Irritable Bowel Syndrome
Irritable Bowel Syndrome (IBS), characterized by chronic cramping, abdominal pain, bloating, gas, diarrhea, and constipation, is associated with co-occurring psychopathology such as anxiety and depression. For example, research has shown that anxiety and depression are more common in patients with IBS, and that anxious and depressive symptoms are elevated during active periods of disease . One study found a significantly higher lifetime prevalence of major depression for the IBS cases compared to cases in the community (27 % vs. 12 %). These findings were similar for 12-month prevalence rates (9.1 % for IBS vs. 5.5 % for community), with a trend toward significance (odds ratio [OR] 1.53, 95 % confidence interval [CI]
0.96-2.45). Lifetime prevalence of panic disorder for those with IBS was also demonstrated (8.0 % vs. 4.7 %, OR 1.59, 95 % CI 0.96-2.63; ). Another study examined two nationally representative Canadian health surveys  and found 12-month depression rates to be 14 and 16 % amongst participants reporting IBS symptoms for each survey, nearly triple the rate of depression in Canada. Moreover, it has been demonstrated that the course of IBS is worse in depressed patients, and there is evidence to suggest that the psychopathology may actually mediate poorer health outcomes in IBS patients .
Evidence-based, cognitive-behavioral interventions have been shown to improve anxiety, depression, and GI-related symptoms in IBS patients. An open trial and consequential randomized controlled trial (RCT) demonstrated cognitive behavior therapy (CBT) to be effective in treating adolescents with IBS and depression . For those adolescents with comorbid anxiety, there was a significant reduction in anxiety as well. While the open trial did not find any change in IBS symptom severity posttreatment, the RCT demonstrated a decrease in the number of individuals with moderate to severe disease posttreatment (29 % pre- vs. 15 % posttreatment). Although the findings were not statistically significant, treatment gains were maintained at 12-month follow-up . Another randomized controlled trial with adults with IBS found clinically significant reductions in anxiety and depression from a CBT program emphasizing relaxation training, distraction, and cognitive restructuring, and treatment gains were maintained through 12-month follow-up . Overall, there is limited but promising evidence suggesting that CBT interventions are accepted and effective in depressed or anxious patients with IBS.
Gastrointestinal disorders are a heterogeneous group of illnesses with varied etiologies, symptoms, and impacts. Accordingly, there is no single psychotherapeutic protocol that can be applied across disorders. Nevertheless, as described above, the research shows that psychosocial interventions based on cognitive behavioral principles can help individuals cope more effectively with symptoms, improve quality of life, and interrupt the feedback loop that often exists between symptoms of anxiety and depression and exacerbation of GI symptoms.