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On any given day, a gastroenterologist will enter a consulting room and have a 25% chance of seeing a patient presented with IBS symptoms. She/he will describe abdominal pain, diarrhoea and/or constipation as severe, disruptive and a significant source of angst. Their exact cause will be as perplexing as the uncertainty that whatever treatment is prescribed will provide much relief.
This much will be clear: One of the only treatments with the strongest empirical support for the full range of IBS symptoms—cognitive–behavioural therapy (CBT)—will be unavailable unless the gastroenterologist happens to work in close proximity to one of the relatively few academic medical centres that dispense CBT. This state of affairs has led to the development of CBT regimens that retain the efficacy of ‘gold standard’ clinic-based CBT delivered one-to-one but are more efficient and easier to implement.
An early approach addressed this issue by dramatically reducing therapist time, featuring a largely home-based version of CBT.1 Other teams emphasised digital technology (eg, internet) to deliver CBT.2 This issue of Gut describes the most recent effort to tackle this problem: the Assessing Cognitive Behavioural Therapy in Irritable Bowel Syndrome (ACTIB).3 The trial has many strengths, chief of which is it is the largest CBT for IBS trial conducted to date. The two CBT treatments (web -based, telephone delivered) were superior to treatment as usual (TAU) at both post-treatment and 12-month follow-up. Like the recently completed National Institutes of Health-funded IBS Outcome Study4 (IBSOS) that pitted home-based CBT against face-to-face CBT, both CBT arms were associated with substantial reductions in scores on the Irritable Bowel Syndrome Symptom Severity Scale (IBS-SSS). Unlike the IBSOS, ACTIB leaves unanswered the most pressing and practical question of whether higher intensity CBT (8 hours of clinician time) was equivalent to the lower intensity (2 hours) version. …
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