Online Cognitive Behavioral Therapy Treats Irritable Bowel Syndrome (IBS)

A Psychological Therapy for a Complex Health Issue

In the United States and in Europe, it is more common among women than among men. In Asia and Africa, it is more common among men than among women. Even though only about 10% of people who have IBS seek medical care, about 50% of all referrals to gastroenterologists involve this condition.
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BS is a puzzling condition that causes alternating diarrhea and constipation, painful bowel movements, and passing of undigested of food particles with stool. It also can cause bloating (sometimes called "balloon belly"), a feeling of incomplete bowel movement after defecation, looser stools when pain starts, harder stools when pain stops, and uncontrollable flatulence.

The symptoms of IBS usually stay below the waist, but some people with the condition develop uncomfortable "lumps in the throat" that seem to be triggered by social interaction, migraine headaches, acid reflux, and chest pain.

Doctors used to classify IBS as a psychosomatic illness because it usually first appearance after a traumatic life event. This might be a break-up or a divorce, the death of a child, a parent, or a spouse, getting sentenced to jail, or severe financial problems. Some people develop IBS after they develop another gastrointestinal condition or after they have abdominal surgery. Later, flare-ups of IBS may occur when the IBS suffer experiences the same smells, same tastes, or same sounds remembered from earlier bout of symptoms.

IBS is not really a psychosomatic illness. Most people who develop IBS have normal psychological profiles before they develop the disease. They may withdraw from social activities once diarrhea and flatulence become a frequent problem, however, and certain actions and attitudes make recovery difficult:

• IBS sufferers who conceal anger and aggressive tendencies don't usually respond well to medication for the disease.
• IBS sufferers who deny the severity of life events (such as deaths in the family, divorce, incarceration, or financial setbacks) tend to have symptoms that are much more severe.
• IBS sufferers who show signs of dysthymia (chronic irritability, difficulty enjoying life, difficulty sleeping) are extremely likely to have symptoms over and over again.

People who have IBS tend also to have other conditions associated with vague symptoms and psychological distress, such as:

• Chronic fatigue syndrome (CFS)
• Dysmenorrhea
• Fibromylagia syndrome (FMS)
• Irritable bladder syndrome
• Migraine headaches
• Multiple chemical sensitivity syndrome (MCSS)
• Myofascial pain syndrome (MPS)
• Periodic limb movement (PLMS)
• Restless leg syndrome (RLS)
• Temporomandibular joint disorder (TMJ)
• Tension headaches

IBS is not life-threatening, but it can make life miserable for people who have it. Doctors used to believe that psychological issues caused IBS. Now the belief is that IBS causes psychological issues. Treating the psychological issues, however, is the basis of a new, experimental treatment for the disease.

Online Behavioral Therapy Helps Some IBS Sufferers

Since IBS makes people hesitant to go out for social interaction but a lack of social interaction usually makes IBS symptoms more severe and more persistent, Swedish researchers have been experimenting with Internet-based treatment for the condition.

Reporting their findings in the American Journal of Gastroenterology, doctors in Sweden recruited 195 IBS sufferers to participate in either a stress-reduction program or cognitive behavioral therapy. Both groups were given self-help texts and assigned an on-line "therapist" with whom they exchanged emails or instant messages.

At the end of the 10-week intervention, patients in both groups reported that their symptoms were under adequate control. Six months after the 10-week intervention, however, the IBS sufferers who were in the cognitive behavioral therapy group were more likely than the IBS sufferers who were in the stress reduction group to report that their symptoms were still under control.

What is the difference between cognitive behavioral therapy and stress reduction?

Cognitive behavioral therapy for these IBS sufferers involved an approach called "graded exposure." People in the cognitive behavioral therapy group were encourage to risk certain foods and certain physical activities in the safety of their own homes. They were then asked to evaluate whether the food or the activity activated IBS symptoms.

This "mindfulness" approach encouraged being concerned about likely problems while feeling better about problems that were less likely to occur. Cumulative experience of few or no symptoms allowed participants in the program to try new foods, new activities, and new social settings with less embarrassment—and the lowered stress reduced the risk of diarrhea, flatulence, and abdominal cramping.

People in the stress reduction group were encouraged to lower their sources of stress in general, but not to try new situations in particular. These volunteers also improved, but their progress with the disease was more likely to be short-lived. People in the stress reduction group were less likely to complete the course than people in the "mindfulness" group.

Why would doctors advocate online treatment?

Face to face meetings with a therapist are costly for health insurance plans and for uninsured patients. They may require travel and time off from work, and they put the IBS sufferer in situations in which rumbling stomach, flatulence, and urgent trips to the bathroom can be especially unpleasant. The anticipation of possible public humiliation itself aggravates IBS.

When therapy is done online, the risk of public humiliation is taken out of the healing process, and the patient can focus on changes in lifestyle, diet, and social interactions that he or she knows to be safe because of experiences in the treatment program.

Different people, of course, respond to different approaches. All of the people in the Swedish study signed up for treatment; that is, they were self-referred, rather than doctor-referred. It may be that people with IBS who are inclined to take control over their treatment respond well to Internet-based therapy, while people who are not inclined to deal with IBS issues may do better with medication or office visits to their therapists.