Reviewer ’s report  
 
Title: Group cognitive behavioural therapy (GCBT) versus treatm ent as usual (TAU) in the 
treatment of irritable bowel syndrome (IBS): a study protocol for a randomized controlled trial  
 
Version: 1 Date: 05 Dec 2019  
 
Reviewer: Sarah Ballou  
 
Reviewer's report:  
 
The authors have provided a thorough response to the original review. However, there are still 
several points that require clarification and/or mention in the limitations section.  
 
1) The authors have added two use ful paragraphs to the introduction to describe CBT -IE. 
However, they have not indicated how their study will "clarify the relationship between 
IBS and psychological stress and will help to elucidate the underlying mechanisms of 
IBS". I don't see how a trea tment study can accomplish these goals. I recommend 
removing this line from the abstract.  
 
2) The exclusion criteria of "past or current psychotherapy" is still unclear. Are the authors 
saying that patients with past or current psychotherapy specifically fo r IBS is 
exclusionary? If so, this seems appropriate. However, if patients who report past or 
current psychotherapy for something else (i.e. depression, anxiety, etc) were excluded, 
then this is a major limitation of the study and the rationale for this de cision should be 
addressed. Given the high comorbidity between IBS and anxiety/depression, eliminating 
patients who are being treated for anxiety/depression is problematic.  
 
3) The fact that patients with Rome III or Rome IV are included should probably be 
mentioned as a limitation.  
 
4) Will gastroenterologists be administering CBT alone, or will a psychologist always be 
there with them? CBT requires advanced training in clinical psychology. If the 
gastroenterologists were always with a psychologist, then thi s is a strength. If the 
gastroenterologists were administering CBT independently, however, this must be 
addressed as a limitation.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your co mments to the authors.  
 
Yes 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistica l review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1.  Have you in the past five years received reimbursements, f ees, funding, or salary 
from an organisation t hat may in any way gain or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation t hat may in any way gain or 
lose financially from the publication of this manuscript, either now or in the 
future?  
 
3.  Do you hold or are you currently applying for any patents  relating to the content 
of the manuscript?  
 
4.  Have you received reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content of the manuscript?  
 
5.  Do you have any other financial competing interests?  
 
6.  Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to al l of the above, write 'I declare that I have  no competing in terests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my nam e will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made availabl e under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editors, which will no t be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Group cognitive behavioural therapy (GCBT) versus treatm ent as usual (TAU) in the 
treatment of irritable bowel syndrome (IBS): a study protocol for a randomized controlled trial  
 
Version: 1 Date: 05 Dec 2019  
 
Reviewer: Sarah Ballou  
 
Reviewer's report:  
 
The authors have provided a thorough response to the original review. However, there are still 
several points that require clarification and/or mention in the limitations section.  
 
1) The authors have added two use ful paragraphs to the introduction to describe CBT -IE. 
However, they have not indicated how their study will "clarify the relationship between 
IBS and psychological stress and will help to elucidate the underlying mechanisms of 
IBS". I don't see how a trea tment study can accomplish these goals. I recommend 
removing this line from the abstract.  
 
2) The exclusion criteria of "past or current psychotherapy" is still unclear. Are the authors 
saying that patients with past or current psychotherapy specifically fo r IBS is 
exclusionary? If so, this seems appropriate. However, if patients who report past or 
current psychotherapy for something else (i.e. depression, anxiety, etc) were excluded, 
then this is a major limitation of the study and the rationale for this de cision should be 
addressed. Given the high comorbidity between IBS and anxiety/depression, eliminating 
patients who are being treated for anxiety/depression is problematic.  
 
3) The fact that patients with Rome III or Rome IV are included should probably be 
mentioned as a limitation.  
 
4) Will gastroenterologists be administering CBT alone, or will a psychologist always be 
there with them? CBT requires advanced training in clinical psychology. If the 
gastroenterologists were always with a psychologist, then thi s is a strength. If the 
gastroenterologists were administering CBT independently, however, this must be 
addressed as a limitation.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your co mments to the authors.  
 
Yes 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistica l review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1.  Have you in the past five years received reimbursements, f ees, funding, or salary 
from an organisation t hat may in any way gain or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation t hat may in any way gain or 
lose financially from the publication of this manuscript, either now or in the 
future?  
 
3.  Do you hold or are you currently applying for any patents  relating to the content 
of the manuscript?  
 
4.  Have you received reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content of the manuscript?  
 
5.  Do you have any other financial competing interests?  
 
6.  Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to al l of the above, write 'I declare that I have  no competing in terests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my nam e will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made availabl e under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editors, which will no t be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Group cognitive behavioural therapy (GCBT) versus treatm ent as usual (TAU) in the 
treatment of irritable bowel syndrome (IBS): a study protocol for a randomized controlled trial  
 
Version: 1 Date: 05 Dec 2019  
 
Reviewer: Sarah Ballou  
 
Reviewer's report:  
 
The authors have provided a thorough response to the original review. However, there are still 
several points that require clarification and/or mention in the limitations section.  
 
1) The authors have added two use ful paragraphs to the introduction to describe CBT -IE. 
However, they have not indicated how their study will "clarify the relationship between 
IBS and psychological stress and will help to elucidate the underlying mechanisms of 
IBS". I don't see how a trea tment study can accomplish these goals. I recommend 
removing this line from the abstract.  
 
2) The exclusion criteria of "past or current psychotherapy" is still unclear. Are the authors 
saying that patients with past or current psychotherapy specifically fo r IBS is 
exclusionary? If so, this seems appropriate. However, if patients who report past or 
current psychotherapy for something else (i.e. depression, anxiety, etc) were excluded, 
then this is a major limitation of the study and the rationale for this de cision should be 
addressed. Given the high comorbidity between IBS and anxiety/depression, eliminating 
patients who are being treated for anxiety/depression is problematic.  
 
3) The fact that patients with Rome III or Rome IV are included should probably be 
mentioned as a limitation.  
 
4) Will gastroenterologists be administering CBT alone, or will a psychologist always be 
there with them? CBT requires advanced training in clinical psychology. If the 
gastroenterologists were always with a psychologist, then thi s is a strength. If the 
gastroenterologists were administering CBT independently, however, this must be 
addressed as a limitation.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your co mments to the authors.  
 
Yes 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistica l review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1.  Have you in the past five years received reimbursements, f ees, funding, or salary 
from an organisation t hat may in any way gain or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation t hat may in any way gain or 
lose financially from the publication of this manuscript, either now or in the 
future?  
 
3.  Do you hold or are you currently applying for any patents  relating to the content 
of the manuscript?  
 
4.  Have you received reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content of the manuscript?  
 
5.  Do you have any other financial competing interests?  
 
6.  Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to al l of the above, write 'I declare that I have  no competing in terests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my nam e will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made availabl e under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editors, which will no t be published.  
 
I agree to the open peer review policy of the journal  
assistant