Diagnosis: Irritable Bowel Syndrome

2015 EST Status: Treatment pending re-evaluation Very strong: High-quality evidence that treatment improves symptoms and functional outcomes at post-treatment and follow-up; little risk of harm; requires reasonable amount of resources; effective in non-research settings

Strong: Moderate- to high-quality evidence that treatment improves symptoms OR functional outcomes; not a high risk of harm; reasonable use of resources

Weak: Low or very low-quality evidence that treatment produces clinically meaningful effects on symptoms or functional outcomes; Gains from the treatment may not warrant resources involved

Insufficient Evidence: No meta-analytic study could be identified

Insufficient Evidence: Existing meta-analyses are not of sufficient quality

Treatment pending re-evaluation

1998 EST Status: Strong Research Support Strong: Support from two well-designed studies conducted by independent investigators.

Modest: Support from one well-designed study or several adequately designed studies.

Controversial: Conflicting results, or claims regarding mechanisms are unsupported.

Strength of Research Support

Empirical Review Status
2015 Criteria
(Tolin et al. Recommendation)
Very Strong
Strong
Weak
Insufficient Evidence
Treatment pending re-evaluation
1998 Criteria
(Chambless et al. EST)
Strong
Modest
Controversial

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Brief Summary

  • Basic premise: Irritable bowel syndrome (IBS) is the most common gastrointestinal disorder, affecting up to 15% of adults worldwide. Lacking a reliable biomarker, IBS is best understood from a biopsychosocial perspective. The biopsychosocial model holds that individual peripheral (e.g. genetic predisposition, altered motility, gut microbiota alterations), behavioral, and higher-order central (brain) processes (e.g. coping, illness beliefs, abnormal central processing of gut stimuli) influences IBS through their interaction with each other and with the environment (e.g. reinforcement contingencies, interpersonal stress). At the heart of the model is recognition that IBS involve a dysregulation in interactions among the cognitive and emotional centers of the central nervous system (CNS). Although alterations at any level of the brain-gut axis may result in hallmark features of symptoms of functional gastrointestinal disorders, multiple lines of evidence underscore the importance of CNS activity in modulation symptoms, particularly in more severely affected patients seen in tertiary care settings. Cognitive behavior therapy is designed to teach patients behavioral change skills that remediate skills deficits that render patients vulnerable to pain and bowel symptoms of IBS.
  • Essence of therapy: The two psychological treatments for which there is the most empirical support are two “dosages” of cognitive behavior therapy.  Standard CBT (S-CBT) is a skills–based training program delivered in 10 weekly, one-hour sessions in a clinic setting. Treatment involves six overlapping phases: (1) education regarding stress and its relationship to IBS; (2) self-monitoring of stressful situations associated with IBS episodes; (3) muscle relaxation exercises to increase physiological self-regulation and to cultivate a sense of self control over GI symptoms; (4) learning to identify, reevaluate, and change negatively skewed thoughts (e.g., catastrophizing) associated with IBS; (5) changing underlying “core” beliefs (e.g., perfectionism) that fuel threatening cognitions; (6) formal training in flexible problem solving to strengthen the ability to cope with realistic stressors associated with IBS. Weekly home exercises are assigned to facilitate skills acquisition. Minimal Contact CBT (MC-CBT) is a home-based version of S-CBT.  It covers the same range of procedures featured in S-CBT but relies extensively on self-study materials (see Lackner, 2007, below under Self-help Books). Whereas S-CBT involves ten, 1-hour clinic visits, MC-CBT meets for only four, 60-minute clinic visits over the same period. At the first MC-CBT session, treatment is explained, self-study materials are provided and muscle relaxation and self-monitoring are introduced. The second treatment session introduces cognitive coping techniques (e.g., decatastrophizing, prediction testing). At the third session, patients learn flexible problem solving training and advanced cognitive coping skills (e.g., modifying core beliefs such as perfectionism). The fourth session introduces relapse prevention skills to help patients maintain treatment gains. Two 10-minute phone contacts are scheduled at week 3 and 7 to troubleshoot any problems.  Clinic- and home-based treatments yield comparable therapeutic benefits (global IBS symptom improvement, reduced severity of IBS symptoms) both at immediate and sustained follow up although there is some evidence that home-based CBT patient gains improve over time.
  • Length: approx. 4 (home-based) or 10 (clinic-based) sessions over 10 weeks.

Treatment Resources

Editors: Jefrey Lackner, Psy.D.

Note: The resources provided below are intended to supplement not replace foundational training in mental health treatment and evidence-based practice

Treatment Manuals / Outlines

Treatment Manuals
Books Available for Purchase Through External Sites

Training Materials and Workshops

Measures, Handouts and Worksheets

Self-help Books

Important Note: The books listed above are based on empirically-supported in-person treatments. They have not necessarily been evaluated empirically either by themselves or in conjunction with in-person treatment. We list them as a resource for clinicians who assign them as an adjunct to conducting in-person treatment.

Video Descriptions

Clinical Trials

Meta-analyses and Systematic Reviews

Other Treatment Resources