Everyday, ordinary life is challenging enough if you suffer from irritable bowel syndrome (IBS). Add the obligations, deadlines, family dynamics, food focus, and travel issues that are associated with the holiday season, and it can be easy to feel anxious and overwhelmed. This busy time can also be one of great joy, as you get to experience the security of tradition, the warmth of being with loved ones, and the time to reconnect with spiritual roots. In order to achieve a healthy balance, self care becomes essential.
Cognitive behavioral therapy (CBT) is a form of psychotherapy that has consistently been shown to be effective in reducing the symptoms of IBS. CBT works by teaching individuals different ways of thinking about things and different ways of handling situations so as to feel better. By applying some basic CBT principles, you can actively work to reduce your stress and free yourself up to enjoy the holidays.
At the heart of CBT is the fact that what we think affects how we feel, both emotionally and physically. The human brain needs to modify data coming in so that we can make sense of things. Sometimes that modification backfires, leaving us with distortions that are not really based on reality. The following is a list of some common distortions, with examples that are more specific to IBS. Each example offers a healthy alternative. When you find yourself thinking in one of these unhealthy ways, see if you can replace your unhealthy thought with a more helpful alternative.
Fortune Telling – If we could truly predict the future, the lottery system would be out of business rather quickly! One of the major difficulties with this distortion is that our anxious minds rarely predict that things will go well. Another difficulty is that this type of projecting into the future takes away the energy needed for planning how you would cope with the variety of possibilities that you might face.
Distortion – My family lives five hours away. I know that as soon as I get in that car, my IBS is going to act up and I will be miserable.
Helpful Substitution – While it is possible that I might have symptoms while in the car, I do not know that for sure. Worrying about it is only going to make it more likely that my system will act up. Let me focus on keeping my body as calm as possible and develop a plan for how I will handle the situation if I start to feel really uncomfortable or if I need quick access to a bathroom.
Perfectionism – Yes, we all want things to go well. Unfortunately, this desire can turn into a self-imposed pressure to do things perfectly, often at the expense of our well-being. Watch out for this one, our perfectionism isn’t all that obvious, but it is what can keep us up well past midnight tying little bows onto things!
Distortion – I am in so much pain all the time that I don’t know how I am going to find the energy to cook the holiday meal. But I’m going to do it, because it is always at my house, everyone is counting on me, and I don’t want to let everybody down.
Helpful substitution – I need to come to grips with the fact that I am not well right now and so I can’t do all of the things that I usually do. It is okay for me to ask for help or ask somebody else to take over. I need to remember that my family cares about me and that my health is more important than following a tradition that is harmful to my health.
Mind reading – This distortion involves worrying about what others will think. Sound familiar? Like fortune-telling, our worries rarely tell us that other people are having positive or caring thoughts about us. More likely, we have convinced ourselves that other people are watching us closely and finding fault with what we say, do, or look like. Remember most people are too busy worrying about what others are thinking of them, to be worrying about what we might be doing wrong. As for the people who truly are critical and judgmental, do you really want to let their unhappy minds determine how you feel?
Distortion – My spouse wants me to spend the holiday weekend at his parent’s house. When they see how much time I need to spend in the bathroom, his family is going to think that I am weird.
Helpful substitution – Even people without IBS know what it is like to need to spend time in a bathroom dealing with diarrhea or constipation. If someone were to actually notice that I am in the bathroom a long time, they will most likely have sympathy for my plight and will not be judging me.
Awfulizing – Often hidden behind a “What if…” thought, awfulizing is when we imagine something that has the potential to be uncomfortable or embarrassing and see it as an absolute catastrophe. When having a “What if…” thought, our brains are really thinking “That would be the worst thing that could happen!”
Distortion – What if I am at the company party and I was to pass some really nasty smelling gas?
Helpful substitution – Everyone passes gas. If an unpleasant smell arises, other people will ignore it or at worst, make a joke about it. Although this would be embarrassing, it is not the end of the world.
Now that we have covered some ways that you can think differently as you make your way through the holiday season, we can move on to discussing some helpful behavioral strategies. Practicing these new skills will help you to keep your focus on your own well-being rather than just being caught up with all of the myriad tasks that this time of year seems to require. Again, watch out for hidden perfectionism. Like any new skill, it is going to take practice and some trial and error for the skill to feel comfortable and natural.
Plan ahead – The unpredictability of IBS can make it difficult to manage some of the demands of the holiday season. Having a well thought-out plan for handling whatever scenario arises can significantly reduce your stress level. Consider the following questions as you devise your own personal holiday survival plan.
- What will I need in order to feel most comfortable?
- Would I feel better if I told the host of the gathering about my IBS?
- How can I make sure that I have access to a bathroom?
- How would I handle it if I needed to leave early because I didn’t feel well?
Practice relaxation exercises – If you do not practice any kind of relaxation exercises on a regular basis, you should. Of the many factors that contribute to the strength of IBS symptoms, anxiety is one that you can actually do something about. The ability to relax your body, whether it be through progressive muscle relaxation, breathing exercises, yoga, or mediation, is an important tool to have in your bag of tricks for managing your IBS.
- Practice at least two times a day in a quiet setting
- Like a boxer who keeps himself loose between punches, monitor your muscle tension throughout your day to make sure you stay as relaxed as possible.
- Use visualization. While in a relaxed state, imagine yourself attending and enjoying a holiday get-together and picture your body and intestines remaining calm and quiet.
Kind and gentle feeding – Even with the best planning and good relaxation skills, the holidays can be stressful. This stress could have the effect of making your digestive system more reactive than usual. You can work to counteract this by actively trying to not abuse your body with too much of the wrong kinds of food. Unfortunately, these are just the types of foods that always seem to be everywhere during the holidays! Treat your body with the kind of tender, loving care that you would bestow upon a small child and make the kind of food choices that you know your body needs.
- Eat small meals throughout your day: Often in a misguided attempt to prevent the onset of symptoms, IBS sufferers will avoid food before a big event. The problem with this strategy is that your body may overreact when food is finally introduced, particularly if introduced in a large quantity. Your system is more likely to work in a smooth manner if you provide it with small meals throughout the day and during the course of the holiday outing.
- Choose stomach-friendly food: Avoid alcohol and the fatty, nutritionally empty foods that are all too present during the holidays. As envious as you may be when you see others indulging, remind yourself that your body is worth taking extra special care of. Those who are over-indulging are certainly not doing themselves any favors and even if they don’t have IBS, odds are that they will be suffering from the effects of their splurging the next day.
Assertiveness and limit setting – The holidays can be a mixed blessing when it comes to dealing with other people. On the one hand, we get to spend time with people that we care about that perhaps we don’t get to see over the rest of the year. On the other hand, we may find ourselves forced to spend time with people that we may not really like or whose behavior is upsetting to us. In order to keep your stress level to a minimum, it becomes important to connect with positive people and protect yourself from those whose negativity can become toxic.
- Tell the caring people in your life about your IBS: Like anyone who is suffering from a major health problem, you deserve the benefits that come from the care and concern of others. Given the high prevalence of IBS, you may be surprised to find out who else is walking in your shoes.
- Speak up about any special needs that you have: People cannot read your mind; they cannot know what will help you unless you tell them.
- Take steps to protect yourself from critical people: Family gatherings are often not quite as comforting as is portrayed in the movies. Dysfunctional family dynamics and unresolved sibling rivalry issues can result in criticism or conflict. This unpleasantness can increase your stress level and set off your system. When possible, practice good self care and remove yourself. If that is not possible, it is okay to actively tune people out – thinking “blah, blah, blah” when someone else is talking can be surprisingly effective!
This year, make a promise to yourself to do things differently. Turn your IBS into a good reason to focus on your own needs as you proceed through this hectic time of year. Use the challenges of the season to practice self care skills, whether that means eating healthy foods or telling others what your special needs might be. Remind yourself that it is okay to be human, that you do not have to do it all and that it is okay to delegate or just take a pass on obligations. Keep things positive. If you make it to a gathering and have to leave because your symptoms are too uncomfortable, focus on the fact that at least you got there. Most importantly, don’t lose sight of the true gift of the season, that of being around the people in your life that you really care about. Happy Holidays!
Barbara Bradley Bolen, PhD is a clinical psychologist in private practice in Farmingdale, New York. She is the author of “Breaking the Bonds of Irritable Bowel Syndrome: A psychological approach to regaining control of your life.” Along with Jeffrey Roberts, she compiled postings from the Internet-based IBS Self Help and Support Group into the self-help book, “IBS Chat: Real life stories and solutions.” She currently is editor of the IBS Health Topics section on www.about.com.