Mind-body therapies are designed to enhance the mind’s positive impact on the body. These therapies are integrative in nature and are an important component of the lifestyle prescription in functional medicine. The balance of bacteria in the gut can change drastically with increased stress. Exposure to stress leads to changes in the composition, diversity, and number of gut microorganisms based on multiple studies on the implication of stress in physiological function. With propensity of stress to induce dysbiosis, there are downstream consequences including immune dysregulation with increased chronic inflammation and alterations in the brain-gut axis.
In light of the strong connection between the stress response, immune health, microbial discordance, and central sensitization for pain in the brain, therapeutic approaches to enhance the relaxation response are a new focal point for the treatment of irritable bowel syndrome (IBS). As part of the patient experience, it is important to elicit stressors that trigger illness and then introduce methods for coping with stress and building resilience in the face of adversity. Below is a list of mind-body treatments that are available for helping health gut dysfunction.
Integrative Psychotherapy
Integrative psychotherapy combines traditional psychotherapy with holistic medicine to approach gastrointestinal (GI) illness from an emotional, physical, mental, and spiritual level. Patients interested in psychotherapy choose a path of self-exploration to understand what triggers pain, anxiety, and changes in mood. Psychologists that see IBS patients can help focus on psychological well-being to help treat underlying IBS type symptoms. A psychologist can help to uncover stressors or life circumstances that led to IBS in order to develop better coping mechanisms. Other patients may need assistance in developing better sleeping habits, relaxation techniques, and daily functioning with chronic pain. The key to a successful psychotherapy experience is to develop an individualized treatment plan for addressing symptoms with the goal of symptom reduction and improved quality of life. Subjects with IBS are well suited for this approach since they may require more time to unravel stress and learn methods to alleviate stress associated with physical symptoms.
Mindfulness Based Stress Reduction (MBSR)
MBSR is a relaxation technique focused on mindful meditation that allows patients to cultivate a moment-to-moment awareness in order to help reduce stress and stress-related conditions. This technique has been shown to modulate positive change in the cardiovascular respiratory, neurologic, endocrine, and immune systems to decrease inflammation and support treatment of stress-related GI conditions. Research has shown that patients with IBS have a heightened response to corticotropin-releasing hormone (CRH) and may benefit from MBSR. There may be substantial therapeutic effect from MBSR on bowel symptom severity, quality of life, and reduced distress with benefits that persist for at least three months after completing therapy.
The postulated mechanisms for improving IBS using MBSR include:
- Reduces fixation on pain by promoting a willingness to let go of perpetual reminders about visceral pain
- Reduces stress which is a known trigger for worsening IBS symptoms
- Reduces anxiety and depression which can lead to improvement in IBS symptoms
A newer study in the Harvard Health System was conducted in IBS and inflammatory bowel disease (IBD) and showed that a nine-week program in meditation led to significant improvement in symptom scores, expression of genes related to inflammation, and maladaptive response to stress. This study also helped to make the case that an organized plan of care that is programmatic in nature leads to better clinical outcomes in gut dysfunction.
There are many meditation apps and resources for IBS subjects to learn meditation and mindfulness. Practitioners can also train in MSBR and offer this in clinical practice in an individual or group setting.
Abdominal & Total Body Massage
Massage therapy is a mind-body technique used to release tension, relax muscle, enhance blood and lymphatic flow, and provide relaxation and stress reduction. Evidence-based medicine supports the use of massage in chronic constipation, but it can also be used in IBS as a mind-body therapy to promote relaxation, reduce stress, and alleviate pain and abdominal tension.
Imagery Guided Therapy
Imagery guided therapy may be used with other mind-body therapies such as integrative psychotherapy and biofeedback training. Imagery is a focused program of directed thoughts that guide the imagination to a relaxed state. Administering this type of therapy can be done with a trained therapist or through pre-recorded audio sources. By harnessing the power of the gut-brain connection, this therapy can help to achieve a relaxed state when all senses are focused on imagining the details of a peaceful place. The relaxed state can help cope with stress and overtime mitigate the effects of visceral hypersensitivity.
Research shows that guided imagery is one of the most effective treatments for IBS. It is commonly used in GI for relaxation and stress reduction, pain relief, procedure preparation, and coping with chronic GI illness.
Biofeedback
Biofeedback is a form of behavioral training that utilizes learned techniques to control the body’s physiological function, such as heart rate or blood pressure. This technique aims to increase mind-body awareness in order to modify muscle tension or autonomic tone. The biofeedback therapist measures specific physiological activity such as muscle contraction, muscle relaxation, respiratory rate, temperature, heart rate, and blood flow to obtain measurements at baseline, under stressful conditions, and under more relaxing circumstances.
Biofeedback is used in a variety of gut disorders including chronic constipation due to outlet dysfunction that can be treated with pelvic floor biofeedback, fecal incontinence, and IBS. In IBS, biofeedback is used to teach subjects the physiologic responses in stress and relaxation to aid in learning relaxation techniques.
Biofeedback training is heavily utilized in physical therapy clinics, medical centers and hospitals. A growing number of biofeedback devices and programs are also being marketed for home use. Recently, some researchers have started to use heart rate variability (HRV) as an interesting marker for resilience and behavioral flexibility. If a person’s system is in more of a fight-or-flight mode, the variation between subsequent heartbeats is low. If one is in a more relaxed state, the variation between beats is high. In other words, the healthier the autonomic nervous system the faster you are able to switch gears, showing more resilience and flexibility. HRV measurements can help create more awareness of how behavior affects nervous system and bodily functions. While it cannot help an individual completely avoid stress, it could help increase understanding of how to respond to stress in a healthier way and bring the body back to the “rest and digest” state.
Acupuncture
Acupuncture is an ancient Chinese medicine technique that is over 5,000 years old. Acupuncture uses fine needles inserted into specific points in the body to relieve pain and administer therapy. The Chinese art form theorizes that acupuncture points lie on channels called meridians through which energy, called chi, flows. Diseases emerge when chi is imbalanced or not flowing. Acupuncture restores health by allowing for free flow of chi.
Proposed mechanisms for acupuncture include increased endorphins, increase in neurotransmitter serotonin, dilating and constricting blood vessels, and closing neural pathways for pain. In integrative gastroenterology, acupuncture has been used for abdominal bloating and flatulence, abdominal pain, change in bowel habits, nausea and vomiting, and reflux.
There is a large research base looking at the role of acupuncture in IBD. Multiple researchers note that acupuncture improves Crohn’s Disease Activity Index scores, quality of life, increases hemoglobin levels, and reduces C-reactive protein levels for Crohn’s disease patients. Additional studies have shown biopsy improvement in the setting of acupuncture therapy. Researchers postulate that acupuncture induces a homeostatic response on the cellular level by regulating the ration of inflammatory response cells. Pro-inflammatory Th17 cells and anti-inflammatory T-reg cells were restored to normal levels and intestinal inflammation was subsequently reduced.
Yoga
Yoga has been practiced for more than 5,000 years, and it originates from India where the body is viewed as channeling of energy and disease as the culmination of blocked channels. Yoga has eight different stages which include poses, rhythmic deep breathing, withdrawing the mind from the sensory overload in the world, meditation, and deep bliss where the body and spirit unite. In medicine, yoga has been an essential integrative medicine technique that promotes relaxation and stress reduction and has been shown to increase the feel-good hormone in the gut called serotonin and endorphins in the brain and decrease the stress hormone cortisol.
Studies of yoga in IBS show that incorporating daily yoga into a treatment plan led to increased relaxation, improvement in colon motility, improved quality of life. Yoga postures and deep breathing can condition and strengthen the abdominal muscles supporting improved digestion and elimination. The poses of yoga can also help to manipulate the sharp bends in the colon to help eliminate gas and stool.
Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapy is ideal for patients who seek to improve GI symptoms by changing thinking patterns, behavior, and the emotional response to GI symptoms. Evidence-based medicine has shown that CBT is an effective adjunct therapy in the setting of IBS. The goal of this therapy is to identify, analyze, and change negative, distorted thoughts and feelings that lead to and enable symptoms of IBS to flourish. CBT also teaches stress management and relaxation techniques. Participants in a CBT program learn healthy cognition and coping mechanisms with the goal of improving symptoms and quality of life. This is accomplished using a strong patient-therapist relationship and using various techniques including self-monitoring, questioning, self-disclosure, role playing, confronting feared situations, stress management, and relaxation training.
