Your tummy trouble could be all in your mind: IBS sufferers can benefit from psychotherapy, says leading expert

• Hypnosis can be used to treat Irritable Bowel Syndrome, according to study
• IBS sufferer Joanna Cowdrey, 31, says she is proof new treatment works
  

By Dr Adam Farmer

Published: 17:00 EDT, 20 April 2013 | Updated: 17:00 EDT, 20 April 2013

If there’s one thing people with irritable bowel syndrome don’t want to hear, it’s that their condition is ‘all in the mind’. Yet that’s what many doctors believe.

It has caused a great deal of debate in the medical community, but while some GPs imply sufferers are a bunch of malingerers or hypochondriacs, it is a very real and very miserable condition.

Symptoms – tending to first appear when patients are in their early 20s to 30s – include bloating, cramps, heartburn and endless embarrassing or uncomfortable situations.

Life-changing: Joanna Cowdrey, 31, has rebuilt her life after she received hypnosis treatment for her Irritable Bowel Syndrome - read her story below

It is thought that up to one Briton in ten suffers from IBS, but we still don’t know what causes it.

It is a diagnosis of exclusion given only when other, more sinister diseases – such as cancer, diverticular disease and stomach ulcers and gallstones – have been ruled out and we can’t find anything physically wrong with the gut.

As a doctor specialising in the health of the digestive system, I know all too well how debilitating IBS is. So I don’t say this lightly: a great number of patients must accept that their state of mind may be the root of their problem.

Of course I don’t mean patients are simply neurotic, but that we must stop looking at the brain and digestive system as separate entities. Complex interactions occur between the two, with each being able to influence the other through a connection known as the autonomic nervous system.

For example, when we are nervous or stressed we often feel ‘butterflies’ in our stomach or an urgent need to go to the toilet. And it is increasingly believed that our minds may also play an important role in digestive disorders such as IBS.

Gut reaction: Digestive health can be influenced by personality traits

Studies in the early Nineties showed that people with IBS often suffer from anxiety and depression. The natural extension of these findings was to prescribe medications to IBS sufferers similar to those used in these psychological disorders, but they do not work in all patients.

In order to understand further the interaction between our brains and our bowels, I teamed up with colleagues to design a study looking at the difference in pain responses between healthy people and those with long-term digestive pain.

First of all we assessed their personality, by asking questions such as ‘Are you talkative?’, ‘Do you find fault with others?’, ‘Are you calm in tense situations?’ to measure whether they were moody and depressed or outgoing and sociable.

We also measured physical markers – their heart rate, blood pressure and responses of the autonomic nervous system to pain.

To cause this pain, we inserted through the nose and into the gullet a tube with a small balloon attached that could be inflated to cause discomfort until the subject could not tolerate any more. Subjects then had to rate the pain.

The results were fascinating. We found that both the healthy and those with chronic gut pain fell into two groups.

The first group were more neurotic and anxious and they tolerated less pain. The second group were more extrovert and less anxious and tolerated more pain.

So what does this mean? Well, accepted wisdom has been that all people have a ‘fight or flight’ response to pain. In other words, every person’s heart rate and blood pressure increase when they are in pain so they can either run away or fight back.

But we found that subjects who were more neurotic, according to their questionnaire results, did not have this response. Instead, their system ‘froze’ when confronted with pain.

Those who were more anxious had a lower tolerance to pain but also saw their blood pressure and heart rate drop, something that hadn’t been seen before.

We found that while in healthy people 60 per cent had a fight or flight response and 40 per cent had the freeze response, in people with chronic gut pain the response was reversed.

Only 30 per cent had a fight or flight response and 70 per cent had the freeze response. This is physical evidence that those who are more anxious are more likely to suffer digestive discomfort.

Our results also provide some explanation as to why some IBS sufferers may respond to cognitive behavioural therapy – a kind of talking therapy – or hypnotherapy rather than drugs like anti-depressants.

We already know that psychological therapies work for some with IBS, but there are not many centres that offer them for gut pain on the NHS. That could change if we can show the cost-effectiveness of these therapies, so we are now recruiting volunteers for a larger, stage two study. IBS sufferers have a poor quality of life and are often shunned by medical professionals. The anxiety and depression that exists alongside the pain is common, but it is a chicken-and-egg situation.

With the right treatment, we might be able to help these people get back to enjoying life.