Irritable Bowel Syndrome: Can psychological treatments help?

Dr Andrew David Dainty, lecturer, registered nurse and researcher working within the College of Health and Social Care at the University of Derby, talks about Irritable Bowel Syndrome and whether psychological treatments can help the common, long-term condition.


What is Irritable Bowel Syndrome?

The Irritable Bowel Syndrome, more commonly known as IBS, is a functional gastrointestinal complaint which usually results in a range of unpleasant symptoms. The term ‘functional’ relates to the fact that although the bowel doesn’t seem to function as well as it perhaps should, there is usually no physiological cause for symptoms. That’s to say, that blood tests and samples taken by doctors usually reveal no abnormality.

Symptoms range from chronic and persistent diarrhea to chronic or intermittent constipation. People with IBS also experience various levels of chronic or intermittent abdominal pain and alternating bowel habits which often seem unrelated to diet or lifestyle and can be troublesome to control. Interestingly, people with IBS also experience much more anxiety and depression compared to people without IBS. Unfortunately, this often leads to stigma surrounding IBS and other medically unexplained symptoms and people are sometimes told that symptoms are ‘in their heads’ or not real.

Who suffers from IBS?

IBS is more common in women than men, with a ratio of about 2:1. It’s unclear why this is so. IBS is more frequently reported during the third and fourth decades of life. Around 14% of women and 6% of men will experience IBS at some point in their lives.

Is IBS easy to manage?

The symptoms of IBS can look very much like symptoms associated with other gastrointestinal problems such as coeliac disease (a condition relating to an intolerance to gluten) or some inflammatory conditions. Therefore, doctors often check for other conditions which can cause symptoms much like those experienced by people with IBS before making an IBS diagnosis. IBS is sometimes challenging for healthcare professionals, as many people fail to gain relief from the medicines prescribed in efforts to curtail symptoms. Around 4 out of 10 individuals will still be experiencing IBS ten years after being diagnosed with the condition, which demonstrates that for some, IBS can become a chronic and persistent problem.

Can psychological treatments help?

I feel extremely privileged to have spent a number of years studying IBS, and led a research study looking into the feasibility of a type of psychological treatment for the condition while studying during a PhD fellowship. Why would one use psychological treatments for a condition largely relating to the bowel you might reasonably ask?

One of the challenges that people with IBS face, is the lack of effectiveness of some of the medical treatments available. Coupled with the fact that people with IBS often face a great deal of stigma and experience a poorer quality of life, it’s not too difficult to see why some people have a real tough time trying to live with the condition.

The aim of the research I have been doing focuses on using a type of psychotherapy called Cognitive Behavioural Therapy (CBT). The aim of using this type of treatment is to help people with IBS live more fulfilling lives and deal with some of the problems brought about by their IBS.

IBS affects people in a variety of ways and it’s been quite an insight to spend time with people who experience these problems and learn how much of an impact IBS really has upon people and their lives.

It isn’t unusual for people to stop going places they once did or to not engage in the activities and pastimes they once enjoyed. CBT helps people to find ways of combatting some of these problems using a variety of evidence based techniques. CBT treatment is now becoming much more accessible to people, particularly for common mental health problems such as anxiety and depression thanks to a variety of government investments in mental health service provision. However, there are few therapists who specialise in using CBT to treat IBS and these treatments are not used routinely within the NHS for IBS.

I would say that although it is not true that IBS is ‘all in the head’, an interesting thing about IBS is that some studies have shown that psychological treatments like CBT also seem to help improve the physical symptoms of IBS. The research I have been working on aims to evaluate whether a low-intensity type of CBT treatment could be delivered by trained nurses within NHS hospitals. The research shows that the intervention was potentially feasible and we learned a great deal about how people experience this kind of intervention. After carrying out interviews with people who experienced various CBT treatments within the study, we now have more information on what might be required to make these types of treatment more acceptable and relevant to people who might choose this approach.

If you are worried you might have IBS

If you are concerned that you might have the symptoms of IBS, it’s very important that you should talk to your doctor who will want to know more about your symptoms and consider whether diagnostic tests or other interventions are required.

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