Last Updated: 24 November 2022

Cognitive Behavioral Therapy for IBS – Does It Help?

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Cognitive behavioral therapy (CBT) has been used for decades to treat issues like depression and anxiety. But more recently, people have started turning to it in the hopes that it can relieve IBS symptoms. In this guide, we investigate exactly what is involved and how it might help (based on the latest research).
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Table of Contents

    What Is Cognitive Behavioral Therapy?

    Regular 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. 1Since 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. 2Unlike 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

    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.

    1. 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. 114In this model, CBT acts primarily by decreasing the stress input, which then results in improvement in IBS symptoms.
    2. 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
    Why does CBT work so well for IBS?
    CBT may work to reduce stress input or may work more directly on symptom reduction

    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. 11For 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:

    CBT for IBS digital applications:

    How to find convenient CBT therapy - 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

    IBS ebook

    Which Foods Really Trigger Your IBS?

    Discover exactly which foods you should and shouldn’t eat using our IBS Food Journal.

    1. Tang QL, Lin GY, Zhang MQ. Cognitive-behavioral therapy for the management of irritable bowel syndrome. World J Gastroenterol. 2013 Dec 14;19(46):8605-10. doi: 10.3748/wjg.v19.i46.8605. PMID: 24379577; PMCID: PMC3870505.

    2. Orock A, Yuan T, Greenwood-Van Meerveld B. Importance of Non-pharmacological Approaches for Treating Irritable Bowel Syndrome: Mechanisms and Clinical Relevance. Front Pain Res (Lausanne). 2021 Jan 21;1:609292. doi: 10.3389/fpain.2020.609292. PMID: 35295688; PMCID: PMC8915633.

    3. Van Oudenhove L, Crowell MD, Drossman DA, Halpert AD, Keefer L, Lackner JM, Murphy TB, Naliboff BD, Levy RL. Biopsychosocial Aspects of Functional Gastrointestinal Disorders. Gastroenterology. 2016 Feb 18:S0016-5085(16)00218-3. doi: 10.1053/j.gastro.2016.02.027. Epub ahead of print. PMID: 27144624; PMCID: PMC8809487.

    4. Kinsinger SW. Cognitive-behavioral therapy for patients with irritable bowel syndrome: current insights. Psychol Res Behav Manag. 2017 Jul 19;10:231-237. doi: 10.2147/PRBM.S120817. PMID: 28790872; PMCID: PMC5530860.

    5. Radziwon CD, Lackner JM. Cognitive Behavioral Therapy for IBS: How Useful, How Often, and How Does It Work? Curr Gastroenterol Rep. 2017 Aug 17;19(10):49. doi: 10.1007/s11894-017-0590-9. PMID: 28819814.

    6. Ford AC, Lacy BE, Harris LA, Quigley EMM, Moayyedi P. Effect of Antidepressants and Psychological Therapies in Irritable Bowel Syndrome: An Updated Systematic Review and Meta-Analysis. Am J Gastroenterol. 2019 Jan;114(1):21-39. doi: 10.1038/s41395-018-0222-5. PMID: 30177784.

    7. Li L, Xiong L, Zhang S, Yu Q, Chen M. Cognitive-behavioral therapy for irritable bowel syndrome: a meta-analysis. J Psychosom Res. 2014 Jul;77(1):1-12. doi: 10.1016/j.jpsychores.2014.03.006. Epub 2014 Mar 26. PMID: 24913335.

    8. Everitt HA, Landau S, O’Reilly G, Sibelli A, Hughes S, Windgassen S, Holland R, Little P, McCrone P, Bishop FL, Goldsmith K, Coleman N, Logan R, Chalder T, Moss-Morris R. Cognitive behavioural therapy for irritable bowel syndrome: 24-month follow-up of participants in the ACTIB randomised trial. Lancet Gastroenterol Hepatol. 2019 Nov;4(11):863-872. doi: 10.1016/S2468-1253(19)30243-2. Epub 2019 Sep 3. PMID: 31492643; PMCID: PMC7026694.

    9. Lacy BE, Pimentel M, Brenner DM, Chey WD, Keefer LA, Long MD, Moshiree B. ACG Clinical Guideline: Management of Irritable Bowel Syndrome. Am J Gastroenterol. 2021 Jan 1;116(1):17-44. doi: 10.14309/ajg.0000000000001036. PMID: 33315591.

    10. Vasant DH, Paine PA, Black CJ, Houghton LA, Everitt HA, Corsetti M, Agrawal A, Aziz I, Farmer AD, Eugenicos MP, Moss-Morris R, Yiannakou Y, Ford AC. British Society of Gastroenterology guidelines on the management of irritable bowel syndrome. Gut. 2021 Jul;70(7):1214-1240. doi: 10.1136/gutjnl-2021-324598. Epub 2021 Apr 26. PMID: 33903147.

    11. Palsson OS, Ballou S. Hypnosis and Cognitive Behavioral Therapies for the Management of Gastrointestinal Disorders. Curr Gastroenterol Rep. 2020 Jun 3;22(7):31. doi: 10.1007/s11894-020-00769-z. PMID: 32495233.

    12. Lackner JM, Jaccard J, Krasner SS, Katz LA, Gudleski GD, Blanchard EB. How does cognitive behavior therapy for irritable bowel syndrome work? A mediational analysis of a randomized clinical trial. Gastroenterology. 2007 Aug;133(2):433-44. doi: 10.1053/j.gastro.2007.05.014. Epub 2007 May 21. PMID: 17681164; PMCID: PMC2645996.

    13. Lackner JM, Jaccard J, Krasner SS, Katz LA, Gudleski GD, Blanchard EB. How does cognitive behavior therapy for irritable bowel syndrome work? A mediational analysis of a randomized clinical trial. Gastroenterology. 2007 Aug;133(2):433-44. doi: 10.1053/j.gastro.2007.05.014. Epub 2007 May 21. PMID: 17681164; PMCID: PMC2645996.

    14. Fukudo S. IBS: Autonomic dysregulation in IBS. Nat Rev Gastroenterol Hepatol. 2013 Oct;10(10):569-71. doi: 10.1038/nrgastro.2013.166. Epub 2013 Sep 3. PMID: 23999321.

    15. Jang A, Hwang SK, Padhye NS, Meininger JC. Effects of Cognitive Behavior Therapy on Heart Rate Variability in Young Females with Constipation-predominant Irritable Bowel Syndrome: A Parallel-group Trial. J Neurogastroenterol Motil. 2017 Jul 30;23(3):435-445. doi: 10.5056/jnm17017. PMID: 28480684; PMCID: PMC5503294.

    16. Lackner JM, Jaccard J, Keefer L, Brenner DM, Firth RS, Gudleski GD, Hamilton FA, Katz LA, Krasner SS, Ma CX, Radziwon CD, Sitrin MD. Improvement in Gastrointestinal Symptoms After Cognitive Behavior Therapy for Refractory Irritable Bowel Syndrome. Gastroenterology. 2018 Jul;155(1):47-57. doi: 10.1053/j.gastro.2018.03.063. Epub 2018 Apr 25. Erratum in: Gastroenterology. 2018 Oct;155(4):1281. PMID: 29702118; PMCID: PMC6035059.

    17. Everitt H, Landau S, Little P, Bishop FL, O’Reilly G, Sibelli A, Holland R, Hughes S, Windgassen S, McCrone P, Goldsmith K, Coleman N, Logan R, Chalder T, Moss-Morris R. Therapist telephone-delivered CBT and web-based CBT compared with treatment as usual in refractory irritable bowel syndrome: the ACTIB three-arm RCT. Health Technol Assess. 2019 Apr;23(17):1-154. doi: 10.3310/hta23170. PMID: 31042143; PMCID: PMC6545494.

    18. Owusu JT, Sibelli A, Moss-Morris R, van Tilburg MAL, Levy RL, Oser M. A pilot feasibility study of an unguided, internet-delivered cognitive behavioral therapy program for irritable bowel syndrome. Neurogastroenterol Motil. 2021 Nov;33(11):e14108. doi: 10.1111/nmo.14108. Epub 2021 Mar 21. PMID: 33745228.

    19. Hunt M, Miguez S, Dukas B, Onwude O, White S. Efficacy of Zemedy, a Mobile Digital Therapeutic for the Self-management of Irritable Bowel Syndrome: Crossover Randomized Controlled Trial. JMIR Mhealth Uhealth. 2021 May 20;9(5):e26152. doi: 10.2196/26152. PMID: 33872182; PMCID: PMC8176342.

    20. Black CJ, Thakur ER, Houghton LA, Quigley EMM, Moayyedi P, Ford AC. Efficacy of psychological therapies for irritable bowel syndrome: systematic review and network meta-analysis. Gut. 2020 Aug;69(8):1441-1451. doi: 10.1136/gutjnl-2020-321191. Epub 2020 Apr 10. PMID: 32276950.

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