Centre for Clinical and Community Applications of Health Psychology, Department of Psychology, University of Southampton, Southampton, United Kingdom.
Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
J Med Internet Res. 2020 Nov 20;22(11):e18691. doi: 10.2196/18691.
Cognitive behavioral therapy (CBT) is recommended in guidelines for people with refractory irritable bowel syndrome (IBS). However, the availability of CBT is limited, and poor adherence has been reported in face-to-face CBT.
Nested within a randomized controlled trial of telephone- and web-delivered CBT for refractory IBS, this qualitative study aims to identify barriers to and facilitators of engagement over time with the interventions, identify social and psychological processes of change, and provide insight into trial results.
A longitudinal qualitative study was nested in a randomized controlled trial. Repeated semistructured interviews were conducted at 3 (n=34) and 12 months (n=25) post baseline. Participants received telephone-based CBT (TCBT; n=17 at 3 months and n=13 at 12 months) or web-based CBT (WCBT; n=17 at 3 months and n=12 at 12 months). Inductive thematic analysis was used to analyze the data.
Participants viewed CBT as credible for IBS, perceived their therapists as knowledgeable and supportive, and liked the flexibility of web-based and telephone-based delivery; these factors facilitated engagement. Potential barriers to engagement in both groups (mostly overcome by our participants) 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 already busy lives, and finding nothing new in the WCBT (WCBT group only). Participants described helpful changes in their understanding of IBS, attitudes toward IBS, ability to recognize IBS patterns, and IBS-related behaviors. Consistent with the trial results, participants described lasting positive effects on their symptoms, work, and social lives. Reasons and remedies for some attenuation of effects were identified.
Both TCBT and WCBT for IBS were positively received and had lasting positive impacts on participants' understanding of IBS, IBS-related behaviors, symptoms, and quality of life. These forms of CBT may broaden access to CBT for IBS.
认知行为疗法（CBT）被推荐用于治疗难治性肠易激综合征（IBS）患者。然而，CBT 的可及性有限，且面对面 CBT 的依从性较差。
在一项针对难治性 IBS 的电话和网络 CBT 的随机对照试验中嵌套了这项定性研究，旨在确定随着时间的推移，这些干预措施的参与障碍和促进因素，确定社会和心理变化过程，并深入了解试验结果。
一项纵向定性研究嵌套在一项随机对照试验中。在基线后 3 个月（n=34）和 12 个月（n=25）时进行重复半结构化访谈。参与者接受基于电话的 CBT（TCBT；3 个月时 n=17，12 个月时 n=13）或基于网络的 CBT（WCBT；3 个月时 n=17，12 个月时 n=12）。采用归纳主题分析对数据进行分析。
参与者认为 CBT 对 IBS 是可信的，认为他们的治疗师知识渊博且支持性强，并且喜欢网络和电话交付的灵活性；这些因素促进了参与。两组参与者都面临一些潜在的参与障碍（大多数参与者都克服了这些障碍），包括对 CBT 的生物心理社会性质的最初怀疑和担忧，对电话提供的谈话治疗的最初担忧，在已经忙碌的生活中维持动力和自律的挑战，以及在 WCBT 中找不到新内容（仅在 WCBT 组中）。参与者描述了他们对 IBS 的理解、对 IBS 的态度、识别 IBS 模式的能力以及 IBS 相关行为方面的有益变化。与试验结果一致，参与者描述了对他们的症状、工作和社交生活产生持久的积极影响。确定了一些效果减弱的原因和补救措施。
针对 IBS 的 TCBT 和 WCBT 均受到积极评价，并对参与者对 IBS 的理解、IBS 相关行为、症状和生活质量产生持久的积极影响。这些形式的 CBT 可能会扩大 CBT 在 IBS 中的应用。
