Cognitive Behavioral Therapy for IBS
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 gastrointestinal (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.’