Cognitive Behavioral Therapy Versus the Low FODMAP Diet for Irritable Bowel Syndrome: A Non-Inferiority Comparison of Two Self-Help Books

Background: IBS is a highly prevalent, chronic gastrointestinal (GI) disorder of gut-brain interaction that can lead to considerable distress and disability. Although IBS does not respond particularly well to standard medical care, empirically supported treatments exist, including CBT and the low FODMAP diet. Many patients with IBS seek self-help and adjunctive treatments to supplement traditional medical care. Therefore, it is important to rigorously test some of those publicly available options to see if they provide measurable benefit to consumers.
Aims: This study compared the efficacy of 2 self-help books (one cognitive-behavioral therapy or CBT book and one low FODMAP diet book) for irritable bowel syndrome (IBS).
Method: This study was a randomized, controlled, optional cross-over, single-blind, non-inferiority trial of 2 popular self-help books with 3 months of longitudinal follow-up. The books were Reclaim Your Life from IBS and The Complete Low FODMAP Diet Book.
Result: Immediately post-treatment, participants in both conditions showed significant improvement in health-related quality of life (HRQL), GI symptom severity, catastrophizing, anxiety about visceral sensations, and depressive symptoms. There were no significant between-group differences at post-treatment in HRQL; although, the low FODMAP group did show greater declines in GI symptom severity. By 3-month follow-up, both groups continued to show significant improvement over baseline in HRQL, and there were no significant between group-differences on any measure.
Conclusion: Reading either book with no professional guidance resulted in substantial improvement in patients with self-reported IBS.

Keywords: Irritable bowel syndrome; Cognitive behavioral therapy; Low FODMAP diet; Health related quality of life; Self-help