# anxiety and panic and IBS



## BBolen Ph.D (Nov 9, 2000)

You asked for it, you got it. My perspective on the relationship among anxiety, panic and IBS is to liken it to a home security system. If the system is set with too low a threshold, the alarm will sound every time the wind blows or a cat walks through the yard. In IBS, the body's fight-or-flight emergency system becomes hyper-responsive to stimuli. When a person with IBS worries about or scans their body for intestinal symptoms (a likely process if they have been traumatized by severe, chronic symptoms), they set off the alarm, triggering the very symptoms they were worried about in the first place. Thus, in order to better manage the disorder, a person with IBS would look to actively use strategies which help to turn the alarm system off, e.g. relaxation techniques, contingency planning, calming self-talk. Hypnotherapy appears to keep the system turned off on a subconscious level. Brain studies have indicated that in response to bowel discomfort, people without IBS stimulate the part of the brain that is associated with the release of opiates, the body's own pain killers. People with IBS stimulate the part of the brain that is associated with arousal, vigilance and anxiety, all of which enhance the sensation of pain. Thus, engaging in behaviors which reduce vigilance and anxiety would help reduce pain sensations. Anxiety disorders and IBS often go hand in hand, particularly panic disorder with agoraphobic avoidance, the development of obsessions and compulsions related to bowel activity, phobias and generalized anxiety disorder. Anti-depressants and anti-anxiety medications are often prescribed as treatment for IBS. Anti-depressants have good anti-pain properties and have an anti-anxiety effect as well. Anti-anxiety medications are generally only recommended on an acute, emergency basis as they can be addicting and often create anxiety on withdrawel.------------------This input is provided solely for educational purposes and is not to be seen as a substitute for professional medical advice, diagnosis or treatment. Always consult a qualified professional about your personal medical needs and any questions you may have regarding this information.


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## eric (Jul 8, 1999)

Thanks Dr Bolen, I like the home security analogy.







Thanks for this post.------------------I work with Mike and the audio 100 program. www.ibshealth.com www.ibsaudioprogram.com


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## Guest (Feb 14, 2001)

Hi Dr.Bolen,I too think that's a very good analogy.When you mention anxiety meds, I assume you mean Benzos (xanax, Klonopin, etc...) when you refer to their being for "emergency basis" and causing addiction. (BuSpar hasn't demonstrated any addictive properties).I wholeheartedly agree with CBT and other self-directed approaches to deconstruct angst-ridden thought patterns. However, I have come to be a very strong advocate of SSRIs as being a similar medium if not long term tool to mitigate the problems of anxiety disorders (GAD, OCD, PTSD).What is your take on SSRIs, and their long-term use?Very often, a person with an anxiety disorder cannot "talk down" the anxiety because they themselves may have doubts about what is causing their symptoms (i.e. cancer or something equally horrible)...if they go too far down the garden path, I seriously doubt the efficacy of CBT alone in timely recovery from an anxiety disorder.My own take is that CBT is an integral tool to recovery, and long-term care, but depending on the severity of the anxiety disorder, medication - coupled with CBT and other relaxation techniques - is the best route.[This message has been edited by RopesEnd (edited 02-13-2001).]


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## BBolen Ph.D (Nov 9, 2000)

My take on SSRI's is that they offer significant symptom relief with a minimal of side effects. The question of therapy alone vs. medication alone vs. a combination can only be answered on a case by case basis, depending on severity of symptoms, attitudes about medication, etc.When a person finds that cognitive challenging (e.g. talk down) is not enough to reduce anxiety, it may be that the overall, baseline anxiety is too high. If this is the case, techniques for reducing the overall anxiety level would be called for, such as regular use of relaxation, monitoring of anxiety states throughout the day, or if necessary, through the use of medication. Cognitive challenging techniques, such as "Where is the evidence that I have cancer?" do require some practice before they become a more automatic response. Again, you can clearly see the relationship between what one is thinking and how one feels. Thus, change your thinking, including underlying beliefs, and you will remain calmer and thus reduce the likelihood of setting off your intestinal system. Thank you for your post, you seem to have a good handle on things.------------------This input is provided solely for educational purposes and is not to be seen as a substitute for professional medical advice, diagnosis or treatment. Always consult a qualified professional about your personal medical needs and any questions you may have regarding this information.


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## JeanG (Oct 20, 1999)

Thanks for the excellant explanation, Dr. Bolen.







JeanG


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## Guest (Feb 14, 2001)

well put, Dr. B. just want to repeat that ant-anxiety meds are generally recommended only for ashort-term acute emergencies.tom


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## partypooper (Mar 22, 2000)

Hi, Dr. Bolen,Thanks for the post. Very interesting. I tried the SSRIs for my IBS-D, but I did not seem to respond - no reduction in D or resulting depression/anxiety. However, I have been taking imipramine since October, and it has helped quite a bit with the D. I do tend to get tired easily and need a lot of sleep though. I also experience "hot flashes", but don't know if this is a side effect of the drug or not. Do you think tricyclics are helpful for IBS sufferers too? Are there any antidepressants effective for IBS that are "safe" to take while pregnant?I am already worried about what will happen when I have to be med free to have kids. Thanks!


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## eric (Jul 8, 1999)

Partypooper, I am just wondering where your at on the tapes. Not to side track your question to Dr Bolen, but I am curious.------------------I work with Mike and the audio 100 program. www.ibshealth.com www.ibsaudioprogram.com


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## BBolen Ph.D (Nov 9, 2000)

Partypooper,I am not a psychiatrist, but from what I have read research does support the use of tricyclics as a treatment for IBS. In terms of safety for pregnancy, you would have to ask your obstetrician. In the meantime, you may want to learn some cognitive-behavioral techniques to help to combat the depression and reduce anxiety should you need to be med-free for pregnancy. And maybe you will be lucky, anecdotal evidence seems to indicate that for some people the hormonal changes in pregnancy result in a reduction of symptoms.------------------This input is provided solely for educational purposes and is not to be seen as a substitute for professional medical advice, diagnosis or treatment. Always consult a qualified professional about your personal medical needs and any questions you may have regarding this information.


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## partypooper (Mar 22, 2000)

Thanks for the info!Eric, I am on day 90 something of the tapes. Getting close to the end now. I don't know what I will do without having Mike's voice to listen to every night before I go to sleep.


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## eric (Jul 8, 1999)

Partypooper, when your done give it some time see how you feel. It actually is said quite commonly that people will miss not listening, but listen for reinforcement when you need too.------------------I work with Mike and the audio 100 program. www.ibshealth.com www.ibsaudioprogram.com


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## eric (Jul 8, 1999)

To the top.------------------I work with Mike and the audio 100 program. www.ibshealth.com www.ibsaudioprogram.com


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## eric (Jul 8, 1999)

Bump------------------I work with Mike and the IBS Audio Program. www.ibshealth.com www.ibsaudioprogram.com


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## eric (Jul 8, 1999)

Bump!







------------------Moderator of the Cognitive Behavioral Therapy, Anxiety and Hypnotherapy forumI work with Mike and the IBS Audio Program. www.ibshealth.com www.ibsaudioprogram.com


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