Cognitive Behavioral Therapy for Chronic Gastrointestinal Disorders

This workshop covers what is known about the etiology and symptoms of IBS, how IBS patients present in clinical practice, IBS in the context of co-morbid panic and agoraphobia and/or social anxiety disorder, formulating appropriate treatment goals and basic cognitive and behavioral strategies for treating IBS, including IBS that is comorbid or secondary to an underlying IBD. Case material reflecting patients along a spectrum of severity will also provide for lively discussion and acquisition of new skills and techniques.

Gastrointestinal disorders of all kinds are exacerbated by stress and are also stressful. Irritable Bowel Syndrome (IBS) is a highly prevalent (approximately 10% of the population) functional bowel disorder that is highly co-morbid with anxiety disorders and depression and shares considerable conceptual overlap with panic disorder, agoraphobia and social anxiety. It also leads to considerable disability and distress. Managing these patients effectively requires a good conceptual understanding of the biopsychosocial and cognitive underpinnings of IBS as well as the kinds of avoidance behaviors (both obvious and subtle) that maintain and often exacerbate both symptoms and disability.  General CBT skills are essential, but incorporating GI specific phenomena (like bowel control anxiety and fear of food) are also important. There is significant empirical evidence supporting the use of CBT in treating IBS. The inflammatory bowel diseases (IBDs), such as Crohn’s Disease and ulcerative colitis, have clear biological pathophysiology, but share some of the same symptoms and can lead to heighted risk for IBS in a subset of patients. In addition, many IBD patients experience shame, avoidance and social anxiety about their condition.

Learning Objectives:

1) How to develop a case conceptualization that integrates GI disorders with any co-morbid mood or anxiety disorders.

2) What unique cognitive distortions and behavioral avoidance strategies (especially fear of incontinence and dietary restrictions) tend to maintain and exacerbate distress and disability in GI disorders.

3) How to modify the standard CBT approach to anxiety disorders to treat GI patients effectively, including collaborating successfully with gastroenterologists.