Does CBT work for IBS?

Instead of concentrating on nutrition for your IBS management, what about considering CBT for IBS treatment?

You may notice that your IBS has worsened when you become stressed and this is not a random coincidence. This connection is due to your gut-brain axis, a complex, two-way communication system between the brain and gut (1).

CBT for IBS targets this axis by helping you manage stress and has been proven by science to work for IBS management. 

In this article, I will explain CBT, how effective it is for IBS is and whether it can cure your IBS.

What is CBT?

CBT is a form of psychological treatment based on talking therapy (2).

The main purpose of CBT is to help you to understand your thoughts, feelings and emotions and how they influence your actions and behaviours (2).

CBT can help you to deal with any mental health issue such as stress, anxiety and depression. It can also help you to identify and resolve any negative thought patterns that may have become destructive to your daily life (2).

CBT differs from other psychological treatments as it focuses on the present rather than analysing past experiences (3).

Can cognitive behavioural therapy help IBS?

Yes, CBT is a useful psychological treatment option for IBS (3). Which is why CBT is often identified as a form of ‘gut-directed psychotherapy’ (4).

Anxiety, stress and depression can be contributing factors to your IBS symptoms as they can have a direct impact on your gut-brain axis (5, 6).

The benefits of CBT for IBS are noted below;

1. Improves IBS Symptoms

The traditional route of IBS treatment is providing you with education such as information about its causes, symptoms, dietary and lifestyle management (7).

Recent research has found that CBT can significantly improve your digestive symptoms vs just providing education about your IBS (7).

2. Refractory IBS Treatment (when nothing else works!)

CBT has also been reported to be particularly helpful in those with ‘refractory’ IBS (8).

‘Refractory’ IBS means – ‘IBS which has been resistant to all other forms of treatment (dietary, lifestyle and pharmacological) with ongoing IBS symptoms after 12 months’ (9).

Please note though that you can and should use CBT alongside dietary and lifestyle advice.

3. You learn skills to manage your own condition long-term

There are many advantages of using CBT as a psychological treatment for IBS. These include its brief, highly-structured and problem focused sessions that are directed towards developing specific skills (4).

These include (3, 10):

• Self-monitoring of stress and IBS symptoms
• Patient psychoeducation about IBS and the gut-brain axis i.e. you start to understand the role of your brain in your IBS
• Practical relaxation techniques including breath work to relieve stress and IBS symptoms
• Cognitive restructuring to understand how fear of your IBS symptoms can increase your stress and anxiety and worsen your IBS symptoms
• Problem solving which includes education on how to adopt healthy coping skills for IBS

How effective is CBT in treating IBS?

According to the guidelines set out by the American College of Gastroenterology, CBT is an effective, evidenced-based treatment option for IBS (4).

To understand how effective CBT is in treating IBS, research is often based on 3 different areas:

• Relief of your IBS symptoms
• Quality of life
• Daily functioning 

1. CBT improves IBS symptoms

Research from a large study has found that when CBT was provided over a 12 month period, 73% of participants had greater improvements in IBS symptoms. This was in comparison to 44.3% in those who received usual treatment (dietary, lifestyle and medications) (11).

More recent research assessing the effectiveness of CBT over a longer period of 24 months has concluded that CBT can produce long-term and sustained improvements to your IBS symptoms (12).

2. CBT improves your quality of life

You may find that your IBS symptoms feel like a burden on your quality of life such as avoiding social events.

The impact of IBS on your quality of life refers to any aspect of your life that is impacted by your IBS symptoms. This includes ability to work and manage daily tasks, reducing unpleasant thoughts, food avoidance and impact on your relationships (13).

Research has shown that CBT for IBS can have a beneficial impact on your quality of life (12, 13).

3.  CBT Will improve your ability to function daily

You may have experienced extreme worry or concern about how you can go about your daily routine alongside an IBS flare up. This can result in a worsening of your IBS symptoms and increase your emotional distress.

Your ability to function daily refers to the degree to which you can engage in daily activities regardless as to whether you experience any IBS symptoms. Daily activities include the ability to engage in work and social activities.

Among all the psychological treatments studied, CBT has been shown to produce the greatest improvement in your ability to function daily with or without your IBS symptoms (14).

Can CBT cure IBS?

At present there is no direct cure for IBS and this includes CBT. This is likely due to the fact that IBS is a multifactorial disorder with a range of complex factors contributing to the causes of IBS.

So no, CBT cannot directly cure IBS. CBT for IBS can help you to better cope with and improve your IBS symptoms and impact on your daily life.

Summary

Overall, CBT is one of the most effective psychological treatment options for IBS. CBT can reduce your IBS symptoms and the impact that they have on your daily life.

To date, there is no direct cure for IBS. But, CBT for IBS can be used in conjunction or as an alternative option to dietary, lifestyle and pharmacological treatment strategies.

So, if you feel that your IBS symptoms may be worsening due to psychological factors, CBT is a highly recommended treatment strategy for you!

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Post written by Emily Stynes BSc. in Human Nutrition and reviewed by Kirsten Jackson