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Patients' experiences of telephone-based and web-based cognitive behavioral therapy for irritable bowel syndrome: Longitudinal qualitative study

Patients' experiences of telephone-based and web-based cognitive behavioral therapy for irritable bowel syndrome: Longitudinal qualitative study
Patients' experiences of telephone-based and web-based cognitive behavioral therapy for irritable bowel syndrome: Longitudinal qualitative study
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.
Cognitive behavioral therapy, Internet, Irritable bowel syndrome, Primary health care, Self-management
1438-8871
e18691
Hughes, Stephanie
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Sibelli, Alice
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vas Falcao, Andrea
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Harvey, J. Mathew
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Everitt, Hazel
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Landau, Sabine
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O'Reilly, Gilly
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Windgassen, Sula
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Holland, Rachel
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Little, Paul
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McCrone, Paul
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Goldsmith, Kim
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Coleman, Nicholas
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Logan, Robert
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Chalder, Trudie
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Moss-Morris, Rona
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Bishop, Felicity
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Hughes, Stephanie
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Sibelli, Alice
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vas Falcao, Andrea
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Harvey, J. Mathew
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Everitt, Hazel
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Landau, Sabine
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O'Reilly, Gilly
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Windgassen, Sula
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Holland, Rachel
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Little, Paul
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McCrone, Paul
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Goldsmith, Kim
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Coleman, Nicholas
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Logan, Robert
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Chalder, Trudie
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Moss-Morris, Rona
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Bishop, Felicity
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Hughes, Stephanie, Sibelli, Alice, vas Falcao, Andrea, Harvey, J. Mathew, Everitt, Hazel, Landau, Sabine, O'Reilly, Gilly, Windgassen, Sula, Holland, Rachel, Little, Paul, McCrone, Paul, Goldsmith, Kim, Coleman, Nicholas, Logan, Robert, Chalder, Trudie, Moss-Morris, Rona and Bishop, Felicity (2020) Patients' experiences of telephone-based and web-based cognitive behavioral therapy for irritable bowel syndrome: Longitudinal qualitative study. Journal of Medical Internet Research, 22 (11), e18691, [e18691]. (doi:10.2196/18691).

Record type: Article

Abstract

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.

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Patients’ experiences of telephone and web-based Cognitive Behavioural Therapy for Irritable Bowel Syndrome JMIR accepted july 2020 - Accepted Manuscript
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More information

Accepted/In Press date: 27 July 2020
e-pub ahead of print date: 20 November 2020
Published date: 20 November 2020
Additional Information: Publisher 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. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.
Keywords: Cognitive behavioral therapy, Internet, Irritable bowel syndrome, Primary health care, Self-management

Identifiers

Local EPrints ID: 443197
URI: http://eprints.soton.ac.uk/id/eprint/443197
ISSN: 1438-8871
PURE UUID: 26b3de4c-a636-40d8-8e56-75a5ced5c9e2
ORCID for Hazel Everitt: ORCID iD orcid.org/0000-0001-7362-8403
ORCID for Felicity Bishop: ORCID iD orcid.org/0000-0002-8737-6662

Catalogue record

Date deposited: 14 Aug 2020 16:30
Last modified: 10 Jan 2022 06:26

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Contributors

Author: Alice Sibelli
Author: Andrea vas Falcao
Author: J. Mathew Harvey
Author: Hazel Everitt ORCID iD
Author: Sabine Landau
Author: Gilly O'Reilly
Author: Sula Windgassen
Author: Rachel Holland
Author: Paul Little
Author: Paul McCrone
Author: Kim Goldsmith
Author: Nicholas Coleman
Author: Robert Logan
Author: Trudie Chalder
Author: Rona Moss-Morris
Author: Felicity Bishop ORCID iD

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