Cognitive Behavioral Therapy for IBS
Many studies show an increase in negative moods in those suffering from functional gastrointestinal (GI) and pain conditions like irritable bowel syndrome (IBS). Are these psychological factors a cause of symptoms – or are they a result of maybe years of disrupted life activities and frequent periods of intolerable symptoms?
Individuals with IBS may not have symptoms of anxiety in general, but only in relation to GI related events or sensations (like meals, abdominal pain, or diarrhea). This is called GI symptom-specific anxiety.
GI symptom-specific anxiety is characterized by increased fear and worry about GI sensations (sometimes even mild ones), and increased attention to them (vigilance). Another part of GI symptom anxiety is avoidance of any situation that might be associated with symptoms and a strong desire to limit oneself to safe places and activities.
These behaviors, which are used to try and limit anxiety in the short run, actually increase and prolong anxiety overall.
There is now a large amount of very positive research showing that certain types of psychological treatments, including cognitive behavioral therapies and hypnosis, can have very beneficial impact on IBS.
Cognitive behavioral therapy aims to help patients change their habitual thoughts, feelings, and behaviors that may magnify stress responses and negative moods by applying a series of self-exploration exercises and stress reducing strategies.
Hypnosis uses relaxation techniques and self-suggestion to help patients gain a more positive feeling about their GI function. It is not surprising that these treatments are targeted in large part to symptom-specific problems such as symptom fears and coping.
An exciting development in this area is a recent study which showed that for many functional GI disorder patients very brief treatments (4 or less sessions) that are well targeted to these symptom-specific problems can be highly effective, and the longer treatment times often used with primary mental health problems may not be necessary.
Unpredictable GI symptoms can lead to anxiety; anxiety can lead to GI symptoms. This creates a vicious cycle. Psychological treatments can lead to decreased GI symptoms and not only changes in mood or coping with symptoms. It should be emphasized that these psychological approaches may be used in combination with medications that improve the disruptions in GI function or nervous system activity that exacerbate symptoms – attacking all sides of the ‘vicious cycle.’