The cause of irritable bowel syndrome (IBS) is not completely understood. For various reasons, the symptoms appear to result from altered patterns of muscle contraction in the gut and increased sensitivity to distension and movement of food, gas, or fecal material through the gastrointestinal tract. There also appears to be a predilection for the bowel to be overly reactive to various triggers: eating, stress, emotional arousal, gastrointestinal infections, menstrual period, or gaseous distension, which can exaggerate or perpetuate the symptoms.
Many studies show an increase in negative moods in those suffering from functional gastrointestinal (GI) and pain conditions like 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 can have very beneficial impact on IBS. Referral for psychological treatment can be recommended as part of a multi-component treatment program to help the patient better manage the symptoms, or to address psychosocial difficulties (e.g., abuse, loss) that may be interfering with daily function and ability to manage their illness. In general, these treatments are reserved for patients with moderate to severe symptoms, particularly if they experience psychological distress. However, the patient must be motivated and see this type of treatment as relevant to their personal needs.
Psychological treatments used to treat IBS include psychotherapy (dynamic and cognitive-behavioral therapy), relaxation therapy, hypnotherapy, and biofeedback therapy. Psychological treatments can also be combined. Review of well-designed treatment studies of IBS supports the use of psychological treatment. Follow-up studies (duration 9–40 months), have demonstrated that psychological treatment maintained superiority over placebo, indicating that these methods have lasting value. The choice of treatment will depend on patient requirements, available resources, and the experience of the therapist.
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.’
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Adapted from IFFGD Publication #230 by IFFGD Research Award Winner Bruce D. Naliboff, PhD, UCLA Center for Neurovisceral Sciences and Women’s Health, Los Angeles, CA.
Last modified on June 11, 2018 at 11:11:14 AM