Table 1 Recent research on the effect of internet-delivered CBT for IBS patients

Bonnert et al

2017

Internet-CBT group: N = 47 Waitlist control group: N = 54

Age range: 13–17 years.

The internet-CBT spanned over 10 weeks and included 10 weekly modules directed at adolescents, and five modules directed at parents. The main principle of the treatment was to use exposure exercises to reduce symptom-fear and avoidance. The modules consisted of short texts, examples, audio-files, and videos. Clinical psychologists with CBT-training provided online support to adolescents and parents.

1) Pretreatment to post-treatment changes on gastrointestinal symptoms as the primary outcome and on almost all secondary outcomes was significantly larger for the internet-CBT group as compared with the control group.

2) After 6 months, the results were stable or significantly improved.

Lalouni et al

2019

Internet-CBT group: N = 46

Treatment as usual group: N = 44

Age range: 8–12 years.

The children’s exercises included exposure to symptom-provoking stimuli (e.g., eating certain foods) and situations in which they feared having symptoms (e.g., physical exercise), and those that decreased their symptom-controlling strategies (e.g., precautionary toilet visits). A short mindfulness exercise was taught as a means to increase awareness of the abdominal symptoms. The parents encouraged their children to work on exposure exercises that decreased their attention from symptom complaints, and increased their attention toward more adaptive behaviors. Licensed psychologists who

specialized in CBT provided online support to children

and their parents.

1) Gastrointestinal symptom severity, quality of life, gastrointestinal-specific anxiety, avoidance behaviors, and parental responses to children’s symptoms improved significantly in the internet-CBT group, as compared with the group that received treatment as usual .

2) The effects of internet-CBT persisted through 36 weeks of follow-up evaluation.

3) The internet-CBT group had significantly less health care usage than group that received treatment as usual, with an average cost difference of US $137.

Hughes et al

2020

Internet-CBT group: N = 17

Telephone-CBT group: N = 17

Mean age (SD): 39.94 (11.71) years.

Internet-CBT program consisted of eight web-based sessions to be completed on a weekly basis, three 30-min telephone support sessions over 9 weeks. The telephone-CBT group received six one-hour telephone-based CBT sessions over 9 weeks. The same CBT content was delivered via telephone and website, with only the mode of delivery being different. The CBT content was based on an empirical cognitive behavioral model of IBS, and comprised educational, behavioral, and cognitive techniques aimed at improving bowel habits, developing stable healthy eating patterns, addressing unhelpful thoughts, managing stress, reducing symptom that focused on preventing relapse. Trained CBT therapists provided telephone support.

(Inductive thematic analysis was used to analyze the data).

1) Participants liked the flexibility of CBT via internet and telephone-, and this facilitated engagement.

2) Potential barriers to engagement in both the groups included: initial skepticism and concerns about the biopsychosocial nature of CBT; initial concerns about telephone-delivered talking therapy; challenges of maintaining motivation and self-discipline given their already busy lives, and finding nothing new in the internet-CBT.

3) Participants described helpful changes in their understanding of IBS, attitudes toward IBS, ability to recognize IBS patterns, and IBS-related behaviors.

4) Consistent with the trial results, participants described lasting positive effects on their symptoms, work, and social lives.

Hunt et al

2021

Internet-CBT group: N = 62

Waitlist control group: N = 59

Age range: 18–63 years.

The application program of internet-CBT consists of eight weekly modules focusing on psychoeducation, relaxation training, exercise, the cognitive model of stress management, applying CBT to IBS symptoms, reducing avoidance through exposure therapy, behavioral experiments, and information about diet.

Gastrointestinal symptoms, IBS-related quality of life and cognition, visceral sensitivity, and fear of foods improved significantly in the internet-CBT group.

Owusu et al

2021

Internet-CBT group: N = 25

Control group: N = 11

Age range: 19–61 years.

The internet-CBT program is self-paced. It consists of eight sessions, designed to be completed within 12 weeks. Therapeutic targets include: knowledge of the biopsychosocial model of IBS and the brain-gut connection; improving bowel habits; developing a stable eating routine; reducing hypervigilance to IBS symptoms; identifying unhelpful gastrointestinal-related thoughts; recognizing how these automatic thoughts affect behaviors, emotions, and gastrointestinal symptoms; and accepting and processing emotions. The internet-CBT program delivers cognitive and behavioral skills and techniques in an interactive manner through repetition of brief learnings and exercises.

1) IBS symptom severity significantly improved at 2-month and 3-month follow-up. The within-group effect size between baseline and 3-month follow-up gastrointestinal symptom scores was large and 63.6% experienced a clinically meaningful improvement.

2) Gastrointestinal-specific anxiety symptoms and cognitions significantly improved at 2-month follow-up, as did unhelpful IBS safety behaviors.

3) Clinically meaningful improvement was observed in depressive and anxiety symptoms at 3-month follow-up among participants with symptoms above the clinical threshold at baseline.