IBS – Treatment with Cognitive-Behavioural Therapy

IBS - Treatment with Cognitive-Behavioural Therapy

Cognitive-behavioural therapy is the branch of psychotherapy that says our thoughts can influence our actions and our emotions.  This form of psychotherapy concentrates on the role our thoughts play.  People suffering from IBS often have negative perceptions of their condition and are very self-conscious.  They will often wonder how others perceive them, for instance, when they make repeated trips to the restroom.  Compounding the negative effects of the symptoms with negative thought patterns can exacerbate the illness and form a vicious cycle where one leads to the other.

Cognitive therapy is based on the assumption that there are certain expectations (cognitions) that determine the way people respond to situations in their lives.  The problems arise when these expectations are irrational or not normal, leading to a negative perception of oneself.  Cognitive therapy is relatively short term and very structured.  It focuses on teaching people to recognize and understand their negative expectations so they can react more appropriately.

Behaviour techniques are effective for problems that are associated with abnormal behaviour patterns that require correction.  It is a common form of treatment and has been used for IBS, alcohol and drug abuse, eating disorders, phobias, anxiety disorders, and obsessive compulsive behaviour.  Behaviour therapies include relaxation training and systemic desensitization.  The relaxation training helps a person gain control over feelings of tension.  Systemic desensitization decreases a person’s fear of certain thoughts that could start or complicate the symptoms of IBS.  Deep muscle relaxation is taught to counter anxiety, so the person is taught to envision scenes that are soothing and safe.  Then the person visualizes uncomfortable scenes or scenes that provoke anxiety.  The two images are repeatedly coupled until the disturbing scenes no longer initiate anxiety.

Cognitive-behavioural therapy helps people recognize the self-defeating thoughts as they happen and look for better or more optimistic ways to view their condition.  In addition, cognitive-behavioural therapy encourages or empowers people to take better control of their body’s autonomic functions without the use of drugs.

A randomized controlled trial in Germany comparing relaxation training with cognitive-behavioural therapy and general advice with dietary consultations showed positive results.  The study found significant benefit for IBS with intensive therapy tailored more to the individual, including education on relaxation techniques, GI function, social skills, and recognizing irrational thoughts.  Good doctor-patient relationship where there was sufficient explanation of the various techniques further reduced anxiety and symptoms.

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Spiller RC. Potential future therapies for irritable bowel syndrome: will disease modifying therapy as opposed to symptomatic control become a reality? Gastroenterol Clin North Am. Jun 2005;34(2):337-354.