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June 23, 2017

Cognitive behavioral therapy (CBT) helps your stress related GI problems

Although stress is not the cause of irritable bowel syndrome (IBS) or of inflammatory bowel disease (IBD), acid reflux (GERD) or chronic indigestion (dyspepsia or non ulcer dyspepsia NUD), it is clear that stress can bring on symptoms of any of these and make these disorders harder to control or cope with.

As healthcare providers, our patients typically approach us looking for diet, medication advice and approaches of a “physical” nature to help symptoms, but we know that ignoring the stress and emotional aspects of a person with these conditions means we’ll have limited success improving quality of life and health status. It’s important then to understand one of the most effective methods of helping people with chronic GI conditions to improve, by recognizing and coping better with chronic stress and its consequences.

(CBT) is a type of talk therapy offered by a variety of psychologists and counselors which is helps address a variety of emotional challenges, as well as in treating conditions such as depression and anxiety which are often present in people with chronic GI ailments.

It does involve discussing your feelings, but the goal is to help teach effective coping skills. When tested against routine medical care, CBT offers additional help to as many as 80% of those who otherwise suffer from difficult GI symptoms like pain, nausea, bowel fluctuations etc. CBT is based on our understanding that the way you think about experiences including symptoms like pain influences the way you feel and behave.

Specifically, negative thought patterns or self-talk can promote feelings of powerlessness, hopelessness, fear and anxiety. These feelings in turn can make you behave in ways that reinforce your negative thoughts such as withdrawing and avoiding, which creates a harmful cycle. If you can identify and correct inaccurate or self-destructive thought patterns, you can modify related behaviors and feel greater joy and control over your symptoms and circumstances.

Numerous studies have shown CBT to be effective in treating depression, anxiety, post-traumatic stress disorder, eating disorders and substance abuse—and IBS, IBD and other chronic GI ailments. It can also help with other stressful life problems, from sleep disturbance to coping with life disruptions. CBT can help teach coping skills and improve resiliency to life and disease challenges.

CBT may be offered individually or in a group . You bring to therapy the problems you wish to focus on. It takes some brainstorming with your therapist and some homework between sessions to learn new skills, put them into practice. You track progress, fine tune the approaches. CBT sessions commonly last 30-50 minutes each, and takes multiple sessions…as few as 3, commonly about 8, to be effective and keep those skills part of you and effective over time. Years after CBT, the majority of those participating remain improved though sometimes benefit from some “refresher”.

Three phases of CBT are typical: an initial assessment phase to get comfortable with your therapist and identify the key goals to pursue, and define a general treatment plan; this focuses mostly on what are the immediate problems but also helps identify current problematic and past ways of coping with stress. Second, a learning phase focuses on new strategies and tools to deal differently with counter-productive thoughts, behaviors and to deal better with distressing symptoms. Like most learning, there are “lessons”, “homework” and commonly some limited journals to keep some notes and observe patterns. Sometimes this is relatively easy, sometimes harder…like learning anything new! The last phase, sometimes called consolidation, helps you apply your new mastered skills more on your own to new problems and review how you’ve done, like an apprentice completing training and becoming self sufficient.

We can usually help identify resources in the community for you to access CBT. Insurance coverage is varied but in most cases is affordable—or essential. Just as we prescribe medication, supplements, diet approaches and other approaches to your digestive healthcare, we prescribe CBT as a most useful modality of treatment and monitor how you’re doing when you have followup care.

For more information regarding various types of therapy to alleviate your digestive ailments, please contact one of our highly trained physicians at inSite Digestive Health Care.

Information obtained from

Mayo Clinic Health Letter July 2017 www.HealthLetter.MayoClinic.com