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by Melissa G. Hunt, PhD

Irritable Bowel Syndrome (IBS), an unpleasant and often debilitating condition, is characterized by frequent, recurrent abdominal pain, as well as problems with constipation and/or diarrhea. People with IBS often experience a strong urge to use the bathroom, and may avoid going to places without easy access to one. This means that many everyday locations (malls, parks, places of worship, movie theaters, classrooms, offices) feel risky, and people might start to limit their activities as a result. People with IBS also start to fear and avoid many foods believed to trigger IBS attacks, often leading to loss of pleasure in eating as well as reduced opportunities to socialize.  This fuels a vicious cycle of discomfort, anxiety, vigilance, avoidance and visceral hypersensitivity, in which GI sensations get horribly amplified. For people with IBS, indigestion can feel like a terrifying event which could lead to excruciating pain, incontinence and humiliation. 

Luckily for sufferers of IBS, cognitive behavioral therapy (CBT) has been found to be an effective treatment for the condition. First, it is important for the practitioner to consult the patient’s other medical providers and ensure that several alternative diagnoses have been ruled out. The most important rule outs are inflammatory bowel diseases (Crohn’s and Colitis) and celiac disease (which leads to complete gluten intolerance). Fortunately, simple blood and stool tests are usually enough to rule these conditions out. The next step is educating the patient about the link between stress and arousal of the sympathetic nervous system, which can directly impact GI discomfort. IBS is not “all in your head” – the pain and GI dysfunction are very real. But stress makes GI problems worse through direct biological mechanisms. The practitioner should then train the patient in relaxation techniques like deep belly breathing. 

Once the patient is able to use these relaxation techniques effectively, it is time to introduce the CBT model, which teaches that beliefs (not situations) affect our emotions and that beliefs can be inaccurate. Inaccurate beliefs, in this case catastrophic beliefs and predictions about GI symptoms, can be altered with the help of behavioral experiments. For example, it can be helpful to send the patient to a movie theater or house of worship and have them sit in the back and count the number of people who get up and leave and then return. Often, the patient will be surprised at how often this happens and how little other people react; it can help the patient understand that having to get up and use the bathroom is not a big deal. 

The final step in CBT is exposure therapy in which the patient starts doing things they’ve been avoiding. For example, if they are afraid of long car trips, have them start by sitting in the car in their driveway for thirty minutes. Once that gets boring and easy, have them drive around the block 20 times. Then have them drive a mile away from home and back, and so on. If the patient fears incontinence, then in the safety of their own home have them experiment with “holding it” when they feel the urge, first for 30 seconds, then a minute, then 5 minutes. This will prove to them that they are able to “hold it” and catastrophizing is unnecessary.

This CBT treatment is presented at a much more detailed level in the book Reclaim Your Life from IBS: A Scientifically Proven Plan for Relief Without Restrictive Diets. The book was actually tested in a randomized controlled trial and was shown to be quite effective (Hunt, M., Ertel, E., Coello, J. & Rodriguez, L. (2014). Empirical Support for a Self-Help Treatment for IBS.  Cognitive Therapy and Research, 39(2), 215-227).  

You can also hear Dr. Hunt discuss this treatment strategy on an ADAA webinar, Overcoming Irritable Bowel Syndrome (IBS): Reclaim Your Life from Anxiety and Distress about IBS Symptoms.

I was just diagnose with Ibs and I don’t know what to eat, I just got through crying and I feel like I am a mess

Where can I turn for help. I'm at my wits end! I can no longer be the functioning career woman. I want to die! Day to day is a struggle with this debilitating, embarrassing issue. I'm fed up and need help.

Go see a Gastroenterologist to start with.

I have flare ups. Greasy food definitely makes it worse. I eat baked fish, veggies, salad. Stress or anxiety makes it worse. Some months I have no problems and then for 4 months straight I run to the bathroom. I feel medical pot helps calm the nerves and it's not so bad.

Hello Brenda,

That sounds terrible. What have you tried already to help yourself feel better? I know how crazy this anxiety can feel. I'm here to help if you want. If you wish, you may email me at optimysticoachk@gmail.com.

Have you tried any calming techniques?

Take time to practice diaphragmatic breathing. Practice while lying down and sitting or standing. Let the breathing rate slow down to about six breaths per minute. Exhale to the count of four and then let it trail off for two more counts, and inhale to the count of three and let it trail for another count.

Avoid Green leafy vegetables e.g. spinach, mustard leaves etc, Raw salad, heavy pulses like Urad, Rajma, Chana etc. Don't Drink water immediately after meals (you can take – sips of water the middle of a meal or soon after), avoid substances that are known to give you digestive trouble

I am in such fear over my flare up that I am going through now. I feel as though I have no where to turn. I have a counselor, GI and. PC, but I really can’t take this anymore.

I have told I have IBS. I have diarrhea type bowel movement every morning but not usually again during the day but if stressed it may happen more often. In the past two years, if I am under extreme stress, my morning movement will turn into severe vomiting and dry heaves that will last 2-3 days I have anti nausea and vomiting meds since I have been hospitalized 3 times now. I just came out of a bout from last week. It wipes me out for a week. Has anyone ever experienced this.

Hi Kate, I experience the exact same thing and I don’t know what to do about it.
My doctor wanted to put me on anti depressants but I said no.
Im not on any meds and I’m afraid to try anything’s.
Sometimes I’m doing really good for a couple months and then it just goes downhill as soon as something stressful in my life happens. I feel like I have no control and I always feel so sick.
Let me know if you ever find something that makes you feel better:( I can’t do this anymore..

I have the exact same problem as you, I get IBS d bowel movements every morning when I wake up but nothing else really throughout the day unless I get stressed and then feeling the urge to throw up. At least I think it’s ibs d? I haven’t got tested get for it but I’m assuming it is that since I have similar symptoms. How are you dealing with it? I don’t really know what to do since I’m only 14 years old, and I find explaining it to my parents/friends every embarrassing so I would prefer to deal with it on my own.

Yes! I was having the same thing happen to me. I let it go on for almost a year before I talked to my doctor, then saw a gastroenterologist and my diagnosis of IBS and gastritis came just this past May. I went on a PPI medication that seemed to help along with being on the BRAT diet for many months.

I got tired of doing things a certain way. Now I just live my life & carry Imodium & other tummy meds with me everywhere. I can't lose time cause of my digestion problems or the fact that my body can tell the difference between stress & excited.