The most commonly reported symptom is known as gastrointestinal-specific anxiety (GSA).
And the higher the GSA, the higher the pain you feel from your IBS symptoms.
GSA is also linked to avoidance, which is the most common strategy people use to cope with IBS.
By avoidance, we mean the way you might be missing out on enjoying certain foods because you fear a flare-up, or staying away from social situations when you aren’t sure about bathroom access. Many people with IBS avoid all kinds of situations that push you out of your safe zone, like traveling or sex and intimacy with a partner.
Even though you may believe avoidance is essential for keeping your IBS under control, researchers found that holding yourself back from experiences, and how you choose to deal with your experiences, often leads to the most suffering.
Think back to the language we mentioned earlier. Do any of these ‘facts’ sound familiar to you?
I can’t go out because I’ll have a flare-up.
I can’t eat that food because I’ll be in pain.
I can’t go on that holiday because travel makes me too nervous.
I can’t meet up with friends because I don’t know what the bathrooms will be like.
Instead of ruminating on these concerns, digging yourself further into the stress-IBS-pain-stress loop, we can change our thinking to accept the events related to IBS and put symptom-related anxiety at an arm's-length. Instead of your thoughts controlling you, you control your thoughts.
Enter cognitive defusion.
Cognitive defusion and IBS
When you learn how to defuse language, it becomes easier to be present and open to living the life you want, even with the thoughts still chattering on like normal inside your head.
Try putting these research-backed cognitive defusion techniques into practice to distance yourself from the negative, controlling thoughts about your IBS symptoms. The idea is these techniques will help you see your thoughts as just thoughts, not proven, definitive facts.
Silly voices.
Say your negative thoughts aloud in a silly voice. If you sound like a cartoon character when you say, ‘There’s nothing I can do about my IBS. I’ll never have sex again’, it becomes much harder to believe.
Slow it down.
Say your thought about IBS pain very slowly, either aloud or to yourself, such as ‘Today [pause 3 seconds] I just know [pause 3 seconds] I’m going to have [pause 3 seconds] a terrible flare-up [pause 3 seconds] after breakfast’.
Show stopper.
When you feel a ‘sticky’ thought coming on (the kind that’s particularly hard to ignore), devise a short phrase to say aloud. This will help you transform the thought into a mental event, separate from yourself. For example, if your anxiety is rising about a symptom like diarrhea, your phrase could be, ‘Oh look, here comes that thought that never helps.’
Make it a movie.
Visualize a negative thought about your IBS symptoms on a giant movie screen, such as ‘I know I will have the worst stomach pain all day’. Picture the thought scrolling slowly up the screen like movie credits. You can’t hang onto the thought; you just watch it appear down the bottom of the screen and then disappear at the top.
Examine it from the outside.
Pretend you’re observing your thoughts like a scientist running an experiment. So, ‘Hmm, I have noticed that I feel anxious, and I see that I am thinking about how I will have painful constipation all day’. Or ‘I see there is extra sweat gathering on my brow and I am noticing unusual stomach sensations; both signs diarrhea is likely within the hour’. Using ‘noticing’ language like this will help you look at your thoughts, not from them.
Drive the bus.
One suggestion from the University of Sydney was to imagine yourself driving a bus. Treat your frustrating thoughts as if they are rowdy passengers. Picture yourself continuing to drive the bus, rather than trying to kick your annoying passengers off. Can you stay focused on driving your bus safely to your destination?
Praise the brain.
Send a shout out of thanks to your mind. Next time an unhelpful thought about your symptoms pops into your head, try saying to yourself, ‘Thanks for that, brain’. After all, your brain thinks it’s helping.
The benefits of cognitive defusion
Cognitive defusion helps you better understand how your mind and gut are connected and how your thoughts might be impacting your IBS symptoms.
Typically, it can feel like we have no control over negative thoughts circling around our minds. And catastrophizing, ‘I’m going to be in pain from IBS forever’, only adds to your distress.
Taking a conscious time-out via cognitive defusion will give you a moment to ponder, ‘Are these thoughts really the truth?’ The benefit of cognitive defusion is it gives your brain some space and distance, helping you see thoughts as what they are, just ideas that come and go in your mind.
Researchers found that when you apply a cognitive defusion technique, such as singing your thoughts aloud, it can break the chain of thoughts running on a loop and potentially decrease the overall frequency of your negative thoughts.
And if you practice cognitive defusion techniques, like saying ‘I’m going to have constipation pain forever’ in a silly cartoon voice, researchers suggest it will lead to a decrease in negative thinking, reduce symptom-related anxiety, and stop you from internalizing your symptoms.
The Wrap Up
Learning about the power of cognitive defusion could prevent negative thoughts about your IBS symptoms from traveling around your mind on an endless loop, which can make your symptoms even worse and more difficult to manage. Scientists have confirmed that the thoughts in your brain are closely connected to your gut, which is why practicing cognitive defusion techniques could decrease your IBS symptoms. Techniques include singing your negative thoughts aloud or using ‘noticing’ language to observe your thoughts like a scientist conducting an experiment. Using cognitive defusion techniques like these allows your mind the distance and space to better understand that thoughts are just thoughts, not verifiable facts.
References
Assaz D, Roche B, Kanter J, Oshiro C. Cognitive Defusion in Acceptance and Commitment Therapy: What Are the Basic Processes of Change?. Psychol Rec. 2018;68(4):405-418. doi:10.1007/s40732-017-0254-z
Cognitive Defusion. Sydney: University of Sydney https://www.sydney.edu.au/content/dam/students/documents/counselling-and-mental-health-support/cognitive-defusion.pdf. Accessed March 16, 2022.
Drossman DA, Chang L, Schneck S, Blackman C, Norton WF, Norton NJ. A focus group assessment of patient perspectives on irritable bowel syndrome and illness severity. Dig Dis Sci. 2009;54(7):1532-1541. doi:10.1007/s10620-009-0792-6
Ferreira N, Gillanders D, Morris PG, Eugenicos, M. Pilot study of acceptance and commitment therapy for irritable bowel syndrome: A preliminary analysis of treatment outcomes and processes of change. Clinical Psychologist. 2018; 22, 241–250. doi.org/10.1111/cp.12123
Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J. Acceptance and commitment therapy: model, processes and outcomes. Behav Res Ther. 2006;44(1):1-25. doi:10.1016/j.brat.2005.06.006
Hinton M, Gaynor S. Cognitive defusion for psychological distress, dysphoria, and low self-esteem: A randomized technique evaluation trial of vocalizing strategies. Int J Behavioral Consultation and Therapy. 2010;6(3):164-185. doi:10.1037/h0100906
Jerndal P, Ringström G, Agerforz P, et al. Gastrointestinal-specific anxiety: an important factor for severity of GI symptoms and quality of life in IBS. Neurogastroenterol Motil. 2010;22(6):646-e179. doi:10.1111/j.1365-2982.2010.01493.x
Levy RL, Olden KW, Naliboff BD, et al. Psychosocial aspects of the functional gastrointestinal disorders. Gastroenterology. 2006;130(5):1447-1458. doi:10.1053/j.gastro.2005.11.057
Mandavia A, Masuda A, Moore M, Mendoza H, Donati M, Cohen L. The application of a cognitive defusion technique to negative body image thoughts: A preliminary analogue investigation. J Contextual Behav Sci. 2015;4(2):86-95. doi:10.1016/j.jcbs.2015.02.003
Masuda A, Hayes SC, Sackett CF, Twohig MP. Cognitive defusion and self-relevant negative thoughts: examining the impact of a ninety-year-old technique. Behav Res Ther. 2004;42(4):477-485. doi:10.1016/j.brat.2003.10.008
Mayer EA, Naliboff BD, Chang L, Coutinho SV. V. Stress and irritable bowel syndrome. Am J Physiol Gastrointest Liver Physiol. 2001;280(4):G519-G524. doi:10.1152/ajpgi.2001.280.4.G519
Saha L. Irritable bowel syndrome: pathogenesis, diagnosis, treatment, and evidence-based medicine. World J Gastroenterol. 2014;20(22):6759-6773. doi:10.3748/wjg.v20.i22.6759
.webp)
.jpeg)
