What Is Cognitive Behavioral Therapy?
Traditional CBT
Cognitive behavioral therapy (CBT) is a type of psychotherapy that was developed back in the 1960’s and first used to treat disorders like depression and anxiety. 1 Since then, CBT has been shown to be effective in treating a wide variety of other conditions, including but not limited to addiction, stress, panic, trauma, and pain. 2 Unlike stereotypical old-school psychoanalysis that aims to dig up all your past childhood trauma, CBT is a short-term, highly-structured, present-centered therapy that focuses on correcting negative thought patterns as well as teaching practical skills.345
CBT for IBS
CBT for IBS is very similar to regular CBT, except that the therapy is centered around IBS symptoms and behaviors. There isn’t one standardized protocol for this type of CBT, but therapy sessions usually will include some combination of the following:5
- IBS education: causes, anatomy and physiology, the gut-brain axis, and the effects of stress and its relationship to IBS
- Reframing and addressing unhelpful thought patterns around symptoms
- Mindfulness and self-monitoring exercises
- Behavioral skills such as problem-solving, relaxation and breathing techniques to manage symptoms and stress
- Exposure therapy to lessen gut-related fears and avoidance behaviors
- Homework to reinforce skill learning
Does CBT Help With IBS?
What the research tells us
Despite what you may think (or at least what we initially thought), CBT is actually one of the most well studied non-pharmacological treatments for IBS. Not only are there a relatively large number of studies on this psychological therapy, but the vast majority of the studies have found it to be quite effective, more so than even some of the commonly used medications, and without the side effects.67
In addition to significantly reducing IBS symptoms and improving quality of life, the results from treatment with CBT tend to last! Studies looking at the longevity of improvements seen after a course of CBT have found that results last up to 2 years.8
What happened after 2 years? Well, we really don’t know because researchers just haven’t taken the time to follow up with people past the 2 year mark yet.
Because of all the research backing the use of CBT to treat IBS, this powerful treatment is recommended by the American College of Gastroenterology (ACG), 9as well as reputable international organizations such as the British Society of Gastroenterology.10
Why does CBT for IBS work so well?
Honestly, researchers don’t know for sure the exact mechanisms behind how CBT is correcting the dysfunction that drives gut-brain disorders like IBS, but they have some theories.
One theory is that the changes in thought patterns and skills taught during treatment help put a stop to stress-induced vicious cycles, where stress of some sort leads to IBS symptoms which then causes even more stress. 114 In this model, CBT acts primarily by decreasing the stress input, which then results in improvement in IBS symptoms.
Alternatively, some researchers have found that CBT for IBS seems to work by improving IBS symptoms and behaviors more directly, which then results in decreases in stress and improvements in quality of life.1213
Either way, it’s likely that all this is happening through changes in one or more of the various pathways that connect our brain and gut. 11 For example, it is understood that chronic stress can lead to dysfunction in the stress response pathway known as the hypothalamic-pituitary-adrenal (HPA) axis.14 It’s possible that CBT may be helping by decreasing the activation of this pathway, resulting in decreased pain and normalization of gastrointestinal motility patterns.
The autonomic nervous system (ANS) is another brain-gut connector that is thought to be a source of dysfunction in some people with IBS.14 Certain exercises and techniques taught during CBT may work in part by shifting neural activity in the ANS, decreasing sympathetic activation and increasing parasympathetic activity.15
The takeaway from the studies
Whatever the mechanism, it does seem clear that by learning how to reframe and manage thoughts and behaviors through CBT, we can cut off one of the fuels to the fire that is IBS.
Why Isn't CBT Being Used More Often For IBS?
Stigma
No doubt one of the reasons is just the unfortunate stigma around psychotherapy in general. Luckily things are improving on this front as more people become educated on the gut-brain axis and how tightly tied our thoughts, feelings, and behaviors are to our physiological functioning.
Limited access to 1-1 face-to-face CBT
Another big reason CBT isn’t used more often to treat IBS is because of limited access to care. Not all insurance companies cover psychotherapy services for IBS, and people may not realistically even have the time to do the 1-hour therapy sessions for 2-3 months, as is typical for CBT. Thankfully, there are some convenient alternative options – which we cover below.
How To Get Access To CBT
How to find a good CBT therapist for IBS
Finding a qualified therapist can be a bit tricky since there isn’t a standardized protocol or CBT for IBS specialized certification just yet. We recommend first checking with your doctor, as they may have a list of experienced therapists that they can make a referral to. If not, you can also check out the online therapist resources below to help narrow down the search.
If you’re having a hard time finding someone in your area, keep in mind that many therapists these days are offering video visits and may be able to work with you remotely. If you’re still unable to find a therapist to work with and are pretty self-motivated, there also are a couple of digital phone apps that are backed by at least some research that you can try.
Online therapist resources:
- Rome Foundation
- American Psychological Association
- Psychology Today
- Association for Behavioral and Cognitive Therapies
- National Register of Health Service Psychologists
CBT for IBS digital applications:
Alternative CBT formats- group, internet, phone & apps
A number of great alternatives to regular face-to-face CBT have been developed and tested. These include:
- Group CBT
- Internet- or web-based CBT
- Telephone CBT
- CBT workbooks or digital applications
Most of the protocols in the studies on these alternative delivery methods did have therapists that interacted directly with participants to some extent, but not nearly as much as full one-on-one, in-person CBT.1617
Self-guided versions of CBT have also been done, but these versions tended to have high dropout rates, 1819as it seems people have a harder time sticking to a program without at least a few appointments with a therapist.
The great news is that all of these delivery methods have been shown to be similarly effective for significantly improving IBS symptoms and improving quality of life for those that go through them.20
Translation? Pick the version that works best for you!
Summary & Verdict
- Cognitive behavioral therapy (CBT) is a type of psychological therapy that has been used for decades to effectively treat several types of disorders.
- CBT is a short-term, highly-structured, present-centered therapy that focuses on correcting negative thought patterns, as well as teaching practical skills.
- CBT for IBS is very similar to regular CBT, except that the therapy is centered around IBS symptoms and behaviors.
- CBT is thought to work by correcting dysfunction in the gut-brain axis
- CBT for IBS is one of the most well-studied and effective non-pharmacological treatments for IBS currently available, as evidenced by numerous studies and meta-analyses.
- Several alternatives to traditional one-on-one CBT have also been studied and shown to be similarly effective. These include group CBT, web- or internet-CBT, and telephone CBT.
- Completely self-guided versions using an app or workbook are also available, but may not be quite as effective and require a lot of self motivation to make sure you keep on track and complete the lessons.
