Nurse practitioner‐delivered cognitive–behavioral treatment as a novel implementation route for irritable bowel syndrome: A proof of concept

Abstract

AbstractBackgroundExposure‐based cognitive–behavioral therapy (exposure‐CBT) is efficacious for irritable bowel syndrome (IBS). However, few patients receive exposure‐CBT due to a lack of behavioral health providers trained in brain–gut behavior therapies. Nurse practitioners (NPs) could fill a critical need for scalable delivery methods. In a pragmatic investigation of a 5‐session NP‐delivered exposure‐CBT for adults with Rome IV‐defined IBS, we evaluated treatment feasibility and acceptability and explored changes clinical outcomes.MethodsExposure‐CBT was delivered as part of routine care involving four sessions every other week and a 2‐month booster session. Patients could electively participate in an observational study including pre‐, mid‐, and post‐treatment surveys and a post‐treatment qualitative interview. Independently coded ratings of NP treatment protocol adherence and competence ratings were completed from audio recordings, rated on a 1 (not at all) to 5 (completely) scale.ResultsTwenty‐five patients consented (ages 22‐67 years; 76% female; 48% IBS‐diarrhea predominant). There was high feasibility—adherence average = 4.1, NP competence average = 4.8, 72% treatment completion, 93% satisfaction scores ≥3. Treatment satisfaction was high (rated as 4/4 “very satisfied” by n = 9 and as 3/4 “mostly satisfied” by n = 5). There were improvements in clinical outcomes across treatment with large effects for IBS‐symptom severity (−53%; Hedge's g = 1.0; 95% confidence interval [CI] = 0.5, 1.5) and IBS quality of life (+31%; Hedge's g = 0.8; 95% CI = 0.4, 1.2).ConclusionsNP‐delivered exposure‐CBT for IBS was initially feasible and acceptable with promising clinical improvements. Findings will inform a future NIH Stage 1B/ORBIT Phase IIB pilot randomized control trial.