Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
Am J Gastroenterol. 2011 Aug;106(8):1481-91. doi: 10.1038/ajg.2011.139. Epub 2011 May 3.
Our research group has developed an internet-delivered cognitive behavioral treatment (ICBT) for irritable bowel syndrome (IBS). We compared ICBT with internet-delivered stress management (ISM) for IBS to assess whether the effects of ICBT are specific.
This was a randomized controlled trial, including 195 self-referred participants diagnosed with IBS. The treatment interventions lasted for 10 weeks and included an online therapist contact. The ICBT emphasized acceptance of symptoms through exposure to IBS symptoms and related negative feelings. The ICBT also included mindfulness training. The ISM emphasized symptom control through relaxation techniques, dietary adjustments, and problem-solving skills. Severity of IBS symptoms was measured with the gastrointestinal symptom rating scale-IBS version (GSRS-IBS). Credibility of the treatments and expectancy of improvement were assessed with the treatment credibility scale. The participants' perceived therapeutic alliance with their online therapist was measured with the working alliance inventory.
At post-treatment and 6-month follow-up, 192 (99%) and 169 (87%) participants returned data, respectively. At post-treatment and 6-month follow-up, we found significant differences on the GSRS-IBS, favoring ICBT. The difference on GSRS-IBS scores was 4.8 (95% confidence interval (CI): 1.2-8.4) at post-treatment and 5.9 (95% CI: 1.9-9.9) at 6-month follow-up. There were no significant differences on the treatment credibility scale or the working alliance inventory between the groups.
Internet-delivered CBT has specific effects that cannot be attributed only to treatment credibility, expectancy of improvement, therapeutic alliance, or attention. Furthermore, a treatment based on exposure exercises specifically tailored for IBS may be a better treatment option than general stress and symptom management for IBS patients. ICBT is a promising treatment modality for IBS as it can be offered to IBS patients in much larger scale than conventional psychological treatments.
我们的研究小组开发了一种互联网提供的认知行为治疗（ICBT）用于治疗肠易激综合征（IBS）。我们比较了 ICBT 与互联网提供的应激管理（ISM）治疗 IBS，以评估 ICBT 的效果是否具有特异性。
这是一项随机对照试验，纳入了 195 名自我诊断为 IBS 的患者。治疗干预持续 10 周，包括在线治疗师的联系。ICBT 通过暴露于 IBS 症状和相关的负面情绪来强调对症状的接受。ICBT 还包括正念训练。ISM 通过放松技术、饮食调整和解决问题的技巧来强调症状的控制。IBS 症状的严重程度用胃肠道症状评定量表-IBS 版本（GSRS-IBS）来衡量。治疗的可信度和对改善的期望用治疗可信度量表来评估。参与者与他们的在线治疗师的治疗联盟用工作联盟量表来衡量。
在治疗后和 6 个月的随访时，192（99%）和 169（87%）名参与者分别返回了数据。在治疗后和 6 个月的随访时，我们发现 GSRS-IBS 有显著差异，ICBT 更有优势。GSRS-IBS 评分的差异在治疗后为 4.8（95%置信区间（CI）：1.2-8.4），在 6 个月的随访时为 5.9（95% CI：1.9-9.9）。在治疗可信度量表和工作联盟量表上，两组之间没有显著差异。
互联网提供的 CBT 具有特定的效果，不能仅仅归因于治疗的可信度、对改善的期望、治疗联盟或注意力。此外，针对 IBS 专门设计的基于暴露练习的治疗可能是 IBS 患者比一般的应激和症状管理更好的治疗选择。ICBT 是 IBS 的一种很有前途的治疗方式，因为它可以比传统的心理治疗为更多的 IBS 患者提供服务。
