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The Stress/IBS Connection

Irritable bowel syndrome (IBS) is a very common and sometimes severe chronic disorder of the stomach and intestines which affects about 10% to 15% of the US population. Its symptoms include cramping, abdominal pain, bloating, gas, and diarrhea. Although IBS rarely poses a threat to people’s lives, IBS is associated with reduced quality of life, impaired life functioning and increased medical expenses. Recently, the University of Missouri School of Medicine looked at data from 4000 US hospitals over a three-year timeperiod and found that the rates of anxiety and depression were twice as high in patients with IBS than those of patients without IBS.

Zahid Ijaz Tarar, MD, Lead Researcher and Assistant Professor of Clinical Medicine at the University put forth an explanation for this apparent connection between mental health challenges and gastrointestinal disorders.

“One possible explanation is the so-called brain-gut axis. We've long suspected that dysfunction of the brain-gut axis is bidirectional, such that IBS symptoms influence anxiety and depression, and on the other hand, psychiatric factors cause IBS symptoms. Medical professionals need to treat both ends of the axis."

Twenty years ago, Donald Moss, Ph.D., reported that patient education, reassurance, and establishment of a good therapeutic relationship were considered standard and important components of good conventional medical management. For some patients, this could be sufficient to ameliorate their symptoms. Conventional treatment was typically limited to pharmacological treatment based on individual symptoms.

More recently, as medicine has advanced, Yezaz Ghouri, MD, Assistant Professor Of Clinical Medicine and Gastroenterology at the University of Missouri tells his patients with IBS, “If they have any type of psychological stress, it will get expressed in some form or another.” He expands this to explain that, "The Mesentery membrane that holds the intestines together has one of the largest collections of nerve cells in the body. When those nerves start firing impulses, that can lead to the state of nervousness in and around the GI tract, resulting in IBS symptoms. The resulting decline in patient quality of life can lead to poor lifestyle choices, such as smoking. Early evaluation and treatment of both IBS and associated psychiatric conditions is essential."

These most recent neuro-biological insights into this gut-brain cross talk have shown that when the autonomic nervous system is out of balance, meaning there is too much stress or too little repair in the system, the gastrointestinal system becomes symptomatic. In a recent review of interventions for Disorders of the Gut-Brain Interaction (DGBI), researchers found that overall, mind-body approaches are an important component of treatment. They assert there is evidence that multidisciplinary approaches are superior to single-modality approaches. 65% patients receiving multidisciplinary interventions had a 50% or greater reduction in symptoms compared to 38% in standard care group. The components they used were cognitive-behavioral therapy (CBT), biofeedback, hypnotherapy, dietary approaches, mindfulness-based practices, and relaxation therapies.

New on the scene, is Heart Rate Variability Biofeedback (HRVB). A person,

using specific breathing techniques, guided by feedback of their heart rate and respiration, can dramatically affect their autonomic nervous system and certain networks in the central nervous system. Learning this biofeedback technique can bring balance and calm to a perturbed and irritable gastrointestinal system allowing it to return to more normal functioning.

In summary, using the complementary therapies, as listed above can reduce IBS symptoms. Specifically, HRV Biofeedback, teaches a self-regulation skill that balances the nervous system and gut. These are effective tools for helping to reduce the stress from having IBS, as well as the stress that brings on IBS symptoms.

Lauren A. Salani, LCSW, BCB, Stress Relief Services, Atlantic Executive Center

107 Monmouth Road, Suite 104, West Long Branch, NJ 07764, 732.542.2638, Website:,


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