- Dr. Amber Cohen
Cognitive Behavioural Therapy (CBT) for IBS
The Mind-Body Connection:
While IBS is a physical medical condition, the mind-body connection is a strong one, so our mental state does have a significant impact on IBS symptoms. In particular, mood and gut functioning have a strong relationship. The central nervous system (our brain and spinal cord) and the enteric nervous system (our gut’s nervous system) communicate information back and forth about our digestion, thoughts, emotions and appetite. Neurotransmitters that impact our mood were once thought to be primarily produced in the brain, but newer research indicates that these neurotransmitters are largely produced in the gut. For example, 95% of our body’s serotonin, a chemical messenger that impacts our mood, sleep, appetite and sex drive, can be found in our gut. As a result, our emotional well-being is closely linked to the healthy communication between our brain and our gastrointestinal tract.
While your symptoms are real and not in your head, IBS and anxiety often coexist. There is evidence supporting two types of relationships between IBS and anxiety. One is that anxiety triggers problems with digestion because when we experience emotional stress, stress chemicals get released in the gut which negatively impact healthy digestion. The second relationship is that having any medical issue, in this case IBS, can trigger anxiety. IBS impacts so many areas of one’s life (i.e., work, family, and social functioning), so it makes sense that this can become a major stressor. How mental health is impacted by digestive conditions rests on a continuum. On one end, there may be some mild stress responses, and on the other end, there may be chronic health anxiety. Health anxiety is the experience of ruminating about a threat to your health, which then triggers your anxiety response. Even for those who do not meet criteria for diagnosis of a psychological disorder, people with IBS often have associated fears and worries that are directly related to their symptom experience.
Chronic IBS Symptoms and Anxiety:
It is a common experience for people with IBS to suffer chronic symptoms for years before being diagnosed. Just the experience of engaging in endless medical testing is very anxiety producing – it is a huge time commitment which is disruptive to one’s schedule and there is the uncertainty of not knowing what a test will result in. Additionally, symptom flare-ups can act as trauma experiences. Especially the first, worst, or most recent symptom experience one has had can take a toll on our mental health. Common fears people with IBS experience are:
Not knowing when the symptoms will arise.
Feeling shame or embarrassment about symptoms.
Being in new or busy situations where one is unsure how they will be able to manage their symptoms.
Feeling uncomfortable in tight fitting clothing.
Not wanting to eat in social situations.
Having to make sure we have our “kit” every time we go out. (i.e., fresh underwear, medications, wipes, etc.)
Worries about forming new relationships (i.e., dating, new colleagues, new friends, etc.)
Having anxiety about eating and food choices.
It makes sense to have these types of fears, because when we experience trauma, our brains kick in to protect us by scanning everything in our environment and bodies. This scanning helps warn us that the experience may be happening again so we can prepare to survive. With anxiety about IBS symptoms, technically your brain is working correctly, but too much of anything is problematic. Too much body scanning and overthinking is no different – if you are always looking for a problem, you can actually trigger a problem.
Chronic IBS Symptoms and Low Mood:
IBS is often also comorbid with low mood. There are so many pieces to manage that it can start to feel incredibly overwhelming. Common contributions to low mood are:
Feeling isolated and alone with our symptoms.
Lower self-confidence due to body image concerns and/or symptom flare-ups.
Avoiding physical and emotional intimacy, which then contributes to feeling more isolated.
No longer finding it fun to engage in social activities.
The experience of chronic pain and discomfort.
The experience of feeling low energy.
Feeling hopeless and/or helpless about the future.
Not feeling comfortable with spontaneity.
Feeling tired of having to read through every ingredient.
Sadness about missing social occasions.
What CBT is:
Research shows Cognitive Behavioural Therapy (CBT) to be effective in improving bowel symptoms, psychological distress, and quality of life in all people with IBS regardless of subtype. CBT as a treatment is based on a shorter-term and collaborative model. A course of treatment is approximately between 12-15 sessions, but this is dependent on the treatment goals you and your therapist agree to.
CBT is based on the relationship between our cognitions (thoughts), behaviours and emotions. Unhelpful thoughts negatively impact how we feel and these difficult feelings impact how we behave, and the feedback loop continues from there. Unfortunately, we can’t directly control our emotions. If you have ever received the advice “Just don’t worry about it!” then you know the difficulty of trying to just turn off a feeling. We do have control over our thoughts and behaviours. Clients work with their therapist to learn to become aware of ineffective thought and behaviour patterns, and learn strategies that help modify these in order to positively influence their emotional state.
How CBT can Help:
CBT treatment will vary based on one’s unique needs and goals. However, these are some ways that CBT can actively help someone living with IBS:
Education and understanding regarding the relationship between our mental state and our IBS symptoms.
Managing ineffective thought patterns to improve mood and relieve stress.
Managing ineffective behavioural patterns to improve mood and relieve stress.
Learning self-regulation strategies that increase both physical and mental relaxation.
Training in flexible problem solving to feel more confident in our ability to cope in stressful situations.
Having a supportive space where you can process your difficulties and feel less alone.
Overall, CBT can leave one feeling more in control of your thoughts, behaviours, emotions and IBS symptoms. If you contend with chronic symptoms, it is definitely worth a try. Physical ailments don’t live in a bubble; therefore, it’s worth seeing our mental health as another way we can help ourselves feel better!