Combo Treatment Best for IBS

New Approach Uses GI Specialist and Psychoanalyst Together

From the WebMD Archives

Nov. 3, 2003 -- Since 1983, several studies have shown that months of psychotherapy can help some patients with irritable bowel syndrome (IBS), a common yet baffling intestinal disorder believed to be largely influenced by stress and anxiety.

But a 50% reduction in symptoms after just two weeks?

That's what is being reported in a new study detailing the latest spin in the "mind-body" approach to treating IBS: A collaborative effort in which both a gastrointestinal specialist and a psychotherapist simultaneously treat the patient with coordinated care.

Patients who received this combination therapy -- with both specialists -- fared much better in terms of abdominal pain, diarrhea, and constipation than patients who only got either traditional medical treatment with drugs and diet or psychotherapy alone, say researchers in the November issue of Clinical Gastroenterology and Hepatology.

"Overall, we found a 50% improvement in symptoms with this collaborative approach," gastroenterologist Charles Gerson, MD, of Mount Sinai School of Medicine, tells WebMD.

And this drop was noticed in two ways: Through the patient's self-reported drop in pain, constipation, diarrhea, and four other symptoms, as noted in daily entries in a diary, and through a physical evaluation that measures these symptoms via established criteria, says Gerson, who studied 41 IBS patients with his wife, Mary-Joan Gerson, PhD, a psychoanalyst and family therapist who works at New York University.

The reduction in symptoms they noted through this team approach to treatment - with both specialists "batting back and forth, together, with the patient," says Charles Gerson - produced similar results after just three sessions as what previous studies have noted in months of weekly therapy.

"It usually takes eight to 10 weeks of psychotherapy (alone) to produce the symptoms improvement we noted after just three sessions," he tells WebMD. "I think the idea of going to therapy was more acceptable with having me in the room. If you just say to patient, 'I want you to see a therapist,' you often get a lot of resistance."

How to Treat IBS?

In the past 20 years, numerous studies have explored how different types of counseling and psychotherapy could be used to treat IBS patients, who include at least 58 million Americans - most of them women. Typically, there are recurrent symptoms of abdominal pain, distention, and altered bowel movements -- diarrhea, constipation, or a combination of both -- that may worsen during periods of stress.

Just two weeks ago, British researchers conducting one of the largest studies to date reported in the journal Gut that hypnosis could be an effective, long-term therapy.

In the psychotherapy used in the Gerson's study, "In essence, I inquired about how IBS was imbedded in the patient's life experience -- how it played out in their relationship life, their work life, their friendship life," says Mary-Joan Gerson, who with her husband also runs the Mind Body Digestive Center in New York City.

"From that we try to draw out possible coping strategies," she tells WebMD. "People tend to think of illness as something contained in their bodies. But there are reactive episodes of illness. You have to think about how you're living your life."

That's why, in addition to the psychotherapy, keeping a diary may have been helpful.

"If you are keeping a diary in which you can track your symptoms and conditions on a daily basis, you can also attend to what's going on in your life," says psychologist Edward Blanchard, PhD, a noted IBS expert who directs the Center for Stress and Anxiety Disorders at the University of Albany.

He was not involved in the Gersons' research but designed the diary that their patients used. Last year, Blanchard headed his own study tracking which psychological treatments seemed most effective in reducing IBS symptoms.

That research, published in the Journal of Consulting and Clinical Psychology, shows that cognitive and behavioral therapy aimed at modifying negative thoughts and actions; psychodynamic therapy focused on personal "insight" and linking present and past experience (such as that used by Mary-Joan Gerson); and hypnosis were most effective. Biofeedback and peer-run support groups were not found to be useful.

"If you're suffering from chronic IBS, you have to realize that is really is a mind-body experience," says Charles Gerson. "So if you want long-term relief, you're going to have to address those psychological issues."

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SOURCES: Gerson, C. Clinical Gastroenterology and Hepatology, November 2003. Gonsalkorale, W. Gut, November 2003; vol 52: pp 1623-1629. Blanchard, E. Journal of Consulting and Clinical Psychology, June 2002: vol 70: pp 725-738. Charles Gerson, MD, associate clinical professor of gastroenterology, Mount Sinai School of Medicine, New York City. Mary-Joan Gerson, PhD, supervisor, New York University postdoctoral program in psychotherapy and psychoanalysis, New York City. Edward B. Blanchard, PhD, director, The Center for Stress and Anxiety Disorders, University of Albany/State University of New York, Albany.
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