Background: Cognitive behavioral therapy (CBT) is recommended in guidelines for people with refractory irritable bowel syndrome (IBS). However, the availability of CBT is limited, and poor adherence has been reported in face-to-face CBT. Objective: Nested within a randomized controlled trial of telephone- and web-delivered CBT for refractory IBS, this qualitative study aims to identify barriers to and facilitators of engagement over time with the interventions, identify social and psychological processes of change, and provide insight into trial results. Methods: A longitudinal qualitative study was nested in a randomized controlled trial. Repeated semistructured interviews were conducted at 3 (n=34) and 12 months (n=25) post baseline. Participants received telephone-based CBT (TCBT; n=17 at 3 months and n=13 at 12 months) or web-based CBT (WCBT; n=17 at 3 months and n=12 at 12 months). Inductive thematic analysis was used to analyze the data. Results: Participants viewed CBT as credible for IBS, perceived their therapists as knowledgeable and supportive, and liked the flexibility of web-based and telephone-based delivery; these factors facilitated engagement. Potential barriers to engagement in both groups (mostly overcome by our participants) included initial skepticism and concerns about the biopsychosocial nature of CBT, initial concerns about telephone-delivered talking therapy, challenges of maintaining motivation and self-discipline given already busy lives, and finding nothing new in the WCBT (WCBT group only). Participants described helpful changes in their understanding of IBS, attitudes toward IBS, ability to recognize IBS patterns, and IBS-related behaviors. Consistent with the trial results, participants described lasting positive effects on their symptoms, work, and social lives. Reasons and remedies for some attenuation of effects were identified. Conclusions: Both TCBT and WCBT for IBS were positively received and had lasting positive impacts on participants’ understanding of IBS, IBS-related behaviors, symptoms, and quality of life. These forms of CBT may broaden access to CBT for IBS.

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中文翻译：

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肠易激综合征患者基于电话和网络的认知行为疗法的经验：纵向定性研究

背景：指南中建议对难治性肠易激综合征（IBS）患者进行认知行为疗法（CBT）。但是，CBT的可用性有限，并且在面对面的CBT中报告了依从性差。目的：该定性研究嵌套在电话和网络交付的难治性IBS的CBT的随机对照试验中，旨在确定随着时间的流逝，干预的障碍和促进者参与，确定社会和心理变化过程，并深入了解试用结果。方法：将一项纵向定性研究嵌套在一项随机对照试验中。在基线后3（n = 34）和12个月（n = 25）进行了重复的半结构式访谈。参与者获得了基于电话的CBT（TCBT； 3个月时n = 17，而12个月时n = 13）或基于网络的CBT（WCBT；3个月时n = 17，12个月时n = 12）。归纳主题分析用于分析数据。结果：参与者认为CBT对于IBS是可信的，他们认为他们的治疗师是知识渊博的支持者，并且喜欢基于Web和基于电话的交付方式的灵活性。这些因素促进了参与。这两个群体参与的潜在障碍（大部分都被我们的参与者克服了）包括：最初的怀疑和对CBT的生物心理社会性质的关注，对电话传递的谈话疗法的最初关注，在已经忙碌的生活中保持动力和自律的挑战，以及发现WCBT中没有新内容（仅适用于WCBT组）。参与者描述了他们对IBS的理解，对IBS的态度，识别IBS模式的能力以及IBS相关行为的有益变化。与试验结果一致，参与者描述了对其症状，工作和社交生活的持久积极影响。确定了一些影响减弱的原因和补救措施。结论：IBS的TCBT和WCBT都受到积极欢迎，并且对参与者对IBS的理解，与IBS相关的行为，症状和生活质量产生了持久的积极影响。这些形式的CBT可能会扩大IBS对CBT的访问。

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