Functional gastrointestinal disorders (FGIDs), including IBS, are disorders of brain-gut interaction. This means that there is a problem with the way the central nervous system (the brain and spinal cord) and the enteric nervous system (the nervous system of the gut) communicate information back and forth about our digestion, appetite, thoughts, and emotions. The pathway between the brain and the gut is called the brain-gut axis, and it relies on chemical messengers, including serotonin, for communication. Indeed, 95% of your body's serotonin, a neurotransmitter (chemical messenger) which is often known for its impact on mood, sleep, appetite, and sex drive, can be found in your gut! Thus, our emotional state is closely linked to the functioning of our gastrointestinal (GI) tract. In other words, the functioning of our GI tract affects our emotions, and our emotions affect the functioning of our GI tract (Figure 1).
But My Symptoms are Real, Not in My Head!
Individuals with FGIDs are more likely than people without GI disorders to have depression and anxiety, although these can be seen as both risk factors for, and outcomes of, FGIDs. However, even for individuals with FGIDs who do not meet criteria for a psychological disorder, fears and worries that are related directly to their symptoms, known as symptom-specific anxiety, can contribute greatly to the severity of their symptoms. This is where cognitive behavioral therapy (CBT) can be a helpful tool to decrease GI symptoms and improve overall quality of life.
Cognitive Behavioral Therapy (CBT)
CBT is a type of psychotherapy originally developed and used to treat mental health issues, such as depression and anxiety. CBT is grounded in the belief that our thoughts (cognitions), feelings, and behaviors are all related (Figure 2). More specifically, unhelpful thoughts negatively impact how we feel and these negative feelings can impact how we behave. By engaging in unhelpful or maladaptive behaviors, we reinforce our unhelpful thoughts. So, how can CBT address this? By evaluating and modifying our thoughts and behaviors to make them more helpful, we can improve our emotional state. CBT as a treatment tends to be short-term and collaborative. You and your therapist work together to make a game plan to address your symptoms, which typically includes both in-session and at-home practice.
CBT for FGIDs
CBT is not just used to treat depression and anxiety; it has been adapted for use in the treatment of many medical conditions, including FGIDs. Below we'll discuss how CBT may be helpful for managing the symptoms of FGIDs.