Predictors of treatment outcome after cognitive behavior therapy and antispasmodic treatment for patients with irritable bowel syndrome in primary care

Abstract 

Objective

To examine predictors of treatment outcome in IBS-patients who participated in a randomized controlled trial in primary care, where 149 irritable bowel syndrome (IBS) patients were randomized to mebeverine hydrochloride (n=77) or mebeverine+cognitive behavior therapy (CBT) (n=72). CBT offered additional benefit over mebeverine alone.

Methods

Regression analyses were used to identify predictors of work and social adjustment 12 months after treatment ended. The intervention groups were analyzed separately in order to look at the separate effects in each group.

Results

Lower levels of psychological distress (anxiety and depression) at baseline predicted a good outcome in the mebeverine group [β=0.388 (95% CI: 0.065–0.936), P=.025] but not in the mebeverine+CBT group. In the adjusted model for the mebeverine+CBT group less adaptive IBS related behavioral coping predicted a good outcome [β=0.285 (95% CI: 0.002–0.210), P=.045].

Conclusion

Different factors are associated with outcome depending on the treatment received. At assessment clinicians should assess patients coping styles and may want to consider recommending CBT to those patients with IBS in primary care who are engaging in unhelpful coping behavior.

Keywords: Cognitive behavior therapy, Irritable bowel syndrome, Primary care, Predictors of treatment outcome, Clinical implications