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Patients’ experiences of telephone and web-based Cognitive Behavioural Therapy for Irritable Bowel Syndrome: A longitudinal qualitative study

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Stephanie Hughes, Alice Sibelli, Andrea vas Falcao, J Matthew Harvey, Hazel Everitt, Sabine Landau, Gilly O'Reilly, Sula Windgassen, Rachel Holland, Paul Little, Paul McCrone, Kimberley Goldsmith, Nicholas Coleman, Robert Logan, Trudie Chalder, Rona Moss-Morris, Felicity L. Bishop

Original languageEnglish
Number of pages33
JournalJournal of Medical Internet Research
Publication statusAccepted/In press - 1 Jul 2020

King's Authors


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.

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.
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.
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 in both groups (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 (web-based CBT group only). 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.
Both telephone and web-based CBT for IBS were 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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