Behavioral Therapy Can Help Ease Irritable Bowel Syndrome
May 9, 2000 -- People with irritable bowel syndrome (IBS) who are given
behavioral therapy along with standard medical treatment say they feel better
than people who get medical treatment alone, a new study has found.
"The data provide evidence that the combination of medical treatment
plus ... behavioral treatment is superior to medical treatment alone in therapy
of IBS," writes researcher Ingeborg Heymann-Mönnikes, MD, of the department
of medicine, Humboldt University in Berlin, Germany. Her study appears in the
current issue of the American Journal of Gastroenterology.
IBS is a common disorder whose cause is unknown. People with IBS, also known
as spastic colon, experience varying degrees of abdominal spasms and pain,
constipation, and/or diarrhea. Stress, depression, poor diet, and drugs can
worsen the symptoms.
There is no cure for IBS, but patients are often treated with
spasm-relieving medicines, mild laxatives, and mild antidiarrheal agents, and
some may also receive antidepressants, sedatives, or pain medications.
High-fiber diets can also help.
Heymann-Mönnikes and colleagues recruited 24 patients with IBS from a clinic
in Germany. The patients were screened to rule out psychological problems, and
divided into two groups. About half received standard medical therapy, seeing a
supportive physician and getting medications to treat their symptoms. The other
group got behavioral therapy along with the medical therapy.
Patients in the second group attended 10 sessions lasting about an hour
apiece, over a period of 10 weeks, Heymann-Mönnikes says. During the sessions,
they were given information about IBS and an analysis of their own illness and
symptoms, as well as training in progressive muscle relaxation, coping
strategies, problem-solving, and assertiveness and social skills.
The people who received the behavioral therapy reported feeling more in
control of their health and having an improved sense of well-being and quality
of life, compared with those who received medical therapy alone.
"This is not a surprise to me," Charles Burnett, PhD, DrPH, tells
WebMD. Burnett is director of psychological services for the Functional
Gastrointestinal Disorders Center at the University of North Carolina at Chapel
He adds that medical therapy alone can?t treat IBS because it is a disease
that involves both the brain and the bowel. "Many gastroenterologists are
becoming more psychologically minded about these disorders, but a bridge needs
to be made for earlier referral for psychological therapy right at the
beginning," Burnett says.
There's no question that psychological factors play a role in IBS. Bruce
Greenwald, MD, an associate professor of gastroenterology at the University of
Maryland School of Medicine, tells WebMD: "With my patients, I offer ...
basic coping skills myself, but if I perceive underlying depression or another
condition requiring psychological help, or if they are just not coping well, I
will refer them to therapy.
"Patients with IBS do need education, especially with respect to the
fact that their condition isn?t going to go away and is going to cause them
some inconveniences in their lives, and they need to develop ways to deal with
- Patients with irritable bowel syndrome (IBS) who receive behavioral therapy
in addition to medications fare better than those who only receive
- Physicians know that there is a strong psychological component to IBS, and
some refer their patients to therapy.
- The behavioral therapy used in the study consisted of giving the patients
information about IBS and an analysis of their illness and symptoms, along with
training in progressive muscle relaxation, coping strategies, problem-solving,
and assertiveness and social skills.