An implementation trial of ACT-based bibliotherapy for irritable bowel syndrome

Background

Irritable Bowel Syndrome is a gastrointestinal disorder that is associated with pain, discomfort, constipation and diarrhea . It affects around 20% of adults in Western countries. Reports of distress and self-consciousness, as well as experiential and situational avoidance are common. Previous studies have shown that ACT may be effective for people with IBS.

Methods

An uncontrolled trial of ACT based bibliotherapy was undertaken in a specialist motility clinic. Outcomes were measured with standardised self-report questionnaires pre-treatment, and at two and six months. Missing data was handled using maximum likelihood imputation. Data was analysed using repeated measures ANOVA.

Results

45 participants enrolled in the study, with 36 providing data at two months, and 24 at six months. Participants were predominantly female, with an average ten-year history of IBS, and 71% of the sample had moderate or severe symptoms. At six months,participants had improved on symptom severity (ηp2=.09, 90% CI=.01−.18), GI specific anxiety (ηp2=.07, 90% CI=.01−.16) and IBS willingness (ηp2=.14, 90% CI=.04−.24), but had not shown behavioural changes towards greater activity, (ηp2=.01, 90% CI=.0−.05) or to reduce IBS avoidance behaviours (ηp2=.05, 90% CI=.0=.13). Contrary to hypothesis, intervention did not reduce the impact of IBS on quality of life(ηp2=.04, 90% CI=.0−.09).

Discussion

Bibliotherapy interventions may be useful for people with refractory IBS, though greater contact and structured exposure may be necessary to change behaviour. The study was limited by problems with attrition, though these data suggest future research in this area would be worthwhile.

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