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Irritable bowel syndrome, also known as IBS, is a complex gastrointestinal disorder that affects about 20% of the population at some time during life, and about 2% of the population in any given year.
Since IBS makes people hesitant to go out for social interaction but a lack of social interaction usually makes IBS symptoms more severe and more persistent, Swedish researchers have been experimenting with Internet-based treatment for the condition.
Reporting their findings in the American Journal of Gastroenterology, doctors in Sweden recruited 195 IBS sufferers to participate in either a stress-reduction program or cognitive behavioral therapy. Both groups were given self-help texts and assigned an on-line "therapist" with whom they exchanged emails or instant messages.
At the end of the 10-week intervention, patients in both groups reported that their symptoms were under adequate control. Six months after the 10-week intervention, however, the IBS sufferers who were in the cognitive behavioral therapy group were more likely than the IBS sufferers who were in the stress reduction group to report that their symptoms were still under control.
This "mindfulness" approach encouraged being concerned about likely problems while feeling better about problems that were less likely to occur. Cumulative experience of few or no symptoms allowed participants in the program to try new foods, new activities, and new social settings with less embarrassment—and the lowered stress reduced the risk of diarrhea, flatulence, and abdominal cramping.
People in the stress reduction group were encouraged to lower their sources of stress in general, but not to try new situations in particular. These volunteers also improved, but their progress with the disease was more likely to be short-lived. People in the stress reduction group were less likely to complete the course than people in the "mindfulness" group.
When therapy is done online, the risk of public humiliation is taken out of the healing process, and the patient can focus on changes in lifestyle, diet, and social interactions that he or she knows to be safe because of experiences in the treatment program.
Different people, of course, respond to different approaches. All of the people in the Swedish study signed up for treatment; that is, they were self-referred, rather than doctor-referred. It may be that people with IBS who are inclined to take control over their treatment respond well to Internet-based therapy, while people who are not inclined to deal with IBS issues may do better with medication or office visits to their therapists.
At the end of the 10-week intervention, patients in both groups reported that their symptoms were under adequate control. Six months after the 10-week intervention, however, the IBS sufferers who were in the cognitive behavioral therapy group were more likely than the IBS sufferers who were in the stress reduction group to report that their symptoms were still under control.
What is the difference between cognitive behavioral therapy and stress reduction?
Cognitive behavioral therapy for these IBS sufferers involved an approach called "graded exposure." People in the cognitive behavioral therapy group were encourage to risk certain foods and certain physical activities in the safety of their own homes. They were then asked to evaluate whether the food or the activity activated IBS symptoms.This "mindfulness" approach encouraged being concerned about likely problems while feeling better about problems that were less likely to occur. Cumulative experience of few or no symptoms allowed participants in the program to try new foods, new activities, and new social settings with less embarrassment—and the lowered stress reduced the risk of diarrhea, flatulence, and abdominal cramping.
People in the stress reduction group were encouraged to lower their sources of stress in general, but not to try new situations in particular. These volunteers also improved, but their progress with the disease was more likely to be short-lived. People in the stress reduction group were less likely to complete the course than people in the "mindfulness" group.
Why would doctors advocate online treatment?
Face to face meetings with a therapist are costly for health insurance plans and for uninsured patients. They may require travel and time off from work, and they put the IBS sufferer in situations in which rumbling stomach, flatulence, and urgent trips to the bathroom can be especially unpleasant. The anticipation of possible public humiliation itself aggravates IBS.When therapy is done online, the risk of public humiliation is taken out of the healing process, and the patient can focus on changes in lifestyle, diet, and social interactions that he or she knows to be safe because of experiences in the treatment program.
Different people, of course, respond to different approaches. All of the people in the Swedish study signed up for treatment; that is, they were self-referred, rather than doctor-referred. It may be that people with IBS who are inclined to take control over their treatment respond well to Internet-based therapy, while people who are not inclined to deal with IBS issues may do better with medication or office visits to their therapists.
- Ljótsson B, Hedman E, Andersson E, Hesser H, Lindfors P, Hursti T, Rydh S, Rück C, Lindefors N, Andersson G. Internet-Delivered Exposure-Based Treatment vs. Stress Management for Irritable Bowel Syndrome: A Randomized Trial. Am J Gastroenterol. 2011 May 3. [Epub ahead of print]
- Photo courtesy of ambernectar on Flickr: www.flickr.com/photos/ambernectar/4381453385/