A cognitive group therapy program for irritable bowel syndrome: A comprehensive interdisciplinary model

Irritable Bowel Syndrome (IBS) is a chronic psychosomatic disorder which affects 18% of the U.S. adult population and accounts for 50% of new gastroenterological patient referrals. IBS has no known organic cause, but is exacerbated by diet and chronic, nonspecific stress and is associated with up to 50% psychiatric comorbidity in patients presenting for treatment. Although several psychological interventions have been studied in the treatment of IBS, only cognitive therapy has been shown to consistently achieve significant and sustained symptom reduction. Regularly overlooked psychological obstacles to clinical improvement include denial by patients of the significant contribution of psychological factors to their IBS symptoms and pathological dependence on the treating physician. An innovative, cost-effective, and easily replicated intervention is proposed involving a combination of cognitive group therapy, psychoeducational elements, and a close working relationship between treating psychologist and physician. Program goals related to IBS clinical improvement include significant reduction in reported physical symptoms, cognitive appraisals of stress, and negative automatic thoughts. Reduction in frequency of IBS physician visits is presented as a novel positive outcome measure, and a comprehensive neurophysiological conceptualization of IBS pathology is proposed.; IBS, despite its chronic nature, is generally associated with positive prognosis when properly managed. A program of this nature meets the profound need for an IBS intervention which is more clinically efficacious and has better long-term cost-effectiveness than medical treatment or psychotherapy alone, while surmounting the common treatment obstacles associated with noncompliance and poor outcome.