Pathways connecting cognitive behavioral therapy and change in bowel symptoms of IBS

Jones, Michael, Koloski, Natasha, Boyce, Philip and Talley, Nicholas J. (2011) Pathways connecting cognitive behavioral therapy and change in bowel symptoms of IBS. Journal of Psychosomatic Research, 70 3: 278-285. doi:10.1016/j.jpsychores.2010.10.004

Author Jones, Michael
Koloski, Natasha
Boyce, Philip
Talley, Nicholas J.
Title Pathways connecting cognitive behavioral therapy and change in bowel symptoms of IBS
Journal name Journal of Psychosomatic Research   Check publisher's open access policy
ISSN 0022-3999
Publication date 2011-03
Year available 2010
Sub-type Article (original research)
DOI 10.1016/j.jpsychores.2010.10.004
Volume 70
Issue 3
Start page 278
End page 285
Total pages 8
Place of publication Philadelphia PA, United States
Publisher Elsevier
Collection year 2012
Language eng
Formatted abstract

A single previous paper on this topic found a direct pathway between cognitive behavioral therapy (CBT) and an irritable bowel syndrome (IBS) global symptom score. This is controversial since under the biopsychosocial model, the expectation is that CBT's effect would be mediated by mood. Using more sensitive bowel symptom scales and measurements at additional time points, we aimed to compare the relative strengths of direct pathways between CBT and change in IBS symptoms and indirect pathways that operate via mood state using structural equation modeling.

Our data set included 105 people with Rome I IBS randomized to individual CBT (n=34), relaxation therapy (n=36), and usual medical care (n=35). The primary outcome was defined as adequate relief of IBS symptoms in terms of the distress, frequency, and impairment according to the Bowel Symptom Severity Scale. Outcomes in functional status (according to the 36-item Short-Form Health Survey) and psychological status (Hospital Anxiety and Depression Scale) were secondary outcomes.


Our data suggest indirect pathways that operate via mood, most clearly anxiety but to a lesser extent depression. Statistically significant pathways were identified that lead from CBT to change in mood state thence to change in bowel symptoms, followed by further changes in mood then changes in bowel symptoms. Our data provide no evidence of direct effect of CBT on bowel symptoms.


The present study suggests that CBT may operate via changes in mood state while not ruling out the possibility of direct effects. Our findings do not directly support, but are consistent with, a biopsychosocial model.
Keyword Cognitive behavior therapy
Iritable bowel syndrome
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Available online 16 December 2010

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2012 Collection
School of Psychology Publications
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 18 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 25 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Sun, 27 Mar 2011, 00:05:43 EST