Problem with the Gut? Go with the Mind

By: Michael Ferguson
Tuesday, November 26, 2013
Specialty: 

A new study suggests that patient participation in brief psycho-educational classes may reduce the severity of symptoms in some patients suffering from irritable bowel syndrome (IBS).

Authors of the study, published in the February 2013 issue of Alimentary Pharmacology & Therapeutics, enrolled nearly 70 patients to identify the effects of psycho-educational courses, which consisted of various “self-efficacy and practical relaxation techniques.” Lead author Emeran Mayer, MD, and his team of researchers divided the participants into two equally populated sets, one of which engaged in a group education program, while the others were told they were on the wait list.

During a five-week period, the group education participants attended weekly two-hour sessions where they discussed the brain’s connection to their syndrome and reviewed several methods for effectively managing symptoms. Participants also learned how stressful situations — such as changes in one’s job or routine — can catalyze their symptoms.

The Stress Factor

Stress is known to more greatly affect the colon’s sensitivity and function in people with IBS, according to the International Foundation for Functional Gastrointestinal Disorders (IFFGD). Because the syndrome affects both the gut and central nervous systems, the IFFGD recommends a bilateral treatment model to address both the minds and bodies of patients with IBS.

Drug therapies, usually in the form of antidepressants acting as pain relievers, are only instituted in severe cases, according to the IFFGD. Other treatment modalities come in non-pharmaceutical form and include journaling about symptom-igniting factors, stress management techniques and cognitive behavioral therapies.

Anticipation of mealtimes, loose stool and stomach pain can cause stressful reactions, known as gastrointestinal symptom-specific anxiety. The increased attention and worry caused by these factors can exacerbate IBS symptoms, so measures to temper these stress reactions can be a vital part of IBS treatment.

Through the cognitive behavioral approach, therapists employ a battery of techniques, including hypnosis, biofeedback and talk therapy, to help patients manage their own thought processes surrounding known symptom stressors.

Recognizing the benefits of this therapy, Johns Hopkins Medicine has instituted the approach — aimed specifically at women, who, according to the institution’s statistics, suffer from IBS two to three times more frequently than men — to help women not only reshape their attitudes surrounding stressors but also cope with the social stigma regarding IBS.

A Need for More

Dr. Mayer’s results confirm the utility of the cognitive behavioral approach. Group education participants demonstrated sustained symptom severity relief and improved quality of life scores over a three-month period compared to the wait-list group.

The growing mountain of clinical evidence demonstrates the efficacy of whole-person treatment and speaks to the value of collaborating with cognitive behavioral therapists to construct comprehensive, individually tailored care for patients with IBS.