U.S. Department of Health and Human Services

Brief Psychological and Educational Therapy Improves Symptoms of Irritable Bowel Syndrome

​Researchers have found that patients with irritable bowel syndrome (IBS) show an improvement in symptoms following a short course of group therapy involving psychological and educational approaches. IBS is a collection of symptoms, including abdominal pain or discomfort (such as cramping), along with diarrhea, constipation, or both. A primary reason why IBS is dificult to treat is that its exact causes are not well understood, although it is believed to have both physical and mental origins. One possible cause is a problem with communication between the brain and the gut, which could lead to changes in bowel habits. Based on this likely mind-body connection, some successful treatment of IBS has been achieved using psychological counseling and education-based therapies to help patients control the activity of their own nervous systems and gastrointestinal tracts, but variable results, along with cost issues, unavailability of trained clinicians, and a general preference for pharmaceutical remedies, have hindered the implementation of psychological therapy as a standard of treatment.

To determine if a combination of psychological and educational therapy can lead to a sustained improvement in IBS symptoms and an increase in the quality of life for patients, a team of scientists performed a clinical trial where IBS patients in the intervention group attended a ive-week series of two-hour group classes co-led by a gastroenterologist and therapist to promote self-eficacy and teach relaxation techniques. As a basis for comparison, a control group of patients was monitored while on the waiting list for the group classes. Patients who attended the group classes learned about the linkage between emotions, stress, and abdominal symptoms with an emphasis on their ability to control the activity of their own bodies. They were also taught about the connection between mood, stress, and GI symptoms, and the difference between ineffective coping styles, such as panicking during moments of anxiety, and more effective responses, such as arriving at conscious, rational solutions during stressful situations. The classes also instructed patients on deep breathing techniques and progressive muscle relaxation, including homework assignments consisting of at least 15 minutes of relaxation exercises twice a day. During and after the trial, the class participants and control patients were asked to monitor and document their symptoms in relationship with their mood states, stressors, and diets. The results of this trial suggested that patients who underwent the group psychological and educational therapy had a reduction in IBS symptoms and a better quality of life, lasting for at least three months after the trial, than those who did not participate in the class. The therapy was particularly helpful for those individuals who had a low or average quality of life prior to starting the intervention, although it had less of an effect for those whose quality of life was higher at the beginning of the study. This study demonstrated an effective, low-cost method of treating IBS symptoms, especially for those with low or average health-related quality of life, and could pave the way for the adoption of such an approach as an alternative to, or a supplement for, pharmacological therapy.

Labus J, Gupta A, Gill HK, et al. Randomised clinical trial:
symptoms of the irritable bowel syndrome are improved by
a psycho-education group intervention. Aliment Pharmacol
Ther 37: 304-315, 2013.