Pocket computer improves unexplained abdominal pain

Cognitive behavioural therapy using a pocket computer reduces dysfunctional complaint-related thoughts and pain in patients with Irritable Bowel Syndrome. The treatment appears to be effective in the short run and in part also in the long run. This is the outcome of a study conducted by researchers from NIVEL and published in Journal of Psychosomatic Research.

Irritable Bowel Syndrome (IBS) is a highly prevalent and often disabling condition. Ten to 25 percent of the general population – twice as many women – suffers from IBS occasionally. Patients experience abdominal pain often combined with diarrhoea or constipation. There is no medical explanation for these complaints. Cognitive behavioural therapy (CBT) may provide a tool to cope with IBS. Researchers from NIVEL (Netherlands institute for health services research) investigated the feasibility and efficacy of CBT delivered through a pocket computer. Participating patients kept electronic diaries for four weeks, three times daily. In addition, they received daily feedback from a psychologist. The electronic diary on a pocket computer has the advantage to alert patients to complete the diary in between daily activities.

Cognitive behavioural therapy - i.e. adjusting dysfunctional complaint-related expectations and ideas - by means of a pocket computer, seems feasible; patients start thinking less negatively about their complaints, which gradually improves their condition. In the long run, their more positive thoughts about the complaints persist, but the pain somewhat increases. NIVEL research co-ordinator Sandra van Dulmen: “We were surprised by this latter finding. But when the intervention would be repeated from time to time, the positive effects on the pain may probably persist as well.”

“The intervention focuses on negative, dysfunctional thoughts, like: “I think my abdominal pain will never disappear”, or “I think I suffer from a serious disease”. We tried to change these thoughts into, for example: “When I avoid stress, the pain diminishes”. As a result of the abdominal pain patients often avoid certain food, even when the relationship is not proven. We let them reflect on their thoughts and activities and have them experience in daily life whether or not these influence their complaints.” Patients reported that they got more insight in their complaints by keeping a diary. They realized which complaints really hindered them and under which circumstances.
An experimental group with 37 patients kept a diary on the pocket computer and completed questionnaires about their pain and the level in which their complaints hindered them. A control group with 38 patients only completed the questionnaires.