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A randomized controlled trial of a cognitive behavioural therapy-based self-management intervention for irritable bowel syndrome in primary care

  • R. Moss-Morris (a1), L. McAlpine (a2), L. P. Didsbury (a2) and M. J. Spence (a3)
  • DOI:
  • Published online: 17 June 2009

Recent guidelines for the treatment of irritable bowel syndrome (IBS) emphasize the need for research to facilitate home-based self-management for these patients in primary care. The aim of the current study was to test the efficacy of a manualized cognitive behavioural therapy (CBT)-based self-management programme for IBS in a pilot randomized controlled trial (RCT).


Sixty-four primary-care patients meeting Rome criteria for IBS were randomized into either self-management plus treatment as usual (TAU) (n=31) or a TAU control condition (n=33). The self-management condition included a structured 7-week manualized programme that was self-administered in conjunction with a 1-hour face-to-face therapy session and two 1-hour telephone sessions. The primary outcome measures were the Subject's Global Assessment (SGA) of Relief and the Irritable Bowel Syndrome Severity Scoring System (IBS-SSS) assessed at baseline, end of treatment (2 months), and 3 and 6 months post-treatment.


Analysis was by intention-to-treat. Twenty-three (76.7%) of the self-management group rated themselves as experiencing symptom relief across all three time periods compared to seven (21.2%) of the TAU controls [odds ratio (OR) 12.2, 95% confidence interval (CI) 3.72–40.1]. At 8 months, 25 (83%) of the self-management group showed a clinically significant change on the IBS-SSS compared to 16 (49%) of the control group (OR 5.3, 95% CI 1.64–17.26).


This study provides preliminary evidence that CBT-based self-management in the form of a structured manual and minimal therapist contact is an effective and acceptable form of treatment for primary-care IBS patients.

Corresponding author
*Address for correspondence: Professor R. Moss-Morris, School of Psychology, University of Southampton, Highfield, SouthamptonSO17 1BJ, UK. (Email:
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RL Akehurst , JE Brazier , N Mathers , C O'Keefe , E Kaltenthaler , A Morgan , M Platts , SJ Walters (2002). Health-related quality of life and cost of irritable bowel syndrome. Pharmacoeconomics 20, 455462.

EB Blanchard (2001). Irritable Bowel Syndrome: Psychosocial Assessment and Treatment. American Psychological Association: Washington, DC.

PM Boyce , NA Koloski , NJ Talley (2000). Irritable bowel syndrome according to varying diagnostic criteria: are the new Rome II criteria unnecessarily restrictive for research and practice? American Journal of Gastroenterology 95, 31763183.

PM Boyce , NJ Talley , B Balaam , NA Koloski , G Truman (2003). A randomized controlled trial of cognitive behavior therapy, relaxation training, and routine clinical care for the irritable bowel syndrome. American Journal of Gastroenterology 98, 22092218.

DA Drossman , BB Toner , WE Whitehead , NE Diamant , CB Dalton , S Duncan , S Emmott , V Proffitt , D Akman , K Frusciante , T Le , K Meyer , B Bradshaw , K Mikula , CB Morris , CJ Blackman , Y Hu , H Jia , JZ Li , GG Koch , SI Bangdiwala (2003). Cognitive-behavioral therapy versus education and desipramine versus placebo for moderate to severe functional bowel disorders. Gastroenterology 125, 1931.

AGC Ehlin , SM Montgomery , A Ekbom , RE Pounder , AJ Wakefield (2006). Prevalence of gastrointestinal diseases in two British national birth cohorts. Gut 52, 11171121.

CY Francis , J Morris , PJ Whorwell (1997). The irritable bowel severity scoring system: a simple method of monitoring irritable bowel syndrome and its progress. Alimentary Pharmacological Therapy 11, 395402.

J Jones , J Boorman , P Cann , A Forbes , J Gomborone , K Heaton , P Hungin , D Kumar , G Libby , R Spiller , N Read , D Silk , P Whorwell (2000). British Society of Gastroenterology guidelines for the management of the irritable bowel syndrome. Gut 47 (Suppl. 2), ii1ii19.

A Kennedy , A Robinson , A Rogers (2003). Incorporating patient's views and experiences of life with IBS in the development of an evidence based self-help guidebook. Patients Education and Counseling 50, 303310.

T Kennedy , R Jones , S Darnley , P Seed , S Wessely , C Chalder (2005). Cognitive behaviour therapy in addition to antispasmodic treatment for irritable bowel syndrome in primary care: randomised controlled trial. British Medical Journal 331, 435.

TM Kennedy , C Chalder , P McCrone , S Darnley , M Knapp , RH Jones , S Wessely (2006). Cognitive behaviour therapy in addition to antispasmodic treatment for irritable bowel syndrome in primary care: randomised controlled trial. Health Technology Assessment 10, 167.

JM Lackner , C Mesmer , S Morley , C Dowzer , S Hamilton (2004). Psychological treatments for irritable bowel syndrome: a systematic review and meta-analysis. Journal of Consulting and Clinical Psychology 72, 11001113.

GF Longstreth , WG Thompson , WD Chey , LA Houghton , F Mearin , RC Spiller (2006). Functional bowel disorders. Gastroenterology International 130, 14801491.

F Mearin , X Badia , A Balboa , E Baro , E Caldwell , M Cucala , M Diaz-Rubio , A Fueyo , J Ponce , M Roset , NJ Talley (2001). Irritable bowel syndrome prevalence varies enormously depending on the employed diagnostic criteria: comparison of Rome II versus previous criteria in a general population. Scandinavian Journal of Gastroenterology 36, 11551161.

R Moss-Morris , M Spence (2006). To ‘lump’ or to ‘split’ the functional somatic syndromes: can infectious and emotional risk factors differentiate between the onset of chronic fatigue syndrome and irritable bowel syndrome? Psychosomatic Medicine 68, 463469.

S Muller-Lissner , G Koch , NJ Talley , D Drossman , P Rueegg , C Dunger-Baldauf , M Lefkowitz (2003). Subject's Global Assessment of Relief: an appropriate method to assess the impact of treatment on irritable bowel syndrome-related symptoms in clinical trials. Journal of Clinical Epidemiology 56, 310316.

JC Mundt , IM Marks , MK Shear , JH Greist (2002). The Work and Social Adjustment Scale: a simple measure of impairment in functioning. British Journal of Psychiatry 180, 461464.

A Robinson , V Lee , A Kennedy , L Middleton , A Rogers , DG Thompson , D Reeves (2006). A randomised controlled trial of self-help interventions in patients with a primary care diagnosis of irritable bowel syndrome. Gut 55, 643648.

YA Saito , GR Locke , NJ Talley , AR Zinsmeister , SL Fett , LJ Melton 3rd (2000). A comparison of the Rome and Manning criteria for case identification in epidemiological investigations of irritable bowel syndrome. American Journal of Gastroenterology 95, 28162824.

AEM Speckens , AM van Hemert , P Spinhoven , KE Hawton , JH Bolk , HGM Rooijmans (1995). Cognitive behavioural therapy for medically unexplained physical symptoms: a randomised controlled trial. British Medical Journal 311, 13281332.

M Spence , R Moss-Morris (2007). The cognitive behavioural model of irritable bowel syndrome. Gut 56, 10661071.

WG Thompson (1999). The road to Rome. Gut 45 (Suppl. 2), II80II81.

WG Thompson , KW Heaton , GT Smyth , C Smyth (2000). Irritable bowel syndrome in general practice: prevalence, characteristics, and referral. Gut 46, 7882.

WG Thompson , GF Longstreth , DA Drossman , KW Heaton , EJ Irvine , SA Muller-Lissner (1999). Functional bowel disorders and functional abdominal pain. Gut 45 (Suppl. II), 4347.

AS Zigmond , RP Snaith (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica 67, 361370.

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