JMIR Publications

ABSTRACT

Background:

Cognitive behavioral therapy (CBT) is recommended for treating irritable bowel syndrome (IBS). However, face-to-face CBT is limited by the need for skilled mental health service providers with specialized skills, and it imposes time and financial burdens on patients. It remains unclear whether traditional face-to-face CBT is as effective as digital, self-help, or telephone-delivered CBT for IBS, and whether these methods have sufficient sample sizes to demonstrate their efficacy.

Objective:

To estimate the relative effect of face-to-face CBT versus digital, telephone-delivered, and self-help CBT for IBS by a Bayesian indirect treatment comparison meta-analysis; and to assess whether there are adequate effective sample sizes to support the findings by assessing the required sample sizes and effective sample sizes.

Methods:

Ovid Medline, Embase, and Cochrane Library were searched up to September 29, 2024, and a supplementary search was conducted on September 27, 2025. A Bayesian random-effects model was employed for the indirect treatment comparison meta-analysis. The primary outcome was the IBS symptom severity scale (IBS-SSS), with secondary outcomes including IBS quality of life (IBS-QOL) and abdominal pain intensity (API). The effective sample sizes and required sample sizes were calculated to estimate whether there are adequate sample sizes. The certainty of evidence was evaluated using the Confidence in Network Meta-Analysis Framework.

Results:

We analyzed 22 studies involving 3161 participants. The number of participants ranged between 28 and 558. The mean age of participants was 37.2 years, and 78.6% were female. Seven RCTs reported face-to-face CBT, six reported digital CBT, four RCTs reported self-help CBT, two assessed both digital CBT and self-help CBT, two evaluated both self-help CBT and face-to-face CBT, and one RCT examined both digital CBT and telephone-delivered CBT. We found that face-to-face CBT had similar effects compared with digital CBT (MD -0.89, 95% CrI -20.78 to 18.73), self-help CBT (MD -1.73, 95% CrI -21.03 to 17.80), and telephone-delivered CBT (MD -0.76, 95% CrI -20.86 to 19.38) in improving IBS-SSS scores. The comparison between face-to-face CBT and self-help CBT had sufficient effective sample sizes (375/140), whereas the effective sample sizes for comparisons with digital CBT (347/729) and telephone-delivered CBT (140/627) were insufficient. The certainty of evidence was moderate to low. Similarly, in improving quality of life and API, face-to-face CBT showed equal effect compared with digital and self-help CBT, with insufficient sample sizes and low to very low evidence certainty.

Conclusions:

Face-to-face CBT has similar effect compared with digital, self-help, and telephone-delivered CBT for IBS, suggesting that digital, telephone-based, and self-help CBT might offer patients with IBS more cost-effective option without loss of benefit in clinical practice. However, the effective sample sizes for most comparisons were inadequate. Therefore, more high-quality studies are warranted in the future. Clinical Trial: Open Science Framework: https://doi.org/10.17605/OSF.IO/ZW2HQ.