This post is written by a friend and colleague, Jessica Naftaly! She is currently a second year graduate student in a Clinical Psychology PhD program.
The Brain Gut Relationship in IBS
Approximately 11% of the population is affected by irritable bowel syndrome (IBS), a common functional gastrointestinal disorder that can significantly affect a patient’s quality of life.1 Functional gastrointestinal disorders can be difficult to diagnose as medical tests like blood tests and imaging scans cannot detect IBS.2 In fact, a diagnosis of IBS is commonly given when diseases that cause inflammation such as inflammatory bowel disease (IBD) are ruled out. IBS is thus mainly diagnosed through ruling out other diseases, and through physician use of specific diagnostic criteria called the Rome criteria.2 Since the diagnostic process can be somewhat subjective, patients with IBS tend to have high health care utilization and usually see multiple doctors before receiving a diagnosis. 3 The long process of receiving a diagnosis of IBS can be a frustrating experience for patients, on top struggling with a debilitating illness.
Psychology and IBS
Since IBS is difficult to diagnose, there is a limited understanding of how the brain and body interact in IBS (aka the mind-body connection). Research shows that stress makes IBS symptoms (e.g., abdominal pain, constipation, diarrhea) worse.4 Additionally, it is common for patients with IBS to also be diagnosed with anxiety and depressive disorders.1
Patients with IBS tend to report more frequent stressful events and have an increased reactivity to stress compared to people without IBS.4 For example, a patient with IBS who plans on going to a concert where there is little access to bathrooms, may be stressed and thus experience abdominal pain. This stressful event, however, may not be considered stressful for someone who does not have IBS.3 A patient with IBS may avoid going to the concert completely due to the fear of not having access to a bathroom. Although the patient knows that he/she is always able to find a bathroom when he/she goes out, this fear persists despite evidence that there will be bathroom access. This anxiety may even exacerbate IBS symptoms. Avoidance of attending the concert is an example of how a patient may cope with the abdominal pain and stress of going to the concert. Furthermore, avoiding the concert can contribute to depressive symptoms, feelings of social isolation, and guilt.3
The Brain and IBS
Researchers believe that there is a relationship between IBS and the brain, specifically through serotonin. Serotonin is an important neurotransmitter that is involved in mood regulation, sleep, pain, and motility in the GI system. Although some serotonin is located in the brain, guess where a majority of serotonin is located? You guessed right-the digestive tract.5 Research shows that patients with IBS may have different amounts of serotonin compared to healthy people, This could be why patients with IBS commonly also have anxiety disorders.5
Psychological Treatment and IBS
Medications like antidepressants are starting to be used as one form of treatment for IBS. Antidepressants can change the amount of serotonin in the body leading to a decrease in IBS symptoms. Additionally, cognitive behavioral therapy (CBT) is a short-term treatment that involves the client and therapist (psychologist, counselor, social worker, etc) working together to address distorted thoughts and behaviors. Talking about these thoughts and behaviors can be helpful for patients with IBS.
We can use the example mentioned earlier (the patient with IBS avoiding the concert) as an example of how CBT can be used. In that example, the patient may have a cognitive distortion such as “I can’t go to the concert because I won’t make it to the bathroom.” The therapist would talk with the client about what evidence the client has that makes this thought true. Although many patients with IBS may have trouble making it to the bathroom, the therapist may find out that the client actually does make it to the bathroom on time but is constantly worried about not making it. The therapist may then have the client use thought records to help the client keep track of the accuracy of these thoughts. The therapist may also teach the client relaxation strategies, give the client homework, and help the client become more aware of inaccurate beliefs. Although talking with a complete stranger may seem scary, research shows that CBT is effective in decreasing IBS symptoms by improving patients’ coping strategies to manage stress and change cognitive distortions.3
Take home message: Although stress does not appear to cause IBS, there is a significant psychological component to IBS symptoms. Treatments like CBT and medications can be used to help decrease IBS symptoms. For more information on CBT please visit http://www.abct.org/Help/?m=mFindHelp&fa=WhatIsCBTpublic.
- Canavan, C., West, J., & Card, T. (2014). The epidemiology of irritable bowel syndrome. Clinical Epidemiology, 6, 71–80.
- Dalton, C. (n.d). UNC center for functional GI & motility disorders: Ask the expert: Question what is a functional GI disorder. Retrieved from https://www.med.unc.edu/ibs.
- Naliboff, B.D., Fresé, M.P., & Rapgay, L. (2008). Mind/body psychological treatments for irritable bowel syndrome. eCAM, 5(1), 41-50.
- Drossman, D.A., Camilleri, M., Mayer, E.A., & Whitehead, W.E. (2002). AGA technical review on irritable bowel syndrome. Gastroenterology, 123(6), 2108-2131.
- McLean, P.G., Borman, R.A., & Lee, K. (2006). 5-HT in the enteric nervous system: gut function and neuropharmacology. Trends in Neuroscience, 30(1), 9-13.