An Implementation Trial of ACT-Based Bibliotherapy for Irritable Bowel Syndrome

Abstract

Background: Irritable Bowel Syndrome is a gastrointestinal disorder that is associated with pain, discomfort, constipation and diarrhoea. 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 tenyear history of IBS, and 71% of the sample had moderate or severe symptoms. At six months,participants had improved on symptom severity (hp 2 = .09, 90% CI = .01 - .18), GI specific anxiety (hp 2 = .07, 90% CI = .01 - .16) and IBS willingness (hp 2 = .14, 90% CI = .04 - .24), but had not shown behavioural changes towards greater activity, (hp 2 = .01, 90% CI = .0 - .05) or to reduce IBS avoidance behaviours (hp 2 = .05, 90% CI = .0 = .13). Contrary to hypothesis, intervention did not reduce the impact of IBS on quality of life(hp 2 = .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.