Irritable bowel syndrome: can psychotherapy help?

Irritable Bowel Syndrome

Irritable Bowel Syndrome (IBS) is a functional gastrointestinal disorder, affecting around 11% of the general population, that tends to be chronic and is certainly bothersome. Even if usually no inflammation or tissues alteration is present, IBS may be a very disturbing and distressing condition, that significantly worsens a person’s quality.

Irritable Bowel Symptoms

People suffering from IBS may experience a great variety of symptoms:

  • abdominal pain: its intensity is usually mild and not severe, it may follow food ingestion and stop after evacuation
  • cramping and/or bloating
  • constipation or diarrhea
  • gas and/or mucus.

The risk factors of IBS are: being woman, being under 45, having a familiar history of IBS and having a mental health problem.

The causes of IBS are still unknown, but it is very likely that several concomitant factors may play a role.

Furthermore, stress seems to have an impact in worsening the syndrome. In particular, the stress condition caused by suffering from IBS may itself create a vicious cycle, fostering IBS symptoms and consequently creating more anxiety. Moreover, it seems that up to 70-90% of people suffering from IBS may experience psychological difficulties, more likely mood or anxiety disorders.

What is neuroscience telling us?

The tight relationship between our brain and our bowel is not a novelty, but in the last decade neuroscience has given us amazingly interesting new information about it.

It seems that our brain and our guts are in constant communication, both influencing each other through top-down and bottom-up processes. But we are not talking only about digestion-related information: our guts have been defined by scientist M. Gershon like a real “second brain”.

Our “second brain” contains indeed around 100 millions of neurons that are responsible for digestion but also for making us experience the so called “gut feelings”, such as “butterflies” in the stomach. Furthermore, it seems that those feelings can have an influence on our mental states even if no conscious thought or decision-making can be undertaken by our second brain. In particular it seems that some specific macrobiota in our guts may impact the functions of our central nervous system; in mice, an impact on anxiety and stress-related behaviours has been found.

Can psychotherapy help?

If you suffer from IBS and you believe you are suffering from anxiety and stress, you may consider taking care of this to avoid a worsening of your IBS.

Research has showed high comorbidities of anxiety and mood disorders in IBS patients, the problematic vicious cycle that anxiety may create and the consequent risk of perceiving a poor quality of life.

Psychotherapy may help you with the aforementioned psychological issues, as our mind and our bowel are so deeply interconnected.

Furthermore, research has showed promising results on the efficacy of psychotherapy, in particular cognitive behavioural therapy and therapies involving relaxation techniques, in improving IBS symptoms, anxiety and the patient’s quality of life.

Suggested links

Irritable Bowel Syndrom Network UK


Al-Asmakh, M; Anuar; Zadjali, F; Rafter, J;  Pettersson, S. “Gut microbial communities modulating brain development and function”. Gut Microbes 2012 Jul-Aug;3(4):366-73. Epub 2012 Jun 29.
Blanchard, E; Lackner, JM; Sanders, K; Krasner, S; Keefer, L; Payne, A; Gudleski, GD; Katz, L; Rowell, D; Sykes, M; Kuhn, E;  Gusmano, R; Carosella, AM; Firth, R;  Dulgar-Tulloch, L. “A controlled evaluation of group cognitive therapy in the treatment of irritable bowel syndrome”. Behavioural Research and Therapy, April 2007, vol 45(4):663-648.
Garakani, A; Win, T; Virk, S; Gupta, S; Kaplan, D; Masand, PS. “Comorbidity of Irritable Bowel Syndrome in Psychiatric Patients: A Review”. Am J Ther. 2003 Jan-Feb;10(1):61-7.
Kuo, B; Bhasin, M; Jacquart, J; Scult, MA; Slipp, L; Riklin, El, Lepoutre, V; Comosa, N; Norton, BA; Dassatti, A; Rosenblum, J; Thurler, AH; Surjanhata, BC; Hasheminejad, NN; Kagan, L; Slawsby, E; Rao, SR; Mackin, EA; Fricchione, GL; Benson, H, Libermann, TA; Korzenik, J; Denninger, JW. “Genomic and Clinical Effects Associated with a Relaxation Response Mind-Body Intervention in Patients with Irritable Bowel Syndrome and Inflammatory Bowel Disease” PLoS One. 2015 Apr 30;10(4):e0123861. doi: 10.1371/journal.pone.0123861. eCollection 2015.

Why change can be so scary?

“There is nothing permanent except change”, Heraclitus

Change: a six-letter word that can enclose and raise so many different feelings and meanings in each of us.

For some change may imply new thrilling experiences when they can test themselves, explore unknown territories and create better ways of living. On the contrary for others changing may be a mandatory and unavoidable step, at times not wanted and burdened with suffering, but possible to deal with. Moreover, for other people change is really scary and may imply the total breakdown of what is “well known” and bring them in a terrific spot of unknown and uncertainty. In these cases, tightly grasping to the past may be a solution.

Why is change so important?

As Heraclitus quoted back in 400 A.C., change is probably the only permanent thing in life.
Darwin explained this concept very well in his Evolutionary Theory: changing allows organisms to better adapt themselves to their environments. Moreover, the better the organism is able to adapt, the higher the likelihood of survival.

If change is natural, why can it be so scary?

Change can refer to thousands of different situations with extremely different features. Obviously the potential scariness will depend on many characteristics, such as how much it was expected, wanted and foreseen, if positive or negative consequences will result from it (their extent and how definitive they are), the amount of secondary changes that it may imply, how much we feel able to deal with it, etc.

Try to think about some of the following important changes that can happen in a lifetime and try to relate them to the aforementioned features: finishing school and starting to work, a marriage or a divorce, a betrayal, changing job, changing city, becoming a mother, the loss of a loved one, going into retirement … the list is potentially infinite.

Each of these changes may assume different meanings to each of us depending on our personal history, current lifestyle, our goals and our intimate beliefs. But a common denominator is that our self-esteem will influence how we will manage these changes: the more we feel that we are able to cope with the related changes and difficulties, the less scary the change will be.

And what if we feel that we are not strong enough, independent enough or lovable enough to succeed in getting through an important change?

In these cases change can be faced in different ways.

Someone could go through it with an intense pain, anxiety or sadness managed with its own specific coping mechanisms. For example someone could find relief by increasing their control over everyday life, or by being extremely dependent on the partner/parents/friend.

On the contrary other people may be so scared about a potential change that he/she may try to stay ahead in the game and work hard to avoid it in the first place.

Instead other people may react to change misrepresenting it, not taking into account its consequences, minimising it or pretending it’s not happening. But denial and keeping our eyes closed will not eventually change things; on the contrary this solution may disconnect you from reality, that sooner or later will intensely materialise.

Usually our typical pattern of reaction to new information is consolidated in the attachment relationship with our parents; but with clinical work it can be changed.

If you recognise yourself in having issues at adapting and accepting important changes in your life, you may try to think about the dynamics written above.

What is scaring you? What are the feared consequences? What are your intimate beliefs about yourself dealing with this change?

Sometimes it may be hard to go through this alone by ourselves. Psychotherapy can help you realise what is preventing you to adapt to how your life is turning out. Moreover, it can help you achieve more flexibility and strengthen your self-esteem.

Being aware of what is happening is, as a matter of fact, the first step to change.

The first panic attack is hard to forget

Symptoms of a panic attack

Suddenly your heart beats fast, like a drum; it’s difficult to breath and you have air hunger. Your stomach hurts, like if someone punched it. Your head is spinning, the world around you or your body seem suddenly unreal, weird.

You feel an intense fear or anxiety, that is increasingly worsening moment by moment. You are worried about going crazy, losing control or that something really bad could happen, maybe you are even afraid that you could die and you feel the sudden impulse to go out, breath new air.

After about ten minutes, everything goes back to normal. But worries about what has just happened still remain: did I have a heart attack? Am I getting crazy? Will this happen again?

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