Cognitive Behavioral Therapy for Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome (IBS) is an often-debilitating condition that’s challenging to treat with medication alone. Many people with IBS have found that cognitive behavioral therapy for IBS can significantly reduce symptoms and improve quality of life. CBT can be used on its own or in combination with Western treatment.

What Is IBS? 

IBS is a common gastrointestinal disorder that affects up to 15% of the population worldwide. The condition can be intensely painful. Symptoms include abdominal pain, bloating, and altered bowel habits that can adversely affect your work and social life. 

Unfortunately, common treatment strategies, such as medication, lifestyle changes, and dietary restrictions, are more often discouraging than helpful in relieving symptoms of IBS. Patients may find them too expensive or experience negative side effects that make continuing treatment impossible. 

This means there is often a treatment gap, leaving patients unable to find adequate relief from their IBS symptoms with Western medicine alone. Complementary and alternative therapies, such as cognitive behavior therapy for IBS, can help manage the physical and psychological symptoms of IBS for long-term relief. 

What is cognitive behavior therapy (CBT)?

A.J. Rush, an American psychotherapist and psychiatrist, developed CBT during the 1960s to treat anxiety and depression. The model includes a psychiatrist or other licensed therapist who works with the patient to identify thought and behavior patterns that lead to negative emotions. 

CBT is used to treat a wide range of psychological conditions, including:

• Anxiety disorders
• Depression
• Substance abuse disorders
• Eating disorders

Three core principles shape the practice of CBT:

1. Faulty ways of thinking contribute to psychological problems.
2. Learned patterns of unhelpful coping behaviors contribute to psychological issues.
3. People experiencing psychological issues can alleviate symptoms by learning better thinking and behavior patterns.

How does cognitive behavioral therapy for IBS work? 

IBS is biopsychosocial, meaning that it often lacks a clear biological cause. A patient’s biology, environment, behaviors, emotions, and higher-order processing skills often play roles in their condition. As a result, patients with IBS are frequently co-diagnosed with psychological conditions such as anxiety, depression, psychosis, and bipolar disorder.

Because of these factors, CBT is an excellent treatment option for IBS. When applied to IBS, the main treatment goal is to reduce physical symptoms of the condition by identifying thought and behavior patterns that exacerbate symptoms.

There are four main components of CBT for IBS:

1. Education regarding IBS: The provider spends time reviewing IBS, especially the impact of stress and other psychological factors on symptoms. They’ll also discuss healthy bowel habits and talk about the risks of some IBS behaviors, such as straining or avoiding the urge to have a bowel movement. 
2. Maintenance of the provider-patient relationship: Much of the work of CBT falls to the patient, to analyze faulty thinking and behavior patterns that contribute to their symptoms. However, the provider must act as a guide through the process, enabling the patient to talk through their problems. 
3. Stress management instruction: A person with IBS needs to understand stress as a biological reaction to threats and its impact on the entire body system. The person then applies this knowledge to identify their triggers, and the provider helps them implement coping strategies until they find those that work best for them.
4. Planning activities and training: Many IBS patients have a stressful relationship with food. If they eat a specific food or at a particular place and it causes symptoms, any time they eat the same food or go to the same restaurant, they may experience stress because they are worried about repeat symptoms. It can be challenging to determine if the symptoms are caused by stress or the individual food. Planning activities can help a patient plan when and where to eat to eliminate those stressors.

What does the research say about CBT for IBS?

Multiple trials have found that CBT for IBS can be highly effective at reducing symptoms. Studies show these improvements can last anywhere from eight months to two years, although it can be longer if patients continue to implement what they learn.

CBT can be effective in as few as four one-hour sessions, completed in a face-to-face or virtual setting. This makes it relatively low-commitment in terms of time in a medical office and associated costs, an excellent alternative to pharmaceutical treatments that may cost thousands of dollars a year.

CBT has been primarily studied in tertiary care settings with patients experiencing severe IBS symptoms. But its success makes it a viable alternative therapy for IBS when other treatments haven’t worked or to complement existing treatment regimens.

How do the results compare to other holistic or natural therapies?

CBT isn’t the only effective complementary therapy used to treat IBS. However, the efficacy of each type of complementary medicine depends on a patient’s specific symptoms and the type of IBS they have.

CBT vs. hypnotherapy  

Hypnotherapy for IBS involves progressive relaxation. The therapist induces a hypnotic state and suggests calming imagery and sensations that address the patient’s specific IBS symptoms. Hypnosis has been found to improve primary symptoms of IBS, such as abdominal pain and diarrhea, and secondary symptoms, like fatigue and lower back pain. 

However, many clinical studies suggest that hypnosis is ineffective in approximately 50% of patients. This may be because they are unreceptive to hypnotic suggestions, or they may have additional underlying causes for IBS. 

CBT, by comparison, offers relief for IBS-related anxiety and depression in up to 72% of patients when compared with a group taking a placebo.

CBT vs. herbal remedies

Herbal remedies for IBS symptoms have been used for centuries. For example, peppermint oil is often used to relax the intestinal muscles and improve gut motility, while chamomile is commonly used to treat IBS-D (diarrhea-predominant) to reduce the intensity of intestinal spasms. 

Recently, ayurvedic herbs have gained popularity as an IBS treatment. Ayurvedic medicine focuses on the elimination of toxins and balances the body’s energies (doshas). Some herbal tonics commonly used in ayurvedic treatments include ginger, aloe vera, and fennel seeds. 

One of the benefits of using ayurvedic herbs is that there are no known drug interactions, so it’s easily incorporated into your Western IBS treatment regimen. 

However, there are mixed results regarding the effectiveness of herbal remedies compared with Western medications used to treat IBS symptoms. More research is needed to determine their efficacy for treating non-physical symptoms of IBS, like depression.

Starting CBT for IBS treatment

Before starting CBT to treat your IBS, it’s best to talk to a professional. Consult your care provider to ask how CBT might fit into your treatment plan. 

For trustworthy information about IBS and complementary and alternative medicine treatment options, follow our blog. To find a CBT practitioner for IBS near you, visit our provider directory today.