The brain gut connection: Addressing the psychological wellbeing of people with Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder.¹ It is characterized by recurrent abdominal pain and disturbed bowel function and accounts for up to 12% of total visits to primary care providers.¹ This has huge social and economic impacts including loss of productivity and work absenteeism. It has been estimated that direct and indirect costs of IBS are upwards of 20 billion globally.¹

The psychological impact of IBS

IBS has been considered a biopsychosocial illness, characterised by the interaction of physiological and psychosocial factors.² Psychological factors, such as stressful life events impact both the onset and severity of symptoms.^3,4

Many people with IBS report experiencing feelings of worry, depression, stress, anxiety, and more specifically, gastrointestinal specific anxiety (the cognitive, emotional, and behavioural response stemming from the fear of experiencing gastrointestinal symptoms). Additionally, some people with IBS report a heightened sense of pain known as pain sensitization.⁵ Pain sensitization has been associated with more severe symptoms and lower quality of life.^6,7

The heterogeneity in symptoms experienced by patients may be one reason why many feel dissatisfied with their prescribed treatment approach.⁸ Given that IBS has psychosocial impacts, it is perhaps not surprising that many patients have found psychological approaches to be effective in alleviating symptoms.⁸

Targeting the psychological symptoms of IBS

Acceptance and Commitment Therapy (ACT) is a psychological approach that uses acceptance, mindfulness, commitment and behaviour change to support people to increase their psychological flexibility by developing their ability to be in the present moment.⁹ ACT is based on the belief that responding to difficult situations with acceptance and mindfulness is more helpful than avoiding difficult emotions. It involves the use of guided exercises and mindfulness strategies to identify effective and fulfilling coping strategies.¹⁰

Psychological flexibility is the ability to contact the present moment more fully to change or persist in helpful behaviours.⁹

ACT has been shown to reduce headache frequency, severity and medication use in people suffering from depression related migraines¹¹ and there is evidence to suggest that ACT can promote self-management in people with long term conditions such as diabetes and cardiac disease.¹²

The application of ACT in patients with IBS is relatively new, however it has had promising results. ACT based therapies may decrease IBS symptom severity and gastrointestinal-specific anxiety.¹³ ACT has also been found to decrease levels of depression in people suffering from IBS, while also enhancing their self-esteem and confidence in their ability to manage problems.¹⁴ A recent systematic review investigated the effectiveness of ACT to address IBS-related pain and found that ACT reduced pain sensitization symptoms and improved quality of life.¹⁵

The Accessibility of ACT

While ACT is most effective when delivered by a trained therapist, it has been found that self-guided exercises completed at home can increase psychological wellbeing.¹⁶ There are many ACT-based exercises available online. Mindfulness, which involves bringing your attention to the present moment, can be facilitated through guided exercises that bring your attention to your breath, emotions or surroundings. Why not try this mindfulness of emotions exercise? You can also listen to a guided mindfulness exercises on our website, here.

References

1. (IFFGD) IFfGD. Facts about IBS. Accessed March 19, 2022. https://aboutibs.org/what-is-ibs/facts-about-ibs/statistics/

2. Windgassen S, Moss-Morris R, Goldsmith K, Chalder T. Key mechanisms of cognitive behavioural therapy in irritable bowel syndrome: The importance of gastrointestinal related cognitions, behaviours and general anxiety. J Psychosom Res. Mar 2019;118:73-82. doi:10.1016/j.jpsychores.2018.11.013

3. Surdea-Blaga T, Băban A, Dumitrascu DL. Psychosocial determinants of irritable bowel syndrome. World J Gastroenterol. Feb 21 2012;18(7):616-26. doi:10.3748/wjg.v18.i7.616

4. Kinsinger SW. Cognitive-behavioral therapy for patients with irritable bowel syndrome: current insights. Psychol Res Behav Manag. 2017;10:231-237. doi:10.2147/prbm.S120817

5. Drossman D. Understanding and managing pain in IBS. International Foundation for Gastrointestinal Disorders. Accessed March 16, 2022. https://iffgd.org/wp-content/uploads/274_Pain_in_IBS_UPDATED.pdf

6. Simrén M, Törnblom H, Palsson OS, Van Oudenhove L, Whitehead WE, Tack J. Cumulative Effects of Psychologic Distress, Visceral Hypersensitivity, and Abnormal Transit on Patient-reported Outcomes in Irritable Bowel Syndrome. Gastroenterology. 2019;157(2):391-402.e2. doi:10.1053/j.gastro.2019.04.019

7. Sebastián Sánchez B, Gil Roales-Nieto J, Ferreira NB, Gil Luciano B, Sebastián Domingo JJ. New psychological therapies for irritable bowel syndrome: mindfulness, acceptance and commitment therapy (ACT). Revista Española de Enfermedades Digestivas. 2017;109:648-657.

8. Tanaka Y, Kanazawa M, Fukudo S, Drossman DA. Biopsychosocial model of irritable bowel syndrome. J Neurogastroenterol Motil. Apr 2011;17(2):131-9. doi:10.5056/jnm.2011.17.2.131

9. Hayes SC. Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behavior Therapy. 2004/09/01/ 2004;35(4):639-665. doi:https://doi.org/10.1016/S0005-7894(04)80013-3

10. Wetherell JL, Afari N, Rutledge T, et al. A randomized, controlled trial of acceptance and commitment therapy and cognitive-behavioral therapy for chronic pain. Pain. Sep 2011;152(9):2098-2107. doi:10.1016/j.pain.2011.05.016

11. Dindo L, Recober A, Marchman J, O’ Hara MW, Turvey C. One-Day Behavioral Intervention in Depressed Migraine Patients: Effects on Headache. Headache: The Journal of Head and Face Pain. 2014;54(3):528-538. doi:https://doi.org/10.1111/head.12258

12. Graham CD, Gouick J, Krahé C, Gillanders D. A systematic review of the use of Acceptance and Commitment Therapy (ACT) in chronic disease and long-term conditions. Clinical Psychology Review. 2016/06/01/ 2016;46:46-58. doi:https://doi.org/10.1016/j.cpr.2016.04.009

13. Gillanders D, Ferreira NB, Angioni E, Carvalho SA, Eugenicos MP. An implementation trial of ACT-based bibliotherapy for irritable bowel syndrome. Journal of Contextual Behavioral Science. 2017/04/01/ 2017;6(2):172-177. doi:https://doi.org/10.1016/j.jcbs.2017.04.006

14. Mirsharifa SM, Mirzaian B, Dousti Y. The Efficacy of Acceptance and Commitment Therapy (ACT) Matrix on Depression and Psychological Capital of the Patients with Irritable Bowel Syndrome. Open Access Maced J Med Sci. Feb 15 2019;7(3):421-427. doi:10.3889/oamjms.2019.076

15. Galvez-Sánchez CM, Montoro CI, Moreno-Padilla M, Reyes del Paso GA, de la Coba P. Effectiveness of Acceptance and Commitment Therapy in Central Pain Sensitization Syndromes: A Systematic Review. Journal of Clinical Medicine. 2021;10(12):2706.

16. Fledderus M, Bohlmeijer ET, Pieterse ME, Schreurs KM. Acceptance and commitment therapy as guided self-help for psychological distress and positive mental health: a randomized controlled trial. Psychol Med. Mar 2012;42(3):485-95. doi:10.1017/s0033291711001206