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How is CBT for IBS different from general CBT?


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Cognitive Behavioural Therapy (CBT) is a broad term for therapies that break down experiences in to four components: Thoughts, behaviours, emotions, and the physical sensations. When CBT is used as a therapeutic approach, it’s based on the notion that all these areas are interconnected and that making changes in one area can have a positive impact on the other areas. CBT is widely used and has been proven to be successful in treating a variety of presenting issues, both mental health and physical health-focused.


One physical health condition that has been shown to be improved by CBT is irritable bowel syndrome (IBS). CBT for IBS is a highly tailored approach, specific to the experience of gut symptoms and based on a biopsychosocial approach to IBS. CBT for IBS there is very different to CBT for anxiety or depression and requires the practitioner to have received training in the use of evidence-based protocols in CBT for IBS.


In CBT for IBS the starting point is rigorous psychoeducation about the gut, how it functions, why individuals have IBS and how IBS is best understood as a disorder of the gut brain connection. Many people have never been told and are unaware of exactly what goes on in the body or what maintains their symptoms. Understanding what physically underpins the symptoms and dispelling the myths is a significant turning point and sets the groundwork for managing symptoms differently.


People adopt specific habits to cope to with gut symptoms that can maintain and even exacerbate gut symptoms over time. The coping strategies people find can provide short-term relief hence why they are used, but in the long-term deregulate the gut. CBT for IBS helps people identify symptom maintainers and introduces specific strategies that support gut regulation to help break out of vicious cycles.


Thoughts can also have a big impact on IBS by adding to stress and increasing hypervigilance to symptoms. Addressing thoughts that are specific to IBS is a key mechanism in treatment and positively impacts the severity of symptoms [1]. These can either be easily recognised or more automatic. Strategies are then used to update thoughts that may be adding to the symptom experience.


Addressing both the behaviours and thoughts in CBT for IBS is key. Research shows that altering gut-specific habits and thoughts are the fundamental factors that lead to a reduction in symptom severity [2]. CBT for IBS takes into account the context and patterns associated specifically with the gut whereas general CBT misses out on these key components.


References

[1] Windgassen, S., Moss-Morris, R., Chilcot, J., Sibelli, A., Goldsmith, K., & Chalder, T. (2017). The journey between brain and gut: A systematic review of psychological mechanisms of treatment effect in irritable bowel syndrome. British journal of health psychology, 22(4), 701–736. https://doi.org/10.1111/bjhp.12250


[2] Windgassen, S., Moss-Morris, R., Goldsmith, K., & Chalder, T. (2019). Key mechanisms of cognitive behavioural therapy in irritable bowel syndrome: The importance of gastrointestinal related cognitions, behaviours and general anxiety. Journal of psychosomatic research, 118, 73–82. https://doi.org/10.1016/j.jpsychores.2018.11.013

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