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Irritable Bowel Syndrome: Psychosocial Assessment and Treatment
  1. T R Bell

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As both a psychologist and a sufferer from irritable bowel syndrome (IBS), I found this book to be a very helpful guide to several controversial issues as well as a thorough analysis of the existing literature. I also found the book comforting, and saying “comforting” is saying a lot when 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, it also should 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 requires 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 for physicians (not just gastroenterological specialists) and patients. As he and others have made clear, psychological treatments such as hypnosis and cognitive behavioural therapy can offer a great deal to patients in addition to what has come to be expected in the treatment of anxiety and depression. This is not the type of psychology where you sit for hours talking about the past, and this is an important message for psychologists, physicians, health professionals, and educators to get across to the public.

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 psychological practitioner has a good knowledge of the disorder as there are potential dangers both in inappropriate treatment and in treatment that does not seem relevant to the patient. The practitioner 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 programmes.

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 behavioural 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.

In addition to the above, Blanchard provides an analysis of prediction of treatment response which gives insight into who will benefit in what way from this type of treatment and who will probably not. 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 together 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 behavioural 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 towards the problem.

While the book is too big and probably too complicated for the average patient, it does point to a need that perhaps someone will fill soon: a brief, simple, and rational explanation of the role psychological therapies can play in the treatment of IBS for patients.

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