Regul8, an eight-session tailored cognitive behavioural therapy (CBT) programme for treating IBS, was developed as a potential cost-effective way of providing help to those individuals with IBS. Regul8 was developed over 18 years using rigorous empirical study. The cognitive behavioural treatment mechanisms included in Regul8 are based on empirical studies predicting the onset and maintenance of IBS symptoms (Spence & Moss-Morris, 2007). The CBT is therefore specific to IBS rather than CBT for a related mood disorder. The content was further developed and modified through early clinical trials (e.g. Kennedy et al., 2005; Moss-Morris et al., 2010). The effectiveness of the patient manual together with 8 hours of telephone therapist contact time has been confirmed in a large effectiveness RCT (n=520) with IBS symptom severity and impact at 12-months follow up the primary outcomes (Everitt et al., 2019a). Regul8 was also more effective than treatment as usual in reducing global ratings of relief of symptoms, depression and anxiety an increasing efficacy to cope with symptoms. Results were maintained at 24 months follow up (Everitt et al 2019b).
The Regul8 patient manual consists of 8 chapters including: (1) Understanding your IBS and the link between symptoms, thoughts, feelings and behaviours; (2) Assessing your symptoms in relation to stress and daily routines; (3) Changing behaviours in response to symptoms, developing consistent eating, activity and exercise routines; (4) Identifying your unhelpful thought patterns; (5) Generating alternative thoughts; (6) Managing stress and sleep (7) Managing emotions; (8) Managing flare-ups and the future.
This Worksop will focus on core aspects on this manualised approach. The first will be how to engage patients with physical symptoms in a behavioural based therapy. The use of explanatory models which include physical as well as psychological explanations of symptoms will be demonstrated. Specific IBS avoidance and safety behaviours will be identified alongside methods to address these. Finally, the importance of symptom and illness cognitions and high personal expectations will be discussed.
Key learning objectives:
- Use the biopsychosocial model of IBS to provide a coherent, personalised explanation to patients as to why they experience IBS symptoms
- Use this model to engage patients in future behavioural and cognitive change.
- Identify IBS specific avoidance and safety behaviours and strategies for treating these.
- Identify IBS-related unhelpful cognitive responses
Rona Moss-Morris is Professor of Psychology as Applied to Medicine and Head of the Department of Psychology at the Institute of Psychology, Psychiatry and Neuroscience, King’s College London. She has been researching psychological factors that affect symptom experience and adjusting to chronic medical conditions, including multiple sclerosis for the past 30 years. This research has been used to design cognitive behavioural interventions, including digital interventions, for a range of patient groups. RCTs to test the clinical and cost effectiveness of these interventions form a key component of her research. In 2015 she was awarded the British Psychological Society Division of Health Psychology’s Outstanding Contribution to Research Award and in 2020 the British Psychological Society Distinguished Contribution to Practice Award. Her teams work on Multiple Sclerosis (MS) was awarded the MS Society Annual Award for MS Research of the Year in 2013 and the work on irritable bowel syndrome, the King’s Excellence in Innovation and Impact Award in 2019. She was National Advisor to NHS England for Improving Access to Psychological Therapies for People with Long Term and Medically Unexplained conditions from 2011-2016. She is a past editor of Psychology and Health and current editor of Health Psychology Review.
Everitt, H.A., Landau, S., O’Reilly, G., Sibelli, A., Hughes, S., Windgassen, S., Holland, R., Little, P., McCrone, P., Bishop, F., Goldsmith, K., Coleman, N., Logan, R., Chalder, T. & Moss-Morris, R. (2019a) Assessing telephone-delivered cognitive-behavioural therapy (CBT) and web-delivered CBT versus treatment as usual in irritable bowel syndrome (ACTIB): a multicentre randomised trial. Gut BMJ 0:1-11 doi:10.1136/gutjnl-2018-317805
Everitt, H.A., Landau, S., O’Reilly, G., Sibelli, A., Hughes, S., Windgassen, S., Holland, R., Little, P., McCrone, P., Bishop, F.L., Goldsmith, K., Coleman, N., Logan, R., Chalder, T. & Moss-Morris, R. (2019b) Cognitive behavioural therapy for irritable bowel syndrome: 24-month follow-up of participants in the ACTIB randomised trial. The Lancet http://dx.doi.org/10.1016/S2468-1253(19)30243-2
Kennedy T, Jones R, Darnley S, Seed P, Wessely S, Chalder T. Cognitive behaviour therapy in addition to antispasmodic treatment for irritable bowel syndrome in primary care: randomised controlled trial. BMJ. 2005 Aug 20;331(7514):435. doi: 10.1136/bmj.38545.505764.06. Epub 2005 Aug 10. PMID: 16093252; PMCID: PMC1188111.
Moss-Morris, R. Bogalo, L. Didsbury, L.P. and Spence, M.J. (2010). A randomised controlled trial of a cognitive behavioural therapy based self-management intervention for irritable bowel syndrome (IBS) in primary care. Psychological Medicine. 40(1) 85-94. doi:10.1017/S0033291709990195.