Survey of Current Practices and Experiences of Clinicians Treating Irritable Bowel Syndrome (IBS) With Cognitive Behavioral Therapy and/or Gut-Directed Hypnosis.

Abstract

Introduction: Cognitive behavioral therapy (CBT) and gut-directed hypnosis (GDH) are the two most widely used brain-gut behavior therapies (BGBT) for irritable bowel syndrome (IBS), but nearly all that is known about their clinical effects comes from formal trials rather than clinical practice. We aimed to collect data from BGBT practitioners on their use and perception of these treatments, including positive and negative effects in their most recently treated patients.

Methods: Rome Foundation Psychogastroenterology section listserv members and other clinicians known to regularly treat IBS with CBT or GDH (166 total) were invited via email to participate in a de-identified Internet survey. The survey included questions about their demographics, nature of their clinical practice, ratings of different outcomes for their last two patients completing each treatment, adverse effects of treatment, factors perceived as important for successful treatment outcomes, and use of virtual therapy.

Results: The survey was completed by 58 therapists. Most (82.8%) reported using both CBT and GDH in their practice. Their ratings of outcomes for their last two patients completing each treatment (ratings for a total of 162 patients included in analysis) showed moderate or large positive treatment effects for a substantial majority of patients in four of the five outcome domains for both therapies, including improvements in bowel symptoms, emotional symptoms, life functioning, and ability to cope with/self-manage IBS symptoms. Adverse effects (rated as mild, moderate, or severe) associated with therapy were reported for six CBT patients (5.2%, all mild) and two GDH patients (2.7%; 1 mild, 1 moderate). The mean number of sessions was 9.6 for CBT (range 2-76) and 7.6 for GDH (range 3-23). Treatment was entirely or partly virtual (via video) for 79.5% of CBT and 76.9% of GDH patients. Most therapists using virtual therapy rated it as at least as effective as in-person therapy for both CBT (86.8%) and GDH (78.4%). Only one therapist reported having ever encountered serious adverse effects of GDH, and two therapists for CBT, in their clinical careers.

Conclusion: This survey provides a unique real-world snapshot of current practice and experiences among therapists treating IBS with CBT and/or GDH. The results indicate that both therapies provide multiple moderate or large therapeutic benefits for the majority of treated IBS patients, with a very low burden of associated adverse effects. Virtual delivery is now the norm for these interventions and is generally found to be as effective as in-person treatment by the therapists.