Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Mar 12, 2020
Date Accepted: Jul 26, 2020
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Patients’ experiences of telephone and web-based Cognitive Behavioural Therapy for Irritable Bowel Syndrome: A longitudinal qualitative study
ABSTRACT
Background:
Cognitive behavioural therapy (CBT) is recommended in guidelines for people with refractory irritable bowel syndrome (IBS). However, availability is limited and poor adherence has been reported in face-to-face CBT.
Objective:
Nested within a randomised controlled trial of telephone and web-delivered CBT for refractory IBS, the objectives of this qualitative study were to: identify barriers and facilitators of engagement over time with the interventions; identify social and psychological processes of change; provide insight into trial results.
Methods:
Longitudinal qualitative study nested in a randomised controlled trial. Repeated semi-structured interviews at three (n=34) and twelve-months (n=25) post baseline. Participants received telephone CBT (n=17 at 3m, n=13 at 12m) or web-based CBT (n=17 at 3m, n=12 at 12m). Inductive thematic analysis.
Results:
Participants viewed CBT as credible for IBS, perceived their therapists as knowledgeable and supportive, and liked the flexibility of online and telephone delivery; these factors facilitated engagement. Potential barriers to engagement (mostly overcome by our participants) included initial scepticism 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 web-based CBT. Participants described helpful changes in their understanding of IBS, attitudes towards IBS, ability to recognise IBS patterns, and IBS-related behaviours. Consistent with the trial results, participants described lasting positive impacts on their symptoms, work, and social lives. Reasons and remedies for some attenuation of effects were identified.
Conclusions:
Both telephone and web-based CBT for IBS were very positively received and had lasting positive impacts on participants’ understanding of IBS, IBS-related behaviours, symptoms and quality of life. These forms of CBT may broaden access to CBT for IBS.
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