Irritable Bowel Syndrome May Be (At Least Partly) Psychological

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Cognitive Behavioral Therapy (or CBT) is the latest treatment to be endorsed in the fight against Irritable Bowel Syndrome (IBS). According to a study published in the medical journal GUT, CBT is more effective at alleviating the discomfort of irritable bowels than current standard care.  

Somewhere between 10 and 20 percent of the population are affected by IBS, enduring symptoms like stomach pain or cramping, bloating, constipation, and diarrhea. Other unpleasant signs include flatulence, fatigue, nausea, and incontinence.

At its most severe, the condition can have a wholly negative impact on a person's daily routine and quality of life. Yet, it is a so-called "functional disorder", which essentially means that no one really knows what causes it. There are no pathological changes that can be detected in the bowel or revealed via a medical test and so, instead, it is diagnosed by symptoms.

That is not to say that the symptoms themselves are not real or that the condition is not life-affecting. As one participant in the trial put it, "I was having to cancel events at the last minute...Wherever I went I checked, subconsciously, where the nearest toilets were!" But if the latest study is anything to go by, it suggests IBS is (at least partly) psychological in origin. 

Current medical advice centers around lifestyle tips (exercise and meditation), nutritional recommendations (try probiotics, avoid processed food, limit caffeine and alcohol consumption, etc), and medication (laxatives and Loperamide-based diarrhea relief tablets, for example). More experimental practices include fecal transplants and helminth therapy (that is, deliberately infecting yourself with intestinal worms). However, the study authors say, talking therapy (CBT specifically) seems to be a more effective method for managing IBS symptoms than traditional care.

The study involved 558 patients who had ongoing IBS symptoms and had tried other treatments for a year or more. While some continued to receive the current standard IBS treatments, others were offered eight CBT sessions specifically designed for IBS treatment. 

Twelve months later and it was the second group that reported significant improvements in their symptoms. Indeed, based on the IBS-SSS measurement system (a scale of 0 to 500), symptoms were 61 points lower in the CBT group compared to the control group post-treatment. (Anything above 50 is considered significant.) While on a personal level, many of the participants expressed relief at the results of the trial.

"There's no other way of putting it: this trial has changed my life," said Laura Day. "Everything used to revolve around my IBS, not by choice but through fear of being caught out by my symptoms. Now, at 31 years old, I barely think about it because I'm symptom-free 98% of the time."

Impressively, CBT appears to work even when it is not carried out face-to-face with a therapist. 

"The fact that both telephone and web-based CBT sessions were shown to be effective treatments is a really important and exciting discovery," Hazel Everitt, Associate Professor in General Practice at the University of Southampton, said in a statement.

"Patients are able to undertake these treatments at a time convenient to them, without having to travel to clinics."

Next steps will involve making the treatment more widely available (at least in the UK). Researchers are working with NHS therapists at pre-existing Improving Access to Psychological Therapy (IAPT) services.

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