The witch doctor succeeds for the same reason all the rest of us succeed. Each patient carries his own doctor inside him. They come to us not knowing that truth. We are our best whenwe give the doctor who resides within each patient a chance to go to work.

- Albert Schweitzer, M.D.

The data on the pathophysiology of IBS and other functional gastrointestinal disorders indicate that symptoms are most likely to arise from a complex interaction of physiological, psychological and social factors. An important component of this model is a chronically enhanced stress responsiveness in patients with functional GI disorders including IBS.

Cognitive and relaxation-response interventions appear to be of significant benefit in functional disorders including IBS.

In order to provide reassurance, health promoting information, and skills in stress reduction to patients, group treatments for patients have been introduced, and preliminary encouraging results have been reported. In a recent study our group evaluated the short and long-term effect of a cognitive-behavioral group intervention (the "IBS class") on global and specific gastrointestinal and psychological symptoms and on quality of life measures in patients with IBS, functional dyspepsia and chronic abdominal pain. The two general goals of the education were to reduce anxiety about symptoms and to facilitate a sense of self-control (self-efficacy) by directing participants toward effective self-management. These goals were addressed by providing the patient with a plausible, neurobiological disease model explaining the interaction between chronic stress, gastrointestinal symptoms and affective disorders by emphasizing the self-healing exercises. In addition we provided an understanding of the effects and side effects of common medications and diet on symptoms and patients were trained to differentiate between ineffective, emotional coping styles and effective rational coping styles.

Significant improvements following the treatment were observed on general symptom severity, upper and lower GI symptoms, bloating, abdominal pain, mood, sleep, and interference with daily activities. Approximately 2/3 of patients reported improvement of general GI symptoms (60%) and abdominal pain (56%)/ 70% indicated an improvement in the interference of GI symptoms with their daily activity. Similar changes were observed at 3-6 month follow up.

The dominant theme of our cognitive behavioral group intervention is emphasis on the patients to become an expert ("be your own doctor") in understanding the pathophysiology of functional GI disorders including IBS and effective management of symptoms. The intervention consists of education about the role of cognitions (dysfunctional thoughts, coping styles, threat appraisal, self inefficacy) in exacerbating IBS symptoms and skill training in ways of identifying and challenging erroneous thoughts about symptoms and life events. Another dominant theme of the IBS class is the relaxation response training performed under guidance of an experienced psychologist. This training focuses on effective ways of self-management of the physiological and psychological responses to stress and stress related symptom exacerbation and the role of breathing techniques and progressive muscle relaxation.

We are currently planning a study to test the beneficial effects of an integrated psychoeducational program ("IBS Class") on conventional IBS therapy. The class will consist of 5 sessions with a group of 8-10 patients. Dr. Emeran Mayer will teach the medical part over approximately 3 hours and a psychologist with a longstanding experience in working with IBS patients will perform 7 hours in stress management techniques, including simple and effective relaxation training. If you qualify for this study, you will either stay on your regular IBS therapy or you will be able to attend the IBS class at no cost. If you are interested in learning more or would like to participate, please contact us at (310) 312-9381.