IBS & Cognitive, behavioural therapy query

I have been working with a GI psychologist doing CBT, and I previously had a therapist who mostly used a CBT approach. I have multiple chronic conditions including chronic pain, m functional dyspepsia, and other IBS-like symptoms without having IBS.

My GI doctor referred me initially to a GI psychologist for gut directed hypnotherapy, which I was very open to and even tried it a bit but our sessions were cut off by the COVID lockdown and it took them a while to get appointments and telehealth up and running. I didn’t have reliable internet access, and we couldn’t continue because with my history we didn’t feel it would be completely safe for me to try new sessions alone.

So we switched to more CBT, but there’s a strict limit on the number of sessions allowed at my academic medical center and she had to discharge me…which eventually led me to the person I’m seeing how.

That may be too much backstory.

Anyway, I’ve had a positive experience each time (it’s a really long story but I’ve had a lot of unforeseen interruptions in my care that led to all the switching). I do feel one has to be ready for acknowledging that it’s not a cure. The goal is to improve symptoms and quality of life and feel better, but you can also have improved quality of life while still having IBS and IBS symptoms, maybe forever.

I follow some of the chronic pain groups on Connect, including some of the IBS conversations and it’s very clear from some of the conversations that some people aren’t ready to accept that either because they’re just not ready, or they’re still in that headspace that if they could only find the right food to eliminate, the right supplement, or just try hard enough, eventually everything would be “back to normal.” And that’s okay and makes sense. I just personally don’t feel CBT would be a good fit.

It’s helping me reduce stress and the suffering from negative feelings about my chronic pain conditions, and especially helped me process complicated feelings, guilt and food confusion/anxiety I developed because of all the pressure to eliminate foods to cure myself. My hope is eventually that could lead to improved symptoms. But for right now, I want to be able to have improved mood, less guilt, and less food confusion.

I find it’s also really helping me because I see a GI dietician, and my psychologist is helping me get through some of the barriers that make it hard for me to implement her strategies. Some of them are barriers to access and time, and just having trouble making the changes, and some of them have to do with psychological barriers and “unhelpful thoughts.”

For example, one of my struggles is I don’t eat enough, so we all share the same goal of trying to help me eat more and more diversity of foods, eat enough, and eat for joy. But it feels like an obstacle course to find something I can tolerate and some things I’m more nervous about trying. That’s something the RD can help us with ideas and a little of how to implement. And the psychologist can help me with how I feel about it, coach me a bit and help me build confidence.

In that way, I feel it’s more directly helping my symptoms because the psychologist is helping me navigate the thoughts and fears about trying different foods.

I feel to really take advantage and make progress, you have to trust your therapist and have it be a fit, it helps for them to understand GI conditions or chronic pain, and you both really have to believe and be committed to improving the brain-gut connection and be willing to work on it—by trying different things to decrease stress and suffering, relaxation techniques, etc. And believing that it’s a real and science-backed way to improve symptoms even if it’s not a cure. But also that even if you might still have symptoms, you can still live a life a value.

I feel like that seems muddled. It feels hard for me to explain.

But if you have specific questions, feel free to ask. I’ve now met or corresponded with 3 GI psychologists and multiple health psychologists for various reasons.

Thankyou for your comprehensive reply, i think i have some understanding of what you have been experiencing…. 🙌
One comment is a little curious to me , if I may ask please, where you say that you have all the symptoms of IBS but not IBS, what makes this a reality for you please? Or is this comment something a GI specialist has advised you?
I feel I am open to anything that may help… And definitely thinking of giving CBT a good try . I wish you wellness . 🙌

You’re welcome, glad it helps at least a bit.

I meant that I don’t have an official diagnosis of IBS. I don’t meet the diagnostic criteria, but I have some symptoms that occur in IBS, such as: intermittent constipation, slowed motility, abdominal distention, abdominal pain, appetite loss and early satiety.

My actual GI diagnosis is for functional dyspepsia (FD), because I have more upper GI symptoms whereas IBS is more lower GI symptoms but both are categorized as functional gastrointestinal disorders that involve brain-gut dysregulation—and those are the types of GI disorders that are a good fit for things like CBT and gut directed hypnotherapy.

But in the big picture, I have other chronic conditions that can trigger either IBS or FD…it just so happens that I have a diagnosis for FD but not IBS and there’s a lot of overlap in symptoms, so also a lot of overlap in treatment options, including CBT. Didn’t meant to confuse you 🙂

I do feel it’s worth trying CBT if you can find a therapist you feel comfortable with, who’s also understanding of GI conditions. That can be tough outside an academic medical center though.

Hope that helps and wishing you all the best!

Thankyou .
Your chat is very interesting to me. I have mostly upper attract discomfort. Bloating to the extreme , extended uppergut , lack of appetite and satiate, easily. constantly burping, i mean several times in a minute, sometimes other times, less frequent,, and all night, long,.
Gas trapped in my chest, causing pain due to non-dispersement and diarrhoea that presents itself quite regularly where food has not been processed at all and with little or no warning, the diarrhoea itself does not create a great deal of pain which I am grateful for. My specialist has not mentioned dyspepsia to me at all… Food intolerances are hard to trace as it seems I can eat something one day and have lots of symptoms and eat the same the next day, without a great deal of issue… I have had a colonoscopy and Endo flight, which showed nothing except a little gastritis. I’m about to have another colonoscopy… I am wondering if IBS is the correct diagnosis for me also.?? I guess we will keep pondering all that we can. Cheers and thank you again.

I have done some apps. A free one for anxiety and Mahana, for IBS, that is free for the first (very useful) segment. There is a GI Psychology group in Burke, VA that only does telehealth appoints. They seem quite popular and of course you could live anywhere and be a client. If you try anything of this ilk you will learn things that are useful. For me, my IBS is in my gut (what I eat) and my head. I have to work on both.

My GI doctor from UCLA has started me on a very low dose of Nortriptyline. It is used in a low dose to treat visceral hypersensitivity. Has anyone taken this medicine?

Thanks for sharing these. I wasn’t familiar with either and those sound like great resources.

I like how you put it, that your IBS is in your gut and your head 🙂

I’ve used Nerva (the app), which does have a free trial, but they’ve since changed to a subscription model that costs quite a bit. Insight Timer (meditation app) has some things labeled as gut directed hypnotherapy but I’m not sure how closely they are to the clinical models. But it’s free.

I haven’t, but I’d be really interested to hear your experience with it if you move forward, or anyone else’s.

I want so much to make more progress but I’m leery of the neuromodulators because I’m very sensitive to medication, even in situations where I took a fraction of the dose. And I always read or year about “limited research” and “some research” to show that low doses of neuromodulators may help, but response is very individual, etc. It just sounds very wishy washy and risky for my medication sensitivity.

But I really hope it works for you if you decide to move forward and would love to hear your experience.

I’ve been Dx with IBS-C for over 2 years. No prescription meds have helped. None of the over-the-counter laxatives work. MiraLAX, which was prescribed by the doctor cause nausea every morning. What helps me manage my pain and symptoms the most is reducing anxiety, stress as well as managing my food. Eating on a routine schedule and making sure my stomach is not empty in the morning have helped.
I reduce stress by daily meditations, engaging in activities that bring me joy, I am involved in a spiritual group and writing group as well as some light physical activity. I’m also very careful about who I spend time with. I chose to be with non-judgmental, kind and spiritual people who think as I do. Yes I still have a difficult starting the day, and I haven’t eliminated all my symptoms, but I’m managing and basically only uncomfortable a couple of hours in am. Hate this disorder for it has changed my life, but I’m alive and trying my best to bring joy and self love to my soul.

Thanks for sharing this. It’s so good to hear of people who’ve benefited from this approach. I think it doesn’t feel as satisfying or easy to do as having a “cure” or taking a pill to make it go away.

The science on the brain/gut connection is real though, and I believe things like this can work—it’s not just hokey or condescending healthism. But the trick is finding strategies that work for each person.

I have functional GI symptoms along with other chronic pain syndromes so it’s likely things in this “category” of interventions will help me.

So glad you’ve been able to find a combination that works for you and are feeling better.