Cognitive Behavioral Therapy and Irritable Bowel Syndrome

1. Cognitive Behavioral Therapy and Irritable Bowel Syndrome Amy Weiman

2. Objectives • Understand irritable bowel syndrome • Realize that cognitive behavioral therapy (CBT) can be an effective counseling method • Observe techniques in brief counseling session • Review outcome of session using CBT

3. Introduction to IBS • Irritable Bowel Syndrome (IBS) is a GI disorder characterized by recurrent abdominal pain, discomfort and bloating, accompanied by alterations in bowel movements such as constipation and diarrhea. • 10-15% of Americans have IBS • There is a link between IBS and stress and anxiety • There is no cure – follow Low Fodmapsdiet • Studies show that managing stress and anxiety can be effective in controlling IBS

4. Cognitive Behavioral Therapy • Our thoughts cause behavior • We can change the way we think/feel • Learning how to think differently leads to change

5. CBT continued… • Counselor’s role: listen, teach and encourage • Client’s role: express concerns, learn and implement that learning • Focus on specific concepts/techniques • Help clients “unlearn” • Change irrational thinking patterns

6. Techniques to implement • motivational interviewing • goal setting • problem solving • behavior modification • self-monitor • Set behavior change goals • Use stimulus control

7. CBT and IBS • aims to help patients change their habitual thoughts, feelings, and behaviors thatmagnify stress and negative moods by applying a series of self-exploration exercises and stress reducing strategies.

8. CBT and IBS • Effective techniques: • Diaphragmatic/abdominal breathing, • Progressive muscle relaxation • Visualization/positive imagery • Hypnosis • Desensitization (gradual exposure to something feared)

9. CBT in ActionSession # 2 • Meet Julie: • 23 year old female • Current weight: 108lbs • Usual weight: 123lbs • Recent diagnosis of IBS • History of gastrointestinal problems • Suffers from anxiety • Full-time office job involving long phone calls and in-person client meetings usually over mealtime (at a restaurant) • Currently afraid to eat anything because of undesirable symptoms at unpredictable times

10. Conclusion • Julie was under the impression that IBS is strictly food related • Counselor helped her realize on her own that other factors might play a role • Julie began to think about her diagnosis differently • Julie is still skeptical but is willing to give some relaxation techniques a try • Counselor left it open-ended, allowing Julie to decide if relaxation will help her or not • Bringing this new idea to Julie’s attention will take time for her to decide if it is true for her or not • Julie is open to thinking about her diagnosis and its treatment differently now

11. Sources Craske, Michelle G., and Kate B. Wolitzky-Taylor. "A Cognitive-Behavioral Treatment for Irritable Bowel Syndrome Using Interoceptive Exposure to Visceral Sensations." NCBI. U.S. National Library of Medicine, June 2011. Web. 17 Nov. 2013. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3100429/>. "IBS Symptoms | IBSgroup.org." IBS Symptoms | IBSgroup.org. N.p., n.d. Web. 17 Nov. 2013. <http://www.ibsgroup.org/symptoms>. Kennedy, Tom, and Roger Jones. "Cognitive Behaviour Therapy in Addition to Antispasmodic Treatment for Irritable Bowel Syndrome in Primary Care: Randomised Controlled Trial." BMJ. BMJ Publishing Group, n.d. Web. 17 Nov. 2013. <http://www.bmj.com/content/331/7514/435>. Shepherd, Sue, and P. R. Gibson. The Complete Low-FODMAP Diet: A Revolutionary Plan for Managing IBS and Other Digestive Disorders. New York: Experiment LLC, 2013. Print. "Stress, Psychological Factors, and IBS." - AboutIBS.org. N.p., n.d. Web. 17 Nov. 2013. <http://www.aboutibs.org/site/what-is-ibs/intro-to-ibs/stress-psychological-factors>. "What Is Cognitive-Behavioral Therapy?" What Is Cognitive-Behavioral Therapy?N.p., n.d. Web. 17 Nov. 2013. <http://www.nacbt.org/whatiscbt.htm>.