Table 1 Summary of the Regul8 web-based self-management sessions

Session 1: Understanding your IBS

Rationale for self-management which includes the following explanations:

1. Possible causes of IBS and illustrative physiology of the digestive system together with the functional changes that occur in the gut as a result of IBS.

2. How the autonomic nervous system (“fight-or-flight” stress system) may interact with the enteric nervous system.

Session 2: Assessing your symptoms

Self-assessment of the interaction between thoughts, feeling and behaviours and how these can impact on stress levels and gut symptoms.

Development of a personal model of IBS which incorporates these elements.

Homework: Daily diaries of the severity and experience of IBS symptoms in conjunction with stress levels and eating routines/behaviours.

Session 3: Managing Symptoms and Eating

Review of the symptom diary.

Behavioural management of the symptoms of diarrhoea and constipation, and common myths in this area are discussed. Goal setting is explained.

The importance of healthy, regular eating and not being overly focused on elimination is covered.

Homework: Goal setting for managing symptoms and regular/healthy eating. Goal setting, monitoring and evaluation continue weekly throughout the programme.

Session 4: Exercise and Activity

Importance of exercise in symptom management is covered.

Identifying activity patterns such as resting too much in response to symptoms or an all-or-nothing style of activity is addressed.

Homework: Goal setting for regular exercise and managing unhelpful activity patterns if relevant.

Session 5: Identifying your thought patterns

Identifying unhelpful thought (negative automatic thoughts) in relation to high personal expectations and IBS symptoms is introduced.

Link between these thoughts, feelings, behaviours and symptoms is reinforced.

Homework: Goal setting plus daily thought records of unhelpful thoughts related to personal expectations and patterns of over activity.

Session 6: Alternative thoughts

The steps for coming up with alternatives to unhelpful thoughts are covered together with personal examples.

Homework: Goal setting plus daily thought records including coming up with realistic alternative thoughts.

Session 7: Managing Stress and Sleep

Basic stress management and sleep hygiene are discussed.

Diaphragmatic breathing, progressive muscle relaxation and guided imagery relaxation are presented in video and audio formats.

Homework: Goal setting for stress management, relaxation techniques and good sleep habits.

Session 8: Managing flare-ups and the future

The probability of flare-ups is discussed and patients are encouraged to develop achievable, long term goals and to continue to employ the skills they have learnt throughout the manual to manage flare-ups and ongoing symptoms.