Psychotherapy for Irritable Bowel Syndrome

Irritable Bowel Syndrome (IBS) causes pain and gastrointestinal discomfort that can interrupt daily life and reduce quality of life. If you have IBS, you may be frustrated that your medical and dietary interventions do not fully manage and control your symptoms. Fortunately, research is filling the gaps left by these interventions with psychological approaches that can also bring relief.  

The mind and the body work together and what we think, feel and believe influences how our gut works. Given the bidirectional communication between our mind and our body, psychological interventions can be used to address IBS.

We know that gastrointestinal conditions such as IBS are affected by stress and beliefs about the condition. For example, high stress levels can trigger stomach cramps. Four types of psychotherapy that appear especially helpful in treating IBS are

1.Cognitive Behavioral Therapy

2. Hypnotherapy

3. Mindfulness-Based Psychotherapy

Cognitive Behavioral Therapy (CBT) for IBS

Originally developed as an intervention for depression, CBT is also typically used to treat anxiety. In CBT, clients evaluate their thoughts, behaviors, and emotions. They learn to intervene with their thoughts, shifting to more helpful thought patterns. They also learn new skills (more helpful behaviors) to reduce or manage stress. These can include relaxation exercises and ways to approach rather than avoid stress.

Given links between IBS, stress, and mood, CBT emerged as a good candidate for IBS treatment. So far, the research generally supports CBT as a good treatment choice for IBS. CBT for IBS focuses on psychoeducation about the mind body connection and teaching helpful techniques for transforming the relationship to the gut.  CBT increases insight about thoughts and behaviors related to IBS symptoms, allowing for change of those responses, and eventually decreasing physical symptoms.

CBT for IBS does not yet have a clear standardized protocol. This means that, if you seek CBT, each CBT practitioner may have a somewhat different approach and the treatment can be tailored to meet your unique needs. Typically, a course of CBT involves between eight and twelve sessions.   Research shows that after completing the initial course of CBT monthly follow-up appointments can be very helpful in maintaining the benefits of the original therapy. CBT provides you with information and skills that you can apply on your own in your daily life.  CBT generally has good long-term benefits because you can continue to use it well beyond the end of your time in therapy.

Hypnotherapy for IBS

Since 1984, researchers have been examining the use of hypnotherapy to treat medical conditions. Researchers on hypnosis found shows positive results for reducing the physical symptoms of several conditions, including autoimmune disorders, such as arthritis, fibromyalgia, and chronic pain. Gut-directed hypnotherapy focuses hypnotic suggestion on the health and functioning of the gastrointestinal tract.

Hypnotherapy for IBS usually involves seven to twelve weekly sessions. During the hypnotherapy sessions, clients first learn to create and deepen their hypnotic state. Then, they are guided through scripted imageries that focus on their gut/GI tract. These scripts include hypnotic suggestions for healing and relaxation that can reduce IBS symptoms. For best results, clients then practice the exercises at home by listening to recordings of their sessions.

There are two standardized protocols for hypnotherapy to treat IBS. One is the Manchester Approach and the other is the North Carolina Protocol. Both have repeatedly shown positive, long-term results for patients with IBS. Hypnotherapy works through a variety of mechanisms, rebalancing the parasympathetic and sympathetic nervous system activation, changing the stress hormone system function, teaching new ways of looking at problems, and more creative problems solving.  Brain imaging studies show that hypnosis may reduce sensitivity to pain.

Mindfulness-Based Approaches for IBS

Mindfulness-Based Therapy (MBT) uses a combination of mindfulness and relaxation techniques. Mindfulness practice promotes presence in the moment and acceptance of experience, thoughts and emotions. Mindfulness teaches us to notice and observe our surroundings with acceptance and without reacting. These skills can be used to increase acceptance of physical symptoms, even when those symptoms may be emotionally difficult or physically painful.

Although you first learn mindfulness skills in psychotherapy through formal exercises, you are asked to take those skills into your daily life. It is helpful to practice the skills at home, so that you can become adept at them. It also helps those skills to become habits that you can quickly engage when needed. When used over time, these strategies can reduce stress and anxiety and the symptoms of IBS.

There are many variations of MBT, but most are based on the original from developed by Jon Kabat-Zinn. His Mindfulness Based Stress Reduction (MBSR) program helps with chronic illnesses, including IBS. When applied to IBS, mindfulness strategies help individuals notice and accept any physical discomfort they might have without struggling to change the experience, push it away, or resist the experience.  Over time the willingness to feel emotions and body sensations increases and suffering decreases.  This level of acceptance and turning attention to the present moment, can reduce anxiety about the IBS symptoms and over time improve the symptoms and quality of life.

Mindfulness-Based treatments are well-supported by research evidence. Studies indicate that MBT may help to reduce hypervigilance of symptoms, reduce negative thinking about one’s health, and lead to an overall improvement in the psychological and physical symptoms associated with IBS. These improvements appear to persist over time, suggesting MBT has long-term benefits.

Treatment for IBS

After reading about your options, you may want to seek out psychotherapy to help treat and manage your IBS. Some psychotherapists and psychologists may be able to utilize all of the above approaches and integrate multiple approaches to best address IBS symptoms. Consider meeting with an integrative psychiatrist, a clinical psychologist specializing in IBS treatment, or a psychotherapist who specializes in hypnosis or CBT for IBS to discuss your treatment options, so that you can develop a treatment plan that addresses your unique needs.