Hybrid Cognitive Behavioral Therapy With Interoceptive Exposure for Irritable Bowel Syndrome: A Feasibility Study

Misako Funaba; Hitomi Kawanishi; Yasushi Fujii; Koyo Higami; Yoshitoshi Tomita; Kazushi Maruo; Norio Sugawara; Yuki Oe; Satsuki Kura; Masaru Horikoshi; Chisato Ohara; Hiroe Kikuchi; Hajime Ariga; Shin Fukudo; Atsushi Sekiguchi; Tetsuya Ando

doi:10.3389/fpsyt.2021.673939

Hybrid Cognitive Behavioral Therapy With Interoceptive Exposure for Irritable Bowel Syndrome: A Feasibility Study

Front Psychiatry. 2021 Sep 9:12:673939. doi: 10.3389/fpsyt.2021.673939. eCollection 2021.

Authors

Misako Funaba¹, Hitomi Kawanishi^{1

2}, Yasushi Fujii^{1

3}, Koyo Higami⁴, Yoshitoshi Tomita⁵, Kazushi Maruo⁶, Norio Sugawara⁷, Yuki Oe^{8

9}, Satsuki Kura¹⁰, Masaru Horikoshi⁹, Chisato Ohara^{1

11}, Hiroe Kikuchi¹², Hajime Ariga¹³, Shin Fukudo², Atsushi Sekiguchi¹, Tetsuya Ando^{1

14}

Affiliations

¹ Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan.
² Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
³ Department of Psychology, Meisei University, Hino, Japan.
⁴ Shinjuku-Gyoenmae Counseling Center, Tokyo, Japan.
⁵ Department of Psychosomatic Medicine, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan.
⁶ Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
⁷ Department of Psychiatry, Dokkyo Medical University School of Medicine, Mibu, Japan.
⁸ Department of Neuropsychiatry, Kyorin University School of Medicine, Mitaka, Japan.
⁹ National Center for Cognitive Behavioral Therapy and Research, National Center of Neurology and Psychiatry, Kodaira, Japan.
¹⁰ Hidaka Dental Clinic, Fukuoka, Japan.
¹¹ Department of Clinical Psychology, Faculty of Human Sciences, Bunkyo University, Koshigaya, Japan.
¹² Department of Psychosomatic Medicine, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan.
¹³ Division of Gastroenterology, Department of General Internal Medicine, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan.
¹⁴ Department of Psychosomatic Medicine, Narita Hospital, International University of Health and Welfare, Narita, Japan.

Abstract

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder, which severely impairs the quality of life of patients. Treatment of refractory IBS patients is needed, but it is not yet widely available. Therefore, we previously developed a Japanese version of cognitive behavioral therapy with interoceptive exposure (CBT-IE) involving 10 face-to-face sessions to treat refractory IBS patients. To disseminate this treatment of IBS in places where therapists are limited, we further developed a hybrid CBT-IE program with complementary video materials that include psychoeducation and homework instructions so that patients can prepare for face-to-face sessions in advance at home and the session time can be shortened, thereby reducing the burden on both patient and therapist. In this study, we conducted a trial to evaluate the feasibility, efficacy, and safety of the hybrid CBT-IE program for Japanese IBS patients. The study was a single-arm, open-label pilot clinical trial. A total of 16 IBS patients were included in the study and 14 patients completed the intervention, which consisted of 10 weekly individual hybrid CBT-IE sessions. We performed an intention to treat analysis. The primary outcome measure for the efficacy of the intervention was a decrease in the severity of IBS symptoms. The feasibility and safety of the intervention were examined by the dropout rate and recording of adverse events, respectively. The dropout rate of the hybrid CBT-IE was comparable to that of our previous CBT-IE with only face-to-face sessions and no adverse events were recorded. The severity of IBS symptoms within-group was significantly decreased from the baseline to mid-treatment [Hedges' g = -0.98 (-1.54, -0.41)], post-treatment [Hedges' g = -1.48 (-2.09, -0.88)], 3-month follow-up [Hedges' g = -1.78 (-2.41, -1.14)], and 6-month follow-up [Hedges' g = -1.76 (-2.39, -1.13)]. Our results suggest that the hybrid CBT-IE is effective and could be conducted safely. To confirm the effectiveness of the hybrid CBT-IE, it is necessary to conduct a multicenter, parallel-design randomized control trial. Clinical Trial Registration: [https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000041376], identifier [UMIN000036327].

Keywords: cognitive behavioral therapy with interoceptive exposure; complementary video materials; feasibility study; hybrid CBT; irritable bowel syndrome.