Predictors of treatment outcome after cognitive behavior therapy and antispasmodic treatment for patients with irritable bowel syndrome in primary care Silje Endresen Reme ⁎ , Tom Kennedy, Roger Jones, Simon Darnley, Trudie Chalder Department of Psychological Medicine, King's College London, UK Received 12 October 2009; received in revised form 17 December 2009; accepted 5 January 2010 Abstract Objective: To examine predictors of treatment outcome in IBS- patients who participated in a randomized controlled trial in primary care, where 149 irritable bowel syndrome (IBS) patients were randomized to mebeverine hydrochloride (n=77) or mebe- verine+cognitive behavior therapy (CBT) (n=72). CBT offered additional benefit over mebeverine alone. Methods: Regression analyses were used to identify predictors of work and social adjustment 12 months after treatment ended. The intervention groups were analyzed separately in order to look at the separate effects in each group. Results: Lower levels of psychological distress (anxiety and depression) at baseline predicted a good outcome in the mebeverine group [β=0.388 (95% CI: 0.065– 0.936), P=.025] but not in the mebeverine+CBT group. In the adjusted model for the mebeverine+CBT group less adaptive IBS related behavioral coping predicted a good outcome [β=0.285 (95% CI: 0.002–0.210), P=.045]. Conclusion: Different factors are associated with outcome depending on the treatment received. At assessment clinicians should assess patients coping styles and may want to consider recommending CBT to those patients with IBS in primary care who are engaging in unhelpful coping behavior. © 2010 Elsevier Inc. All rights reserved. Keywords: Cognitive behavior therapy; Irritable bowel syndrome; Primary care; Predictors of treatment outcome; Clinical implications Introduction Few studies have looked specifically at predictors of treatment outcome after cognitive-behavioral treatments (CBT) for irritable bowel syndrome (IBS). Those who have find psychological disturbance to be an important predictor of a poor outcome. Less baseline anxiety predicted a better outcome in one study [1], whereas others have found a lower likelihood of success with the presence of one or more psychiatric disorders [2,3] and baseline depression [4]. Although psychological distress overall seems to predict a poor outcome in CBT treatments, studies from other psychological treatments reveal results that point in the opposite direction [5,6]. Symptom characteristics also show some inconsistencies in the literature, in that severity of gastrointestinal symptoms predicted a poor outcome in one study [1] and a good outcome in another [7]. Conflicting results may reflect the different measures of outcome or criterion used, the intervention received, or lack of statistical power due to few participants in the studies. In a recent randomized controlled trial (RCT) from primary care where CBT was added to antispasmodic treatment (mebeverine), we found that CBT offered addi- tional effects over mebeverine alone [8]. CBT might therefore be useful to certain IBS patients in primary care. In order to find out who may benefit from which treatment, predictors of treatment outcome need to be identified. This article reports on predictors of treatment outcome through a secondary analysis of the aforementioned RCT in primary care. We Journal of Psychosomatic Research 68 (2010) 385 – 388 ⁎ Corresponding author. Research Centre for Health Promotion, Faculty of Psychology, University of Bergen, Christies gt 13, 5015 Bergen, Norway. Tel.: +47 55583991; fax: +47 55 58 98 78. E-mail address: silje.reme@uib.no (S.E. Reme). 0022-3999/10/$ – see front matter © 2010 Elsevier Inc. All rights reserved. doi:10.1016/j.jpsychores.2010.01.003