with refractory symptoms, telephone disease self-management and contingency management were both superior to attention placebo control (0·52 [0·28–0·94] and 0·50 [0·26–0·96], respectively) and routine care (0·46 [0·31–0·69] and 0·45 [0·24–0·85], respectively), and group CBT (0·50 [0·29–0·86]), internet-based minimal contact disease self-management (0·58 [0·40–0·86]), and dynamic psychotherapy (0·61 [0·44–0·86]) were all superior to routine care. Analyses for global IBS symptoms at first point of follow-up post-treatment, and for global IBS symptoms at first point of follow-up post-treatment when behavioural therapies were studied according to treatment class, showed evidence of publication bias when compared with waiting list control. The Cochrane risk of bias tool indicated that no RCT was at low risk of bias across all domains.

Interpretation​

Several behavioural therapies are efficacious for global symptoms in IBS, although the most evidence exists for those classed as brain–gut behaviour therapies. However, certainty in the evidence for all direct and indirect comparisons across the network were rated as either low or very low confidence, due in part to publication bias and the risk of bias of the included trials.


paywalled
 
Several behavioural therapies are efficacious for global symptoms in IBS, although the most evidence exists for those classed as brain–gut behaviour therapies. However, certainty in the evidence for all direct and indirect comparisons across the network were rated as either low or very low confidence, due in part to publication bias and the risk of bias of the included trials.​

Funny way to say: We were unable to find robust evidence for the validity or relevance of these therapies.
 
Sly Saint said:
However, certainty in the evidence for all direct and indirect comparisons across the network were rated as either low or very low confidence, due in part to publication bias and the risk of bias of the included trials.
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Meaning that you should have discarded every single study and said that:
  1. there is no evidence in favour of the interventions
  2. there are no justifications for using the interventions
  3. the people running the trials should do better
The authors should be ashamed of their apparent lack of integrity and critical thinking in this matter. There are simply no excuses.
 
Sly Saint said:
as per usual, the headlines don't exactly match the actual findings
see the Independent

Best cure for IBS could start with training the mind, study suggests​


Therapy may be the most effective way to ease irritable bowel syndrome​

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This is especially impressive because the study absolutely cannot and does not say that. The conclusions do say some things, but there is no actual supporting data for it. In fact this is effectively a thorough debunking, but neither data nor outcome matter so we get headlines like this. So effectively nothing said here is real. And, as is tradition, no one involved ever thinks about the consequences of promoting pseudoscientific bullshit, how it affects the credibility of every single thing they do and say.

I do find the idea that there is such a thing as "specific techniques" here genuinely laughable, but only in itself. Even the claims made in homeopathy aren't as ridiculous as this. Just as wrong, sure, but not nearly as silly.

The only valid conclusion is that this entire paradigm is flawed to the point of being worse than nothing at all. It would literally fail a superiority comparison with itself, but since that would be done with flawed tools and reasoning, it doesn't actually matter. Self-graded homework always gets a passing grade, all that's needed is a name at the top.

What if you could compares apples and the color orange? Does it matter? Not one bit. But apparently you can do this for decades and call it evidence-based medicine, thus removing all meaning from any of those words.
 
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