Complementary and alternative medicine for IBS in adults: mind–body interventions

Abstract

Standard treatment for IBS focuses on the management or alleviation of the predominant gastrointestinal presenting symptoms, such as diarrhea or constipation, often using pharmacological therapy. For many patients, this approach is unsatisfactory, and patients frequently seek the advice of complementary and alternative medicine (CAM) practitioners in order to explore other treatment options. CAM practices include a broad range of modalities, and mind–body interventions hold particular promise as treatment modalities for IBS because psychological factors could have an important role in IBS symptomatology and quality of life. Psychological stressors are postulated to result in gastrointestinal symptoms through alteration of intestinal function mediated by the autonomic nervous system, hypothalamic–pituitary–adrenal axis and immune system. Hypnotherapy has the strongest supportive evidence as a beneficial mind–body intervention for IBS. Clinical studies of hypnotherapy have uniformly shown improvement of gastrointestinal symptoms, anxiety, depression and quality of life in patients with IBS. Mindfulness meditation remains unstudied for IBS, but is theoretically attractive as a stress-reduction technique. There is a suggestion that relaxation therapy or multimodal therapy (a combination of relaxation therapy, education and psychotherapy) is beneficial for IBS. The most generally accepted psychological mind–body intervention is cognitive behavioral therapy, and clinical trials support the beneficial effects of cognitive behavioral therapy in patients with IBS.

Key Points

  • 21–51% of individuals with IBS use complementary and alternative medicine practices

  • Mind–body treatments might improve IBS symptomatology by modulation of the stress response, as described in the biopsychosocial model of medicine

  • Hypnotherapy is an evidence-based treatment for IBS—several trials show improvement of gastrointestinal symptoms, quality of life and reduced medical resource utilization in patients with IBS after hypnotherapy

  • Home-study hypnotherapy programs for IBS remain poorly studied

  • Several studies suggest that patients with IBS benefit more from cognitive behavioral therapy than routine medical care; however, long-term follow-up studies are needed

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

References

  1. 1

    Drossman DA et al. (1997) Irritable bowel syndrome: a technical review for practice guideline development. Gastroenterology 112: 2120–2137

  2. 2

    Leong SA et al. (2003) The economic consequences of irritable bowel syndrome: a US employer perspective. Arch Intern Med 163: 929–935

  3. 3

    Talley NJ et al. (1995) Medical costs in community subjects with irritable-bowel-syndrome. Gastroenterology 109: 1736–1741

  4. 4

    Everhart JE and Renault PF (1991) Irritable-bowel-syndrome in office-based practice in the United States. Gastroenterology 100: 998–1005

  5. 5

    Wilson A et al. (2004) Quality of life in managed care patients with irritable bowel syndrome. Manag Care Interface 17: 24–28

  6. 6

    Hahn BA et al. (1997) Differences between individuals with self-reported irritable bowel syndrome (IBS) and IBS-like symptoms. Dig Dis Sci 42: 2585–2590

  7. 7

    Miller V et al. (2004) Suicidal ideation in patients with irritable bowel syndrome. Clin Gastroenterol Hepatol 2: 1064–1068

  8. 8

    Martin R et al. (2001) Irritable bowel syndrome: toward a cost-effective management approach. Am J Manag Care 7: S268–S275

  9. 9

    Thompson WG et al. (1997) Irritable bowel syndrome: The view from general practice. Eur J Gastroenterol Hepatol 9: 689–692

  10. 10

    Whitehead WE et al. (2004) Usual medical care for irritable bowel syndrome. Aliment Pharmacol Ther 20: 1305–1315

  11. 11

    Koloski NA et al. (2003) Predictors of conventional and alternative health care seeking for irritable bowel syndrome and functional dyspepsia. Aliment Pharmacol Ther 17: 841–851

  12. 12

    Kong SC et al. (2005) The incidence of self-prescribed oral complementary and alternative medicine use by patients with gastrointestinal diseases. J Clin Gastroenterol 39: 138–141

  13. 13

    Institute of Medicine (2005) Committee on the use of complementary and alternative medicine by the American public. Complementary and alternative medicine in the United States. Washington D.C.: National Academics Press

  14. 14

    Murray CD et al. (2004) Effect of acute physical and psychological stress on gut autonomic innervation in irritable bowel syndrome. Gastroenterology 127: 1695–1703

  15. 15

    Whitehead WE et al. (1992) Effects of stressful life events on bowel symptoms: subjects with irritable bowel syndrome compared with subjects without bowel dysfunction. Gut 33: 825–830

  16. 16

    Bennett EJ et al. (1998) Functional gastrointestinal disorders: psychological, social, and somatic features. Gut 42: 414–420

  17. 17

    Blanchard EB et al. (2008) The role of stress in symptom exacerbation among IBS patients. J Psychosom Res 64: 119–128

  18. 18

    Mulak A and Bonaz B (2004) Irritable bowel syndrome: a model of the brain-gut interactions. Med Sci Monit 10: RA55–RA62

  19. 19

    Mayer EA et al. (2006) Neuroimaging of the brain-gut axis: From basic understanding to treatment of functional GI disorders. Gastroenterology 131: 1925–1942

  20. 20

    Mayer EA (2000) The neurobiology of stress and gastrointestinal disease. Gut 47: 861–869

  21. 21

    Gibbs-Gallagher N et al. (2001) Selective recall of gastrointestinal-sensation words: evidence for a cognitive-behavioral contribution to irritable bowel syndrome. Am J Gastroenterol 96: 1133–1138

  22. 22

    Gomborone JE et al. (1993) Selective affective biasing in recognition memory in the irritable bowel syndrome. Gut 34: 1230–1233

  23. 23

    Whorwell PJ (2005) Review article: the history of hypnotherapy and its role in the irritable bowel syndrome. Aliment Pharmacol Ther 22: 1061–1067

  24. 24

    Palsson OS and Whitehead WE (2002) The growing case for hypnosis as adjunctive therapy for functional gastrointestinal disorders. Gastroenterology 123: 2132–2135

  25. 25

    Palsson OS et al. (2002) Hypnosis treatment for severe irritable bowel syndrome: Investigation of mechanism and effects on symptoms. Dig Dis Sci 47: 2605–2614

  26. 26

    Prior A et al. (1990) Changes in rectal sensitivity after hypnotherapy in patients with irritable bowel syndrome. Gut 31: 896–898

  27. 27

    Houghton LA et al. (1999) Gut focused hypnotherapy normalizes rectal hypersensitivity in patients with irritable bowel syndrome (IBS). Gastroenterology 116: A1009

  28. 28

    Simren M (2006) Hypnosis for irritable bowel syndrome: The quest for the mechanism of action. Int J Clin Exp Hypn 54: 65–84

  29. 29

    Whorwell PJ et al. (1992) Physiological effects of emotion: Assessment via hypnosis. Lancet 340: 69–72

  30. 30

    Webb AN et al. Hypnotherapy for treatment of irritable bowel syndrome. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD005110. 10.1002/14651858.CD005110.pub2

  31. 31

    Whorwell PJ et al. (1984) Controlled trial of hypnotherapy in the treatment of severe refractory irritable-bowel syndrome. Lancet 2: 1232–1234

  32. 32

    Whorwell PJ et al. (1987) Hypnotherapy in severe irritable-bowel syndrome—further experience. Gut 28: 423–425

  33. 33

    Palsson OS (2006) Standardized hypnosis treatment for irritable bowel syndrome: The North Carolina protocol. Int J Clin Exp Hypn 54: 51–64

  34. 34

    Gonsalkorale WM et al. (2003) Long term benefits of hypnotherapy for irritable bowel syndrome. Gut 52: 1623–1629

  35. 35

    Gonsalkorale WM et al. (2002) Hypnotherapy in irritable bowel syndrome: a large-scale audit of a clinical service with examination of factors influencing responsiveness. Am J Gastroenterol 97: 954–961

  36. 36

    Houghton LA et al. (1996) Symptomatology, quality of life and economic features of irritable bowel syndrome—the effect of hypnotherapy. Aliment Pharmacol Ther 10: 91–95

  37. 37

    Galovski TE and Blanchard EB (1998) The treatment of irritable bowel syndrome with hypnotherapy. Appl Psychophysiol Biofeedback 23: 219–232

  38. 38

    Gonsalkorale WM (2006) Gut-directed hypnotherapy: The Manchester approach for treatment of irritable bowel syndrome. Intl J Clin Exp Hypn 54: 27–50

  39. 39

    Palsson OS et al. (2006) Hypnosis home treatment for irritable bowel syndrome: A pilot study. Int J Clin Exp Hypn 54: 85–99

  40. 40

    Harvey RF et al. (1989) Individual and group hypnotherapy in treatment of refractory irritable bowel syndrome. Lancet 1: 424–425

  41. 41

    IBShypnosis.com [http://www.ibshypnosis.com/]

  42. 42

    Gwee KA et al. (1999) The role of psychological and biological factors in postinfective gut dysfunction. Gut 44: 400–406

  43. 43

    Baer RA (2003) Mindfulness training as a clinical intervention: a conceptual and empirical review. Clinical Psychology: Science and Practice 10: 125–143

  44. 44

    Kabat-Zinn J (2002) Commentary on Majumdar et al.: mindfulness meditation and health. J Alternative & Complementary Medicine 8: 731–735

  45. 45

    Miller JJ et al. (1995) Three-year follow-up and clinical implications of a mindfulness meditation-based stress reduction intervention in the treatment of anxiety disorders. Gen Hosp Psychiatry 17: 192–200

  46. 46

    Bishop SR (2002) What do we really know about mindfulness-based stress reduction? Psychosom Med 64: 71–83

  47. 47

    Center for mindfulness in medicine, health care, and society [http://www.umassmed.edu/cfm/mbsr]

  48. 48

    Kabat-Zinn J et al. (1987) Four-year follow-up of a meditation-based program for the self-regulation of chronic pain: Treatment outcomes and compliance. Clin J Pain 2: 159–173

  49. 49

    Grossman P et al. (2004) Mindfulness-based stress reduction and health benefits. A meta-analysis. J Psychosom Res 57: 35–43

  50. 50

    Gross CR et al. (2004) Mindfulness meditation to reduce symptoms after organ transplant: a pilot study. Adv Mind Body Med 20: 20–29

  51. 51

    Randolph PD et al. (1999) The long-term combined effects of medical treatment and a mindfulness-based behavioral program for the multidisciplinary management of chronic pain in west Texas. Pain Digest 9: 103–112

  52. 52

    Kabat-Zinn J and Chapman-Waldrop A (1988) Compliance with an outpatient stress reduction program: rates and predictors of program completion. J Behav Med 11: 333–352

  53. 53

    Moyers B and Zawacki J (1993) Stress Reduction. In Healing and the Mind, 145–155 (Ed Flowers BS) New York: Doubleday

  54. 54

    Lackner JM et al. (2004) Depression and abdominal pain in IBS patients: The mediating role of catastrophizing. Psychosom Med 66: 435–441

  55. 55

    Naliboff BD et al. (1997) Evidence for two distinct perceptual alterations in irritable bowel syndrome. Gut 41: 505–512

  56. 56

    Chang L et al. (2000) Differences in somatic perception in female patients with irritable bowel syndrome with and without fibromyalgia. Pain 84: 297–307

  57. 57

    Labus JS et al. (2004) The Visceral Sensitivity Index: development and validation of a gastrointestinal symptom-specific anxiety scale. Aliment Pharmacol Ther 20: 89–97

  58. 58

    Brown KW and Ryan RM (2003) The benefits of being present: mindfulness and its role in psychological well-being. J Pers Soc Psychol 84: 822–848

  59. 59

    Baer RA et al. (2006) Using self-report assessment methods to explore facets of mindfulness. Assessment 13: 27–45

  60. 60

    Stam R et al. (1997) Trauma and the gut: interactions between stressful experience and intestinal function. Gut 40: 704–709

  61. 61

    Almy T (1951) Experimental studies on the irritable colon. Am J Med 10: 60–67

  62. 62

    Hazlett-Stevens H et al. (2003) Prevalence of irritable bowel syndrome among university students: the roles of worry, neuroticism, anxiety sensitivity and visceral anxiety. J Psychosom Res 55: 501–505

  63. 63

    Labus J et al. (2005) Gastrointestinal-specific anxiety: further validation of the visceral sensitivity index. Gastroenterology 128: A67

  64. 64

    Gralnek IM et al. (2000) The impact of irritable bowel syndrome on health-related quality of life. Gastroenterology 119: 654–660

  65. 65

    Spiegel BM et al. (2004) Clinical determinants of health-related quality of life in patients with irritable bowel syndrome. Arch Intern Med 164: 1773–1780

  66. 66

    Astin JA (1997) Stress reduction through mindfulness meditation. Effects on psychological symptomatology, sense of control, and spiritual experiences. Psychother Psychosom 66: 97–106

  67. 67

    Monti DA et al. (2005) A randomized, controlled trial of mindfulness-based art therapy (MBAT) for women with cancer. Psychooncology 14: 1–11

  68. 68

    Shapiro SL et al. (1998) Effects of mindfulness-based stress reduction on medical and premedical students. J Behav Med 21: 581–599

  69. 69

    Williams KA et al. (2001) Evaluation of a wellness-based mindfulness stress reduction intervention: a controlled trial. Am J Health Promot 15: 422–432

  70. 70

    Speca M et al. (2000) A randomized, wait-list controlled clinical trial: the effect of a mindfulness meditation-based stress reduction program on mood and symptoms of stress in cancer outpatients. Psychosom Med 62: 613–622

  71. 71

    Davidson RJ et al. (2003) Alterations in brain and immune function produced by mindfulness meditation. Psychosom Med 65: 564–570

  72. 72

    Tacon AM et al. (2003) Mindfulness meditation, anxiety reduction, and heart disease: a pilot study. Fam Community Health 26: 25–33

  73. 73

    Cohen-Katz J et al. (2004) The effects of mindfulness-based stress reduction on nurse stress and burnout: a quantitative and qualitative study. Holist Nurs Pract 18: 302–308

  74. 74

    Ma SH and Teasdale JD (2004) Mindfulness-based cognitive therapy for depression: replication and exploration of differential relapse prevention effects. J Consult Clin Psychol 72: 31–40

  75. 75

    Teasdale JD et al. (2000) Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. J Consult Clin Psychol 68: 615–623

  76. 76

    Keefer L and Blanchard EB (2002) A one year follow-up of relaxation response meditation as a treatment for irritable bowel syndrome. Behav Res Ther 40: 541–546

  77. 77

    Bennett P and Wilkinson S (1985) A comparison of psychological and medical treatment of the irritable bowel syndrome. Brit J Clin Psychol 24: 215–216

  78. 78

    Blanchard EB et al. (1993) Relaxation training as a treatment for irritable bowel syndrome. Biofeedback Self Regul 18: 125–132

  79. 79

    Lynch PM and Zamble E (1989) A controlled behavioural treatment study of irritable bowel syndrome. Behav Ther 20: 509–523

  80. 80

    Schwarz SP et al. (1986) Behavioral treatment of irritable bowel syndrome: a 1-year follow-up study. Biofeedback Self Regul 11: 189–198

  81. 81

    Blanchard EB et al. (1988) A multi-component treatment for irritable bowel syndrome. Behav Ther 19: 67–73

  82. 82

    Neff DF and Blanchard EB (1987) A multi-component treatment for irritable bowel syndrome. Behav Ther 18: 70–83

  83. 83

    Guthrie E et al. (1991) A controlled trial of psychological treatment for the irritable bowel syndrome. Gastroenterology 100: 450–457

  84. 84

    Schwarz SP et al. (1990) Behaviorally treated irritable bowel syndrome patients: A four-year follow-up. Behav Res Ther 28: 331–335

  85. 85

    Blanchard EB et al. (1992) Two controlled evaluations of multicomponent psychological treatment of irritable bowel syndrome. Behav Res Ther 30: 175–189

  86. 86

    Heymann-Monnikes I et al. (2000) The combination of medical treatment plus multicomponent behavioral therapy is superior to medicla treatment alone in the therapy of irritable bowel syndrome. Am J Gastroenterol 95: 981–994

  87. 87

    Radnitz CL and Blanchard EB (1988) Bowel sound biofeedback as a treatment for irritable bowel syndrome. Biofeedback Self Regul 13: 169–179

  88. 88

    Radnitz CL and Blanchard EB (1989) A 1- and 2-year follow-up study of bowel sound biofeedback as a treatment for irritable bowel syndrome. Biofeedback Self Regul 14: 333–338

  89. 89

    Hutton J (2005) Cognitive behaviour therapy for irritable bowel syndrome. Eur J Gastroenterol Hepatol 17: 11–14

  90. 90

    Clark DA (1995) Perceived limitations of standard cognitive therapy: A reconsideration of efforts to revise Beck's theory and therapy. J Cognit Psychother 9: 153–172

  91. 91

    Toner BB (2005) Cognitive-behavioral treatment of irritable bowel syndrome. CNS Spectrums 10: 883–890

  92. 92

    Blanchard EB (2005) A critical review of cognitive, behavioral, and cognitive-behavioral therapies for irritable bowel syndrome. J Cognit Psychother 19: 101–123

  93. 93

    Greene B and Blanchard EB (1994) Cognitive therapy for irritable bowel syndrome. J Consult Clin Psychol 62: 576–582

  94. 94

    Payne A and Blanchard EB (1995) A controlled comparison of cognitive therapy and self-help support groups in the treatment of irritable bowel syndrome. J Consult and Clin Psychol 63: 779–786

  95. 95

    Boyce PM et al. (2003) A randomized controlled trial of cognitive behavior therapy, relaxation training, and routine clinical care for the irritable bowel syndrome. Am J Gastroenterol 98: 2209–2218

  96. 96

    Drossman DA et al. (2003) Cognitive-behavioral therapy versus education and desipramine versus placebo for moderate to severe functional bowel disorders. Gastroenterology 125: 19–31

  97. 97

    Sanders KA et al. (2007) Preliminary study of a self-administered treatment for irritable bowel syndrome: comparison to a wait list control group. Appl Psychophysiol Biofeedback 32: 111–119

  98. 98

    Blanchard EB et al. (2007) A controlled evaluation of group cognitive therapy in the treatment of irritable bowel syndrome. Behav Res Ther 45: 633–648

  99. 99

    Blanchard EB et al. (2006) Prediction of treatment outcome among patients with irritable bowel syndrome treated with group cognitive therapy. Behav Res Ther 44: 317–337

  100. 100

    Shaw G et al. (1991) Stress management for irritable bowel syndrome: a controlled trial. Digestion 50: 36–42

  101. 101

    Corney RH et al. (1991) Behavioural psychotherapy in the treatment of irritable bowel syndrome. J Psychosom Res 35: 461–469

Download references

Author information

Correspondence to David J Kearney.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Kearney, D., Brown-Chang, J. Complementary and alternative medicine for IBS in adults: mind–body interventions. Nat Rev Gastroenterol Hepatol 5, 624–636 (2008). https://doi.org/10.1038/ncpgasthep1257

Download citation

Further reading