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In the absence of satisfactory medical therapies for irritable bowel syndrome (IBS) and other disorders of brain gut interactions, clinical guidelines identify self-management as a first line treatment. Its goal is for patients to acquire skills to help reduce the impact of their condition, optimize function, and, in the absence of curative therapy, gain optimal control of symptoms. Behavioral self-management modalities typically emphasize a strategy called cognitive behavioral therapy (CBT). CBT is a learning-based treatment that teaches practical skills for unlearning symptom-aggravating processes such as symptom related worry and avoidance, substituting more adaptive self-management skills.

In a collaborative study with Dr. Jeff Lackner from the University of Buffalo, NY, we aimed to test the hypothesis that CBT-treated patients with IBS who learn to self-manage painful gut symptoms show improvement in cognitive flexibility, abdominal pain, and quality of life. Participants included 130 patients with a mean age of 40 years and with moderate-to-severe symptoms who were randomly assigned to either CBT (N = 86) or a nonspecific education/support (EDU) intervention (N = 44).

CBT but not EDU patients showed significant symptom improvement from baseline to post-treatment in cognitive flexibility. For CBT patients, changes in cognitive flexibility were significantly associated with changes in IBS symptom severity, abdominal pain, and IBS QOL. IBS subjects whose symptoms improved on CBT, also showed distinct changes in brain network connectivity and in the gut microbiome.The ability to self-manage painful IBS symptoms refractory to conventional medical and dietary treatments is related to the ability to respond flexibly across shifting contexts using cognitive change procedures featured in CBT for IBS.