Professor Craig White MML ClinPsyD PhD FRCP FBPsS
Consultant Clinical Psychologist
Psychological Therapy for Distressing Bowel Symptoms
Psychological assessment focused on understanding bowel symptoms will initially concentrate on gathering information that will assist you and Professor White to make sense of the ways in which physiological, psychological and social factors might influence coping with your symptoms.
This in turn will allow examination of whether any of the following are present:
- worries about IBS symptoms leading to hypervigilance and greater attentional focus to bodily sensations:
- greater attentional focus leading to heightened sensitivity to pain and discomfort
- greater discomfort leading to more worry and in turn to greater sensitivity
- greater sensitivity to feelings of pain and movement within the digestive system
- avoiding activities (such as socialising, or taking specific types of exercise) for fear of making symptoms worse, or because of embarrassment about symptoms
- changing eating habits and diet in response to symptoms
- unhelpful toileting behaviours (such as checking stools, straining for long periods on the toilet, always sitting near exits in order to readily access to toilets)
- ‘boom or bust’ cycles of activity (e.g. catching up with activities when IBS symptoms are under control, leading to symptom exacerbation and slowdown, leading to a cycle of over-vigorous activity alternating with enforced rest)
- unhelpful and/or negative thoughts about the illness and symptoms (e.g. concerns about passing wind in public, or having fixed ideas about ‘appropriate ‘ bowel habits)
- concern about as-yet undetected biological/ medical causes for symptoms
This then informs decisions about the specific physical, emotional, behavioural and cognitive factors that can be modified and, with repeated practice on this, reductions in the frequency and intensity of the bowel symptoms and related distress.
A summary of recent research on this approach to clinical assessment and treatment of distressing bowel symptoms will appear shortly.