Irritable bowel syndrome could be relieved with techniques taught in types of therapy
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Therapies that change the behavior of people with irritable bowel syndrome (IBS) may be more effective than existing standard-of-care treatments. If offered digitally, these could also help speed up their relief.
IBS usually causes bloating, diarrhea, constipation, and abdominal pain. Although its causes are unclear, disorders of gut-brain signaling are thought to play a major role. Intestinal infections or certain foods can trigger the gastrointestinal tract to send alarm signals to the brain, while psychological stress can send them the other way. This is why people with IBS are encouraged to find ways to relax.
Dietary advice and medications like laxatives can help, but for some, symptoms persist, leading researchers to explore new approaches such as fecal transplants. As something of a last resort, doctors often turn to behavioral therapies, which a 2020 study suggests may be more effective than routine care.
These can include cognitive behavioral therapy (CBT), which helps people change the way they think and act to manage and accept their symptoms, and gut-directed hypnotherapy, where people are put into a trance-like state before being given suggestions that their symptoms are improving.
With more studies published since then, Alexander Ford of the University of Leeds in the UK and his colleagues – some of whom participated in the previous review – have now screened 67 randomized controlled trials, involving more than 7,000 participants. These compared behavioral therapies lasting four to 12 weeks with various control groups who received standard interventions such as dietary advice or laxatives, or who were on a waiting list for therapy.
“This is the largest study of behavioral treatments for IBS in terms of number of studies and participants. [to my knowledge]”, explains Perjohan Lindfors of the Karolinska Institute in Sweden.
Researchers found that CBT and gut hypnotherapy – delivered in person, via an app or the internet – were more effective than standard treatments, based on participants’ comparison of before and after symptoms.
Rather than being offered only when standard interventions haven’t helped enough, and usually only in person, the findings suggest that behavioral therapies should be deployed much earlier, with digital approaches helping to implement them quickly, Ford says. “They could give you a way to scale up behavior therapy so that it can be delivered at scale,” he says. But more trials directly comparing digital therapies to standard therapies are needed before the guidelines can be updated, says Ford, who thinks it could take another five years.
Additionally, most study participants couldn’t be unaware of which group they were in, so some of the benefits could be due to the placebo effect, says Lindfors. Trials in which participants receive either a full form of therapy or only parts of it could help gauge the magnitude of this effect, if they all felt like they were receiving the real behavioral treatment, Lindfors says.
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