Treating IBS with Cognitive Behavioral Therapy

By Christopher Cutler, M.D. 

Irritable bowel syndrome (IBS) affects 10-15% of adults in the United States.  It is a functional disorder of the gastrointestinal tract characterized by abdominal pain and altered bowel habits.  IBS is usually treated with dietary modifications and medications directed at underlying symptoms (diarrhea, constipation, abdominal pain, bloating).  Patients may also receive benefit from antidepressants, probiotics, and antibiotics.  But what about patients with refractory symptoms that do not respond to traditional therapies?  What are their options?  One promising alternative to consider is cognitive behavioral therapy (CBT).  CBT is a short-term therapy (4-10 one hour sessions with a therapist) that focuses on modifying behaviors and altering dysfunctional thinking in hopes of improving mood and GI symptoms.  

The Brain-Gut Connection 

In patients with IBS, there is dysregulation of the gut brain axis, a complex neurologic communication between the brain and GI tract.  Stress and psychological factors can directly influence gut function via this pathway, contributing to IBS symptoms.  Patients with IBS have an increased tendency to experience pain in response to normal bowel function.  This may be attributed in part to abnormal pain processing in the brain.  People affected by IBS also have a fear of bowel symptoms and associated avoidance of situations where symptoms may occur.  It is a vicious cycle since symptoms themselves become a stressor, and this anxiety contributes to increased gut pain sensitivity and altered motility causing worse GI symptoms and worse anxiety.   

Given the importance of brain-gut interactions in IBS, psychological interventions are an effective option for this condition.  These modalities may include cognitive behavioral therapy, hypnotherapy, and mindfulness.  CBT has been the most extensively studied with more than 20 published randomized clinical trials showing relief of IBS symptoms in 50-70% of patients.  These benefits are frequently maintained for up to one year after therapy.  

Treating IBS with CBT 

CBT involves relaxation strategies such as specialized deep breathing.  This increases the patient’s awareness of the connection between distorted thinking patterns, stress, and digestive symptoms.  CBT also helps patients develop coping strategies by encouraging them to shift from a solution-focused approach to a self-management approach to deal with this chronic condition.  CBT also uses exposure techniques which involve facing situations the patient avoids because of fear of symptoms.  With time, avoidance behaviors decrease and the thought of symptoms being harmful is reduced. 

The American Gastroenterology Association recommends psychological interventions for patients with moderate-to-severe IBS who do not respond to standard medical therapies, and for patients for whom psychological factors exacerbate their symptoms.  CBT is an effective treatment option for patient with IBS, and its use to treat this disorder is becoming more widely accepted.  The physicians at Granite Peaks are experts in the diagnosis and therapy of IBS and are eager to help you.  Please call us to discuss traditional and alternative strategies to help you manage your IBS symptoms. 

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