How cognitive behavioural therapy for irritable bowel syndrome works

Talking Therapy for IBS does NOT mean your symptoms are "all psychological"

IBS is by now well-established to be a biopsychosocial condition. What this means is that it is not caused by one single factor, but instead multiple factors varying in nature (biological, psychological and social) combine and interact, causing the onset of symptoms. That means what contributes to the onset of one person's IBS will be very different to what contributes to someone else's IBS. There are often common themes in the onset of IBS.

In cognitive behavioural therapy (CBT) we make the distinction between predisposing factors and precipitating factors. Predisposing factors can be thought of as the background factors that may serve as an underlying contributor to gut issues. These may be genetic factors (biological), familial attitudes to bowel symptoms (social), or early anxieties/difficulties around toileting (psychological). We can consider these predisposing factors as things that can cause an underlying sensitivity, which may or may not turn into gut issues. Precipitating factors can be thought of as the triggering events that interact with predisposing factors, leading to the onset of IBS. Again precipitating factors tend to cross the biopsychosocial spheres.

Take, for example, Mary. She has grown up in a family with a history of bowel symptoms. Sometimes her stomach can feel a bit sensitive to different foods and she tends to need the toilet a lot when she is highly anxious. Generally, she is not too concerned with her bowel symptoms and gets on well at school and university. She has high standards for her work and gets a good job out of university. There is a lot of responsibility, pressure and deadlines but Mary has always gotten on with this. She pushes through. She then takes a holiday with her friends and becomes unwell with a bug. She is on the toilet a lot during the holiday which is uncomfortable but also upsetting as she has been working really hard and needed the break. When she comes back to work, she is not feeling herself and she is worried that her work is suffering. She then starts to avoid eating so that she doesn't exacerbate her symptoms. We can consider the succession of different factors the precipitating event to IBS. Note how there are biological/physiological contributors (stomach bug), psychological (high standards, pushing through) and social (disrupted holiday, work pressure).

In CBT for IBS, we are not looking to necessarily target the specific factors causing IBS. This is a contrast in the biopsychosocial approach as opposed to the biomedical approach. Usually, when we suffer an acute health condition, the biomedical model of healthcare dictates that we find the root cause so that we can address it. For example, identifying a bacterial infection and getting the right topical cream. With CBT for IBS we are instead looking at the next stage of the journey: the maintenance cycle of IBS.

CBT for IBS involves identifying the different elements (behaviours, thoughts, emotions and physiological factors) that keep IBS going. Fundamentally, IBS is a functional disorder of the gut which involves dysregulation of the colon, altered mucus production and, for some, hypersensitivity in the gut. A tailored CBT protocol for IBS involves creating a holistic foundation aimed at establishing gut re-regulation and facilitating the reduction of hypersensitivity. This involves establishing gut-friendly routines, reducing behaviours that exacerbate gut-related concerns and avoidance, and working with symptom-related stress. A key component of CBT for IBS is understanding how the gut works and what is going on when you experience IBS symptoms. This has a big role in reducing anxiety and increasing control over symptoms.

We run a CBT for IBS group 3-4 times a year. We also provide individual one-to-one support for those with IBS. If you'd like to learn more, you are welcome to email or use the contact us form.

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