How does Cognitive Behavioural Therapy (CBT) Help With Irritable Bowel Syndrome (IBS)?
Have you ever noticed that your stomach feels upset when you're very busy or under stress? This isn't just a coincidence—there's a complex relationship between the gut and the brain, and it’s now well recognised the brain-gut connection plays a key role in Irritable Bowel Syndrome (IBS). Cognitive Behavioural Therapy (CBT) and Hypnotherapy are the two of the most studied mind-body treatments for IBS, which work by targeting the gut-brain connection. Both therapies have been shown to be effective in improving symptoms and quality of life in patients with IBS, with long term results of up to 5 years (Black et al, 2020). This blog focuses on CBT, exploring what it is and how it can help individuals to navigate the challenges of living with IBS, and reclaim a sense of control over their symptoms.
What is Cognitive Behavioural Therapy?
CBT is a research-based talking therapy, whereby the therapist and patient work together to target problems through the use of cognitive and behavioural techniques, to deal with situations in a more helpful manner. CBT for IBS usually involves teaching the client cognitive techniques like calming self-talk, identifying unhelpful thought patterns, and imaginal exposure. Behavioural strategies may also be used to handle certain situations for example, deep breathing exercises and progressive muscle relaxation calm the body and help cope with symptoms etc. Generally, symptom improvements continue long after treatment has ended, unlike other treatments, for example, ‘The low FODMAP diet’ - the gold standard dietary approach. CBT is also a highly effective treatment for anxiety and stress, and as stress is a significant contributor to brain-gut dysregulation and IBS symptoms, then reducing anxiety should also improve IBS symptoms.
Here are 5 ways CBT can help with IBS:
Reshapes Unhelpful Thought Patterns:
CBT helps us to recognise and challenge unhelpful thought patterns related to our symptoms, such as catastrophising or magnifying the severity of symptoms. For example, we might worry about the symptoms we could face at a family meal, or job interview. Or sometimes, when experiencing painful cramps and spasms, we may start worrying about the cause of the symptoms, and become fixated on the sensations to the point they overwhelm us. We know from research, that these thought patterns, can sometimes actually make our symptoms worse through the body’s physiological stress response, and the interaction of the gut-brain connection. Therefore, by reframing these thoughts and adopting more helpful and balanced perspectives, it can reduce anxiety and distress associated with IBS, leading to improved symptom management.
Teaches us Coping Tools for Stress
Stress is a common trigger for IBS symptoms. It can alter the functioning of our gut, exacerbating any dysfunction and increasing symptom severity. This can in turn trigger more stress and worsening symptoms and gut function - so it can be a bit of a vicious cycle! CBT equips us with practical coping strategies, that help us to effectively manage the stress and end this cycle! For example, relaxation techniques, such as deep breathing exercises and progressive muscle relaxation, calm the nervous system and help us to cope with symptoms, reducing the impact stress has on our guts’ functioning.
Enhancing our Problem Solving Skills
IBS symptoms can be unpredictable and challenging to manage, leading to us feeling frustrated, helpless and like we have no control over our symptoms. CBT teaches us problem-solving skills to identify symptoms triggers, anticipate and plan for any potential flare-ups, and implement proactive strategies to minimise their impact on daily life.
Reduces Avoidant or Safety Behaviours
Sometimes with IBS, we learn to avoid certain social situations or we restrict foods due to fear of symptoms, and this can have a huge impact on our quality of life. We call these ‘safety behaviours’ and CBT helps us to identify these, and overcome these behaviours, so we can live our life as we would want to. Gradually and gently, CBT encourages us to expand our comfort zone, overcome these barriers and helps us regain fulfilment in our lives again.
Builds our Self-Confidence and Resilience
Living with a chronic condition like IBS can take its toll on our self-confidence and can make us feel worn down. CBT focuses on building our self-efficacy and resilience, and empowers us to take active role in managing our symptoms. CBT also encourages positive lifestyle changes that support digestive health and well-being, and it can help us to feel more confident to make these changes and re-build a sense of control over our IBS symptoms and gut health.
Cognitive Behavioral Therapy (CBT) offers multifaceted approach to IBS, addressing the interconnected relationship between psychological factors, gut dysfunction, and symptom severity. By empowering us to identify and challenge unhelpful thought patterns, develop effective coping strategies, and make positive lifestyle changes, CBT equips us with the tools needed to navigate the challenges of living with IBS and improve our overall quality of life. As awareness of the role of psychological factors in IBS continues to grow, integrating CBT into mainstream treatment approaches represents a paradigm shift towards a more holistic and personalised approach to digestive health and well-being.
References
Black, C.J., Thakur, E.R., Houghton, L.A, Quigley, E.M.M, Moayyedi, P., Ford, A.C. (2020) Efficacy of psychological therapies for irritable bowel syndrome: systematic review and network meta-analysis. Gut. Aug; 69(8):1441-1451. doi: 10.1136/gutjnl-2020-321191. Epub 2020 Apr 10. PMID: 32276950.
Vasant, D.H., Paine, P.A., Black, C.J., Houghton, L.A., Everitt, H.A., Corsetti, M., Agrawal, A., Aziz, I., Farmer, A.D., Eugenicos, M.P., Moss-Morris, R., Yiannakou, Y., Ford, A.C. (2021) British Society of Gastroenterology Guidelines on the Management of Irritable Bowel Syndrome. Gut. Jul;70(7):1214-1240. doi: 10.1136/gutjnl-2021-324598. Epub 2021 Apr 26. PMID: 33903147.
