title: A Comprehensive Self-Management Irritable Bowel Syndrome Program Produces Sustainable Changes in Behavior After 1 Year.
abstract: OBJECTIVE
  We developed a comprehensive self-management (CSM) program that combines cognitive behavioral therapy with relaxation and dietary strategies; 9 sessions (1 hour each) over 13 weeks were shown to reduce gastrointestinal symptoms and increase quality of life in a randomized trial of patients with irritable bowel syndrome (IBS), compared with usual care. The aims of this study were to describe strategies patients with IBS selected and continued to use, 12 months after the CSM program began.
  
  
  METHODS
  We performed a cohort study to continue to follow 81 adults with IBS (87% female; mean age, 45 ± 15 years old) who received the CSM program in the previous clinical trial. During the last CSM session, participants selected strategies they intended to continue using to manage their IBS. CSM strategies were categorized into subthemes of diet (composition, trigger foods, meal size or timing, and eating behaviors), relaxation (specific relaxation strategies and lifestyle behaviors), and alternative thoughts (identifying thought distortions, challenging underlying beliefs, and other strategies). Twelve months later, participants were asked how often they used each strategy (not at all or rarely, occasionally, often, very often, or almost always).
  
  
  RESULTS
  At the last CSM session, 95% of the patients selected the subthemes of specific relaxation strategies, 90% selected diet composition, and 90% identified thought distortions for continued use. At 12 months, 94% of the participants (76 of 81) were still using at least 6 strategies, and adherence was greater than 79% for all subthemes.
  
  
  CONCLUSIONS
  We developed a CSM program to reduce symptoms and increase quality of life in patients with IBS that produced sustainable behavioral changes in almost all patients (94%) after 1 year of follow-up.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, University of Washington, Seattle, Washington. Electronic address: JZia@medicine.washington.edu.
authors.forename: Jasmine K
authors.initials: JK
authors.lastname: Zia
authors.affiliation: Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, Washington.
authors.forename: Pamela
authors.initials: P
authors.lastname: Barney
authors.affiliation: Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, Washington.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Cain
authors.affiliation: Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, Washington.
authors.forename: Monica E
authors.initials: ME
authors.lastname: Jarrett
authors.affiliation: Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, Washington.
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Heitkemper
mesh_terms: D000328:Adult; D001519:Behavior; D015331:Cohort Studies; D004032:Diet / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000473:pathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012064:Relaxation Therapy / Q000379:methods; D012648:Self Care / Q000379:methods*
keywords: Alternative Medicine; Behavioral Therapy; Psychology; Self-Management