A mixed methods feasibility study to evaluate the use of a low-intensity, nurse-delivered cognitive behavioural therapy for the treatment of irritable bowel syndrome.

INTRODUCTION: Irritable bowel syndrome (IBS) is characterised by symptoms such as abdominal pain, constipation, diarrhoea and bloating. These symptoms impact on health-related quality of life, result in excess service utilisation and are a significant burden to healthcare systems. Certain mechanisms which underpin IBS can be explained by a biopsychosocial model which is amenable to psychological treatment using techniques such as cognitive behavioural therapy (CBT). While current evidence supports CBT interventions for this group of patients, access to these treatments within the UK healthcare system remains problematic. METHODS AND ANALYSIS: A mixed methods feasibility randomised controlled trial will be used to assess the feasibility of a low-intensity, nurse-delivered guided self-help intervention within secondary care gastrointestinal clinics. A total of 60 participants will be allocated across four treatment conditions consisting of: high-intensity CBT delivered by a fully qualified cognitive behavioural therapist, low-intensity guided self-help delivered by a registered nurse, self-help only without therapist support and a treatment as usual control condition. Participants from each of the intervention arms of the study will be interviewed in order to identify potential barriers and facilitators to the implementation of CBT interventions within clinical practice settings. Quantitative data will be analysed using descriptive statistics only. Qualitative data will be analysed using a group thematic analysis. ETHICS AND DISSEMINATION: This study will provide essential information regarding the feasibility of nurse-delivered CBT interventions within secondary care gastrointestinal clinics. The data gathered during this study would also provide useful information when planning a substantive trial and will assist funding bodies when considering investment in substantive trial funding. A favourable opinion for this research was granted by the Nottingham 2 Research Ethics Committee. TRIAL REGISTRATION NUMBER ISRCTN: 83683687 (http://www.controlled-trials.com/ISRCTN83683687).

Study of irritable bowel syndrome and co-existing psychological illness.

AIM: To assess the feasibility of using qualitative methods to explore psychological comorbidities associated with irritable bowel syndrome (IBS). BACKGROUND: IBS is a condition that often has a significant effect on quality of life. It has a high prevalence of co-existing psychological illness, which has been associated with more severe and persistent symptoms and an increased need for specialist referral. Only a small number of research studies have explored patients' perceptions and experiences of IBS, particularly when they are compounded by the presence of psychological comorbidity. DATA SOURCES: Semi-structured interview methods were used to explore the patients' experiences and perceptions of IBS and co-existing psychological illness. REVIEW METHODS: All interview data were transcribed before conducting a thematic analysis. DISCUSSION: The paper reports the methods used to conduct a small feasibility study and discusses and justifies these methods. Methodological issues and the implications these may have on the conduct of the study are presented and critically discussed. CONCLUSION: Important issues were identified during the design and conduct of the feasibility study relating to the quality of participant information, participant recruitment and the suitability of the proposed methods. IMPLICATIONS FOR RESEARCH/PRACTICE: Semi-structured interviews are suitable methods for exploring complex issues such as the psychological comorbidities associated with IBS. Further research should explore the patient perception and experience of concomitant psychological illness, which would help researchers develop effective interventions for patients with IBS.