Anxiety. Perhaps nowhere is the GI-stress connection more apparent than with irritable bowel syndrome. It's called a "functional" disorder because, though it can cause severe pain, bloating, and altered bowel habits, there is no physical explanation as there is for Crohn's. As many as 60 percent of people with IBS suffer from anxiety disorders, and historically, many doctors dismissed their complaints as psychological.
Not anymore—though the solution, ironically, appears to lie in that direction. Research has shown that IBS sufferers have a heightened sensitivity to pain as well as "motility" problems like diarrhea and constipation. Stress, while it doesn't cause IBS, makes the symptoms worse. Two promising medications have failed to deliver: Besides the withdrawn Zelnorm, Lotronex has been restricted to women with debilitating IBS-related diarrhea because in rare instances it causes lethal bowel obstructions and intestinal damage. This has left IBS sufferers with few good treatment options beyond what over-the-counter medications, exercise, and avoiding certain foods can provide. But hypnosis and cognitive behavioral therapy offer hope.
Cognitive behavioral therapy, like hypnosis, teaches patients relaxation skills. It also focuses on getting them to identify and change overly negative or unrealistic thoughts, and to work on problem-solving skills so they can better handle stress. In a study published in August of 75 IBS patients who were randomly assigned to one of three groups, nearly three quarters of those who learned CBT skills mostly on their own using a manual, supplemented by four sessions with a therapist, reported significant improvement in quality of life and symptoms. A smaller proportion—61 percent—saw similar improvement after receiving 10 sessions with a therapist, but without a self-help manual. Only 7 percent of the control group, which received no treatment, experienced significant relief.
"You're tapping into people's sense of control over symptoms that have made them feel helpless," says Jeffrey Lackner, director of the Behavioral Medicine Clinic at the University at Buffalo School of Medicine, who led the National Institutes of Health-funded trial. Earlier this month, Lackner announced that he'd received an $8.5 million grant from the National Institute of Diabetes, Digestive and Kidney Diseases to fund a seven-year clinical trial to study his program in nearly 500 IBS patients at a number of sites. A program that emphasizes self-management, such as that practiced by the most successful group, could be a boon to patients: Insurers may refuse to cover what they consider psychological rather than medical treatments.
After a dozen years suffering with upset stomachs and painful diarrhea that left her taking Imodium "like candy," Melissa Brunner of Buffalo, 35, signed up for Lackner's study in 2006. She learned to identify the connection between her symptoms and stressful events and to use deep breathing and other relaxation skills to reduce her anxiety and give up the need for control. "You realize what you're stressing about and ask yourself whether you have any control over it," she says. "If you don't, there's no need to stress about it." Brunner still avoids fast food, but more than two years later, she pronounces herself "80 percent better."
It may take some time before the average GI doctor offers hypnosis. But if you're one of the millions of people unable to celebrate Thanksgiving with gusto, you might want to do some digging to find relief.