Internet-Delivered Cognitive Behavior Therapy for Adolescents With Irritable Bowel Syndrome: A Randomized Controlled Trial
Internet-Delivered Cognitive Behavior Therapy for Adolescents With Irritable Bowel Syndrome: A Randomized Controlled Trial
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DOI：
10.1038/ajg.2016.503
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发表时间：
2017-01-01
影响因子：
9.8
通讯作者：
Ljotsson, Brjann
中科院分区：
文献类型：
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作者：
Bonnert, Marianne;Olen, Ola;Ljotsson, Brjann
注意事项：很少有治疗方法能够有效地管理小儿肠易激综合征（IBS）。基于腹部症状暴露的互联网认知行为疗法（Internet-CBT）对成人IBS有效。本研究的目的是评估行为暴露的基础上，青少年IBS的疗效互联网CBT。方法：青少年IBS履行罗马III标准被随机分配到互联网CBT或等待列表控制。互联网-CBT是一项为期10周的干预，其主要组成部分是通过减少腹部症状的避免而不是逐步激发症状来暴露于IBS症状。主要观察指标为肠易激综合征胃肠症状评定量表（GSRS-IBS）总分。次要结局包括患者和父母评定的生活质量和父母评定的胃肠道症状。组间差异进行了评估，从治疗前到治疗后和互联网CBT组也进行了评估，在6个月后治疗completion.RESULTS：共101例青少年IBS（13-17岁）被纳入本研究。脱落率较低（6%），所有随机化患者均纳入基于混合效应模型的意向治疗分析。分析显示，与对照组相比，互联网-CBT组的主要结局GSRS-IBS（B=-6.42，P=0.006，效应量Cohen's d=0.45，95%置信区间（0.12，0.77））和几乎所有次要结局的治疗前至治疗后变化显著更大。6个月后，结果稳定或明显改善。结论：基于暴露练习的互联网认知行为疗法对青少年IBS患者的胃肠道症状和生活质量有明显改善作用。
OBJECTIVES: Few treatments have been able to effectively manage pediatric irritable bowel syndrome (IBS). Internet-delivered cognitive behavior therapy (Internet-CBT) based on exposure for abdominal symptoms is effective for adult IBS. The objective of this study was to evaluate the efficacy of Internet-CBT based on behavioral exposure for adolescents with IBS.METHODS: Adolescents with IBS fulfilling the Rome III criteria were randomized to either Internet-CBT or a wait-list control. The Internet-CBT was a 10-week intervention where the main component was exposure to IBS symptoms by reduction of avoidance of abdominal symptoms and instead stepwise provocation of symptoms. The primary outcome was total score on Gastrointestinal Symptoms Rating Scale for IBS (GSRS-IBS). Secondary outcomes included adolescent-and parent-rated quality of life and parent-rated gastrointestinal symptoms. Difference between groups was assessed from pretreatment to posttreatment and the Internet-CBT group was also evaluated at 6 months after treatment completion.RESULTS: A total of 101 adolescents with IBS (13-17 years of age) were included in this study. Dropout rates were low (6%) and all randomized patients were included in intent-to-treat analyses based on mixed effects models. Analyses showed a significant larger pretreatment to posttreatment change on the primary outcome GSRS-IBS (B=-6.42, P=0.006, effect size Cohen's d=0.45, 95% confidence interval (0.12, 0.77)) and on almost all secondary outcomes for the Internet-CBT group compared with the control group. After 6 months, the results were stable or significantly improved.CONCLUSIONS: Internet-CBT based on exposure exercises for adolescents with IBS can effectively improve gastrointestinal symptoms and quality of life.