Psychotherapy for IBS

Is all psychotherapy created equal? The question intrigues those of us who have spent considerable time and effort arguing that different therapies do not produce the same results.

Some work better than others. Some do not work at all. Freudian therapy, the grandfather of most of it, now has been shown to be clinically ineffective. It’s most significant proponent—post Freud—declared it to be a scam.

Of course, its few remaining defenders will argue that healing mental illness is not the point. Psychoanalysis was created to affect a cultural revolution, to overthrow the hegemony of Anglo-Saxon and Judeo-Christian civilization.

For most people, the airy platitudes and the empty promises were not enough. Especially in Great Britain and America they expected to see results. Serious psychoanalysts believe that the concern with mental health and with normality is a cultural bias, bespeaking the influence of Anglo-Saxon empiricism and pragmatism.

Still, every once in a while someone will produce an academic study showing that psychoanalytic therapy does produce some therapeutic benefits. The problem is that most of those who practice it do not agree on what psychoanalysis is any more. The theory has been worked over so many times that it is no longer recognizably Freudian. In truth, it suffers from so many variations that it makes no sense to say that two psychoanalysts are really offering the same treatment. Thus, the tests that purport to show the effectiveness of psychoanalysis are compromised from the start.

In the past, similar studies showed that prospective patients who had been put on waiting lists, thus, who did not receive any kind of therapy, did better than those who had.

And of course, we all learned recently that many studies in social and clinical psychology often could not be replicated. Some scientists suggested that upwards of half of them were junk.

The studies are one thing. The marketplace is quite another. By all evidence the market for psychoanalysis has disappeared. People are not walking into analyst’s offices and asking for a long-term exploration of their unconscious minds. They do not have the time or the patience for the enterprise. They have seen it at work for others and do not think it worth the investment.

True enough, in places like France and Argentina psychoanalysis continues to attract clients, but the practice in those countries is more frankly a cultural indoctrination. People see analysts in France and Argentina because they want to escape the influence of British empiricism and American pragmatism.

They want to live for their desire and they know, because Lacan told them, but also because it’s true, that there is no such thing as an empirical verification that you want this and not that. You can say that if you have something you cannot desire it, but just because you don’t have it doesn’t mean that you want it.

You cannot say “I wish I were here” but you can say “I wish you were here”— only if you are not here. Culture warriors love the concept of desire because it detaches them from reality.

Of course, if psychoanalysis and other forms of analytic therapy had been doing so well the world would not be awash in Prozac. And people would not be turning toward cognitive and behavioral therapies. At the least, these do not vary as much from practitioner to another and they have produced more consistently good results than other forms of therapy.

Case in point: the treatment of irritable bowel syndrome, better known by its acronym: IBS. Apparently, up to 10% of the world is suffering from this condition—statistic that deserves considerable skepticism.

At times, the condition is treated by medication. At times, by therapy.   Previous studies had shown that therapy was about as effective as medication, and that it did not matter which therapy was being offered.

Patients had about the same improvement rates with different kinds of treatment. Now, however, some scientists from Vanderbilt University have shown that one form of treatment works better than the others. No, it is not psychoanalysis. It is not even psychoanalytically-oriented psychotherapy. It is cognitive-behavioral treatment—CBT.

The research from Vanderbilt University showed this:

Previous studies have found that, on average, psychotherapy is just as effective as medications in reducing the severity of symptoms of this gastrointestinal disorder and the type of psychotherapy did not seem to matter.

Now, psychologists at Vanderbilt University have looked at different types of psychotherapy to determine which is best at improving the ability of IBS patients to participate in daily activities. They found that one form, called cognitive behavior therapy, was the most effective.

“Evaluating daily function is important because it distinguishes between someone who experiences physical symptoms but can fully engage in work, school and social activities and someone who cannot,” said Kelsey Laird, a doctoral student in Vanderbilt’s clinical psychology program.

All forms of therapy produced some benefits, but cognitive behavioral treatment produced the most benefits. Why was this so?

The authors speculate that the greater improvement observed in patients who received CBT may be due to the fact that treatments often incorporate “exposure:” a technique in which individuals gradually expose themselves to uncomfortable situations. For someone with IBS, this could include long road trips, eating out at restaurants and going places where bathrooms are not readily accessible.

“Encouraging individuals to gradually confront such situations may increase their ability to participate in a wider range of activities,” said Laird. “But more research is needed before we can say why CBT appears more effective for improving functioning in IBS compared to other therapy types.”

The treatment concerns itself less with states of mind and more with behaviors. It teaches people to desensitize themselves to threatening realities and thus to manage their symptoms by modifying their behaviors. It teaches them to develop new and better habits.

It’s not about insight or awareness; it’s not about why or how anyone came to suffer from this condition. It’s about how best to manage the symptoms. If a patient can change the behaviors that supposedly express the illness, the new behaviors will attenuate its effects.