Irritable bowels: can psychotherapy help?

Irritable Bowel Syndrome (IBS) is a functional gastrointestinal disorder, affecting around 11% of the general population, that tends to be chronic and is certainly bothersome. Even if usually no inflammation or tissues alteration is present, IBS may be a very disturbing and distressing condition, that significantly worsens a person's quality.

People suffering from IBS may experience a great variety of symptoms:

  • abdominal pain: its intensity is usually mild and not severe, it may follow food ingestion and stop after evacuation
  • cramping and/or bloating
  • constipation or diarrhea
  • gas and/or mucus.

The risk factors of IBS are: being woman, being under 45, having a familiar history of IBS and having a mental health problem.  

The causes of IBS are still unknown, but it is very likely that several concomitant factors may play a role.

Furthermore, stress seems to have an impact in worsening the syndrome. In particular, the stress condition caused by suffering from IBS may itself create a vicious cycle, fostering IBS symptoms and consequently creating more anxiety. Moreover, it seems that up to 70-90% of people suffering from IBS may experience psychological difficulties, more likely mood or anxiety disorders.

What is neuroscience telling us?

The tight relationship between our brain and our bowel is not a novelty, but in the last decade neuroscience has given us amazingly interesting new information about it.

It seems that our brain and our guts are in constant communication, both influencing each other through top-down and bottom-up processes. But we are not talking only about digestion-related information: our guts have been defined by scientist M. Gershon like a real “second brain”.

Our “second brain” contains indeed around 100 millions of neurons that are responsible for digestion but also for making us experience the so called “gut feelings”, such as “butterflies” in the stomach. Furthermore, it seems that those feelings can have an influence on our mental states even if no conscious thought or decision-making can be undertaken by our second brain. In particular it seems that some specific macrobiota in our guts may impact the functions of our central nervous system; in mice, an impact on anxiety and stress-related behaviours has been found.

Can psychotherapy help?

If you suffer from IBS and you believe you are suffering from anxiety and stress, you may consider taking care of this to avoid a worsening of your IBS.

Research has showed high comorbidities of anxiety and mood disorders in IBS patients, the problematic vicious cycle that anxiety may create and the consequent risk of perceiving a poor quality of life.

Psychotherapy may help you with the aforementioned psychological issues, as our mind and our bowel are so deeply interconnected.

Furthermore, research has showed promising results on the efficacy of psychotherapy, in particular cognitive behavioural therapy and therapies involving relaxation techniques, in improving IBS symptoms, anxiety and the patient's quality of life.

Bibliography
Al-Asmakh, M; Anuar; Zadjali, F; Rafter, J;  Pettersson, S. “Gut microbial communities modulating brain development and function”. Gut Microbes 2012 Jul-Aug;3(4):366-73. Epub 2012 Jun 29.
Blanchard, E; Lackner, JM; Sanders, K; Krasner, S; Keefer, L; Payne, A; Gudleski, GD; Katz, L; Rowell, D; Sykes, M; Kuhn, E;  Gusmano, R; Carosella, AM; Firth, R;  Dulgar-Tulloch, L. “A controlled evaluation of group cognitive therapy in the treatment of irritable bowel syndrome”. Behavioural Research and Therapy, April 2007, vol 45(4):663-648.
Garakani, A; Win, T; Virk, S; Gupta, S; Kaplan, D; Masand, PS. “Comorbidity of Irritable Bowel Syndrome in Psychiatric Patients: A Review”. Am J Ther. 2003 Jan-Feb;10(1):61-7.
Kuo, B; Bhasin, M; Jacquart, J; Scult, MA; Slipp, L; Riklin, El, Lepoutre, V; Comosa, N; Norton, BA; Dassatti, A; Rosenblum, J; Thurler, AH; Surjanhata, BC; Hasheminejad, NN; Kagan, L; Slawsby, E; Rao, SR; Mackin, EA; Fricchione, GL; Benson, H, Libermann, TA; Korzenik, J; Denninger, JW. “Genomic and Clinical Effects Associated with a Relaxation Response Mind-Body Intervention in Patients with Irritable Bowel Syndrome and Inflammatory Bowel Disease” PLoS One. 2015 Apr 30;10(4):e0123861. doi: 10.1371/journal.pone.0123861. eCollection 2015.

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Written by Ilaria Tedeschi

Ilaria Tedeschi is a cognitive behavioural psychotherapist in Marylebone, London, with several years of experience working with depressive, anxiety, sleep and relational problems.… Read more

Written by Ilaria Tedeschi

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