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Irritable Bowel Syndrome
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David Carbonell, Ph.D.
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May 31, 2006 17:52 PDT
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THE ANXIETY COACH®
Helping People Thrive in an Anxious World
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Volume 7, Issue 5
IN THIS ISSUE
Irritable Bowel Syndrome is a surprisingly common condition
which causes a lot of anxiety and worry, but studies show
that cognitive behavioral treatment can be helpful in
managing the disorder.
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INDEX
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1. Dave's Note
2. Upcoming workshops for professionals
3. Treatment Approaches for Irritable Bowel Syndrome
4. About The Anxiety Coach®
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Dave's Note
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May 31, 2006
Dear Reader,
This month's topic is Irritable Bowel Syndrome. IBS is
surprisingly common, affecting 10-15% of the population. It
is one of the most common disorders seen by primary care
physicians.
IBS is characterized by a group of symptoms in which
abdominal pain or discomfort accompanies a change in bowel
pattern, such as loose or more frequent bowel movements,
diarrhea, and/or constipation.
It is often associated with increased anxiety and phobias.
In my work with patients who have IBS, I find that it affects
their lives in the same way panic disorder does. They become
afraid of having trouble, they feel embarrassed and make excuses
to avoid activities, and gradually find their lives becoming
more limited.
IBS is what's called a "functional" disorder. This means that
the disorder isn't caused by an inflammatory, infectious, or
structural problem, and so it can't be diagnosed with the
traditional methods of physical exam, blood test, or x-rays.
The article which appears below is a reprint of an article
which ran recently in the Los Angeles Times. For additional
information about IBS, visit these links:
http://www.aboutibs.org/
http://www.irritablebowel.net/index.htm
http://www.panix.com/~ibs/
See you next month!
Dave Carbonell
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BREAKING THE PANIC CYCLE: A WORKSHOP FOR PROFESSIONALS
For professional therapists who want training in the treatment
of panic disorder (and CEU's), here is the summer schedule for
my day-long workshop, "Breaking the Panic Cycle".
June 14: Eau Claire, WI
June 15: Minneapolis, MN
June 16: Bloomington, MN
July 19: Charlotte, NC
July 20: Winston-Salem, NC
July 21: Raleigh, NC
For information and registration, visit:
http://www.pesihealthcare.com
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Treatment Approaches For Irritable Bowel Syndrome
by
Shari Roan of the Los Angeles Times
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When a disease is poorly understood, when it's of a distinctly
personal nature and when medication doesn't help, there's often
little left to do but to suffer in silence.
That's the case for the 15% of Americans, about 25 million
people, who have irritable bowel syndrome. Although television
commercials and magazine advertisements promise easy relief
for a chronically misbehaving gut, many people with the
condition know better. The constipation, bloating, diarrhea
and gas make their lives miserable, limiting some to short
excursions when they leave home at all.
Although the pharmaceutical industry is eagerly pursuing new
drug treatments for irritable bowel syndrome, these potentially
more effective medications are several years away. Now
researchers say the best hope may be the most basic of
treatments: lifestyle changes.
Experts meeting last week in Los Angeles for Digestive Disease
Week, the world's largest gathering of gastrointestinal health
professionals, reported that behavior modification and dietary
alterations can significantly ease symptoms of the still
little-understood condition.
For example, even a brief, self-help course of cognitive
behavior therapy -- in which people identify their symptoms'
triggers and learn techniques, such as relaxation and thought
processes, that can alter the response -- significantly helped
most patients in one study presented at the meeting. Another
study found that 12 sessions of hypnotherapy reduced symptoms
in many patients for at least one year.
The findings support recent theories that irritable bowel
syndrome involves a communications glitch between the brain
and gut. But experts disagree on whether drugs that act on the
gastrointestinal tract or psychological therapies that alter
thoughts and emotions will ultimately prove most beneficial.
"There is a camp totally focused on the GI tract. But there
is also a lot of talk about how we're beginning to understand
the mind-body connection," said Dr. Emeran Mayer, director of
the UCLA Center for Neurovisceral Sciences and Women's Health.
Dissatisfaction with the two medications currently approved
for IBS has led to a resurgence of interest in how patients
can help themselves, said Jeffrey M. Lackner, an assistant
professor of medicine at University at Buffalo, State
University of New York.
"At this point, there are no drugs that seem to be satisfactory
for the full range of symptoms," he said. "The real burden of
IBS rests on the shoulders of patients on a day-to-day basis."
It wasn't long ago that many doctors doubted that IBS was a
real disease. Affecting mostly women, the disorder is
characterized by chronic abdominal pain and discomfort,
bloating, gas, constipation and diarrhea. But there is no
injury, infection or inflammation in the gut, which raised
doubts about the true nature of the condition.
The word "irritable" refers to the reaction of nerve endings
in the bowel wall that control muscle function and the
sensations of the gut. In people with the disorder, the
intestinal tract is highly sensitive, overreacting to normal
events such as eating. Specific foods can set off symptoms in
many patients, but strong emotions and stress are considered
the most powerful triggers.
Scientists now believe this hypersensitivity is caused by
abnormal levels of certain chemicals that transmit messages
between the brain and gut, such as serotonin.
"Up until the last 10 years, irritable bowel syndrome was a
wastebasket diagnosis. We used to think people were crazy,"
said Dr. John Johanson, a gastroenterologist at the
University of Illinois. "Now we're realizing, 'Hey, maybe
there are some effective therapies out there.' "
The discovery of a potential biological explanation for the
disorder has led to the development of two prescription drugs
that focus on serotonin receptors, Lotronex and Zelnorm. Both
medications, however, have been plagued with safety concerns.
Lotronex was withdrawn from the market shortly after it was
approved in 2000 due to reports of life-threatening ischemic
colitis, an inflammation caused by a disruption of blood flow
to the large intestine.
The drug was re-approved with tighter restrictions in 2002
and is now recommended only for women with severe, diarrhea
predominant IBS who have not responded to other therapies.
Zelnorm, approved for women with constipation-predominant IBS,
was approved in 2002 based on studies showing a modest
improvement in symptoms. But the drug was relabeled in 2004 to
warn of a rare, serious side effect involving low blood
pressure. Zelnorm, too, has been linked with rare cases of
ischemic colitis, but there is no evidence that the medication
causes the problem.
Many patients reject the drug treatments currently available,
Johanson said.
"Surveys show as many as 70% of patients have tried various
medications and less than half are satisfied," he said.
A third drug, lubiprostone (Amitiza), was approved in January
for the treatment of chronic constipation in adults. A
preliminary study presented last week by Johanson showed it
appears to be safe and effective in IBS patients whose primary
symptom is constipation.
But psychotherapies may work just as well, without side
effects, to alter the communication between the brain and
the gut.
Brain scans demonstrate that people with IBS react differently
to emotions and stress. Specific behavioral therapies, Mayer
said, can reestablish a more normal connection between the
prefrontal cortex, the part of the brain that controls rational
thought, and the brain's limbic system, which responds to
emotions.
"Somehow that control is strengthened during cognitive
therapy," he said.
Cognitive behavior therapy has long shown promise in helping
IBS patients, but it's hard to find therapists who offer it
for IBS, said Dr. Robert Sandler, vice president of the
American Gastroenterological Assn.
In addition, the therapy can be expensive and time-consuming.
In the government-sponsored behavior study presented last week,
Lackner randomly assigned 59 patients to receive a 10-week,
clinic-based behavioral treatment; a four-session home-based
program (using a self- study workbook); or nothing.
The behavior therapy goal is to learn new ways to think about
the disorder and coping behaviors. For example, patients learn
muscle relaxation exercises, which can reduce stress, and how
to avoid worrying about having an "attack" out in public.
Overall, 74% of the patients in the 10-week program reported
moderate to substantial improvement in symptoms, but so did
73% of the patients in the quicker and less costly, four
session program. A follow-up examination of the patients after
three months showed the benefits persisted. Those who got no
therapy did not improve.
"People with IBS tend to think the worst," said Lackner.
"That triggers physiological and emotional reactions that
aggravate symptoms. Patients need to increase their repertoire
of skills so they can effectively take control of their
symptoms."
The manner in which hypnotherapy works is harder to explain,
said the lead author of that study, Dr. Magnus Simren of
Sahlgrenska University Hospital in Sweden.
In two studies, IBS patients were randomized to a group
receiving hypnotherapy, one receiving education and visits
from a nurse or no therapy at all. Just over half of the
patients in the hypnotherapy group improved while the patients
in the control groups did not.
"I was afraid patients would think this is hocus-pocus, but
they were very open to it," Simren said. "I think we need to
address [IBS] with different kinds of therapies. We need new
drugs. But we should not only focus on drugs."
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THE ANXIETY COACH®
++++++++++++++++++++++
The Anxiety Coach® is a publication of the Anxiety
Treatment Center, Ltd. The Center is a small group of
clinical psychologists who specialize in the treatment of
anxiety problems. The Center has offices in Chicago and
several nearby suburbs.
Dr. Carbonell, a licensed psychologist, is the founder and
director of the Anxiety Treatment Center.
The information contained in this publication is not a
substitute for consultation with healthcare professionals.
Each individual's health concerns should be evaluated by a
qualified professional.
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SUBSCRIPTION INFORMATION
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To unsubscribe, follow the link at the very end of this
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CONTACT INFORMATION
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David A. Carbonell, Ph.D.
Anxiety Treatment Center, Ltd.
E-mail: dire-@anxietycoach.com
Web: http://www.anxietycoach.com
1340 Remington Road, Suite D
Schaumburg, IL 60173
847.605.0453
© 2006, Anxiety Treatment Center, Ltd.
All rights reserved.
Anxiety Coach® is a registered mark of Anxiety Treatment
Center, Ltd.
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may not copy it to a web site without prior permission.
Reprint permission will be freely granted, upon request,
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