# CBT...does it work?



## bluejeanbabyamy (Aug 8, 2007)

Hi all,I'm new to the forum. My name is Amy, and I'm a 21-year-old entering my last year of college. I was recently diagnosed with IBS and have been taking numerous tests at my GI doctor since January. After taking a breath test, the doc is convinced I have SIBO. I took one course of Xifaxan and had no change. I'm about to take Neomycin. Needless to say, I'm pretty frustrated at the lack of clarity about how to remedy my symptoms at this point. I pretty much always feel what I describe as "full" -- or bloated -- to the point where I'm uncomfortable and can barely eat more than a few bites of food. In addition to this, I have emetephobia -- an INTENSE fear of vomiting -- so I don't want to push my stomach to any limits for fear that it'll make me sick.In short, the constant physical discomfort has caused me to have panic attacks which I've had for the last few years. Within the last few months, I was having so many attacks that I was diagnosed with panic disorder. I take Xanax as needed, approx. every 3 days. My psychiatrist recommended I go on anti-depressants, but I'm extremely reticent to the idea. Instead, I'm trying CBT. I went to one woman from Jan.-April, but she was harsh and things didn't work out. Since June, I've been seeing a new guy I really like. But I'm still unsure of how much faith I have in this breathing, exposure therapy type stuff. My CBT guy seems convinced he can eradicate or at least largely control my fear of vomiting, eliminating my constant stress levels. But I've barely seen a result. All I can think about is feeling sick ALL the time. And when I'm in physical discomfort, it's nearly impossible for me to focus on anything else.In short, I'm really frustrated and heading into my final year of school, I just can't handle feeling sick and anxious all of the time. Does anyone have any advice?Thanks,Amy


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## cookies4marilyn (Jun 30, 2000)

Hi Amy and welcome!CBT can be very helpful for many conditions - our moderator Kathleen had CBT for her IBS and did extremely well. However, that was for IBS only, not for anxiety, etc. issues.Just as we are all different, here is no "one-treatment -fits -all solution. For SIBO and conditions that can be treated through meds, CBT can help you cope, but it can't take away physical infections, bacterial overgrowth, etc.As far as the CBT for your other conditions, you have to give it some time - hopefully Kathleen will see this and can give you a time frame - however, we are all different, and your time to see results may be different. If your CBT therapist feels he can help you, than give it a chance - hopefully he will! Just need to be patient with yourself.Although it does not address all the areas you mention, you may want to consider at some point, looking into what helped me out - clincal hypnotherapy - it might not be right for your situation, however, it works on the subconscious level, takes a bit of time, but it breaks the mind-gut connection of anxiety and addresses pain issues that are connected to IBS. Many here on the BB have done the program discussed on this forum. I don't know if it would be helpful to you or not, but at least it does work on taking the thoughts away - though it does not address emetephobia, only IBS symptoms, anxiety related to IBS, and IBS pain - it also helps you to be more relaxed and calm, so perhaps indirectly it would help with your over all wellbeing and help you to cope with your pain and help to minimize the pain and thinking about it.IBS is a mind-gut disorder and a functional disorder, meaning there is no real "cause" but there are differences in the way and IBS functions - the mind in the gut responds differently and it is all interconnected to reactions throughout the day. CBT works with your conscious mind to give you tools to deal with those symptoms and reduce them on a conscious level - you have to "do" something actively with your thoughts and mind - with hypnotherapy, your subconscious does it for you, and gradually you automatically begin to react differently when symptoms start.IBS is NOT SIBO, not food allergy or intolerances. There may be foods you need to avoid because they become "triggers" to the IBS response, but the food itself is not the problem. However, and IBS patient may have food allergies, SIBO, etc. in addition to IBS, not as a cause of it - though these conditions can give IBS-like symptoms.My daughter is about your age and takes meds too for her anxiety and depression - it is a hard road sometimes, but we do keep changing things and she sees a therapist as well - so I can relate to what you are going through. I admire your determination to treat your condition, and I wish you all the best to feeling better very soon.If I can support you in any way, do let me know.Take care, hon.


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## Kathleen M. (Nov 16, 1999)

Well I did CBT for my IBS, but I didn't have quite as much going on at the same time as you have.In the clinical trial they did 3 months of therapy and by the end about 70% were better. I got a lot of benefit about 1/2 way through.How long can vary. For some people medications may help control the symptoms enough that you don't have as much to battle all at once. There are quite a few trials where they do both medication and CBT and that improves the response rate to higher than either one alone.It can be very frustrating to deal with all this. For me once I had some hope things could get better it really helped a lot. The thought patterns of "this will never end" and "I can't deal with this" seem to make my symptoms worse. It isn't always easy to have that hope, and I really couldn't use that until I started seeing some results. Once I knew I could feel better that made it easier to control.K.


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## eric (Jul 8, 1999)

Just fyi this is new Gastroenterology. 2007 Aug;133(2):433-44. Epub 2007 May 21. How does cognitive behavior therapy for irritable bowel syndrome work? A mediational analysis of a randomized clinical trial.Lackner JM, Jaccard J, Krasner SS, Katz LA, Gudleski GD, Blanchard EB.Division of Gastroenterology, Department of Medicine, University at Buffalo, State University of New York, Buffalo, New York.Background & Aims: Although multiple clinical trials support the efficacy of psychological treatments for reducing irritable bowel syndrome (IBS) symptoms, the mechanisms responsible for symptomatic improvement are unknown. One hypothesis is that psychological treatments work by alleviating comorbid psychological distress implicated in the worsening of bowel symptoms and quality of life. An alternative hypothesis assumes that changes in distress are not strictly a cause but a consequence of IBS that will decrease with symptomatic improvement. Methods: We evaluated these 2 hypotheses by applying structural equation modeling (SEM) to the data set of a large number (n = 147) of Rome II diagnosed participants randomized to CBT, psychoeducation, or wait list. Per Rome guidelines, the primary end point was global improvement of gastrointestinal (GI) symptoms measured 2 weeks after a 10-week regimen. Secondary end points were distress and quality of life (QOL). Results: SEM analyses lend support to a model in which CBT is associated with improvements in IBS symptoms, but that therapeutic gains do not depend on changes in patients' overall level of psychological distress. Symptom severity, but not clinical status (pain catastrophizing, predominant bowel habits, symptom duration, abuse, diagnosable psychiatric disorder) or relevant sociodemographic variables (eg, gender, age), moderated treatment outcome. Conclusion: CBT has a direct effect on global IBS symptom improvement independent of its effects on distress. Improvement in IBS symptoms is associated with improvements in the QOL, which may lower distress. Symptom improvements are not moderated by variables reflecting the mental well-being of IBS patients.PMID: 17681164


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