What is Irritable Bowel Syndrome (IBS), and what sort of help is available for IBS sufferers in Brisbane?
Seeing a psychologist for IBS doesn’t mean it’s “all in your head” – we now know there are physiological factors at play. Rather, a psychologist with experience in this area can assist with strategies to help you manage the triggers and symptoms so you can enjoy a better quality of life.
Symptoms of IBS
Studies suggest that 20% of Australians experience IBS at some time in their lives. The main symptoms include constipation or diarrhoea, bloating, nausea and stomach pain; it is usually classified as being constipation-dominant, diarrhoea-dominant or alternating.
The most distressing symptom is diarrhoea that is hard to control – the diarrhoea-dominate type. In this case most of the time stools are just loose, but sometimes when they are liquid, it can feel difficult to keep them in the body without exploding. Soiling clothes is rare, but a real fear. Somebody with this condition may not venture far without finding out where the toilets are first, and whether they can be accessed quickly. For good reasons diarrhoea-dominant IBS causes enormous anxiety, and can restrict a person’s social and work life.
Medical Checks First
Most people with IBS see their medical practitioner to make sure nothing more serious is causing IBS, such as cancer or inflammatory bowel disease. IBS cannot cause these more serious conditions.
Common Causes
The cause of IBS is not exactly known, but there are a number of factors that may be involved (see below).
Food intolerance is usually the first one that is focused on. By the time a person comes to see a Psychologist, they have usually been checked for food allergies. The most common food triggers are dairy products (lactose intolerance), sorbitol and fructose.
Medications may also trigger the problem. Pathogens such H. Pylori, a cause of stomach ulcers, has no association with IBS (1), however infections can cause IBS, probably by disrupting the normal balance of bacteria in the gut (the micro biome).
A More Technical Explanation for Cause
IBS used to be regarded as a condition with no physiological abnormalities, and patients felt stigmatised that it was “all in their heads”.
Stress and especially anxiety do correlate highly with IBS. However research has moved on and now it has been found that there are biological abnormalities present. The best understanding comes from the Biopsychosocial Model which ascribes the cause to a genetic predisposition, low-grade inflammation, dysregulation of the gut-brain axis, gut motility problems, overuse of antibitotics, visceral gut hypersensitivty, gut bacteria imbalances and psychological factors. These are chiefly stress and anxiety that contribute to gut-brain dysfunction, and also stressful life events (2).
Visceral Gut Hypersensitivity and Visceral Anxiety
What we think and feel is conveyed very directly by the gut-brain axis to our gut. Even our common speech reflects this. For example a person might say: “she makes me sick” or “I have had a gutful of him”.
We frequently experience gut symptoms corresponding to our emotions. In IBS, visceral gut hypersensitivity is often core to symptomology. Brain imaging studies have shown the IBS patients amplify emotional arousal networks in the brain in response to gut stimuli that healthy people do not, subsequently becoming more anxious, and feeding back more arousal into the autonomic system.
A person with IBS may report bloating for example, when there is no visible distention. A gut-brain axis/arousal network feedback loop is formed making things progressively worse. The good thing is, these studies give us clues to how to resolve the problem.
Psychological Interventions
Psychological interventions are effective at reducing symptoms and increasing control (3), and are considered to be an important part of overall treatment.
The results of a meta-analysis have shown improvement in bowel symptoms, such as pain and bowel functioning, reduced distress and quality of life improvements. Specialised CBT has been demonstrated consistently as an effective treatment whose gains are maintained post-treatment.
How Does CBT work?
Because our thoughts and feelings influence the Gut-brain axis, and crank up arousal networks making the gut more symptomatic, we look at our thoughts around IBS symptoms and restructure them.
Phase One: We use worksheets to track these thoughts , and when we change them this decreases stress, anxiety, and arousal and therefore decreases symptoms. We also used emotion-focused coping to track down our arousal networks.
Phase Two: Patients typically avoid places where symptom-related anxiety is high and accidents could happen, thus restricting their lives. Avoidance of anxiety only makes anxiety worse, and keeps symptoms in their place.
In the second phase the patient does some exercises to reduce their fear of symptoms and feared foods, and then goes into situations that were formerly avoided. This is done in a progressive manner, starting with easy situations first. What is discovered is that the person no longer appraises symptoms in locations as threatening, and can delay evacuation such that “urgency” is no longer a problem.
Microbiome (gut bacteria)
Utilising shotgun and 16S rRNA amplicon sequencing on feces, studies have shown different fecal microbiota composition among patients with IBS and healthy controls, but not between IBS-subtypes (4). It is hypothesised that imbalances in the composition of the microbiome may contribute to IBS, and dietary manipulations that correct these may improve symptoms.
Help for IBS Brisbane
I have a wealth of experience in helping people with IBS.
I completed my qualifications at Medical School, in the Department of Psychological Medicine, which means I am well equipped to work with conditions that have a psychological component such as IBS. I have an integrated approach that may utilise a GP in the first instance, if the sufferer has not already been.
CBT can be employed at any time medical investigations are being engaged. Next I use CBT in phases 1 then 2 to reduce symptoms. An irritable bowel severity scale is used to track progress.
Lastly, I am a partner at Microba, a company that sequences the fecal microbiome, and their report, in conjunction with consultations with their scientists, can be used to make further improvements.
Author: Paul Carver, Bsc, Msc, PG Dip Health Psych.
Paul Carver is a Brisbane psychologist with a very wide range of experience, and is focused on bringing the very best evidence-based treatments to his clients – including how to overcome anxiety disorders without medication.
To make an appointment try Online Booking. Alternatively, you can call Vision Psychology Brisbane on (07) 3088 5422.
- Qin Xiang Ng et al. Is there an association between H Pylori infection and IBS? A meta-analysis. , Gatroenterol 2019 25(37): 5702-5710
- Kinsinger, S.W. Cognitive-behavioral therapy for patients with irritable bowel syndrome: current insights. Psychology Research and Behaviour Management 2017; 10: 231-237.
- Altayar et al. Psychological Therapies in patients with IBS: a systematic review and meta-analysis of controlled trials. Gastroenterology Research and practice 2015.
- I B. Jeffery et al. Differences in Fecal Microbiomes and Metabolomes of People With vs Without Irritable Bowel Syndrome and Bile Acid Malabsorption. Gastroenterology; 2019; 158, p1016