title: Rapid response to cognitive behavior therapy predicts treatment outcome in patients with irritable bowel syndrome.
abstract: OBJECTIVE
  Cognitive behavior therapy (CBT) is an empirically validated treatment for irritable bowel syndrome (IBS), yet it is unclear for whom and under what circumstances it is most effective. We investigated whether patients who achieved a positive response soon after CBT onset (by week 4), termed rapid responders (RRs), maintain treatment gains compared with non-rapid responders. We also characterized the psychosocial profile of RRs on clinically relevant variables (eg, health status, IBS symptom severity, distress).
  
  
  METHODS
  The study included 71 individuals (age, 18-70 y) whose IBS symptoms were consistent with Rome II criteria and were of at least moderate severity. Patients were assigned randomly to undergo a wait list control; 10 weekly 1-hour sessions of CBT; or four 1-hour CBT sessions over 10 weeks. RRs were classified as patients who reported adequate relief of pain, adequate relief of bowel symptoms, and a decrease in total IBS severity scores of 50 or greater by week 4.
  
  
  RESULTS
  Of patients undergoing CBT, 30% were RRs; 90% to 95% of the RRs maintained gains at the immediate and 3-month follow-up examinations. Although the RRs reported more severe IBS symptoms at baseline, they achieved more substantial, sustained IBS symptom reduction than non-rapid responders. Both dosages of CBT had comparable rates of RR.
  
  
  CONCLUSIONS
  A significant proportion of IBS patients treated with CBT have a positive response within 4 weeks of treatment; these patients are more likely to maintain treatment gains than patients without a rapid response. A rapid response is not contingent on the amount of face-to-face contact with a clinician.
authors.affiliation: Division of Gastroenterology, Department of Medicine, University at Buffalo, State University of New York, Buffalo, New York 14215, USA. lackner@buffalo.edu
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Lackner
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Gudleski
authors.forename: Laurie
authors.initials: L
authors.lastname: Keefer
authors.forename: Susan S
authors.initials: SS
authors.lastname: Krasner
authors.forename: Cathrine
authors.initials: C
authors.lastname: Powell
authors.forename: Leonard A
authors.initials: LA
authors.lastname: Katz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000523:psychology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult