Functional gastrointestinal disorders affect 35% to 70% of people at some point in life, women more often than men, according to the Harvard Medical School’s Mental Health Letter. These disorders have no apparent physical cause â€” such as infection or cancer â€” yet result in pain, bloating, and other discomfort.
Multiple factors â€” biological, psychological, and social â€” contribute to the development of a functional gastrointestinal disorder. Numerous studies have suggested that stress may be particularly important, however. The relationship between environmental or psychological stress and gastrointestinal distress is complex and bidirectional: stress can trigger and worsen gastrointestinal pain and other symptoms, and vice versa. This is why psychological therapies are often used in combination with other treatments â€” or even on their own â€” to treat functional gastrointestinal disorders.
Reviews suggest that several types of psychotherapies may help ease persistent gastrointestinal distress â€” or at least help people learn to cope with such symptoms. Although this research has limitations â€” in particular, many studies have been criticized for using a waiting-list control, which does not allow investigators to account for the therapeutic effects of receiving medical attention â€” the evidence suggests that the following psychotherapies may provide some relief for many people with severe functional gastrointestinal disorders.
Cognitive behavioral therapy (CBT). This standby of psychotherapy helps patients to change counterproductive thoughts and behavior and learn coping skills to better manage stress and anxiety. One three-month study involving 431 adults with functional gastrointestinal disorders found that CBT was significantly better than patient education at improving overall symptoms and well-being, but had little or no effect on pain. This and other research suggests that CBT may be most useful in helping patients to cope with persistent gastrointestinal distress, rather than reducing pain. Preliminary research suggests that CBT can be modified for children with such disorders.
Relaxation therapy. This encompasses a number of techniques designed to help people relax and reduce reactivity to stress. Techniques include progressive muscle relaxation, visualization, and restful music. Relaxation therapy has seldom been studied alone, but the research suggests that it is effective for gastrointestinal disorders when it is combined with CBT.
Hypnosis. Gut-directed hypnotherapy â€” which combines deep relaxation with positive suggestions focused on gastrointestinal function â€” may be helpful for people whose symptoms occur even without obvious stress. In one small randomized controlled study, patients with severe irritable bowel syndrome underwent three months of hypnotherapy that involved placing their hands on their abdomens while being asked to feel warmth and imagining they had control over gastrointestinal function. By the end of the study, symptoms had significantly improved in the hypnotherapy group when compared with a control group who underwent supportive psychotherapy. Another study suggests that benefits of gut-directed hypnosis may persist for years.
What to do about stress and the sensitive gut (8/10)
August 10, 2010