Patients' Experiences of Telephone-Based and Web-Based Cognitive Behavioral Therapy for Irritable Bowel Syndrome: Longitudinal Qualitative Study.
cognitive behavioral therapy
internet
irritable bowel syndrome
primary health care
self-management
Journal
Journal of medical Internet research
ISSN: 1438-8871
Titre abrégé: J Med Internet Res
Pays: Canada
ID NLM: 100959882
Informations de publication
Date de publication:
20 11 2020
20 11 2020
Historique:
received:
12
03
2020
accepted:
26
07
2020
revised:
24
06
2020
entrez:
20
11
2020
pubmed:
21
11
2020
medline:
2
3
2021
Statut:
epublish
Résumé
Cognitive behavioral therapy (CBT) is recommended in guidelines for people with refractory irritable bowel syndrome (IBS). However, the availability of CBT is limited, and poor adherence has been reported in face-to-face CBT. Nested within a randomized controlled trial of telephone- and web-delivered CBT for refractory IBS, this qualitative study aims to identify barriers to and facilitators of engagement over time with the interventions, identify social and psychological processes of change, and provide insight into trial results. A longitudinal qualitative study was nested in a randomized controlled trial. Repeated semistructured interviews were conducted at 3 (n=34) and 12 months (n=25) post baseline. Participants received telephone-based CBT (TCBT; n=17 at 3 months and n=13 at 12 months) or web-based CBT (WCBT; n=17 at 3 months and n=12 at 12 months). Inductive thematic analysis was used to analyze the data. Participants viewed CBT as credible for IBS, perceived their therapists as knowledgeable and supportive, and liked the flexibility of web-based and telephone-based delivery; these factors facilitated engagement. Potential barriers to engagement in both groups (mostly overcome by our participants) included initial skepticism 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 WCBT (WCBT group only). Participants described helpful changes in their understanding of IBS, attitudes toward IBS, ability to recognize IBS patterns, and IBS-related behaviors. Consistent with the trial results, participants described lasting positive effects on their symptoms, work, and social lives. Reasons and remedies for some attenuation of effects were identified. Both TCBT and WCBT for IBS were positively received and had lasting positive impacts on participants' understanding of IBS, IBS-related behaviors, symptoms, and quality of life. These forms of CBT may broaden access to CBT for IBS.
Sections du résumé
BACKGROUND
Cognitive behavioral therapy (CBT) is recommended in guidelines for people with refractory irritable bowel syndrome (IBS). However, the availability of CBT is limited, and poor adherence has been reported in face-to-face CBT.
OBJECTIVE
Nested within a randomized controlled trial of telephone- and web-delivered CBT for refractory IBS, this qualitative study aims to identify barriers to and facilitators of engagement over time with the interventions, identify social and psychological processes of change, and provide insight into trial results.
METHODS
A longitudinal qualitative study was nested in a randomized controlled trial. Repeated semistructured interviews were conducted at 3 (n=34) and 12 months (n=25) post baseline. Participants received telephone-based CBT (TCBT; n=17 at 3 months and n=13 at 12 months) or web-based CBT (WCBT; n=17 at 3 months and n=12 at 12 months). Inductive thematic analysis was used to analyze the data.
RESULTS
Participants viewed CBT as credible for IBS, perceived their therapists as knowledgeable and supportive, and liked the flexibility of web-based and telephone-based delivery; these factors facilitated engagement. Potential barriers to engagement in both groups (mostly overcome by our participants) included initial skepticism 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 WCBT (WCBT group only). Participants described helpful changes in their understanding of IBS, attitudes toward IBS, ability to recognize IBS patterns, and IBS-related behaviors. Consistent with the trial results, participants described lasting positive effects on their symptoms, work, and social lives. Reasons and remedies for some attenuation of effects were identified.
CONCLUSIONS
Both TCBT and WCBT for IBS were positively received and had lasting positive impacts on participants' understanding of IBS, IBS-related behaviors, symptoms, and quality of life. These forms of CBT may broaden access to CBT for IBS.
Identifiants
pubmed: 33216002
pii: v22i11e18691
doi: 10.2196/18691
pmc: PMC7718092
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e18691Subventions
Organisme : Department of Health
ID : 11/69/02
Pays : United Kingdom
Informations de copyright
©Stephanie Hughes, Alice Sibelli, Hazel A Everitt, Rona Moss-Morris, Trudie Chalder, J Matthew Harvey, Andrea Vas Falcao, Sabine Landau, Gilly O'Reilly, Sula Windgassen, Rachel Holland, Paul Little, Paul McCrone, Kimberley Goldsmith, Nicholas Coleman, Robert Logan, Felicity L Bishop. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 20.11.2020.
Références
BMJ. 2005 Aug 20;331(7514):435
pubmed: 16093252
Behav Cogn Psychother. 2012 Mar;40(2):175-91
pubmed: 21929831
Psychol Med. 2010 Jan;40(1):85-94
pubmed: 19531276
BMJ. 2009 Sep 28;339:b3702
pubmed: 19786485
Lancet Gastroenterol Hepatol. 2019 Nov;4(11):863-872
pubmed: 31492643
BMC Med. 2010 Dec 07;8:82
pubmed: 21138574
J Med Internet Res. 2013 Sep 03;15(9):e190
pubmed: 24001787
Gut. 2007 Aug;56(8):1066-71
pubmed: 17324974
Cochrane Database Syst Rev. 2009 Jan 21;(1):CD006442
pubmed: 19160286
Am J Gastroenterol. 2014 Sep;109(9):1350-65; quiz 1366
pubmed: 24935275
Gastroenterology. 2018 Jul;155(1):47-57
pubmed: 29702118
Br J Health Psychol. 2017 Nov;22(4):737-762
pubmed: 28862389
BMC Gastroenterol. 2010 Nov 18;10:136
pubmed: 21087463
J Med Internet Res. 2011 Aug 05;13(3):e52
pubmed: 21821503
J Med Internet Res. 2011 Mar 10;13(1):e30
pubmed: 21393123
Br J Health Psychol. 2018 Sep;23(3):561-579
pubmed: 29508539
Aliment Pharmacol Ther. 1997 Apr;11(2):395-402
pubmed: 9146781
BMJ Open. 2015 Jul 15;5(7):e008622
pubmed: 26179651
Gut. 2019 Sep;68(9):1613-1623
pubmed: 30971419
Health Expect. 2009 Mar;12(1):45-59
pubmed: 19250152
Br J Gen Pract. 2018 Sep;68(674):e654-e662
pubmed: 30061195
Behav Res Ther. 2009 Sep;47(9):797-802
pubmed: 19570525