# A breakthrough after years



## Kathleen M.

In my twenties I developed a sleep disorder that was not diagnosed until I was about 20 (young, slim, females are not the high risk group for sleep apnea-like disorders). During this time I had mild symptoms of IBS and fibromyalgia, both of which were probably related to the disordered sleep. I also have a history of severe allergies which has also developed into asthma as an adult. When my allergies flare up I have a greater tendancy to GI upset.After the sleep disorder was cleared up and the allergies were getting under control the IBS symptoms were less, although I did tend to have some loose stools during times of stress. During this time there was a little bit of cramping, but nothing really bothersome.In 1997 I was on a field study camped out along the side of a large hog waste lagoon. I may have picked up something there that didn't agree with me as when we got back I started feeling bad, ran a low grade fever for about 6 weeks, but it wasn't enough for me to go to the doctor over. During this time the cramps started and continued to get worse. After the fever broke, the pain was still there. The pain was triggered by eating, by walking, and by doing anything (like picking up things off the floor) where I used my abdominal muscles. My allergy shots seemed to be making it worse, so I saw my allergist about that and let him know that an ostomy bag was starting to look really good and I was about ready to remove my own colon by myself, and he got me a referal to Dr. Drossman.Prior to that appointment they got me into see another local GI doctor who did a sigmoidoscopy, gave me Levbid and later added BuSpar, which got me functional. I wasn't free of symptoms, but they were tolerable, which was a big step up from where I had been.When I saw Dr. Drossman he approved the medication and he told me about his clinical trials. I was accepted as a subject and ended up in the Cognitive Behavioral Therapy treatment group in one of his studies. I wasn't able to handle the drug washout, and they kept me on while monitoring my drug use and switched me to Levsin SL rather than the longer acting Levbid. I was taking about 7-8 Levsin to make it through the day, along with 15 mgs BuSpar 2X a day at the start of the therapy. Also I was unable to complete some of the tests done at the begining and the end of the trial because they set off my symptoms to badly.About 1/2 way through the therapy something happened. I had a breakthough about some issues, but I don't know how this caused the results. In one week I dropped down to 2-3 Levsin SL a day and over the next week or two stopped taking the morning BuSpar (it makes me lightheaded in the morning, but doesn't bother me in the evening).As the therapy progressed I began taking less and less Levsin, and most of the time it wasn't to be functional, but to get rid of very mild cramping that I just didn't want to deal with. The stool consistancy had not improved much, but I didn't care about a few loose stools given that I was no longer in pain. I was able to complete all the testing at the end of the study.Since the therapy ended I have continued to improve. The stool consistancy went back to normal within three months of finishing the therapy (My internal hemaroids let me know about the return to formed stools, but they chilled out after a couple of days) and know I rarely if ever have an attack. I am down to 7.5 mgs of BuSpar at night, and hope that I may be able to go drug free soon. I am taking my allergy shots again, and they still upset the GI tract, so I may need to complete those before I can get off of the BuSpar entirely.K.


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## MajaSol

What is this therapy you mention where? psycological therapy? this webpage is anonymus, so you can tell?(sorry if i have spelling mistakes, english not my first language)







during psyclogical diffucilties in my life, my IBS have been at its worst, crippeling me,just staying in bed with crippeling pain, (soory for this detail - green stools!), when my lifesituation changed for the better, my tummy got better, have had therapy as well, made me better but never cured..they say the tummy have brain cells, maybe they react to emotions? in some peopke, maybe you have a especially sensitive tummy to problems in your life, a lot of people are like this







good that you share your story, diet is not always the whole answer, very interesting!


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## Kathleen M.

No other name than Cognitive Behavioral Therapy as I called it in paragraph 5.It actually tends to work best for people who are not currently depressed or having other major issues like that.The brain talks to the gut all the time, not just when you are upset.http://www.ncbi.nlm.nih.gov/pubmed/12851867 is the full clinical trial I was in.A lot of people hear of a Mind-Body therapy and may think the only thing being treated is a psychological issue. Our bodies get signals from the brain all the time. Changing the brain's thought processes (even from one non-pathological one that tends to ramp up symptoms for another normal pattern that tends to calm them down) will help.The body doesn't just do what it does in complete isolation from your brain. It needs the brain to help regulate the organs, time when things should happen, and a whole host of functions. After all it takes a host of machines to keep the body functional at all when the brain dies. They can do it, but they disconnect the machines and without the brain the body fails very quickly. So the brain can be a huge force for good in helping the body work. Finding how to use that for your own benefit can make a huge difference for a lot of things from diseases to athletic performance.You do not need to be in psychological distress for mind-body approaches to work, and often if you have a lot of psychological distress you need, IMO, to get that under control before you get the most physical benefit from some of the mind body approaches. If you are so distressed from anxiety or recent emotional upset it is hard to focus on the work needed to use your own mind to heal your body.


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## Day by day

CBT is very good for IBS considering a lot of what causes IBS is the mind gut connection. I'm happy you are revived kathleen and hope to one day share a similar story. You are all so brave on this forum... Sometimes its hard to suffer the way we do because there are few miracle stories, but yours kathleen I hope gives others strength like me


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## AsktheAges

I'm a little confused. Does this mean that you were doing CBT to deal with psychological issues of stress/anxiety/depression and the improvement in your mental state ended up helping your IBS? Or is there a sort of CBT that actually somehow focuses on the signals your mind sends to your gut in the first place? I've been doing CBT for several years to deal with anxiety, depression, and obsessive ruminating anger. I'm a huge advocate of it. (My IBS has not gotten better though, maybe worse if anything.) If there is some way that it can be applied to GI-related issues, I'd love to know.


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## AsktheAges

OK, after reading the abstract, I think you meant the former, which makes much more sense, really. They were comparing CBT and education vs antidepressants so it seems like they were comparing ways to manage psychological stress and seeing how this affects bowel disorders. Do you mind sharing which CBT techniques you used? I'm fond of automatic thought records and mindfulness meditation myself.


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## Kathleen M.

I really don't think it merely manages stress.For me the biggest thing that calms the nervous system down when the symptoms are acting up is focusing on "this too shall pass".Even at my calmest and least stressed mentally if I am thinking about how long will this last it seems to maintain the symptoms where focusing on the symptoms passing and returning to normal helps to soothe the system and calm it down.I really don't think merely managing stress would drop the pain from 9.7 to 3 in a couple of days (once we hit the right thing). I think there is more to it than that, but your mileage may vary.Antidepressants also have a direct effect on the gut nerves. They don't know they are prescribe for the 5% of the serotonin using nerves in the body in the mood center and are more than happy to work on the 95% of the serotonin using nerves in the gut. Several of the drugs developed specifically for IBS focus on effecting the serotonin receptors in the gut and I don't think that is just "stress management". 95% of the serotonin in your body is in the gut nerves. The antidepressant used in the study does not effect mood at the doses used. They are too low. But with the gut nerves you don't have to get the drug across the blood-brain barrier so it seems easier to get effects on the gut than on the brain.Now no one treatment will work for everyone, and the CBT in the study was gut-directed not anxiety or depression directed. I haven't seen any studies or indication that general stress management mind-body work is as effective as the gut-directed CBT and Clinical Hypnotherapy studies. And generally when people say "oh I did that, didn't work" they were doing the techniques for other issues, not in a way designed to target the IBS symptoms. But again your mileage may vary.


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## AsktheAges

This is extremely exciting! As I say, I have found CBT to be logical and helpful with other things and would be eager to apply it to IBS. Could you share some of the CBT techniques that you use? It makes sense to me that this could work.


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## Kathleen M.

Some of it the week that really had a big change was challenging a belief I developed over time and choosing a new belief.The big one I use ongoing is the "this too shall pass" thought.http://drbarbarabolen.com/breaking_the_bonds.htm is the main text I know that talks about the techniques, so that may be more helpful. I dunno if they used all of them.


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## AsktheAges

Thanks. I requested that book from my public library.


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## AsktheAges

I had high hopes for the Bolen book but I did not really find that it told me anything new, unfortunately. I have plenty of emotional stress in my life but I rarely stress out significantly over my IBS symptoms so I did not see much I could do with CBT in that area. (I already apply CBT techniques for my more general anxiety and depression.)


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## AsktheAges

At the same time, though, I really feel like there has to be some mind-body stuff going on here: I don't get attacks when I'm sleeping. I almost never need to stop a 3h lecture to go to the bathroom. So it makes sense that CBT could work here. I just need to figure out how.


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## AsktheAges

AsktheAges said:


> I had high hopes for the Bolen book but I did not really find that it told me anything new, unfortunately. I have plenty of emotional stress in my life but I rarely stress out significantly over my IBS symptoms so I did not see much I could do with CBT in that area. (I already apply CBT techniques for my more general anxiety and depression.)


I just realized today how I was wrong! In my head, on some level, I'm always thinking about my symptoms, worrying about what will trigger them, anticipating how I'll react to any food, tensing my body up the whole time. I've started trying to practise self-talk, basically telling myself that there's nothing to worry about, that there's really no logical reason for me to have IBS, and am trying to stay relaxed.


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## SWER

Hi, CBT makes sense to me. It takes years for us to develop a way of thinking. I have experienced that meals and having to eat has become a stress factor. i become anxious at the idea of having to eat out. I have wondered if IBS is not also somehow related to repressed emotions. I wonder if we dont avoid certain issues and emotions and at a point our bodies just respond in order to inform us there is something wrong. I would like to hear your opinions about this.

Swer


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## Kathleen M.

I don't think just repressing an emotion and nothing else will cause IBS. I'm a big believer in the GI viruses or other physical issues get the IBS going. Your thoughts or emotions are not going to damage the nervous system of the gut all by themselves.

That being said. We do develop over time for various reasons particular thought patterns and coping mechanisms to avoid emotions we don't want to deal with. Those patterns may interact with the IBS and make it worse than it has to be.

Altering these patterns may help relieve symptoms if you can get to a new pattern that tends to help the body calm the symptoms down rather than one that tends to ramp the symptoms up or maintain them once they start.


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## LilyWillow

Kathleen M. said:


> The antidepressant used in the study does not effect mood at the doses used. They are too low. But with the gut nerves you don't have to get the drug across the blood-brain barrier so it seems easier to get effects on the gut than on the brain.


Kathleen, Can you tell me what antidepressant and what dose you are referring to? I am really scared of taking antidepressants and the affect they will have on my brain but I really need help.

Years ago I was put on amitriptyline for migraines by my GP and when he jumped the dose to 75 too fast I had my first suicidal thoughts out of the blue. It scared the *ell out of me. I quit taking it and never regretted it. I don't want to ever feel that way again. I swear my brain has never been the same since.


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## Kathleen M.

Desipramine. Usually the doses for mood are 100 mgs and up. IBS usually is in the 10-50 mg range. The tricyclics were originally developed as an antihistamine, so they can make people drowsy like Benedryl can.

Desipramine is in a different group of tricyclics from amitryptaline and generally has fewer side effects, but I would talk it over with the doc carefully before trying it out.


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## jaumeb

Happy to read that you recovered. This gives all us some hope. Looking forward to read more recovery stories. I decided to start meditation. I wonder if it can achieve results similar to CBT.


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## kaydee82

Hi- Along these lines ... I've been doing the IBS Audio 100 self-hypnosis program. It's too soon to tell if it will really work for me, but you might want to check it out ...

http://www.ibsaudioprogram.com

Best of luck!


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