Review of IBS: Psychosocial Assessment and Treatment, by Edward Blanchard
Thomas Bell, Psy.D.
Unfortunately I have to begin this review with a brief explanation of irritable bowel syndrome or IBS as it is still a relatively unknown even though an common disorder. (Blanchard does go into this issue more thoroughly in the book, but generally speaking the incidence has been estimated at between 10 and 30% of the population with 5 to 10% of that number experiencing it to a severe or disabling degree). IBS is a multi-faceted disorder of intestinal motility which is generally speaking usually diarrhea or constipation predominant. It is a functional disorder in the sense that there are typically no organic structural findings and in the sense that the problem is in the way the body works. Appropriate treatment generally includes dietary and lifestyle changes and may or may not include medication which at this point in time is directed at the symptoms which can include extreme pain. There are several potential causes, including stress, and it is often associated with depression and anxiety.
As both a psychologist and an IBS sufferer, I found the book comforting, and saying "comforting" is saying a lot when you?re talking about IBS. However, the amount of research and analysis he offers here not only confirms my experiences and validates my clinical insights and practices. The book should also provide the means for other psychologists and mental health professionals to help the many of us out here. So much for the personal!
Understanding the wealth of material he offers here does require some psychological sophistication, but it is rewarding to any who choose to pursue it. The issues he raises and discusses in a clear and straightforward fashion are important issues for physicians (not just gastroenterological specialists) and patients. As he and others have made clear at this point in time, psychological treatments such as hypnosis and cognitive behavioral therapy can offer a great deal to patients in addition to what has come to be expected of them in the treatment of anxiety and depression. This is not the type of psychotherapy where you sit for hours talking about the past, and this is an important message for psychologists, physicians, and health professionals and educators to get out to the public.
Whichever particular treatment turns out to be best, and of course this depends on the skill of the practitioner and the needs of the particular patient, the important message of the book is that these treatments do work and there is considerable evidence that they do work, evidence that he evaluates here: hypnosis, cognitive behavioral treatment, and brief psychodynamic therapy are all effective in treating the disorder and all of these plus biofeedback and relaxation are helpful for treating specific symptoms.
There are, however, several aspects of psychological treatment that need to be considered by physicians wanting to refer for treatment and patients seeking help. It is very important that the practitioner have a good knowledge of the disorder as there are potential dangers both in inappropriate treatment and in treatment that does not seem relevent to patients. The practioner should be sophisticated enough to screen out and deal with inappropriate candidates. The practitioner also should be aware of and be able to use appropriately tools such as Blanchard provides for symptom and dietary tracking and monitoring and also be able to provide appropriate referrals for dietary and lifestyle programs.
In additon to the above, Blanchard provides an analysis of prediction of treatment response which provides insight into who will benefit in what way from this type of treatment and who probably won't. There is a good summary of what is currently known about the disorder and an analysis of the extent and significance of what appears to be altered pain sensitivity along with an analysis of whether stress precedes or follows the start of IBS.
He also provides detailed treatment manuals for hypnotherapy, cognitive therapy, and cognitive behavioral treatment as well as numerous useful forms for assessment and treatment and a description of a model for a psychoeducational support group. All in all, Dr. Blanchard has done a valuable service for psychologists interested in providing treatment for IBS sufferers. He has also done a valuable service for primary care physicians and patients interested in pursuing this type of treatment. With the availability of this book, any patient or physician should expect competent and knowledgeable treatment from any mental health practitioner, and expect that the treatment will be appropriately directed toward the problem.
Blanchard, Edward B. Irritable Bowel Syndrome: Psychosocial Assessment and Treatment. Washington, DC, American Psychological Association, 2001.
Another recent book, Breaking the Bonds of Irritable Bowel Syndrome : A Psychological Approach to Regaining Control of Your Life, by Barbara Bolen (New Harbinger Press, 2000), should prove helpful to psychologists and physicians as well as the general public which is it's primary audience. Other helpful books include Be Good to Your Gut, by Pat Baird (Cambridge, MA., Blackwell Healthcare, 1996) on dietrary suggestions;
Eating for IBS : 175 Delicious, Nutritious, Low-Fat, Low-Residue Recipes to Stabilize the Touchiest Tummy by Heather Van Vorous (Marlowe, 2000); and Food Allergies and Food Intolerance : The Complete Guide to Their Identification and Treatment by Jonathan Brostoff and Linda Gamlin (Rochester, VT, Healing Arts Press, 1999) on the possibility of concurrent food allergies or intolerances..