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Stress and Irritable Bowel Syndrome

Paper outline:

Introduction
What is Irritable Bowel Syndrome?

Comorbidity

Cost of IBS
How Stress is measured in Studies linking Stress with IBS
How Stress links to IBS

Use of Mindful-Meditation as a Psychological Treatment of IBS
Conclusion

 
 
Abstract
Irritable Bowel Syndrome (IBS) is a major condition that affects people in all ages of life. This study brings out the relationship between stress and IBS. It aims to show that only approaches to treat IBS that recognize its dependence on the mental condition of the patient succeed in treating the condition. In the same relation, patients who respond to treatment demonstrate recognition of their mental status role in accepting and dealing with the condition. This research discusses finding, methodologies and implication of other studies that have examined the relationship of stress and depression, treatment of IBS and the role of stress in determining the severity of IBS. Results of the discussion confirm the hypothesis that stress is responsible for the severity of IBS and determines the efficacy of treating IBS. The paper does not look into other variables that may cause stress in IBS patients or how other variables may dilute the influence of stress on the recovery of the IBS patient. However, the paper contributes to the overall understanding of the relationship of stress and IBS and offers insights to the treatment of IBS.
Stress and Irritable Bowel Syndrome
Introduction
The Irritable Bowel Syndrome (IBS) is a chronic problem of the stomach and intestines (gastrointestinal). The problem manifests through abdominal pains, bloating and a mostly results to a difference in a person’s bowel habit. Actual extent of the spread on the problem in the world varies according to the criteria used, however all studies done to find out its prevalence report that it is a common disorder and affects a significant number of people in any population. Therefore, physicians and other health practitioners frequently address the disorder (Spiller et al., 2007). This paper looks at the relationship between stress and IBS. The discussion presents confirm that stress if a significant variable in the severity of IBS and is a consequence of IBS. While IBS may be responsible for the stressful conditions of a patient due to its inconveniences, the patient has a responsibility of reacting positively to IBS and adapting to recommended behavioral practices to ensure a quick recovery. The relevance of stress occurs when treating IBS and several studies examined in the paper show that the physician-patient relationship, the experiences of the patient and their perception to treatment play a key role in determining their recovery.
What is Irritable Bowel Syndrome?
. Although IBS is widespread and troublesome, the disorder has not been linked with any chronic symptoms or development of a serious disease cause high rates of mortality. However, the fact that IBS is associated with a variety of other health problems frequently makes it a significant contributor to health care costs. Clinically IBS is diagnosed when a patient exhibits the following symptoms. In order to clarify that a patient is having IBS, symptoms must be present for at least six months. Six months ensure that other conditions like infections or progressive diseases like bowel cancer do not cause the observed symptoms. These other conditions are diagnosable within six months (Spiller et al., 2007).
The symptoms of IBS are abdominal pains and other discomforts that are associated with bowel function. When the discomfort is relieved by defacation then its likely to originate from the colon, otherwise the discomfort is usually associated with the stool consistency thus displaying an intestinal transit association. Other noteworthy symptoms that do not form the diagnostic criteria are bloating, abnormal stool and abnormal frequency. Moreover, patients report straining during defecation, the passage of mucus per rectum and an incomplete evacuation. The symptoms of IBS are usually different among different group of patients. The symptoms vary with their intensity and there prevalence. Patients having a constant pain of up to four days may be having a severe condition of IBS that requires early recognition. Patients suffering from this severe condition do not respond well to conventional treatments and suffer causal psychological disturbances (Spiller et al., 2007).
Comorbidity
Patients having IBS may be suffering from other diseases. For example, 20 to 50 per cent of IBS patients also suffer from fibromyalgia. Fifty one per cent of patients having chronic fatigue also have IBS and the same is true for 64 per cent of patients having temporomandibular joint disorder. Additionally, fifty per cent of patients with chronic pelvic pain also report to suffering from IBS. Therefore when making diagnosis about IBS it is helpful to have a systematic questioning for patients to identify comorbid diseases because such patients are likely to be suffering from chronic versions of IBS.
To sum up, IBS patients will complain of abdominal pains. Some patients with IBS are more sensitive to experimental gut stimulation compared to others. The chronic pain in these patients takes various forms either central or peripheral. Focus on treating IBS needs to differentiate these diverse forms so that patients are treated specifically (Spiller et al., 2007). Any organism undergoing stress mediates response by integrating the hypothalamo-pituitary-adrenal (HPA) axis with the sympathetic section of the autonomic nervous system of its immune system (Spiller et al., 2007).
Cost of IBS
(Evritt et al., 2010) In UK, IBS affects 10-22 per cent of the population and the National Health Service of UK has to spend in excess of 200 million pounds annually to address the health costs of IBS. Other than the health implications, IBS lowers the quality of life and the social functioning of its victims forcing them to take time from work which is costly to the economy. The treatment of IBS is dependent on a correct and early diagnosis lumped up with the appropriate reassurance and lifestyle advice for the patient. Cases of IBS are usually ongoing symptoms which necessitates the administration of lifestyle advice by qualified personnel to ensure that patients are able to cope in their daily life schedules and interactions. Evritt, et al. (2010) agree to other research findings that IBS patients are likely to exhibit additional stress manifestations in their lives and a reduced ability to cope because the condition although managed in general practice still leaves them with notable restrictions. The patients cannot participate in their daily activities and therefore have to put up with a diminished life quality.
According to Lu et al. (2007), IBS and other diseases suffered by patients contribute to negative appendectomy. The authors note that many patients having IBS end up receiving appendectomy and pelvic surgery. Prior studies as reported by the authors have connected IBS with high chances of having appendectomy but the authors note that their study goes further and actually links IBS with negative appendectomy. In their discussion, the authors speculate that IBS patients having visceral hypersensitivity unintentionally confuse their physicians to make a faulty diagnosis that leads to negative appendectomy. IBS also contributes to patient’s anxiety emotional instability that adds on to a depression from other social conditions they face and this leads to higher probabilities for negative appendectomy (Lu et al., 2007).
How Stress is measured in Studies linking Stress with IBS
            Keefer et al., (2008) offer a literature review that gives a significant insight of the nature of studies that link stress with IBS. Studies examining the role of stress in IBS use a prospective research design that follow participants for an extended time of about one year. The design includes a follow up interval regularly placed at an average of 5 weeks. When defining stress, most studies go with the general definition of stress as an environmental event. The authors recommend that future studies adopt the transactional model because it offers a complete picture of stress response and allows the researcher to differentiate stress effects on patients as they address other variables interacting with the stress that might be responsible for explaining the results measured. The measure of stress relies on major life events, the experiences of hassles or minor annoyances. Studies use the two measures or a single one. On the first measure, questionnaires are used and most fail to take into account how having stress of a chronic disease affects how an individual experiences life events. Questionnaires may also be biased when they include other questions that ate not specific to health-related problems. Reliance on life events as the only measure of stress is erroneous because there is no standard experience of life events for every individual. A case study that reports the stress scores will not provide an adequate comparison among groups because of this fact. On the other hand studies using the second definition of stress adopt it because of their intention to be more conclusive. These studies measure daily stresses by monitoring the hassles using inventories such as the Hassles Questionnaire, 48. This inventory captures the minor stressors and assumes that they add up to a significant proportion of a person’s stress levels compared with once-off events. The findings of this study indicate that there is a lacking sound paradigm that can be used to approach the study of stress and IBS conclusively. The reason why studies fail to draw concrete conclusions on the relationship between stress and IBS may be attributed to this fact that a significant methodological issue in smoking the visibility of this area of study (Keefer et al., 2008).
How Stress links to IBS
Many IBS patients have psychological disorders. Seemingly, these patients when more severely affected with increased clinical recurrence exhibit stress-enhanced immune and inflammatory deregulation. Therefore, acute stress may represent the alleged link to both mental disorders and guts inflammation in the stress-sensitive individuals (Santos et al., 2008). According to Santos et al. (2008), life stress is a critical factor for mucosal inflammation in IBS patients. IBS patients exhibit a clinical and biological heterogeneity and a simplistic hypothesis of a stress-related stepwise progression concerning gut inflammation is appropriate in gaining an operative knowledge that leads to the rendering of a better and specific diagnosis marker and an improved therapeutic option.
Eriksson et al., (2008) conducted a study to expound the difference in psychological and somatic as well as biochemical forms among different subtypes of IBS. They report that there are acute differences in the psychological feedback from the three subtypes namely D-IBS, C-IBS and A-IBS. All IBS patients under the study had a low quality of life that the authors attributed to use of passive coping strategies. Within the different subtypes, men falling under D-IBS demonstrated less body awareness and less psychological symptoms which suggested an unconscious mental stress due to an a adrenergic drive.
IBS symptoms are responsible for a significant reduction in health Related Quality of Life subscales as measured by Graham, SAVAS§, White and El-Serag (2010). The authors compared the Health Related Quality of Life (HRQOL) in female veterans who do not display IBS symptoms to examine how much post-traumatic stress disorder and depression contributed to HRQOL. The authors used a sample of 339 female veterans who self-reported on questionnaires that they were assigned. The participants responded of their perceived IBS symptoms, depression and anxiety in addition to post-traumatic stress disorder. The study found out that despite IBS contributing significantly to low HRQOL, the sample population, female veterans, usually experience low HRQOL compared to the general population of the U.S., however this does not dispute the findings of the study.
Also significant to the study is the fact that it is the first that examines the HRQOL measures specific to disease or general in women veterans having IBS symptoms or lacking the symptoms. To explain why the test subjects had a generally low HRQOL measure, the authors indicate that they are vulnerable to other co-morbid mental health conditions that are responsible for their anxiety and depression. While acknowledging the significant influence that IBS symptoms have on lowering HRQOL measures, it is important to note that the influence was on ly recorded in 2 of 8 subscales. This indicates that it is important to include disease specific HRQOL measures when examining HRQOL in IBS to properly allocate each variable and its influence on the measures recorded. Therefore, by contributing to lower scores of HRQOL, IBS contributes to heightened levels of stress but the actual increase in stress in attributed to a complex relation of the IBS symptoms together with other comorbid conditions like depression and anxiety (Graham et al., 2010).
Iovino, et.al. (2009) found out from a study of ten children with IBS that the condition is responsible for stressful conditions and stress manifestations in the lives of the sampled children. Their study indicated that there was a higher anxiety score and sleep disturbance as measured by visual analogue scales. The findings suggested that indeed, as according to their hypotheses, that IBS children have a personality profile that display the characteristics of itch actions and impatience together with being distressed and mostly anxious. When the children are emotionally unstable, their ability to cope with stressful life conditions is highly impaired. These children will have difficulties or may be unable to live with refusal, failure and disappointments in their homes, school or other social places. Most of the children having difficulties in using accommodative coping strategies also report to having severe abdominal pains. The condition is also similar to adults. The general finding of this study was that psychological factors are modulators of visceral hypersensitivity however; the study may be limited by the fact that it only used a generally small sample size. Given that there are different subscales of IBS, the study also failed to differentiate the severity of their IBS symptoms in the children used as sample. Overall there is a mutual interaction of personalities profiles and visceral hypersensitivity that may explain the mechanism that governs how children percept the IBS symptoms (Iovino et al., 2009).
When an individual is exposed to traumatic experiences in early life or acute and chronic stressors then the individual becomes less capable of coping. This may lead to a malfunctioning of HPA axis activity and limbic functions, when this occurs the individual is likely to be stress-vulnerable. A dependence of steroids decreases the production of new granule neurons in adulthood that is induced by maternal separation. This suggests that stress in early life may be responsible for permanent impairment of hippocampus dependent learning and memory that makes the patient to have a heightened defenselessness to depression. Chronic stress and prolonged exposure to elevated corticosteroid levels impair proliferation and apoptosis in neurons from the dentate gyrus and may be responsible for the considerable impact on cognitive learning. Proper nutrition throughout the early development time seems to be dire to prevent some of the negative environmental conditions. Other studies on animal models have highlighted the importance of the genetic background of the individual in the stress response (Shamshiri et al., 2009). For most individuals, the clinical result of disabled ability to cope with stress is the surge of anxiety and episodes of depression. Such individuals are likely to have aggressive social engagements and isolations that frequently determine unhealthy outcomes associated with IBS (Santos et al., 2008).
Shen et al., (2009) present the relationship between IBS and psychological stress in Chinese university students to increase the available literature on IBS in Asia. They confirm that IBS has significant socioeconomic consequence and leads to a lower living quality of patients. The authors indicate that for Chinese university students used in the study the main sources of stress were learning tasks, the university environment, job seeking tasks, their interpersonal relationships and emotional disorders. Moreover, the student’s educational background, social experience and their living conditions and psychosis contributed to the onset of IBS that lead to a higher prevalence. This study confirmed previous study findings that note the independent prediction of the occurrence of IBS occasioned by anxiety, depression and other psychological stressors. In addition, there was co-occurrence of psychiatric disorders with IBS symptoms. The authors suggests that in line with the development theories of IBS, fear conditioning and visceral interceptive cues contribute to the development of the full IBS. Furthermore they indicate that there exists a reciprocal relation between stress and symptoms. Because the interactions of brain and body conduct important roles in symptom pathogenesis, IBS should be regarded as a psychological-related disease.
Liu & Alloy (2010) note that a substantial amount of studies indicates that stress is a generation effect in depression. Depression is associated with succeeding stress occurrences. Within the last 20 years, the research on stress has expanded from focusing on the effects of depressive symptomology on stress and now includes preliminary proof that chronic stress and childhood maltreatment add on to the succeeding occurrence of dependent stress. Research looking into other predictors of stress has also indicated similar results of a stress generation as applied earlier. This research has centered on the cognition and personality or the interpersonal vulnerabilities of individuals experiencing stress. A depressogenic consequence of stress generation extends beyond the individual and influences others in their company.
Treatment of IBS
Chiou and Nurko (2010) note, patient treatment is usually psychological for mild conditions of IBS. They indicate that with reassurance over a given period, the patient usually recovers from the mind condition of IBS. It is for the severe conditions of IBS that specialized treatment needs to accompany a correct diagnosis. To treat children and adults with IBS successfully, there needs to be a trusted effective patient-physician relationship where the physician assumes an active listening approach. In addition, the physician should demonstrate enthusiasm towards the patients and become positive and encouraging in the attitude towards the treatment. Most patients when seeking physician help are not aware of IBS and instead think that they are suffering from another disease. It shocks them to be told that they have symptoms for IBS. Therefore, it is the work of physicians to address the patient’s concerns and fears in addition to reassuring them that a positive diagnosis of IBS is not a failure to identify other illnesses. Patients have to be prepared for the eventuality of normal results of laboratory tests or investigations. These may be appropriate at helping the patient accept the diagnosis of IBS. Physicians may also choose to inform the patients of the relationship in pathophysiology of visceral pain and the complaints that arise within the context of brain-gut pathway. Patients might appreciate the information however each symptom needs to be validated as real. Another prerequisite for treatment is to inform patients that the treatment is a gradual response to the patient reaction and this also adds up to the need of having realistic goals for the treatment. Patients should not expect to be cured promptly, they have to understand that getting well will be gradual as they improve their coping with symptoms and how much they are able to maintain their normal daily living schedules (McOmber & Shulman, 2007).
Placebo effect has a potential power that physicians have to recognize regardless of their specific therapeutic interventions. According to Chiou and Nurko (2010), 58 per cent of patients receiving placebo felt better at the end of the study in comparison with 63 per cent of patients receiving amitriptyline to treat IBS. This explains that the failure of an intervention to show significant benefit is not because of the intervention lacking any improvement result but because there is a due observation of a strong placebo effect. In this regard, there has to be a positive patient-physician relationship that forms the foundation for promoting a positive therapeutic response to the treatments of IBS.
Major therapeutic approaches for IBS are dietary, psychological, pharmacological and complementary medicine interventions (You et al., 2010). Psychological interventions encompass parental education, family therapy, cognitive-behavioral techniques, biofeedback and guided imagery. While this strategies aim to have a direct effect on the somatic symptoms, they are also useful in promoting a patient’s ability of self-manage the IBS symptoms. The success of psychological treatments is notable especially on somatic symptoms of adults and children exhibiting functional gastrointestinal disorders. Psycho-education communicates information to patients and families on how abdominal pain is connected to physiological triggers and other factors that exacerbate pain. These may be social reinforcements of school avoidance among others. On the family front who constitute the immediate social network of the patient, the therapy targets family interactions and relationships instead on the individual so that it changes maladaptive behaviors. This increases the tolerance of the IBS symptoms and encourages the development of independent coping skills. When parents pay attention to the complaints of their children regarding IBS symptoms, the attention increases the number of complaints. Parents should use alternative methods of taking note and deflecting their attention from the symptoms to reduce their importance and a tendency by children to make them superfluous.
Most physicians dealing with IBS patients use the cognitive-behavioral therapy (CBT) that is based on the complex reactions of thoughts, feelings and behaviors (Spence & Moss-Morris, 2007). The CBT is employed to make patients learn better coping and problem-solving skills, to identify triggers and reduce maladaptive reactions to the triggers. The CBT uses specific techniques like keeping diarie entires for symptoms, feelings associated with the symptoms, thoughts and behaviors. Behaviors include adapting to relaxation and distraction strategies, use of positive and negative reinforcement to modify behaviors and confrontation of symptoms and beliefs. These behavioral interventions are only known to work in the short-run and should not be encouraged for patients with chronic conditions; moreover, not all patients react to the behavioral techniques in the same way.
The most direct intervention for reducing psychological stress is relaxation. Relaxation is accompanied with other psychological therapies to achieve a psychological state that is opposite of how the body reacts under stress. Relaxation may employ several methods that have the effects of decreasing heart rate, the respiratory rate and blood pressure. Others include reduced muscle tension, brain-wave activity and oxygen consumption. An abdominal breathing stimulates the parasympathetic nervous systems and this increases the feeling of calmness and relaxation. A relaxation exercises often involves tensing and relaxation of each muscle group in the body, patients then focus their attention on the relaxed feeling. When guided imagery is combined with relaxation technique, a state of increased receptiveness to gut-specific suggestions and ideas is achieved. Guided Imagery is a specific relaxation strategy that where the patient is relaxed and focused as they are taught to imagine being in a peaceful scene as they create an experience that is without stress and anxiety. Hypnotherapy as explained above may be combined with electronic equipment to create biofeedback. The combination is used to create visual or auditory indicators of muscle tensions, skin temperatures and anal control that enable the patient, mostly children, to confirm externally the physiological changes.
Use of Mindful-Meditation as a Psychological Treatment of IBS
The importance of a bio physiological perspective on treating IBS symptoms has been demonstrated by the relative success of behavioral treatments such as cognitive-behavioral therapy (CBT). Mindfulness meditation is a unique and new behavioral intervention technique that involves the intentional self-regulation of attention. Patients learn to attend to present-moment experience and withdraw from cognitive fixation on thoughts based on their experiences or future expectations (Gaylord et al., 2009).
Increasing attention has been put on the use of Mindful Meditation intervention in reducing stress. Branstrom et al (2010) examined the effects of mindfulness stress reduction training on the perceived stress and physical wellbeing. The study uses a randomized sample of 70 female participants and 1 male participant. All participants involved in the study had previously been diagnosed with cancer. The study used five-facet mindfulness questionnaire to measure effects and report the effects of the mindful intervention on the perceived stress by participants. The research findings indicated a significant decrease in perceived stress levels and little posttraumatic avoidance symptoms in the intervention group. The participants also demonstrated positive mind states during the intervention. The researchers then approve that the training of mindfulness stress reduction can meaningfully improve the physiological wellbeing of the participants (Branstrom et al, 2010).
            Oman et al (2008) evaluated the effects of Mindful Meditation on stress, rumination forgiveness and hope for a period of eight weeks. Each week had a 90 minute training program for college undergraduates in meditation based stress management tools. The study had a total of 44 participants who were divided into three groups of wait list control, Eswaran’s Eight-point Program (EPP) and mindful based stress reduction. Each group had 15 participants except for the EPP which had 14 participants. Using relevant self-reporting measurement tools the authors collected pre-test, post-test and 8-week follow-up data. In their findings, Oman et al observed that there was no significant difference in the results obtained by the EPP group and MBSR group. They also noted that there was no significant difference in the post-test results and those of the 8-week follow-up. Unlike in the control, treated participants demonstrated a significant increase in the benefits for stress and forgiveness and a marginal benefit for rumination.
The findings by Oman et al, (2008) confirmed their hypothesis that college students are able to reduce their levels of perceived stress significantly using meditation based stress management tools. They also show that effects of both EPP and MBSR are the same in reducing the perceived level of stress in undergraduate students. Their findings support the argument of offering meditation-based programs like MBSR and EPP to college students. The study however does not fully offer answers to the question of long-term resilience on stress. Their findings only demonstrate a reduction in the perceived stress in the short term. However, it is hoped that the programs studied assist the participants in having resilience because they offer growth and refinement strategies of coping with day-to-day stressful conditions (Oman et al, 2008). The results by Oman et al (2008) were based on tests done mostly on white first year undergraduate women and therefore might not be applicable fully to men. Other limitations of the study were the small sample size used and the decreased precision in accessing changes over time. The later was an effect of a reduced statistical power associated with the low sample size. In addition, the study did not have an active control group that would have made it possible to account for the observed changes. Finally, the study failed to use psychological measures of stress and wellbeing and only relied on paper and pencil reports.
The mindfulness practice has been empirically demonstrated to reduce the symptoms of stress and pain. It also ameliorates the symptoms of fibromyalgia and depression, however the exact extent to which mindfulness is responsible for the alleviation of stress related to IBs has yet to be conclusively studied. Current information only related to the assumptions of the effects on IBS based on related effects on similar psychological conditions as noted in the discussion above. Further studies on mindfulness practice should be carried out because mindfulness training has already been associated with a notable reduction of symptoms of IBS notably stress and pain. Secondly, mindfulness techniques are teachable in groups. Thirdly, other areas that use mindfulness as wellness programs have reported significant participant improvement in life-style changes as well as improved stress management. Fourth, when adopted as a wellness program, mindfulness is teachable by instructors unlicensed in other fields and these teachers when well trained in mindfulness deliver a safe and effective program. Lastly, with mindfulness teaching as a wellness program, fulfillment levels are high and failure levels are low (Gaylord et al., 2009).
Given the potential presented by mindfulness practice and the successful use of behavioral interventions, mindfulness meditation can be a unique method of treating the underlying psychological symptoms of IBS. This point is strengthened by the fact that IBS patients show an increased sensitivity to pain from intestinal digestion positively correlated with anxiety about the significance of these sensations. Patients also harbour selective attention to gastrointestinal sensations. Mindfulness meditation induces alterations that affect the neural circuits implicated in neuro-visceral awareness, sensitivity to stimuli and self-regulation in addition to improving the ability to control attention processes and as a result may exert a salutary effect on irritable bowel symptomatology as well as the underlying mechanisms of the symptoms (Gaylord et al., 2009).
Psychotherapy interventions when combined with acupuncture show considerable improvement in the treatment results of patients (Adeyemo, 2008). The improvement is significantly greater than when acupuncture is combined with drug treatments or herbal treatments. This further strengthens the view of IBS being a mental condition as much as it is a physical condition. Any treatment approach of IBS has to put into consideration the mental state of the patient and how it significantly affects the patient’s response to the treatment (Adeyemo, 2008).
According to Kelley et al. (2009), the placebo effect of a treatment depends on the patient extraversion, amicability, openness to experience and gender. However, the effects are only notable in IBS patient treated with placebo acupuncture. For a generalization of the placebo effect, only patient extraversion holds true. In their study, Kelley et al. (2009) indicate that IBS patients treated with placebo acupuncture experienced significant improvements in symptoms indicating that a positive therapeutic relationship can greatly enhance the effect of placebo acupuncture. The authors highlight that different practitioners have relatively large differential effects on the placebo response even when they are using the same scripts that are highly standardized. Moreover, when the practitioners fostered a therapeutic relationship with their patients, their results were ideal as hypothesized in the study. On the contrary, practitioners having no or limited fostering of a therapeutic relationship with their patients only had a moderate correlation with the ideal healthcare prototype. The sharp difference besides highlighting the psychological nature of the patient’s response to the treatment, explains the why there was a difference in the argumented group that received treatments delivered in a warm empathetic manner compared to the limited group that got treatments in a neutral fashion. The study does not explain how the patient-practitioner interaction achieves its effect, however the findings are in agreement with other studies on the manner in which IBS patients respond to behavioral interventions. It provides a specific application of a specific behavioral intervention and its effect, which is handy in substantiating the findings of other studies on the matter of IBS patient response to treatment. The study also fails to explain why there were differences in the results from different practitioners yet they all used a scripted and highly standardized procedure.
Mykletun et al., (2010) tries to make a conclusive relation of IBS and psychopathology noting that previous studies have used small sample sizes that are prone to biases. Moreover, most evidence cited is related to population-based studies that use a self-report screening instrument for psychopathology. The study findings indicate that indeed there is an IBS-mental health association as reported by previous researches. However, the study does not agree with study findings from population-based studies and clinical interview based studies. The authors fail to find a conclusive evidence and report that the consistent association of IBS with psychopathology is only an indicative evidence that IBS is a disorder having a psychosomatic aspect.
The knowledge of the person having a disease is more important that knowing the disease to which the person is suffering is an adage that Hayee and Forgacs (2007) used in their study to examine the psychological approach used in management of IBS. When treating IBS doctors rely on their teaching that IBS is a diagnosis of exclusion while patients relate negatively with the treatment once they realize that nothing is wrong with them. The negativity mood when established becomes hard to dispel. Consequently, people appreciate that the range of treatments available are short on scope and effectiveness. As indicated in this paper, patients having IBS are more likely to be depressed and display abnormal behavior patterns. To avoid the consequences of negativity to treatment approaches, practitioners need to make positive diagnosis in the first place. A positive diagnosis is therapeutic from the initial consultation hence its strength in overcoming or avoiding negativity. With the recognition of IBS as a psychological related condition, several psychological management options are used in its treatment, the exact effectiveness of these approaches has been demonstrated by several researches and are subject to the analysis methods used and their interpretations. In mentioning, the options are use of antidepressants like tricyclic antidepressants, selective serotonin and reuptake inhibitors, secondly, cognitive behavior therapy is used and lastly hypnotherapy. The exact treatment administered to a patient matters with the specific aspect of the disorder that is the focus of the treatment and the individual patient. The prevalence of IBS causes many patients to be denied assistance as they lack access to therapists having the appropriate psychological skills. In this regard, Primary care services provisions for IBS need to be enhanced so that early psychological treatment of the condition, which has a real improvement chance, can be practiced effectively.
Conclusion 
This paper has demonstrated that IBS is a stress sensitive disorder such that a predisposed individual sustaining stress can result to an enhance responsiveness of dominant stress circuits. In addition, have a dysregulation of adaptive systems that increase their vulnerability to having a functional disorder, in this case Irritable Bowel Syndrome (Chang, 2008). The paper has also highlighted the significance of childhood conditions in determining the level of coping ability for an individual to life stressors. Individuals having a past associated with maltreatments especially in their childhoods will have an impaired stress response system that makes them vulnerable to developing chronic conditions of IBS. Psychological interventions have had a positive outcome in treating IBS and the research in their efficacy is ongoing.
Cognitive behavioral approaches and hypnotherapies are examples of psychological interventions on the treatment of IBS that have had a considerable success. The fact that IBS is not a diagnostic disease presents challenges to its treatment. When patients learn that they have no disease but a condition, they are likely to become negative in their reaction to the treatment. Moreover, physicians treating patients with IBS symptoms tend to use an exclusion strategy that reinforces the negativity and contributed to a negative diagnosis. It is important that the patients and doctors perception of IBS are addressed early in the treatment process so that negativity is avoided (Tang et al., 2008). Stress is a major contributor of IBS and is a result of the diagnosis of IBS. Therefore, treatment and prevention measures that incorporate a therapeutic approach are most likely to show positive results.
 
 
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