Mental Health
We often think of mental and physical health as two separate things, but in reality they're interconnected in many different ways. Your thoughts, feelings, and attitudes can affect your physical health and your physical health can influence your mental well-being.
This mind-body connection can play a big role in IBS. Poorly managed stress and mental health issues can be a trigger for IBS symptoms and IBS symptoms can contribute to mental health issues like anxiety and depression.
Find out more about IBS and mental health and check out some management strategies ...
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Watch the video
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Click on the links in the white box
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Just scroll down!
Mental Health and IBS
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IBS isn't all in your head, but research is showing that there are links between mental health, especially anxiety and depression, and IBS symptoms.
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In the regular population about 10% have symptoms of anxiety or depression
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For those with IBS, about 40% have symptoms of anxiety and 30% symptoms of depression
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Anxiety and depression are seen more often in IBS patients with severe symptoms
The primary link between psychological factors and GI symptoms is the gut-brain axis. This can be affected by many things, including stress response, the immune system, the nervous system and the gut microbiome. It can even be affected by your mood and your thoughts.
The gut's nervous system (ENS) may be triggered by emotional shifts in people with IBS and for decades experts thought that anxiety and depression contributed to IBS symptoms. But now some are thinking that it could be the other way round and irritation in the gut could send signal to the central nervous system that can trigger changes in mood.
So which one comes first? Does IBS cause anxiety and depression? Or is it the other way round?
Research is still ongoing, but there are indications that IBS and anxiety/depression may share some of the same pathways and mechanisms in the body, as opposed to one condition causing the other. There may even be a genetic component where IBS and mood disorders overlap.
Research also shows that 50-60% of IBS patients with mental health issues had gut symptoms first and then experienced mental health issues and 40-50% had mental health issues followed by IBS.
Either way, it can become a viscous cycle...
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Mental Health
IBS
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Anxiety, depression and other psychological stressors can trigger or worsen IBS symptoms
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May interfere with seeking or following through with treatment options
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IBS can affect quality of life - work, social interactions, body image, worry about symptoms and chronic pain
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Stigma about digestive issues could lead to shame and more social isolation
The Stigma of IBS
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In the past, people with IBS were often told that their pain was "all in their head" because medical tests showed there was nothing physically wrong. This view is changing, but there are still people inside and out of the medical profession that don't understand IBS is a real condition, with real symptoms and many treatment options.
Many people with IBS still feel alone, confused and frustrated. Their family and friends may not believe the diagnosis and think it's being used as an excuse. They may be embarrassed to discuss symptoms and continue to suffer in silence. They may not be given treatment options or may be overwhelmed by the chronic nature of the condition.
Stigmatization, plus the unpredictable, embarrassing and painful symptoms of IBS, can affect mental health.
Survey says...!
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On average IBS patients willing to give up 15 years of life to live symptom free
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14% would risk 1 in a 1000 chance of death to live symptom free
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11% said when symptoms are at their peak they would rather be dead
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IBS patients feel stigmatized most by employers and co-workers
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So, for your own mental health....
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IBS is real and if anyone in your life questions this, show them this site
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Openly discuss what it's like to live with IBS
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Pooping and gas are a part of life for everyone, so don't be embarrassed
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IBS is considered a chronic condition, but it can be managed
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There's lots of treatment options
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Know that you're not alone
Management Strategies
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IBS has been classified as a disorder of the gut-brain axis (DGBI). This means there is a problem with the way the gut and the brain communicate with each other.
The gut and the brain communicate in many different ways and can affect each other, so treatment strategies that target both body and mind are often recommended for managing IBS. Integrated care is important and may require a doctor, registered dietitian and psychologist.
The following sections outline approaches that have been shown to help with mental health, especially anxiety and depression, and IBS symptoms.
The following strategies are not a substitute for advice given by a mental health professional.
If you have severe anxiety or depression, seek help from a mental health professional if possible.
Resilience Therapies
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The focus of resilience therapies is a stronger mind that is better able to cope with stress and difficult life situations. Studies show that some people with IBS are less resilient to the effects of stress in both body and mind. They are also less able to recover from stressful events. These psychological therapies could help to break the negative feedback loop between emotion and gut function in order to reduce symptoms.
Resilience therapies include techniques like cognitive behavioural therapy and mindfulness. They are often used along with other strategies, like diet or medication, for the treatment of IBS.
Scroll down to find out more about the more common approaches that have been shown to improve IBS symptoms. Keep in mind that everybody's IBS is different. The best approach for you will depend on your own personal preferences, needs and symptoms.
One on one guidance from a mental health professional is always a plus, but online courses and apps have also been shown to be helpful.
Resilience therapy may help lessen IBS symptoms and change the way you perceive and act on them...
Changing Thought Patterns
Helps to identify and change negative thought patterns and beliefs related to IBS symptoms, creating a more positive mindset.
Mind-Body Connection
Relaxation and awareness can help to improve communication between the gut and the brain and lessen the impact of stress on the gut.
For example, a food situation you can't control...
Stress Management
Provides tools to manage stress, often a trigger for IBS. Go to the Stress Management section for more info.
Coping Mechanisms
Develops healthy strategies to deal with IBS symptoms and the fear, anxiety or shame that may come along with them.
Resilience therapy can help in many ways...
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Identify beliefs and perceptions that aren't serving you
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Not being controlled by worst case scenarios
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Dealing with what is and not what might be
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Awareness of the connections between your mind and body in order to develop personal, tailored strategies
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Positive coping mechanisms instead of avoidance
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Concrete steps to lessen anxiety
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Stress management techniques to calm the body and mind and improve symptoms
Cognitive Behavioural Therapy (CBT)
Cognitive behavioural therapy is one of the most tested psychological interventions for IBS. It has been shown to be effective for about one third of IBS patients and can even be helpful for IBS sufferers that don't meet the criteria for a mood disorder.
CBT is designed to reframe unhelpful thoughts, reduce emotional distress and promote healthier behaviours. It focuses on reducing the cycle of fear, avoidance and symptom hyperawareness that often makes IBS worse.
It's not uncommon for people with IBS to avoid foods or situations they feel may cause or worsen symptoms, but over time this could lead to unnecessary food restrictions and social isolation. CBT is used to adjust these reactions and create action plans and coping strategies. It could also be used for excessive fear of reemerging symptoms in the reintroduction phase of the FODMAP diet.
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CBT for IBS isn't only for severe mental health issues.
It's actually more effective for people with IBS who...
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Have stress induced or flare prone IBS
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Have anxiety about food, travel or symptoms
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Want more than food restrictions or meds
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Want a drug free approach to manage symptoms
Finding a psychotherapist...
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Best if has experience with IBS clients
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Get a referral from doctor or gastroenterologist
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If you live in Canada, Ignite Nutrition has a psychologist on staff. ignitenutrition.ca
Online programs have also been shown to be effective in treating IBS. For example...
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Optimal Health and Resilience Program
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Strategies from CBT, ACT and stress management
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FREE (part of study so questionnaires to answer!)
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7-week program for GI disorders
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Go to mindovergut.com/ibs
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CBT and gut-directed hypnotherapy based program
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Delivered via app with paid subscription
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Free trial available
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6-week program - 15 min per day
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Download app or go to try.nervaibs.com
Gut-Directed Hypnotherapy (GDH)
Gut-directed hypnotherapy is a form of medical hypnosis that has been well researched in patients with IBS and has been shown to improve pain, constipation, diarrhea and bloating. In fact it's shown similar results as the FODMAP diet, reducing symptoms by 75% in the majority of IBS patients.
The goal of GDH is to gain better control over IBS symptoms by addressing communication between the brain and the gut, changing how the brain perceives and responds to sensations in the gut. The format it often follows is relaxation of the body and soothing imagery, followed by symptom-based suggestions.
If you have a history of dissociation or substantial trauma, this may not be a safe treatment option. And everyone should be sure to use only credible online programs like Nerva, or find a licensed hypnotist with experience in GI issues. If you live in the US try ibshypnosis.com
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Acceptance and Commitment Therapy (ACT)
Acceptance and commitment therapy is a behavioural and mindfulness based form of psychotherapy. It helps people develop psychological flexibility to better handle difficult thoughts and feelings, accepting these experiences rather than trying to suppress or eliminate them. It could help to create flexible and effective ways to live with IBS.
It was originally developed for mental health conditions like anxiety and depression, but has also been shown to be effective for chronic pain and other medical conditions. Its use in IBS is not as common as other therapies like CBT and GDH, but results have been promising.
Dynamic Psychotherapy
Dynamic psychotherapy has also shown promising results for the treatment of IBS by exploring the link between emotional distress and gut issues. It's a talk therapy that focuses on unresolved emotional conflicts, bad past experiences and interpersonal issues that may be linked to IBS symptoms
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Mindfulness and Relaxation Techniques
Mindfulness and relaxation techniques are often focused on the impact of stress on IBS and the stress that symptoms can cause. They can be included in psychological therapies like CBT, GDH and ACT or used on their own.
Put very simply, mindfulness is the act of observing reactions and symptoms in a non-reactive and non-judgemental way. It has been shown to improve the way symptoms are perceived, as well as reduce their severity, and decrease visceral hypersensitivity.
To find out more go to Mindfulness in the Stress Management section.
There are many relaxation techniques to help shift your body and mind from a flight/fight or freeze response to rest and digest. Diaphragmatic breathing, progressive muscle relaxation and positive imagery visualizations are often used.
You'll find lots of ideas in the Stress Management section.
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The Vagus Nerve
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The vagus nerve, also known as the vagal nerves, are the main nerves of your parasympathetic nervous system (PNS). The PNS is often referred to as the "rest and digest" system because it promotes relaxation.
The vagus nerve is a key communicator in the gut-brain axis, influencing mood, stress response, and GI function. Vagal tone, which is the activity level of the vagus nerve, is linked to both IBS and mood disorders like anxiety and depression.
The vagus nerve also plays a crucial role in the immune system and can help to regulate inflammation, a factor implicated in both mood disorders and IBS.
There are many strategies to improve vagal tone, including mindfulness practices, yoga, exercise and breathing techniques.
To find out more go to The Vagus Nerve in the Stress Management section.
The Gut Microbiome
The gut microbiome is very important for the functioning of your GI tract and a key player in the communication system between your gut and your brain. And now it's becoming a hot topic in the treatment of mental health issues.
There is much more research to be done, but studies are showing that IBS and mental health could be linked by the gut microbiome. For example, dysbiosis (imbalance) in gut bacteria is common in IBS patients and can also have an effect on anxiety and depression. GI issues can trigger mood changes and vice-versa, and both can be influenced by gut bacteria and the compounds they make.
One study found people with both IBS and anxiety were more likely to have been treated frequently with antibiotics during childhood - possibly altering the gut microbiome and influencing nerve development and mood.
To find out more about the gut microbiome and health strategies go to The Gut Microbiome section.
Food for Mood
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Of course, it's not as simple as good food equals good mood, but there's a number of ways that food and nutrition could be a link between your mental state and IBS.
The brain and gut are constantly communicating. Stress and mood can trigger IBS symptoms and IBS symptoms can contribute to anxiety and depression. Diet is a major factor influencing this connection. It can do this in many ways, including impacting the gut microbiome, hormones and the overall health of the gut.
A good place to start for your mental health and your IBS symptoms is a healthy and balanced diet, with an emphasis on unprocessed foods and fibre.
Go to Tips for Healthy Eating for more info.
Diet Related Anxiety
Anxiety and depression can be linked with IBS when it comes to food related distress. IBS sufferers often have long standing dietary restrictions and many of them might not be necessary. They may have strongly held beliefs around food and a reluctance to change those beliefs. Or they may have a fear of eating out in places where they can't control their food choices.
If these fears and restrictions get too extreme, they could lead to disordered eating or an eating disorder.
For more info go to Disordered Eating and IBS.
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The Low FODMAP Diet
This diet may help you discover trigger foods and help you reduce your IBS symptoms. In this way it could positively affect your mental health. However, its restrictiveness may increase anxiety around food and trigger disordered eating in some people. This diet is not for everyone. Make sure you're a good fit before you start.
For more info go to the Intro to the Low FODMAP Diet section.
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Exercise
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Physical activity also influences the gut-brain connection, where stress and mood impact digestion and vice versa. Exercise can be linked to both mood and IBS in a number of ways.
Exercise is a stress management tool that can be used to help regulate the gut-brain axis and improve both mood and IBS symptoms. One of the ways it does this is by helping to release "happy hormones" like dopamine and serotonin.
Exercise could also help with the health of your gut microbiome and your immune system.
For more info go to Get Moving for IBS!
Sleep
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Sleep problems, IBS, and mental health conditions, like anxiety and depression, are also closely linked through the gut-brain axis. In fact, they are so interconnected they could create a negative feedback loop, making all three conditions progressively worse.
Poor Sleep
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Can increase visceral hypersensitivity and affect gut motility, making IBS symptoms worse
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Can significantly worsen mental health conditions like depression and anxiety
IBS Symptoms
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Pain and cramping can disrupt sleep
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Can trigger mental health issues
Mental Health Issues
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Common triggers for both IBS and sleep problems
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For more info go to the Sleep and IBS section.
Medications
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In the case of IBS, most proscribed medications are for GI symptoms. There has been some research into the use of drugs normally proscribed for mood disorders to treat IBS, but currently there is not enough evidence to make solid recommendations.
Selective serotonin reuptake inhibitors (SSRIs) are drugs that increase levels of serotonin, a neurotransmitter that can improve mood and reduce symptoms of anxiety and depression.
Even though it has an effect on the brain, 95% of your serotonin is actually found in your gut. It's involved in many important functions of the GI tract, like intestinal motility and inflammation and levels are often out of whack in people with IBS.
This highlights yet another link between mental health and IBS. Further research into this area could lead to better evidence backed recommendations, so certainly a space to watch.