Psychotherapy for IBS

For obvious reasons I am always on the lookout for evidence about the relative effectiveness of psychotherapy. All forms of therapy—even psychoanalysis—claim to offer treatment that works, but I remain somewhat skeptical about the results. Especially because many forms of therapy are practiced differently by different practitioners. With the exception of cognitive and behavioral therapies most therapies are not practiced with anything that resembles uniformity.

And besides, how many patient problems resolve themselves for reasons that have nothing to do with psycho insights, by a change in lifestyle, for example? And how many resolve themselves because patients believe that therapy will work—call it the placebo effect.

Now, we have a new study that demonstrates that psychotherapy can help patients who suffer from irritable bowel syndrome. You know it by its acronym: IBS.

Researchers at Vanderbilt University report their findings:

Worldwide, roughly one adult in 10 suffers from a painful and sometimes debilitating condition called irritable bowel syndrome, or IBS.

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.

Time for a revision. Further studies discovered that the type of therapy really did matter. Patients who were offered cognitive behavior treatments did better than those who received other forms of therapy:

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.

Indeed, the researchers were correct to evaluate the effectiveness as a function of the patients' ability to function effectively in their everyday life.

Why is 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.”

It’s not about performing mental exercises as much as exposing oneself to situations that one would normally avoid. That is, by changing everyday behavior. If anxiety causes you to behave one way, CBT does not ask why you feel anxious. It teaches you a behavior that would have been performed by someone who did have the problem or the attendant anxiety. By gradually exposing oneself to such situations the patient with IBS learns to function in them. In that way he or she overcomes the anxiety that prevents normal functioning.