Therapy may be the most effective way to ease irritable bowel syndrome

Recent findings suggest that behavioral therapies aimed at modifying the actions of individuals with irritable bowel syndrome (IBS) could outperform current standard treatments. When implemented through digital formats, these therapies may also expedite the relief process.

IBS often leads to symptoms like bloating, diarrhea, constipation, and abdominal discomfort. While the exact causes remain elusive, abnormal gut-brain interactions are believed to significantly contribute. Factors such as gut infections or certain foods might provoke the gastrointestinal system to transmit distress signals to the brain, while psychological strain can trigger reverse signals, highlighting why individuals with IBS are advised to relax.

While dietary adjustments and medications like laxatives may provide some relief, numerous patients still endure persistent symptoms, prompting researchers to investigate alternative treatments like fecal transplants. Behavioral therapies have often been considered as a final option, but a review in 2020 indicated that these approaches might be more effective than standard care.

Such therapies include cognitive behavioral therapy (CBT), which assists individuals in altering their thought processes and actions to better manage and accept their symptoms, and gut-focused hypnotherapy, where patients enter a trance-like state to receive suggestions aimed at alleviating their symptoms.

Following an analysis of numerous studies published since the 2020 review, Alexander Ford and his team at the University of Leeds in the UK reviewed 67 randomized controlled trials featuring over 7000 participants. These studies compared behavioral therapies lasting four to 12 weeks with control groups that followed standard treatments such as dietary advice, laxatives, or those who were waiting for therapy.

“To my knowledge, this represents the largest review of behavioral treatments for IBS in terms of the number of studies and participants involved,” remarks Perjohan Lindfors from the Karolinska Institute in Sweden.

The research indicated that CBT and gut-focused hypnotherapy—whether delivered face-to-face or via digital platforms—proved to be more effective than standard treatments, as assessed by participants’ symptom evaluations before and after the therapies.

Instead of being reserved solely for patients who have not responded to conventional treatments, the evidence advocates for the earlier integration of behavioral therapies, with the potential for digital solutions to enhance accessibility and speed of delivery, states Ford. “Such methods could facilitate the wide-scale implementation of behavioral therapy,” he adds. However, further trials comparing digital therapies with conventional methods are necessary before updating clinical guidelines, an undertaking Ford estimates may take an additional five years.

Additionally, since most participants in these studies were not blinded to their group allocation, some observed benefits might stem from the placebo effect, cautions Lindfors. Future trials incorporating complete versus partial therapy exposure could help illuminate the magnitude of this effect, provided that participants are led to believe they are receiving the full behavioral treatment, he concludes.