# Questions about behavioral therapy



## 16653 (Jan 7, 2007)

My general doctor recommended I go see a behavioral therapist, so I went to that appointment. We talked a little bit about what is going on in my IBS-D life. She then gave me a piece of paper about breathing techniques and told me to practice my breathing (directions were on the paper) and come back in a month. It felt like a waste of money to me- I felt nothing "got done", especially since I already take deep breaths to calm myself down when sick. What does a behavioral therapist do for someone sick with stomach problems? Is it worth going back to more appointments? My only concern is cost- I am being booted off my parents insurance plan and having to carry on my own policy...and seeing how I'm out of work, my funds are kaput, thank goodness for my dear boyfriend.







I don't want to be paying for appointments about deep breathing- but if behavioral therapy really works for some, I will tough it out. Thank you!


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## eric (Jul 8, 1999)

This depends on the therapist and what they know about IBS and how they approach treating you. This doesn't happen right away though, its a process.FYI UNC "Digest""Ask the ExpertStephan R. Weinland, PhDQuestion Why see a psychologist when the diagnosis is IBS?Many people experience distress and anxietywhen their doctor makes a recommendation thatthey see a psychologist. This reaction often comes from the belief that a referral to a psychologist carries with it assumptions about symptoms being â€œall in your headâ€ or the result of â€œmental illnessâ€.These are two of the biggest misconceptionsabout the practice of psychology in a medicalsetting, and they can often stand in the way ofpatients achieving a meaningful reduction insymptoms. In this column, I hope to dispel someof these misconceptions around psychology in amedical setting, and in doing so communicate afew of the benefits you might be able to achievein working with a psychologist to address yoursymptoms of IBS.First things first, your physical problems arereal! If your doctor gives you a recommendationto meet with a psychologist it does not meanthat the symptoms are â€œall in your headâ€ or theresult of â€œmental illness.â€ Your experience ofIBS is likely to be debilitating to you, and it can have wide ranging effects on your loved ones,yourself and activities that you want to engage in. Psychologists and physicians work together, with the understanding that the mind and body are connected. If you are feeling ill and having many symptoms of IBS, you may also experience an increased level of stress and discomfort. This stress and discomfort contribute to a cycle of worsening symptoms that can spiral into more severe IBS. Psychologists and physicians worktogether with you to interrupt that cycle and help you learn to decrease the number and severity of your symptoms.Psychologists that work in medical settingsoften specialize in a field of psychology knownas â€œBehavioral Medicineâ€. This specializationfocuses on thoughts, feelings and behaviors thatget in the way of effective coping with biomedical symptoms, and also focuses on teaching you and those around you good self-care behaviors. One question you might be asked when you come into our office is â€œWhat steps are you taking to take care of yourself?â€ Increasing the number of good self-care behaviors that you are implementingis often a great place to start in addressing your symptoms.Sometimes patients with IBS are dealingwith a heavy burden of past life stresses andcircumstances. While talking about these eventscan occasionally be beneficial, it does not needto be the focus of therapy for you to see progress.Often, learning to implement good sleep, hygiene, stress reduction, and other coping strategies for dealing with situations can go a long way in making you feel more in control of your symptoms, rather than feeling like IBS is controlling you. Increasing your control over symptoms is another one of the steps towards improvement in your IBS.Often, people experience distress related toproblems and difficulties that arise around their IBS symptoms rather than from the IBS symptoms themselves. For example, occasionally patients with IBS get anxious when leaving the house or any â€œknownâ€ environment because of a fear of becoming incontinent. Over time, this fear grows and fewer places and activities are deemed â€œsafeâ€, resulting in a withdrawal from previously enjoyed activities. This fear or â€œanticipatory anxietyâ€ is part of a vicious cycle that can actually make your symptoms worsen or even contribute to an episode of incontinence. Through discussion andindividually developed behavioral exercises, apsychologist can help you reduce these fears andre-engage in activities that you have wanted toengage in, thereby helping you break the viciouscycle of your symptoms.Psychologists also work with you to examinebehaviors, thoughts and feelings that are getting in the way of effective coping with your IBS symptoms. Just like physicians, our ultimate goal as psychologists is to make ourselves unnecessary.We do this by helping you develop your own skills that can allow you to handle challenging situations more effectively by yourself. If you are living with a medical diagnosis, chances are that you are already getting a lot of â€œadviceâ€ from everyone around you. In all likelihood, a psychologist will not give you â€œadviceâ€; instead, he or shewill work with you to develop your own plan foraddressing the symptoms that are bothering you.Treatment plans and directions are establishedcollaboratively with the overall goal of helpingyou see your symptom picture improve.So how does psychology work? There is no magic.IBS is a diagnosis that involves sensitization of nerve endings in the GI tract. This sensitization can occur from a number of different sources (infection, inflammation, significant stress, or chronic activation of the autonomic nervous system). This sensitization has the effect of turning up the volume on your symptoms. One way that psychologists can work with you is toteach you ways of slowing down your autonomicnervous system, using tools of progressivemuscle relaxation, guided imagery, focusedconcentration, or even biofeedback. Essentially,learning and practicing these behaviors hasthe effect of turning down the volume on yoursymptoms, and it can go a long way to giving youincreasing numbers of low symptom days.IBS is a chronic condition. There is no magical pill that will take away your symptoms or turn back the clock to the time â€œbefore this all started.â€ Because of this, the ultimate focus of treatment with a psychologist is minimizing the debilitation and discomfort you feel as a result of your symptoms.Just because a disease process is chronic or longstanding does not mean you have to suffer with it.Working with a psychologist is one way to accessa range of new tools for living with your IBS.In conclusion, IBS is multi-determined and canbenefit from being addressed using a multidisciplinary treatment approach. Working with a psychologist is just one part of that treatment approach, and it has been shown to be an effective addition to traditional biomedicaltreatment. Using a combination of the tools andplans discussed in this column, patients can seea significant reduction in their symptoms. Pleasefeel free to contact me if you have any questions about seeing a psychologist when the diagnosis is IBS â€" http://www.med.unc.edu/ibs and from Dr Bolen who is a member of the bb here and helped put together the recent IBS Chat Book along with jeff the administrator of the bb.Barbara Bradley Bolen, [email protected] 5, 2002COGNITIVE BEHAVIORAL THERAPY FOR IRRITABLE BOWEL SYNDROMEThere is an old saying that if you give a child a fish, you feed that child for a day, but if you teach a child to fish, they are fed for a lifetime. In accordance with this old proverb, Cognitive behavioral therapy (CBT) is a form of psychotherapy that strives to actively teach people skills and strategies that they can use to help themselves feel better. A considerable amount of research indicates that CBT is effective in helping to reduce the symptoms of Irritable Bowel Syndrome.Many people wonder how psychotherapy can help IBS if IBS is a physical disorder. One of the major triggers that can set off or exacerbate IBS is stress. In addition, IBS is a very stressful disorder to live with. CBT provides an individual with tools for combating stress, reducing the anxiety response and thus calming the GI system.The cognitive therapy part of CBT helps individuals to identify, challenge and replace unhealthy thought patterns. When we are thinking clearly, we are able to deal with the world in a calm, rational manner. However, our thinking often gets distorted, due to our personalities, our past history, our emotional state or lack of information. When thinking gets distorted it can lead to excessive emotional reactions. For an individual with IBS, these thought distortions may lead to an anxiety response that can trigger symptoms. For example, if a person with IBS thinks "My stomach is rumbling. Uh, oh! I know I am going to be sick. What is I can't make it to the bathroom? This is terrible!", that person is going to experience anxiety and perhaps set off the very symptoms they are afraid of. If instead, the person thinks, "Just because my stomach is making some noise does not necessarily mean I am going to have symptoms. I will just focus on what I am doing and see what happens", that person will remain calm and be less likely to stimulate their digestive system.The behavioral aspect of CBT involves skill training. Relaxation techniques, including deep breathing skills and progressive muscle relaxation, help the individual to reduce the physiological symptoms of anxiety. An anxiety reaction can be likened to a home security alarm. Relaxation techniques send the message to the body that there is no emergency and that the alarm can be shut off. CBT for IBS may also include skill training in assertion and anger management, as research has shown that IBS patients often have difficulty in these areas.IBS can wreak havoc on a person's quality of life. CBT helps IBS sufferers to regain a sense of control over their life. With the skills gained in CBT, one no longer needs to be a passive victim of this disruptive disorder, but can now actively use strategies which are effective in reducing the frequency, intensity and duration of IBS symptoms. Barbara Bradley Bolen, [email protected] of:Breaking the Bonds of Irritable Bowel SyndromeNew Harbinger Publications (2000)


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## Kathleen M. (Nov 16, 1999)

Relaxation techniques like breathing are one part of CBT, but not the one and only thing that is done. It usually is a starting point for any of the mind-body type of things.We went over that when I did CBT and biofeedback. Even if you do it on your own you might look to see if the method as described on the sheet is different or more effective than what you invented on your own. Often they want regular practice, not just to calm yourself down if and when you get upset.No treatment ever is a one shot all things fixed all at once. It is a process and from what I have seen all of these processes tend to feel like they start off a bit slow.K.


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