Researchers have identified a link between the digestive system and the brain, so cognitive behavioral therapy (CBT) may be a helpful option for treating the symptoms of irritable bowel syndrome (IBS).

Irritable bowel syndrome (IBS) refers to a group of gastrointestinal (GI) symptoms that regularly appear together. It’s classified as a functional GI disorder, which means the underlying cause has to do with how your brain and gut communicate with one another.

IBS symptoms typically include cramping, abdominal pain, bloating, and bowel changes. While IBS does not permanently damage your GI system, it can flare up and cause intense discomfort during daily life.

Because IBS is a functional GI disorder, there’s a definite link between your emotional state and your IBS symptoms — and that’s where CBT may have a place in treatment.

Cognitive behavioral therapy (CBT) can help you manage the psychological factors that may worsen IBS symptoms.

According to research reviews from 2017 and 2021, it’s an effective treatment option for IBS even when administered through different formats, such as face-to-face versus online.

CBT, however, does not appear to be used as often as it could be. This may be because it requires the guidance of a professional trained in CBT (a psychotherapy approach), as well as one trained in GI disorders (a component of physical health).

CBT for IBS works by addressing the emotional factors that can contribute to IBS symptoms.

IBS and other functional GI disorders are caused by dysfunction in the gut-brain axis. This is the direct communication pathway between your central nervous system (the brain and spinal cord) and the nervous system of your gut (the enteric nervous system).

A typically functioning gut-brain axis is constantly trading chemical messengers. The brain and the gut share neurotransmitters responsible for everything from digestion to emotions. Many of the neurotransmitters that affect your mood, like serotonin, are primarily produced by the gut, 2018 research suggests.

This is why negative emotions can cause GI discomfort, and why GI discomfort can result in negative emotions.

CBT works for IBS because it may help manage the stress response in the gut when your negative emotions are high. It uses thought restructuring to help you steer clear of catastrophic thinking and rumination.

CBT uses behavioral methods to teach you adaptive coping strategies for negative thoughts and emotions. Instead of fixating on thoughts of anxiety, for example, CBT provides go-to relaxation options like mindfulness or grounding.

All of this is done with the goal of relaxing the digestive system, taking it out of the survival mode caused by negative emotions, and allowing it to return to a calm state.

What’s the relationship between stress and IBS?

Stress is anything that challenges your body physically or psychologically. When your body perceives a challenge, it activates your sympathetic nervous system. This is the part of your central nervous system responsible for the fight-or-flight response.

Flight-or-fight is a survival state. Your body undergoes a number of physiological changes in anticipation of a threat, and your digestive system is no exception.

Stress aggravates the digestive system. Digestion can slow down as your body attempts to conserve energy. If you live with IBS, your digestive system may be hypersensitive to these changes, and experiencing stress may cause IBS to flare up.

CBT isn’t considered a cure for IBS. It’s a treatment option to help you manage symptoms that may be worsened by heightened emotional states.

CBT for IBS works by promoting emotional regulation before and during IBS flare-ups.

CBT can help reduce the frequency of IBS symptoms by helping you cope successfully with real and perceived threats before they trigger GI discomfort. If you’re naturally nervous before a big presentation, for example, CBT can help you learn how to remain calmer.

IBS symptoms can’t always be prevented. During these times, CBT can help you manage the pain of IBS by teaching you in-the-moment relaxation strategies for the gut-brain axis, like deep breathing or progressive muscle relaxation.

Negative emotions can trigger IBS, but IBS can also be a source of negative emotions. CBT can help with this, too.

CBT provides a structured environment where fears about life with IBS, like being out in public too long away from a restroom, can be reduced through therapist-guided exposure.

CBT and other psychological interventions are currently recommended by the American Gastroenterological Association for moderate-to-severe IBS that is not responding to traditional treatments or is complicated by other psychological factors.

According to a 2017 review, CBT for IBS appears to have the highest rate of success for people living with comorbid psychological symptoms or those experiencing a very low quality of life.

Finding a CBT therapist for IBS may be a challenge. IBS is a physical condition typically managed by a gastroenterologist or your primary doctor. CBT is a specialized psychotherapy framework usually overseen by a mental health professional.

It’s not common to find one person who is skilled in both medical fields.

That doesn’t mean it’s impossible to find a CBT therapist for IBS. A good place to start is your GI doctor. They may have a list of colleagues they can recommend, or they may be willing to work closely with a mental health professional of your choice.

IBS is a condition caused by miscommunication in the gut-brain axis. Because of how closely the central nervous system and the enteric nervous system work, stress and negative emotions can make IBS symptoms worse — and vice versa.

CBT for IBS is one possible treatment option. It may help you decrease the frequency of symptoms, manage discomfort, and reduce IBS-related concerns that can interrupt daily life.

CBT for IBS may be most beneficial for moderate-to-severe IBS that doesn’t respond well to traditional treatments or IBS that is accompanied by other psychological symptoms, like depression or anxiety.