Cognitive behavioral therapy can help women living with irritable bowel syndrome manage anxiety and improve overall well-being.
By Diana Price
Anyone who has ever felt “butterflies” in their stomach when nervous or been hit by a wave of nausea or an urge to run for the bathroom when they are especially stressed—and isn’t that most of us?—knows that the mind-body connection is clear and present where our gastrointestinal (GI) system is concerned.
For women who live with irritable bowel syndrome (IBS), this connection is magnified. IBS is a collection of ongoing symptoms that include bloating, intermittent abdominal pain, episodes of diarrhea and of constipation, and a variety of other symptoms that can vary from one person to the next.1 For many the stress and anxiety of living with these uncomfortable symptoms have a significant negative impact on quality of life.
“Many patients with IBS have a fear of not finding a bathroom in time, worry about dealing with traffic and travel in general, have concerns about dating and intimacy, and struggle with workplace issues,” says Frank Sileo, PhD, a licensed psychologist who works with many IBS patients in his Ridgewood, New Jersey, practice—and who lives with IBS himself.
The good news: Current research increasingly reflects the potential benefit of psychological interventions to help women cope with the symptoms of IBS. Cognitive behavioral therapy (CBT), specifically, has been shown to provide women with valuable coping skills to manage IBS-related anxiety. For women facing a diagnosis of IBS, understanding the mind-gut connection and the role of CBT as part of an overall treatment plan can be a proactive step toward wellness.
Understanding the Mind-Gut Connection
“There is definitely a relationship between the neurons in the GI tract and the neurons in the brain,” says Shivani Kiriluk, DO, a gastroenterologist at Suburban GI in Naperville, Illinois.
In fact, there are more than 100 million nerve cells lining your GI tract, from your esophagus to your rectum, which together make up the enteric nervous system (ENS).2 These cells communicate with the central nervous system (CNS). The result: the GI tract responds to stress and anxiety and, according to recent research, the ENS may actually trigger emotional responses.2
Each woman will experience this connection in a unique way. “Anxiety and depression can certainly be reflected in the gut and affect how the GI tract works,” says Ellen Stein, MD, a gastroenterologist and an assistant professor of medicine at Johns Hopkins Medicine, “but for some the connection is much stronger than others.”
Dr. Stein also notes that while IBS can certainly trigger anxiety and depression, physicians should be aware of existing mental health concerns at the outset when working with a patient to manage IBS. “There are a lot of women with preexisting anxiety and depression, and identifying these conditions early on is important because if you’re already living with anxiety, IBS symptoms can make it worse; if you’re depressed, the symptoms of IBS can feel unmanageable.”
Cognitive Behavioral Therapy and IBS
Whether anxiety and depression are preexisting or are brought on by the daily reality of living with the symptoms of IBS, learning to manage the emotional impact of the symptoms can go a long way toward improving well-being for women living with the condition. Cognitive behavioral therapy is one therapeutic approach that has been found to help patients reduce the stress and anxiety related to IBS.
“Cognitive behavioral therapy is a here-and-now focused form of psychotherapy that involves collaborating with a therapist to examine one’s thoughts, beliefs, attitudes, and assumptions about oneself and about situations,” says Dr. Sileo. Through CBT, patients learn coping strategies to manage physical discomfort, such as abdominal pain, and mental exercises to relax the mind and body. “This is accomplished by teaching the person with IBS how to challenge unproductive thoughts, engage in positive self-talk, and use mindfulness exercises,” Dr. Sileo adds.
Kelley Kitley, LCSW, uses CBT in her work with clients struggling emotionally in the wake of IBS. Kitley says that the anxiety that many of her clients experience is rooted in the loss of control the condition brings. “I work with my clients to accept what is, instead of fighting the reality, which can create more anxiety. Over the course of treatment, I educate clients about distorted ways of thinking, identify triggers and feelings, journal thoughts and behaviors, and work to restructure negative, catastrophic thoughts.”
The work patients do through CBT to deconstruct negative thought patterns and build healthier mental approaches to various situations can help them manage the ongoing anxiety about symptoms and their impact, says Dr. Stein. When patients are focused on the symptoms and their impact, the stress of that can be overwhelming; CBT, she says, “can help you design a pattern of thinking that is more productive and alleviates anxiety; when you refocus energy to be more productive, symptoms that were so overwhelming are put in perspective.”
Both Kitley and Dr. Sileo note that, to be effective, CBT must be a truly collaborative approach, wherein the patient is expected to be an active participant in treatment. Following sessions with a therapist in which they discuss their concerns and coping strategies, patients will practice mindfulness and breathing techniques and engage in “homework” assignments that might include tracking their thoughts between sessions, practicing meditation, and engaging in good sleep hygiene.
Patients who actively engage in the process of CBT as part of an overall treatment plan, which will likely also include dietary modification and medication, can see significant benefits. “The tools that CBT provides can offer increased confidence and self-esteem and critical insight into core beliefs and values,” Kitley says.
One Piece of a Holistic Plan
For women living with IBS, effective management will likely involve a variety of interventions. “Many women get great symptom relief from basic medications like laxatives and from dietary change,” says Dr. Stein; “for others, with persistent symptoms, it’s really important to take the whole person into consideration and make sure we’re not missing a component like anxiety or depression.” When these issues are present, she says, CBT can be an effective tool.
Dr. Kiriluk agrees that women should look for an integrative approach to symptoms, and notes that finding the right solutions for each person’s unique symptoms may take a while: “Be patient with the working relationship with your doctor; finding the right balance among medication, CBT, and dietary solutions can all take time.”