Objectives  Understand irritable bowel syndrome  Realize that cognitive behavioral therapy (CBT) can be an effective counseling method  Observe techniques in brief counseling session  Review outcome of session using CBT

 Irritable Bowel Syndrome (IBS) is a GI disorder characterized by recurrent abdominal pain, discomfort and bloating, accompanied by alterations in bowel movements such as constipation and diarrhea.  10-15% of Americans have IBS  There is a link between IBS and stress and anxiety  There is no cure – follow Low Fodmaps diet  Studies show that managing stress and anxiety can be effective in controlling IBS

 Our thoughts cause behavior  We can change the way we think/feel  Learning how to think differently leads to change

 Counselor’s role: listen, teach and encourage  Client’s role: express concerns, learn and implement that learning  Focus on specific concepts/techniques  Help clients “unlearn”  Change irrational thinking patterns

 motivational interviewing  goal setting  problem solving  behavior modification  self-monitor  Set behavior change goals  Use stimulus control

 aims to help patients change their habitual thoughts, feelings, and behaviors that magnify stress and negative moods by applying a series of self-exploration exercises and stress reducing strategies.

 Effective techniques: › Diaphragmatic/ab dominal breathing, › Progressive muscle relaxation › Visualization/positiv e imagery › Hypnosis › Desensitization (gradual exposure to something feared)

 Meet Julie: › 23 year old female › Current weight: 108lbs › Usual weight: 123lbs › Recent diagnosis of IBS › History of gastrointestinal problems › Suffers from anxiety › Full-time office job involving long phone calls and in-person client meetings usually over mealtime (at a restaurant) › Currently afraid to eat anything because of undesirable symptoms at unpredictable times

 Julie was under the impression that IBS is strictly food related  Counselor helped her realize on her own that other factors might play a role  Julie began to think about her diagnosis differently  Julie is still skeptical but is willing to give some relaxation techniques a try  Counselor left it open-ended, allowing Julie to decide if relaxation will help her or not  Bringing this new idea to Julie’s attention will take time for her to decide if it is true for her or not  Julie is open to thinking about her diagnosis and its treatment differently now

Craske, Michelle G., and Kate B. Wolitzky-Taylor. "A Cognitive-Behavioral Treatment for Irritable Bowel Syndrome Using Interoceptive Exposure to Visceral Sensations." NCBI. U.S. National Library of Medicine, June Web. 17 Nov "IBS Symptoms | IBSgroup.org." IBS Symptoms | IBSgroup.org. N.p., n.d. Web. 17 Nov Kennedy, Tom, and Roger Jones. "Cognitive Behaviour Therapy in Addition to Antispasmodic Treatment for Irritable Bowel Syndrome in Primary Care: Randomised Controlled Trial." BMJ. BMJ Publishing Group, n.d. Web. 17 Nov Shepherd, Sue, and P. R. Gibson. The Complete Low-FODMAP Diet: A Revolutionary Plan for Managing IBS and Other Digestive Disorders. New York: Experiment LLC, Print. "Stress, Psychological Factors, and IBS." - AboutIBS.org. N.p., n.d. Web. 17 Nov "What Is Cognitive-Behavioral Therapy?" What Is Cognitive-Behavioral Therapy? N.p., n.d. Web. 17 Nov