Cognitive behavioral therapy (CBT) may be a new way to help alleviate irritable bowel syndrome (IBS) symptoms.
Imagine you’re at a party and you suddenly need to use the bathroom but there’s a line, or you experience an irritable bowel syndrome (IBS) flare-up during a long flight. For IBS sufferers, these situations are the norm. IBS symptoms like diarrhea or gas can be embarrassing, which can make socializing and traveling stressful and worrisome.
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.
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