How Therapy Can Help You Manage the Mental Health Side of IBS-C

Excruciating abdominal pain. Bloating. Irregular, painful bowel movements. The symptoms of irritable bowel syndrome with constipation (IBS-C) can be overwhelming. So overwhelming, in fact, that many people with the condition struggle with one or more mental health disorders — in particular, depression and generalized anxiety disorder, according to Laurie Keefer, PhD, a professor of medicine and psychiatry at the Icahn School of Medicine at Mount Sinai in New York City.

Plenty of help is available, though. Thanks to an increasing awareness and understanding of the toll that all types of IBS can take on mental and emotional well-being, there are several proven psychological therapies for mental health disorders brought on by IBS-C that people with the condition can explore with their healthcare providers.

The Mental Challenges of IBS-C

With IBS-C symptoms, it’s not only the complications that people have to manage, but also the unpredictability of when they might occur.

Living with this chronic, unpredictable, and painful condition can make navigating daily life all the more difficult, and for some, it becomes too much to handle. “People often give up their engagement in pleasurable events, which can lead to low mood and feelings of hopelessness,” says Dr. Keefer.

Worrying about symptoms and situations in which they may occur can make it hard to feel fully engaged in life. “I describe IBS as a background app tracking your location: It’s always there and drains your battery,” she says.

What’s more, the primary driver of IBS-C and mental health challenges is the gut-brain connection, says Keefer.

The brain-gut pathways are thought to be a contributing factor with IBS. Because stress and anxiety from worrying about the condition can cause the brain to misinterpret signals of pain coming from the gut, symptoms can actually worsen.

It’s important to remember that it’s a two-way street, though. IBS-C symptoms can negatively affect mental health, but alternately, tending to mental health and well-being can calm that brain-gut connection and have a positive impact on the condition.

Therapies and Additional Treatments That Can Help With IBS-C

Brain-Gut Therapy

Self-management training, gut-directed cognitive behavior therapy (CBT), and gut-directed hypnotherapy are all part of brain-gut therapy. According to Keefer, some trials have found that a majority of participants experience a reduction in pain and related symptoms.

“There’s evidence that CBT may have an effect on the gut microbiome, which could help reduce IBS-C symptoms even further,” says Supriya Rao, MD, a board-certified physician in gastroenterology and lifestyle medicine and managing partner at Integrated Gastroenterology Consultants in Boston.

She points to a study published in 2023 in the journal Microbiome, which found that after 12 weeks of CBT treatment, participants had increased levels of beneficial gut bacteria in their microbiome, compared with those who didn’t receive CBT treatment.

Mind-Body Practices

Yoga, meditation, and music therapy have little science behind them to show they can help ease IBS-C. But, says Keefer, “Anything you can do to reduce the physical impact of stress on the body, increase moment-to-moment awareness of your body, and experience movement” could help.

Stress management in particular can have a significant positive effect on gut health. “Research shows that chronic stress can worsen or even cause digestive conditions,” says Dr. Rao. Mental stress has a direct impact on the digestive system, activating the fight-or-flight response. “This causes hormones to be released, which can trigger a cascade of physiological responses, such as an increase in blood pressure, heart rate, and respiration, all of which are linked to the onset or worsening of IBS-C,” she says.

Antidepressants

Medications that increase the availability of serotonin, a primary chemical messenger between the gut and brain, can be highly effective in treating depression brought on by IBS-C. “Ninety-five percent of your body’s serotonin is in your gut,” Keefer explains.

Why is it important to increase serotonin when talking about gut health? The chemical has been associated with how quickly food moves through and is absorbed by your body and also plays a role in the communication between your gut and brain.

Three classes of antidepressants affect serotonin levels: selective serotonin reuptake inhibitors (Lexapro, Zoloft), norepinephrine reuptake inhibitors (Effexor, Cymbalta), and tricyclic antidepressants (Norpramin, Tofranil). Taking these medications can improve psychological and emotional symptoms of IBS.

Finding the Right Therapist

• The Rome Foundation, a nonprofit organization aiming to improve the lives of people managing gastrointestinal (GI) disorders, features a directory of GI psychologists by state.
• Psychology Today can help you find a therapist with expertise in chronic illness, CBT, or other evidence-based therapies.

At the end of the day, if you’re living with IBS-C, it’s important to address any mental health concerns as early in your treatment as possible. Keefer notes that, thanks to many years of research, there are several helpful strategies you can incorporate into your IBS-C management routine to help you live your best life.