WHAT IS BEHAVIORAL THERAPY AND WILL IT HELP MY PATIENTS WITH IBS?

The past 20 years has witnessed the development and application of multiple psychosocial therapies for irritable bowel syndrome (IBS). Their theoretical roots are grounded in the biopsychosocial model that holds that individual biology (eg, genetic predisposition, GI physiology), behavior, and higher-order cognitive processes (coping, illness beliefs, abnormal central processing of gut stimuli) influence the expression of IBS symptoms through their interaction with each other, with early life factors (eg, trauma, modeling, parenting practices), and with the individual’s sociocultural environment (eg, reinforcement contingencies). Research based on the biopsychosocial model points to three main pathways through which psychological factors are believed to influence IBS. The first pathway is directly through biological systems that mediate gut function and sensation. The second pathway is through the adoption of illness behaviors that exacerbate IBS symptoms, obscure symptom profile, and compromise function. Health behaviors are strongly influenced by psychosocial factors. 1 A third pathway is by mediating the risk for development of chronic IBS symptoms, which usually involves focusing on the high rates of early life adversity in patients seeking treatment. To the extent that psychological factors influence the expression of IBS, it is believed that symptoms are more effectively managed by addressing their presumed underlying psychosocial processes. By targeting one of the pathways linking psychological factors to IBS, psychological treatments presumably cause an improvement in symptoms or other outcome parameters (eg, function, healthcare use, quality of life).