What’s more, just anticipating an IBS flare can trigger stress, causing symptom-related anxiety to exacerbate bowel sensitivity, which can then worsen GI symptoms, creating a vicious cycle. One way to manage is through cognitive behavioral therapy (CBT), a form of psychotherapy that focuses on symptom-related worry. “CBT targets brain-gut pathways which are thought to be a key contributor to IBS,” says Sarah Kinsinger, PhD, a clinical health psychologist and director of behavioral medicine for the digestive health program at Loyola University Health System in Chicago. People with IBS tend to have a super sensitive gut, so stress and anxiety can aggravate what’s going on in a person’s tummy. For example, anxiety can cause the brain to misinterpret pain signals from the gut, causing more severe stomach pain. A study published in the journal Brain, Behavior, and Immunity explored how stress is related to IBS symptoms, and researchers found that people with IBS may have an altered physical response to stress that causes their immune system to activate during stress, which triggers inflammation and IBS symptoms. “With CBT, we can directly influence symptoms because we’re using the brain to more effectively communicate with the gut,” says Dr. Kinsinger. “We don’t have a cure, but we can help people get a handle on this disorder.”
What Does the Science Say About Cognitive Behavioral Therapy?
While there haven’t been studies that directly compare psychological therapies to medication, research does suggest that treatments like CBT can help with IBS symptoms. “Cognitive behavioral therapy as a treatment for IBS is supported by over 30 years of research,” Kinsinger says. “Studies have consistently found a majority of patients experience a significant reduction in IBS symptoms — less pain, more regular bowel movements — following a course of treatment.” According to research by Kinsinger that appeared in a paper published in July 2017 in the journal Psychology Research and Behavior Management, studies consistently show CBT can be effective in alleviating IBS symptoms for at least one year after treatment. In fact, there have been studies, like a review published in July 2016 in the journal Clinical Gastroenterology and Hepatology, that showed people who received CBT maintained a drop in GI symptoms at both short-term and long-term follow-up. But CBT isn’t for everyone with IBS, cautions Christine Frissora, MD, a gastroenterologist and associate professor of clinical medicine at the Joan and Sanford I. Weill Medical College of Cornell University in New York City. “If you think stress or anxiety is a trigger for your IBS, cognitive therapy can be helpful,” she says. But for people who develop IBS following a bout of a severe food poisoning or intestinal infection, the trigger is likely due to a shift in bacteria balance in the GI tract. “Cognitive therapy can’t change the bacterial environment in the gut,” says Dr. Frissora. But she does think it can provide coping strategies and help people be more aware of their symptoms. “For IBS, you have to treat everything, so I would use CBT, medication, exercise, diet, and even physical therapy to help,” she says.
How Does This Type of Therapy Work and Why Is It Effective?
For starters, CBT isn’t the same as traditional psychotherapy. “CBT is a form of treatment for a medical condition — it involves focusing in on factors, like anxiety, that play a role in symptoms,” says Kinsinger. It’s generally designed for the short term, requiring as few as four to five sessions. Plus, many patients find it appealing because it’s a nonmedication treatment approach, she says. CBT teaches people to better regulate the body’s physical response to stress. Some of the coping skills work to:
Dispel myths about IBS, teaching people how the mind and body are connected and reasons why behavioral therapy can help.Help people learn relaxation skills, such as deep breathing (diaphragmatic breathing), which can have a calming effect on the gut and reduce symptoms in the moment. There are many free apps available that can be helpful for understanding and practicing this technique.Reduce the negative thinking patterns that can worsen symptoms.
Using techniques such as cognitive restructuring, Kinsinger teaches people to recognize when they’re having distorted thoughts and to replace them with more positive self-talk. “If a person starts having cramps or their IBS acts up at a social event, we help them shift their thinking about their symptoms, like convincing themselves the symptoms will pass, or finding a distraction so they don’t fixate on the anxiety all night,” she says. So how do you find a therapist that practices CBT? Unfortunately, there aren’t many psychologists who specialize in GI-related anxiety, notes Kinsinger. “You would have to find a psychologist who specializes in health psychology — someone who’s worked with patients in a hospital setting,” she says. But resources like the Association for Behavioral and Cognitive Therapies and the Rome Foundation can help you find the right practitioner.
