Irritable Bowel Syndrome (IBS) Helped by Cognitive Behavioral Therapy

Irritable Bowel Syndrome (IBS) is a collection of symptoms arising from the large bowel, or colon; there’s cramping, pain, bloating, and diarrhea or constipation (or both).  Although distressing, there’s no structural damage to the colon, no evidence of infection, and no risk of cancer.  IBS is one of the so-called ‘functional’ gastrointestinal diseases, where symptoms are caused by changes in the normal function of the organ. 

Cognitive behavioral therapy (CBT) has had some success in treating IBS, but it’s unclear for whom and under what circumstances it’s most effective.  (CBT combines two effective kinds of psychotherapy.  Cognitive therapy shows you how certain thinking patterns are causing symptoms, while behavior therapy helps you weaken the connections between troublesome situations and your habitual reactions to them.)  A publication in Clinical Gastroenterology & Hepatology explores the best way to use CBT in IBS patients, focusing on those who achieved a positive response to CBT within 4 weeks of starting therapy.

The researchers studied 71 patients with IBS aged 18 to 70 who had at least moderately severe symptoms.  They were randomly assigned to 10 weekly 1-hour CBT sessions, four 1-hour CBT sessions spread over 4 weeks, or no therapy (waiting-list controls).  Subjects who had adequate pain relief, adequate bowel symptom relief, and a 50-point decrease in IBS scores by week 4 were classified as ‘rapid responders’.    

 Both groups that received CBT had 30% rapid responders; and 92% of the rapid responders maintained their gains in response at a 3-month follow-up examination.  The rapid responders reported more severe INBS symptoms at baseline, but they had more sustained symptom reduction than non-rapid responders. 

This is an important study.  It shows that 4 weeks’ CBT is sufficient to see if the patient is one of the 30% who’s likely to have prolonged improvement in symptoms.  CBT (in expert hands) is clearly a serious competitor to medicinal therapy for treating moderate to severe IBS symptoms.