Cognitive Behavior Therapy (CBT) for IBS and IBD

Patient Expert

If you read my last Sharepost then you know that on top of living with IBD and IBS I am now also working through some anxiety issues. And if I may be so bold as to assume, I suspect many other IBD and IBSers also live with some anxiety as well.

After discussing this with my general doctor, she referred me to a licensed therapist who works with Cognitive Behavior Therapy, or CBT. I started seeing the therapist, Anne, two weeks ago. And in those two weeks I have realized just how much my physical body is affecting my emotional mind. I have also come to realize that I simply don't trust my body not to betray me at an inopportune moment. And, in a weird twist, Anne also helped me to realize that I'm dealing with a bit of delayed post-traumatic stress from a serious car accident that happened 7+ years ago. So, take all of that, wrap it in a nice package, and if I don't deal with how to work through these anxieties and fears they will just continue to rear their ugly heads at will and continue to affect my quality of life as much, or more, than the IBD and IBS.

If you have IBS - Irritable Bowel Syndrome - then you know that it's not caused by emotions. But, you also probably realize that emotions, like stress and anxiety, can make the physical symptoms of IBS worse. This is exactly how I can tell the difference between an IBD - in my case colitis - flare-up and an IBS flare-up. My IBS symptoms tend to pop up before I travel by air or go to a social event or go on a road trip in the car, etc. I've had a few bad bathroom experiences in one or two of these particular situations in the past and so those negative events are now stuck in my head in a bad memory pattern and thus, cause further anxiety and trepidation in similar situations.

This is where CBT can help some of us. According to Cynthia Radnitz, a clinical psychologist and professor of psychology at Fairleigh Dickinson University, New Jersey, "Cognitive-behavior therapy is based on the idea that thoughts affect behavior, and that by changing thinking, we can change behavior." She goes on to explain further that, "That there's something about the way thinking affects physiology which is associated with irritable bowel syndrome. Fears of being too far from a bathroom and having an accident or fears of passing gas in public make them anxious. The therapy involves examining those kinds of thoughts and trying to help people think about it differently so they are not as anxious, and consequently IBS symptoms can be reduced."

For me, Dr. Radnitz has hit the nail squarely on the head. It is experiences like these and the associated memories and fears that go along with those memories that can get my anxiety fired up. And once the anxiety gets going it can take over and become its own vicious cycle - feel anxious over anticipation of not finding a bathroom in time, have a bout of diarrhea, feel even more anxious because now diarrhea has started, have another bowel movement, and so on. It gets even worse if this whole cycle takes place where I have limited control over the situation like on an airplane or in a car or at a restaurant with only one bathroom. Then the whole situation can go from just fear to straight out panic attack.

But thankfully, in my short time working with Anne I've been able to see how my thoughts are affecting my gut. And that, fellow IBSers, is the crux of CBT - to get the IBS patient to examine their thoughts and to ask whether they are rational, realistic fears or irrational, unhelpful thoughts - basically, is the fear or anxiety based on actual evidence or has the fear been created?

In the past few years there have actually been a few studies done using CBT with IBS patients. One of those studies, funded by the National Institute of Diabetes and Digestive and Kidney Diseases, showed that 30% of the IBS patients who participated were "rapid responders" - individuals who achieved rapid, substantial and sustained improvement in their symptoms within four weeks of a ten week treatment plan. Of these rapid responders it was also found that between 90 and 95% maintained the gains at a three-month follow-up.

So, the next logical question is this, will CBT work for you? I think it could help a good number of my fellow IBSers, and maybe even IBDers. But, in the end it is like most other treatments and you won't know if it works for you until you try it. But knowing that there is a real mind-gut relationship bodes pretty well that many of us could find some mental, and therefore, physical relief from learning to reconfigure or rephrase our thoughts.

We all know that having a disease that affects one of the body's most basic functions can be exhausting. And if there is a therapy out there that can help those of us affected by these diseases learn to cope with the thoughts, emotions, and feelings that goes along with having IBS or IBD then I'm all for trying it. And the good news is, CBT isn't considered a long-term therapy option. Most IBSers can tell in four weeks if CBT will help them, and a typical treatment plan consists of 10 weekly, one-hour sessions. Plus, many health insurance plans will cover the treatment. So, it just may be worth a try.