Cognitive Behavioural Therapy for Irritable Bowel Syndrome 

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In recent systematic reviews [1], cognitive behavioural therapy (CBT) for irritable bowel syndrome (IBS) has been found to be the most well-evidenced effective psychological approach for improving IBS symptom severity as well as reducing IBS-related anxiety and improving quality of life. CBT for IBS is not the same as general CBT. It is a specifically tailored protocol to improve and regulate the gut-brain axis interactions. 

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For some people with IBS, my approach is to largely stick to the evidence-based protocol, that my research team and I used in the largest randomised control trial of CBT for IBS to date [2]. For others with additional presentations, or additional needs, I may use more of an integrative approach drawing from CBT, acceptance & commitment therapy (ACT), mindfulness and compassion focussed therapy. ​All therapy will aim to create a shared understanding of the gut-brain axis and what factors may be contributing to any dysregulation. 

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Online Group Cognitive Behavioural Therapy for IBS

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The online Cognitive Behavioural Therapy Group for Irritable Bowel Syndrome is now open again. We had amazing results from the first online group cohort, including an average reduction in abdominal symptoms by half and increased satisfaction in bowel habits by double! 

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The cognitive behavioural therapy (CBT) for IBS group uses the CBT protocol used in the Assessing Cognitive Therapy in Irritable Bowel Syndrome (ACTIB) Study, as published in the BMC journal and The Lancet Gastroenterology & Hepatology journal and covered in the Independent, Guardian, Sun and Telegraph. This protocol is aimed at improving bowel function and reducing bowel-related anxiety and stress. 

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All participants in the group will have IBS and will agree to confidentiality to what is discussed within the group. The sessions will be hosted by Dr Sula Windgassen, Senior CBT Therapist and Health Psychologist and facilitated by Dr Alicia Hughes, Health Psychologist and Assistant Health Psychologist, Amina Saadi. The group will involve a mixture of interactive information provision and smaller group break out rooms to become familiar with the material and try out home practice tasks. For each week there will be particular home practice tailored to your own experience of IBS. A set of questionnaires will be issued at the beginning of the programme and again at the end to measure progress. 

 

The program covers:

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• Information about the gut-brain axis and bowel functioning in IBS

• Ways our behaviours impact our bowels and what goals to set to improve bowel function

• Ways our thoughts and emotions impact our bowel function and what goals to set to improve bowel function and impact on our lives

• Methods of introducing self-care, relaxation and stress management 

 
It will include:

-    8 x 1.5-hour sessions in a group of people with similar experiences of IBS
-    A self-management CBT manual for IBS 
-    Worksheets for home practice 
-    Support from two Health Psychologists accredited by the HCPC and an Assistant Psychologist 
-    Access to an actively moderated forum to share experiences of home practice and to support each other for up to 3 months after the course finishes
-    Discounted option for 30-minute one-to-one follow-ups 

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Who is eligible?

You are eligible if you have IBS and this has been communicated to you by a healthcare professional. The group will not be suitable for people with an active eating disorder, for those actively following the FODMAP diet, for those with inflammatory bowel disease, coeliac disease or those 60 or over who have not had their symptoms checked by a consultant in the last 2 years. It is also not suitable for those who are in crisis. The following questionnaire is to determine whether our group will be appropriate. Once you have completed and submitted it, I will confirm whether the group is the most appropriate option.

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• The next intake TBC.

• Groups run 6pm (GMT) to 7.30pm

• The price of the group is £650, with the option to pay in 4 instalments. Places secured with a  £150 deposit. Cancellations made within 14 days of the course date cannot be refunded. You can  register here

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Mindfulness for Irritable Bowel Syndrome 

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Mindfulness is more than paying attention on purpose. It involves the development of an observer perspective on experience with the qualities of compassion and non-judgement. This is not an intuitive stance for our brains, and so it takes practice to cultivate. There are many benefits of mindfulness, including reduced depression, improved mood and reduction of physiological markers of stress [3]. 

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Trials have shown that mindfulness can improve symptom severity and improve the quality of life for people with IBS. These studies have assessed this in the context of mindfulness groups tailored for IBS, including learning ways to sit with sensations, and reducing the anxiety and discomfort that they produce over time [4]. I incorporate elements of mindfulness into therapy. To what degree we use mindfulness will depend on your preference and individual clinical formulations. 

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Psychological Approaches for Inflammatory Bowel Disease

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Inflammatory bowel disease is the term to describe two distinct bowel conditions: Crohn's and ulcerative colitis. These bowel conditions can look very different across individuals and come with a unique set of challenges. Common persistent symptoms reported in IBD, when not in a flare, are urgency, pain and fatigue. Lots of health psychology research shows that psychological interventions can be effective in reducing these outcomes in the context of chronic illness. More recently, a clinical research trial I was involved in developing, IBD Boost, created and assessed the efficacy of a CBT-based intervention targeting those outcomes in IBD. This intervention was developed in partnership with people living with IBD and working collaboratively with Crohn's & Colitis UK (CCUK). The study is just now drawing to an end, but the research so far is showing promising results. 

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I work with people with IBD to help with a range of issues. These include:

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• Difficulties adjusting to the condition

• Reducing urgency and fears regarding urgency

• Improving fatigue and pain  

 

References

[1] Black, C. J., Thakur, E. R., Houghton, L. A., Quigley, E. M., Moayyedi, P., & Ford, A. C. (2020). Efficacy of psychological therapies for irritable bowel syndrome: systematic review and network meta-analysis. Gut, 69(8), 1441-1451.

[2] Everitt, H. A., Landau, S., O'Reilly, G., Sibelli, A., Hughes, S., Windgassen, S., ... & Moss-Morris, R. (2019). Cognitive behavioural therapy for irritable bowel syndrome: 24-month follow-up of participants in the ACTIB randomised trial. The Lancet Gastroenterology & Hepatology, 4(11), 863-872.

[3] Creswell, J. D., Lindsay, E. K., Villalba, D. K., & Chin, B. (2019). Mindfulness training and physical health: mechanisms and outcomes. Psychosomatic medicine, 81(3), 224.

[4] Garland, E. L., Gaylord, S. A., Palsson, O., Faurot, K., Douglas Mann, J., & Whitehead, W. E. (2012). Therapeutic mechanisms of a mindfulness-based treatment for IBS: effects on visceral sensitivity, catastrophizing, and affective processing of pain sensations. Journal of behavioral medicine, 35(6), 591-602.

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