Behavioral therapy may ease irritable bowel syndrome
By KAREN PALLARITO • HEALTHDAY • February 5, 2008
When drugs and dietary changes don't provide relief from the pain, bloating and other unpleasant gastrointestinal symptoms of irritable bowel syndrome, patients may want to try a different approach.
Recent studies show that using one's own thoughts in a process called cognitive behavioral therapy may help ease symptoms. Likewise, using hypnosis to visualize the pain and imagine it seeping away can be a powerful treatment strategy, too.
"Research indicates that the probability of achieving benefits is excellent with either approach, even for patients who haven't improved from standard medical care," said Olafur S. Palsson, a clinical psychologist and associate professor of medicine at the University of North Carolina at Chapel Hill's Center for Functional GI & Motility Disorders.
As many as 45 million Americans may have irritable bowel syndrome, or IBS, the International Foundation for Functional Gastrointestinal Disorders reports. Sixty percent to 65 percent of IBS sufferers are women.
In addition to pain and discomfort, people with IBS experience chronic or recurrent constipation or diarrhea — or bouts of both. While the exact cause of the condition isn't known, symptoms seem to result from a disturbance in the interaction of the gut, brain and nervous system, according to the foundation.
Doctors generally advise patients to avoid certain foods that may exacerbate symptoms. Several different medications may be recommended for relieving abdominal pain, diarrhea and constipation. But these approaches don't always provide adequate relief.
"For some people, medications and dietary changes are the perfect match, but most of our patients — the great, great majority of patients — have not responded to medications and dietary changes," said Jeffrey M. Lackner, assistant professor of medicine at the University of Buffalo, State University of New York, and a behavioral medicine specialist whose research focuses on gastrointestinal disorders, particularly IBS.
For many patients, cognitive behavioral therapy, which uses the power of the mind to replace unhealthy beliefs and behaviors with healthy, positive ones, may be the answer. But, Lackner observed, very few facilities around the country specialize in this type of treatment.
Recognizing this, he and his colleagues set out to devise and test a treatment program that IBS patients could administer themselves.
Seventy-five women and men were divided into three groups. One group was placed on a "wait list" for 10 weeks while they monitored their symptoms. Another group received the standard treatment of 10 cognitive behavioral therapy sessions over 10 weeks. The third group had once-a-month therapy sessions over four months and practiced relaxation and problem-solving exercises at home.
Not surprisingly, people on the wait list did not do well at all, while those in the 10- and four-week sessions showed significant improvement. "They said at the end of treatment they had achieved adequate relief from pain and adequate relief from bowel problems, and a significant proportion of patients said they improved their symptoms," Lackner explained.
While more studies are needed, the findings suggest that traditional and self-administered cognitive behavioral therapy both provide adequate relief and improve symptoms, said Lackner, who first reported the findings at large meeting of GI professionals.
Hypnosis may be another option. A pair of Swedish studies presented at that same meeting found that patients who received "gut-directed hypnotherapy" had significant improvement in symptoms compared with those who did not receive this intervention.
Hypnosis treatment has been reported to improve symptoms of the majority of treated IBS patients in all published studies, noted UNC's Palsson.
For patients who've tried the diet-and-drug regimen to no avail, Palsson said he would recommend either of these two psychological treatments.
"If a patient's main goal is substantial relief of bowel symptoms, hypnosis is probably the better choice," he said, for the research literature strongly suggests that it improves the gastrointestinal symptoms far more reliably.
On the other hand, he added, if a patient wants to cope better with the illness or improve mental well-being, then cognitive behavioral therapy is equally good or perhaps even the better treatment option.