Psychological therapies for IBS – latest evidence

In medicine there is a thing called the ‘hierarchy of evidence’ you’ll see an example below. How is this relevant to psychological therapies for IBS you may ask? Stick with me and it will make sense.

Psychological therapies for IBS

‘Hierarchy of evidence’ With thanks to the IJSTD

The hierarchy of evidence is a visual representation of how we value evidence. At the bottom are things like; expert opinion, anecdotal evidence, the sort of stuff which might give you an idea of where to look for an answer but nothing more. At the top are systematic reviews and meta-analysis. A meta analysis brings together all the quality research to get the largest possible body of evidence. It can be said that a meta-analysis is like reading the 10-20 most rigorous studies in one. This is why they are considered the ‘Gold standard’ of evidence.

So why am I banging on about meta-analysis in a blog about IBS?  Well you may well have guessed,  it’s important to know that the evidence we are about to look at is more important than most. So now that we’ve set the scene lets look at the evidence itself

Psychological therapies for IBS – body and mind

A team of medics and psychologists for the Vanderbilt University, Nashville, TN, USA , have been diligently conducting a meta-analysis of the effects of psychological therapies for IBS on mental health and daily functioning and they have just published. Why are they limiting themselves to ‘Mental health and daily functioning’ you may ask? That would be because the same team showed that psychological therapies for IBS worked for gastro-intestinal symptoms in a meta-analysis last year (Laird, Tanner-Smith,  Russell, et al 2016), and its these two papers I want to talk about.

Psychological therapies for IBS – what they did

The Nashville team looked at four main types of psychological therapy in both studies;

  1. Cognitive Behavioural Therapy (CBT) – a model of therapy which  examines and challenges underlying beliefs about the world.
  2. Hypnotherapy – Whereby suggestions and imagery to calm and strengthen the digestion are given to a patient in a hypnotic state.
  3. Psychodynamic – In which early learnings and repeated patterns of thought and behaviour are examined.
  4. Relaxation therapy – In which patients are taught relaxation techniques to reduce their general stress levels, but may also use it situation specifically.

They also included Mindfulness meditation, in which the patient is taught to focus on the moment, often in combination with yoga or stretching exercises, in the meta-analysis of efficacy for gastrointestinal symptoms.

By combining the findings of all the high quality studies they were able to identify, they have  managed to conclude that overall psychological approaches were demonstrated to  have significant positive effects on;

  • Gastrointestinal symptoms
  • Mental health.
  • Daily activity.

There was very little difference between the four types of therapies in terms of efficacy and effects appear to be maintained at long-term follow up . However, it was interesting to note that CBT produced some of the most varied outcomes, having some of the most (Ljótsson 2011) and least effective interventions (Tkachuk et al 2003) for gastrointestinal symptoms.

This adds significant weigh to the concept that psychological approaches can help with physical problems.  More on psychological therapies for IBS

psychological therpaies for IBS

Author – Matt Krouwel is a  hypnotherapist in Birmingham (UK) working with and researching psychological therapies for IBS.





Psychological therapies for IBS – References
Laird, K. T., Tanner-Smith, E. E., Russell, A. C., Hollon, S. D., & Walker, L. S. (2016). Short-term and long-term efficacy of psychological therapies for irritable bowel syndrome: a systematic review and meta-analysis. Clinical Gastroenterology and Hepatology, 14(7), 937-947.


Laird, K. T., Tanner-Smith, E. E., Russell, A. C., Hollon, S. D., & Walker, L. S. (2017). Comparative efficacy of psychological therapies for improving mental health and daily functioning in irritable bowel syndrome: A systematic review and meta-analysis. Clinical Psychology Review, 51, 142-152.
Ljótsson, B., Andersson, G., Andersson, E., Hedman, E., Lindfors, P., Andréewitch, S., … & Lindefors, N. (2011). Acceptability, effectiveness, and cost-effectiveness of internet-based exposure treatment for irritable bowel syndrome in a clinical sample: a randomized controlled trial. BMC gastroenterology, 11(1), 110.
Tkachuk, G. A., Graff, L. A., Martin, G. L., & Bernstein, C. N. (2003). Randomized controlled trial of cognitive–behavioral group therapy for irritable bowel syndrome in a medical setting. Journal of Clinical Psychology in Medical Settings, 10(1), 57-69.