Can Cognitive Behavioral Therapy Alleviate IBS Symptoms?

Imagine you’re at a party and you suddenly need to use the bathroom, but there’s a line, or you experience an irritable bowel syndrome (IBS) flare-up during a long flight. For IBS sufferers, these situations are normal. Symptoms like diarrhea or gas can be embarrassing, and can make socializing and travel stressful and worrisome.

What’s more, the anticipation an IBS flare can itself trigger stress, causing symptom-related anxiety to exacerbate bowel sensitivity, which can then worsen GI symptoms, creating a vicious cycle.

One way to manage is through cognitive behavioral therapy (CBT), a form of psychotherapy that focuses on symptom-related worry.

“CBT targets brain-gut pathways, which are thought to be a key contributor to IBS,” says Sarah Kinsinger, PhD, a clinical health psychologist and the director of behavioral medicine for the digestive health program at Loyola University Health System in Chicago.

People with IBS tend to have a super-sensitive gut, so stress and anxiety can aggravate what’s going on in a person’s tummy. For example, anxiety can cause the brain to misinterpret pain signals from the gut, causing more severe stomach pain.

A study published in the journal Brain, Behavior, and Immunity explored how stress is related to IBS symptoms, and researchers found that people with IBS may have an altered physical response to stress that causes their immune system to activate, triggering inflammation and IBS symptoms.

“With CBT, we can directly influence symptoms because we’re using the brain to more effectively communicate with the gut,” says Dr. Kinsinger. “We don’t have a cure, but we can help people get a handle on this disorder.”

What Does the Science Say About Cognitive Behavioral Therapy for IBS?

While there haven’t been studies that directly compare psychological therapies with medication, research does suggest that treatments like CBT can help with IBS symptoms.

“Cognitive behavioral therapy as a treatment for IBS is supported by over 30 years of research,” Kinsinger says. “Studies have consistently found that a majority of patients experience a significant reduction in IBS symptoms — less pain, more regular bowel movements — following a course of treatment.”

According to an article published by Kinsinger in Psychology Research and Behavior Medicine in 2017, studies consistently show CBT can be effective in alleviating IBS symptoms for at least one year after treatment.

Some studies, including one published in 2019 in the Lancet Gastroenterology & Hepatology, have found that people who receive CBT maintain a drop in GI symptoms for up to 24 months, suggesting the therapy works both in the short and long term.

But CBT isn’t for everyone with IBS, cautions Christine Frissora, MD, a gastroenterologist and an associate professor of clinical medicine at the Joan and Sanford I. Weill Medical College of Cornell University in New York City.

“If you think stress or anxiety is a trigger for your IBS, cognitive therapy can be helpful,” she says. But for people who develop IBS after a bout of a severe food poisoning or intestinal infection, the trigger is likely a shift in bacterial balance in the GI tract.

“Cognitive therapy can’t change the bacterial environment in the gut,” says Dr. Frissora.

But she does think it can provide coping strategies and help people be more aware of their symptoms.

“For IBS, you have to treat everything, so I would use CBT, medication, exercise, diet, and even physical therapy to help,” she says.

How Does CBT Work and Why Is It Effective for IBS?

For starters, CBT isn’t the same as traditional psychotherapy. “CBT is a form of treatment for a medical condition — it involves focusing in on factors, like anxiety, that play a role in symptoms,” says Kinsinger.

It’s generally designed for the short term, requiring as few as four to five sessions. Plus, many patients find it appealing because it’s a nonmedication treatment approach, she says.

CBT teaches people to better regulate the body's physical response to stress.

Some of the coping skills work to:

• Dispel myths about IBS, teaching people how the mind and body are connected and reasons why behavioral therapy can help.
• Help people learn relaxation skills, such as deep breathing (diaphragmatic breathing), which can have a calming effect on the gut and reduce symptoms in the moment. There are many free apps available that can be helpful for understanding and practicing this technique.
• Reduce the negative thought patterns that can worsen symptoms.

Using techniques such as cognitive restructuring, Kinsinger teaches people to recognize when they’re having distorted thoughts and to replace them with more positive self-talk.

“If a person starts having cramps or their IBS acts up at a social event, we help them shift their thinking about their symptoms, like convincing themselves the symptoms will pass, or finding a distraction so they don’t fixate on the anxiety all night,” she says.

Virtual Cognitive Behavioral Therapy for IBS

Research has shown that face-to-face CBT can help ease IBS symptoms, but is virtual therapy via the web or phone as effective?

One study published in April 2019 in the journal Gut sought to answer this question. Researchers randomly assigned 558 participants with IBS to one of three groups: standard treatment only — including dietary changes and medication; or usual treatment combined with either web or phone-based CBT.

After one year of follow-up, those who participated in one of the two CBT groups in addition to dietary changes and medication reported a much greater reduction in symptom severity than people who received only the standard treatment.

“Sometimes with chronic diseases such as IBS, people get into unhelpful patterns of behavior and have unhelpful thoughts that exacerbate their symptoms and the impact of the symptoms on their ability to live their lives,” says the lead study author, Hazel Everitt, MBBS, PhD, a general practitioner and a researcher at the University of Southampton in the United Kingdom.

“Our CBT programs enable patients to pinpoint things that they can do to reduce the impact of their IBS on their lives, and this helps them manage their IBS more effectively than current treatment as usual,” Dr. Everitt says.

A research review published in June 2022 in the Journal of Medical Internet Research found that internet-delivered CBT had medium to large effects on symptom severity for IBS patients in both the short and long term, though the authors note more robust studies are needed.

How to Find a Therapist Who Practices CBT for IBS

So how do you find a CBT therapist specifically for IBS? Unfortunately, there aren’t many psychologists who specialize in GI-related anxiety, notes Kinsinger.

“You would have to find a psychologist who specializes in health psychology — someone who’s worked with patients in a hospital setting,” she says.

Resources like the Association for Behavioral and Cognitive Therapies and the Rome Foundation can help you find the right practitioner. Also, many university GI centers have GI psychology groups now, which you can look up to find the help you need.