INTRODUCTION Irritable bowel syndrome (IBS) is a common and debilitating disorder. When dietary and pharmacological interventions are not satisfactory, psychological treatment may produce good results. However, the access to such treatment is scarce, and therefore, it is of importance to make use of technical solutions. In this study, we wanted to investigate the real-world effectiveness of an Internet-delivered exposure-based cognitive behavior therapy (ECBT) for IBS and to replicate an earlier finding regarding the working mechanism of the treatment. METHODS A total of 309 consecutively recruited patients from the Internet Psychiatry Clinic in Stockholm received ECBT for 12 weeks. The patients' IBS symptoms, quality of life, avoidance behaviors, and gastrointestinal symptom-specific anxiety were monitored, and we used a bivariate cross-lagged panel model to investigate time-related change in symptoms and avoidance behaviors. RESULTS IBS symptoms, measured with the Gastrointestinal Symptom Rating Scale for IBS, were reduced from 48.06 (SD = 11.26) before treatment to 33.06 (SD = 10.81) 6 months after treatment ( P < 0.001). The effect size (calculated by Cohen d ) was 1.30 (1.08-1.51). There was a significant ( P < 0.001) cross-lagged effect from reduction in avoidance behavior to reduction in symptoms but not in the reverse direction, indicating that the treatment effect is mediated by behavioral change. DISCUSSION We conclude that ECBT is effective under real-world conditions, also when delivered through the Internet, and that an important treatment mechanism is the reduction of avoidance behaviors.

中文翻译：

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互联网提供的基于暴露的肠易激综合征认知行为疗法：一项临床有效性研究。


引言 肠易激综合征 （IBS） 是一种常见且使人衰弱的疾病。当饮食和药物干预不令人满意时，心理治疗可能会产生良好的效果。然而，获得这种治疗的机会很少，因此，利用技术解决方案非常重要。在这项研究中，我们想调查互联网提供的基于暴露的认知行为疗法 （ECBT） 对 IBS 的真实世界有效性，并复制关于治疗工作机制的早期发现。方法 从斯德哥尔摩互联网精神病学诊所连续招募的 309 名患者接受了为期 12 周的 ECBT。监测患者的 IBS 症状、生活质量、回避行为和胃肠道症状特异性焦虑，我们使用双变量交叉滞后面板模型来研究症状和回避行为的时间相关变化。结果 用 IBS 胃肠道症状评定量表测量的 IBS 症状从治疗前的 48.06 （SD = 11.26） 降低到治疗后 6 个月的 33.06 （SD = 10.81） （ P < 0.001）。效应量（由 Cohen d 计算）为 1.30 （1.08-1.51）。从回避行为的减少到症状的减轻存在显著的 （P < 0.001） 交叉滞后效应，但不是相反的，表明治疗效果是由行为改变介导的。讨论 我们得出结论，ECBT 在现实世界条件下是有效的，通过互联网提供时也是如此，并且一个重要的治疗机制是减少回避行为。