{"id":18732,"date":"2020-06-01T14:27:47","date_gmt":"2020-06-01T19:27:47","guid":{"rendered":"http:\/\/thepapergown.zocdoc.com\/?p=18732"},"modified":"2023-03-06T09:57:12","modified_gmt":"2023-03-06T14:57:12","slug":"is-therapy-the-answer-for-irritable-bowel-syndrome","status":"publish","type":"post","link":"https:\/\/www.zocdoc.com\/blog\/healthcare-trends\/is-therapy-the-answer-for-irritable-bowel-syndrome\/","title":{"rendered":"Is Therapy the Answer for Irritable Bowel Syndrome?"},"content":{"rendered":"

For people with irritable bowel syndrome, it\u2019s common to hear that symptoms such as cramping, alternating diarrhea and constipation, and bloating are \u201call in their head.\u201d In the case of IBS, there\u2019s actually some truth to this.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/span><\/p>\n

It\u2019s not that their symptoms don\u2019t exist. IBS is a very real disorder, and managing its physical toll often becomes an all-consuming effort. The litany of concerns that accompany so many activities \u2014 always scouting the closest bathroom, making sure you can reach it in time, farting in public \u2014 keeps many people with IBS from having a social life.\u00a0<\/span><\/p>\n

Yet according to some experts, IBS is not solely about what\u2019s going on in the digestive system; rather, the brain exacerbates the condition. \u201cIBS is a disorder of brain-gut dysregulation,\u201d explains GI psychologist Sarah Kinsinger, who is also co-chair of the psychogastroenterology section of the Rome Foundation. Accordingly, addressing the \u201cbrain\u201d side of IBS through cognitive behavioral therapy with a trained psychologist may help decrease both the anxiety that’s often associated with the disorder and its physical symptoms.<\/span><\/p>\n

\u201cCBT really should be the first-line treatment for people with IBS. It’s the treatment with by far the most <\/span>empirical support<\/span><\/a>, and when done well, it can be curative,\u201d says Melissa Hunt, associate director of clinical training in the psychology department at the University of Pennsylvania.<\/span><\/p>\n

In a <\/span>series of trials<\/span><\/a> published last year<\/span><\/a>, researchers in the UK compared the standard treatment for IBS (typically diet and lifestyle modifications and\/or medication) with eight sessions of CBT delivered over the phone or online. Before and after the trials, participants answered questionnaires designed to measure their anxiety, depression and ability to cope with their illness. Two years after the trials, 71 percent of the phone-CBT group and 63 percent of the online-CBT group <\/span>reported clinically significant changes in their IBS symptoms<\/span><\/a>. Meanwhile, less than half of the standard-treatment group reported such an improvement. Those who did CBT also exhibited lower levels of anxiety and depression and higher coping ability than other participants.<\/span><\/p>\n

In an earlier meta-analysis (a study of studies), published in 2018 in the <\/span>Journal of Gastrointestinal and Liver Diseases<\/span><\/i><\/a>, a different team of researchers also found that CBT appeared to reduce both psychosocial distress and the severity of IBS symptoms, with a greater effect on the physical symptoms than on the mental ones.\u00a0<\/span><\/p>\n

The brain-gut connection<\/h2>\n

How this happens is not completely clear at this point, but it’s believed to have something to do with how the gut and brain communicate.<\/span><\/p>\n

\u201cIBS is thought to be a disorder of centralized pain processing,\u201d Hunt explains. \u201cThere is miscommunication between the pain centers in the brain and the nerves in the gut. In people with IBS, pain signaling gets inappropriately amplified.\u201d Discomfort that wouldn’t even register in the majority of people feels like being stabbed in the gut to a person with IBS. \u201cThe best way to address that is to find ways to help reduce pain signaling, and that’s with a psychologist,\u201d Hunt says.<\/span><\/p>\n

CBT for IBS entails learning relaxation techniques, such as diaphragmatic breathing and progressive muscle relaxation, which help reduce the \u201cvolume\u201d of the pain signals by activating the parasympathetic nervous system, i.e., the body\u2019s \u201crest and digest\u201d response. \u201cThis can also lead to increased blood flow and oxygen to the digestive system, which helps the GI tract to function in a more rhythmic way,\u201d says Kinsinger, who is also an associate professor at Chicago\u2019s Loyola University Medical Center.<\/span><\/p>\n

CBT also involves thought restructuring. IBS can cause a cycle of worry: Worrying about symptoms leads to being hyperfocused on the slightest hint of any symptom, which increases anxiety, which aggravates symptoms.\u00a0People with IBS also often catastrophize, meaning they assume the worst will happen (\u201cIf I have an accident at work, I’ll get fired and never get another job\u201d), develop social anxiety and become withdrawn. <\/span>CBT addresses these issues by shifting attention away from IBS symptoms and using exposure therapy to help people gradually engage in more activities outside their homes.<\/p>\n

Additionally, using CBT, people with IBS learn to identify and change dysfunctional ways of thinking. For example, consider someone with school-aged children who asks their spouse to attend all school functions because they’re afraid of farting in a room with other parents, which would inevitably cause humiliation and might even make people think they’re disgusting\u00a0 <\/span>A therapist might ask them how often they notice bodily noises from other people to help them realize that we’re a lot more cognizant of our own bodily functions than other people are. \u201cIn other words, we identify the catastrophic beliefs and then search for evidence supporting them or not,\u201d Hunt says.<\/p>\n

CBT is a skills-based, goal-oriented approach to treating mental disorders that emerged in the mid-20th century. All CBT programs share the same underlying goal of helping patients identify and modify negative or unhelpful thought patterns and behaviors. \u201cIt teaches patients techniques that they can then implement on their own.\u201d says Kinsinger. \u201cIt can be done pretty efficiently, depending how motivated and receptive one is to learning these skills.\u201d But over time, customized versions of CBT have been developed for specific conditions including insomnia, schizophrenia and IBS. Different versions of CBT use different techniques, such as role-playing, exposure therapy and relaxation exercises, and vary in length. On average, CBT for IBS lasts between 4 and 10 sessions in total.<\/p>\n

Jeffrey Lackner, professor and chief of the division of behavioral medicine at the University at Buffalo, SUNY, says their program is structured like a course: \u201cYou learn a specific skill to manage your GI symptoms, process information differently or respond to stress in a less extreme way. Then you practice that skill in session before using it in the real world.\u201d Often therapists also give patients homework to fine-tune the skills they learn. They come out of CBT with a toolbox of techniques to manage the day-to-day burden of IBS.<\/span><\/p>\n

Some people with IBS do CBT on their own, using self-help books, online materials or apps without ever seeing a therapist. \u201cNot many psychologists are trained to treat GI disorders specifically, so physicians don’t often have anyone to refer patients to,\u201d Kinsinger says. The Rome Foundation trains psychologists and maintains a <\/span>directory of gastrointestinal psychologists<\/span><\/a>, but if someone can\u2019t find a provider in their area, Hunt and Kinsinger recommend looking for a psychologist who\u2019s trained in CBT and has experience treating chronic pain, panic disorders or anxiety.\u00a0<\/span><\/p>\n

Reducing sensations vs. reducing sensitivity<\/h2>\n

Not everyone is fully on board with CBT for IBS. One <\/span>2018 review study<\/span><\/a> found \u201cinsufficient evidence to demonstrate the effectiveness of online CBT to manage mental and physical outcomes in gastrointestinal diseases\u201d including IBS. A different 2018 review concluded that although <\/span>psychological treatments for IBS appear to help in clinical trials<\/span><\/a>, it’s unclear if they work in other settings and which treatments \u2014 such as CBT, mindfulness-based stress reduction and guided affective imagery \u2014 are most effective.\u00a0<\/span><\/p>\n

IBS is a complex problem, and some doctors prefer to integrate CBT with other treatments. But \u201cby the time we see them,\u201d Lackner says, \u201cmany of our patients have found that the medical treatments have not provided adequate symptom relief.\u201d\u00a0<\/span><\/p>\n

Some IBS patients also find the<\/span> traditional approaches too hard to stick with. The most commonly prescribed treatment is a \u201clow-FODMAP\u201d diet, which requires giving up all dairy and legumes, plus many grains, fruits and vegetables. \u201cSome trials show that even if the diet reduces or eliminates GI symptoms, it doesn’t improve quality of life because it’s crazy restrictive,\u201d<\/span> Lackner points out.<\/p>\n

\u201cWith IBS, the nerve endings in the gut have become hypersensitized, and the brain magnifies those signals in the gut,\u201d Hunt says. \u201cThe low-FODMAP diet tries to reduce the sensations, whereas CBT reduces the hypersensitivity. When you turn down the volume on the sensations, then you can eat whatever you want.\u201d<\/span><\/p>\n

Whether CBT helps with this brain-gut dysregulation, addresses distorted thinking and anxiety, or increases confidence in a person’s ability to manage gastrointestinal symptoms \u2014 or all of the above \u2014 <\/span>it’s helped people with IBS resume parts of their life they’d put on hold.<\/p>\n

\n

Ready to book a doctor’s appointment? Visit Zocdoc.<\/span><\/a><\/span><\/h1>\n","protected":false},"excerpt":{"rendered":"

According to some experts, IBS isn’t just about the digestive system. The brain plays a role too. <\/p>\n","protected":false},"author":40,"featured_media":18733,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[229],"tags":[140,152,71],"class_list":["post-18732","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-healthcare-trends","tag-digestion","tag-stomach-issues","tag-therapy","reviewer-dr-nassim-assefi"],"yoast_head":"\nIs Therapy the Answer for Irritable Bowel Syndrome? - Healthcare Trends<\/title>\n<meta name=\"description\" content=\"According to some experts, IBS isn't just about the digestive system. 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