Just as diet has come into focus as an essential aspect of treatment for irritable bowel syndrome, so have behavior and lifestyle. The way a person responds to stress can greatly affect symptoms.

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Cognitive behavioral therapy (CBT), hypnosis and interpersonal psychotherapy can help patients with IBS cope, and recent research has shown it can also benefit patients with other chronic gut ailments, which can cause as much mental anguish as physical disability.

But, as in the case of diet, many gastroenterologists are not trained to provide more advanced behavioral counseling to patients with IBS. These therapies require specialized training — more than even many clinical psychologists are equipped to offer.

Megan Riehl, Psy.D., a clinical health psychologist at the University of Michigan, is the state's only psychologist with a specific focus on gastrointestinal disorders. IBS is the most common GI illness that brings patients to her clinic.

"About 65 percent of patients present with IBS or a functional bowel disorder," she says.

Typically, U-M gastroenterologists refer patients to Riehl who may have exhausted medical treatment options and who might benefit from stress and anxiety management techniques.

Increasingly, behavioral therapy is becoming routine in the treatment of patients with IBS.

Impairment on quality of life is similar for patients with IBS and those with inflammatory bowel disease (IBD), contributing to disability, creating challenges in communicating the complexities of their condition and interfering with the things they want to do.  

Traditionally, however, behavioral therapy has not been recommended for patients with IBD, those with Crohn's disease, ulcerative colitis and other inflammatory bowel disorders.

But a preliminary analysis of quality of life and treatment response suggests GI behavioral therapy is valuable for both groups, according to an abstract Riehl presented at the annual Digestive Disease Week scientific sessions.

Gut-directed therapy 101

Behavioral therapy is personalized for each patient, but therapy in general is designed to help patients deal with the uncontrollable and unpredictable aspects of IBS. Patients learn relaxation and stress management tools that can be applied to everyday life stressors.

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"My goal is to help patients learn to cope effectively and efficiently with worries that can interfere with social, occupational and family life," Riehl says.

Most often, behavioral therapy for patients with IBS involves interventions based on CBT, a short-term, collaborative treatment that focuses on a patient's current problems.

"CBT involves helping patients find new ways of thinking and behaving to help in managing stressful situations," Riehl explains.

For example, patients with IBS may experience anxiety-provoking thoughts such as, "Where will a bathroom be if I need it?" "What if I'm having symptoms before a big exam or presentation?" or "How will I ever be intimate with a partner?"

CBT teaches patients how to manage emotional responses to these potentially stress-inducing situations.

"My goal is to aid patients in self-management strategies that benefit GI health, emotional well-being and overall quality of life," Riehl says. "People learn tools to create long-term change, without remaining in treatment for long periods of time. It's very rewarding."