If you (or a loved one) have been diagnosed with IBS, you’re likely familiar with the impact it can have on one’s life when symptoms are flaring up. It disrupts relationships at times, making socializing more challenging, or at the very least more stressful. It gets in the way of day-to-day functioning at work and in other areas of living.

And when IBS symptoms subside, there is often a looming fear that they might flare up again, a lingering worry about your symptoms coming back. What if I can’t go on that trip? What if the symptoms get worse the next time around? Will I feel okay enough to celebrate my birthday?

There is anxiety when symptoms are present, and there is anxiety when they are gone, when your brain starts thinking about all the possible worst-case scenarios of what may happens next (something we call “catastrophizing). In a nutshell, anxiety often comes as a very unwelcome side-effect with an IBS diagnosis. 

And as if that weren’t enough, you are then told that you shouldn’t feeling this anxious because it will make your symptoms worse. *eye rolls* It feels like you can never win, doesn’t it?

Is it in my head? 

If your provider has suggested you try therapy for irritable bowel syndrome, you may have felt a ping of resentment if it was ever implied that your symptoms are all in your head. 

I am here to make it clear that IBS is not “all in your head.” And if you’re reading this, you’ve likely experienced first-hand the challenges of IBS symptoms (diarrhea, constipation, bloating, gas, pain), and you know that they are very real!  And, again, the fact that your symptoms are not immediately explained by structural or biochemical abnormalities doesn’t imply that it’s “all in your head” either. Rather, research suggests that IBS is due to a very complex array of factors.

IBS is considered a disorder of gut-brain interaction (DGBI). That means that we believe the communication between the brain and the gut (via the nervous system) is impaired in some ways. In that sense, IBS results, in part, from of a miscommunication between your stomach and your brain, causing visceral hypersensitivity and other disturbances in the GI tract. However, our brain likely contributes to some of the symptoms you are experiencing.

Health psychologists and therapists who specialize in chronic illness are an important part of your care team when learning to manage IBS, and they can help improve your quality of life. Having a team of providers who are all on the same page and supportive of your treatment teams can make all the difference! As a therapist specializing in GI psychology, I find that working alongside your gastroenterologist, dietitian, and other providers involved in your treatment allows for the best care. So, if your medical provider suggested therapy as a new treatment for irritable bowel syndrome, it is not that they’re trying to pass you along to someone else, it might very well be a helpful addition to your IBS treatment.

Irritable Bowel Syndrome Therapy – Introducing CBT for IBS 

Cognitive Behavioral Therapy (CBT) is a relatively new form of treatment for IBS, which focuses on learning skills to manage the disease in order to improve someone’s quality of life. This treatment is short-term and emphasizes changes in behaviors and thoughts to improve your mood and mitigate stress and physiological symptoms. 

Behavioral strategies for the treatment of IBS (The “B” in CBT)

IBS can present in different forms. IBS with constipation (IBS-C), IBS with diarrhea (IBS-D), or IBS with mixed bowel habits (IBS-M). Regardless of your disease presentation, a key aspect of CBT for IBS is relaxation training, which is often introduced in the first few sessions. Relaxation training (including diaphragmatic breathing, progressive muscle relaxation, and visualization) is an important skill to learn and practice, as it helps activates the sympathetic nervous system, the part of your nervous system that is responsible for relaxation and comfort. Relaxation practice can help turn down pain signals a notch and regulate gut motility. In other words, you can help turn down IBS pain by engaging in relaxation, a behavior that is under your direct control. 

Another important goal of CBT for IBS is to help you engage in a range of activities that are important to you and which you may have been avoiding. Many of my patients share that they miss going out with friends and family, making them feel isolated and sometimes sad. They may also dread going on a trip or going to a restaurant or party, and described that IBS has taken away so much joy out of their day-to-day life.

Avoidance can result from a fear of experiencing uncomfortable or embarrassing symptoms in situations where you don’t have easy access to a restroom or a fear of eating certain foods that you worry might make symptoms worse. Exposures (e.g., eating at a restaurant, going out with friends, etc) and behavioral experiments are done gradually and with the help of a trained professional in order to allow you to participate more fully in activities and situations that are meaningful to you and to improve your quality of life. As you work with your therapist, you will take steps toward facing situations and challenging possible misconceptions about the impact of your symptoms.

Cognitive strategies for IBS (The “C” in CBT)

"I've made myself worse because of my anxiety" 

"My IBS is flaring and it’s my fault, I’m too anxious” 

"I'm so worried and I know it's not good for me, but I don't know what to do."

“I won’t be able to deal with the pain if I’m out of the house”

“It’s not reasonable to go out when I’m flaring up”

Sounds familiar?

The above thoughts are fairly common in those living with chronic illness. Yet, if we take a closer look at them, we could argue that they are not necessarily 100% accurate. At the very least, it is fair to say that they are not always helpful. An important aspect of CBT treatment is to become more mindful of unhelpful or distorted thinking patterns and their impact on our emotions and the decisions we make. 

The way we think about a situation can exacerbate our stress (e.g., “I will have an urge to use the bathroom in the middle of a discussion and will have to run to a bathroom, that will be so embarrassing”), and, in turn, make GI symptoms worse. One of the emphasis of treatment is to practice noticing when catastrophizing (i.e., thinking about the worst-case scenario) is kicking in or when we may be overestimating the probably of a negative outcome. With the help of the therapist, one can then practice thinking more flexibly about their symptoms and their ability to engage in a wider range of activities.

If you are reading this, you’re likely feeling overwhelmed by your GI symptoms and ready to learn another way to manage them as well as the anxiety that often comes along. Like you maybe, many of my patients realize that their anxiety and stress is exacerbating their symptoms, yet, they also find it difficult to do things different in a way that feels sustainable. CBT treatment can provide the support you need to start learning new ways to respond to your IBS symptoms and explore strategies to make your life less painful and more in line with your personal and professional goals.  

I’m a health psychologist in Miami and specialize in therapy for chronic illness

Did you even know that was a thing?! I am a health psychologist and work primarily with adults who struggle with physical or medical issues and want to better manage them to improve their quality of life. In addition to CBT for IBS, I can also gut-directed hypnotherapy as part of your treatment for IBS pain and other symptoms.

If you can’t find a chronic illness therapist near you, online therapy offers an excellent venue to engage in treatment for IBS symptoms. In fact, many of my current clients have opted for online counseling to find support with their IBS diagnosis. 

If you live in Miami or surrounding cities, in-person therapy is also an option!