Table 1.

Summary of the Self-Management Sessions included in the Regul8 website and the TCBT patient manual

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 that 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: Learning to relax, improving sleep, managing stress and emotions	Basic stress management and sleep hygiene are discussed Diaphragmatic breathing, progressive muscle relaxation and guided imagery relaxation, are presented in video and audio formats Identifying common positive and negative emotions, and the participant's current ways of dealing with these New strategies to facilitate expression of emotion as well as coping with negative or difficult emotions are discussed Homework: Goal setting for stress management, good sleep habits and emotional processing
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

IBS, Irritable bowel syndrome; TCBT, therapist delivered cognitive behavioural therapy.