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Rapid Response to Cognitive Behavior Therapy Predicts Treatment Outcome in Patients with Irritable Bowel Syndrome.

Clin Gastroenterol Hepatol. 2010 Feb 16;

Authors: Lackner JM, Gudleski GD, Keefer L, Krasner SS, Powell C, Katz LA

BACKGROUND:: Cognitive behavior therapy (CBT) is an empirically validated treatment for irritable bowel syndrome (IBS), yet it is unclear for whom and under what circumstances it is most effective. We investigated whether patients who achieved a positive response soon after CBT onset (by week 4), termed 'rapid responders' (RRs), maintain treatment gains, compared with non-rapid responders (NRRs). We also characterized the psychosocial profile of RRs on clinically relevant variables (e.g., health status, IBS symptom severity, distress). METHODS:: The study included 71 individuals (ages 18-70 years) whose IBS symptoms were consistent with Rome II criteria and of at least moderate severity. Patients were randomly assigned to undergo a wait list control; 10 weekly, 1-hour sessions of CBT; or 4, 1-hour CBT sessions over 10 weeks. RRs were classified as patients who reported adequate relief of pain, adequate relief of bowel symptoms, and a decrease in total IBS severity scores of >/=50 by week 4. RESULTS:: Of patients undergoing CBT, 30% were RRs; 90%-95% of the RRs maintained gains at the immediate and 3-month follow-up examinations. Although the RRs reported more severe IBS symptoms at baseline, they achieved more substantial, sustained IBS symptom reduction than NRRs. Both dosages of CBT had comparable rates of RR. CONCLUSIONS:: A significant proportion of IBS patients treated with CBT have a positive response within 4 weeks of treatment; these patients are more likely to maintain treatment gains than patients without a rapid response. A rapid response is not contingent on amount of face to face contact with a clinician.

PMID: 20170751 [PubMed - as supplied by publisher]

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