CBT for IBD: Techniques to Try Today

Your phone sends that familiar — ding ding — as you get a text invite to your friend’s birthday party next weekend!


But that initial excitement to celebrate comes to a screeching halt as your automatic negative thoughts creep in. You remember all the reasons you can’t or shouldn’t go because you’re living with an inflammatory bowel disease.


The voice in your head starts saying things like: “but they’ll hate me if I get tired and need to leave early“, or “I’ll stand out if I don’t eat the cake, so I just shouldn’t go at all.”


These unfavorable thoughts are shaped by our past experiences and influence our current behaviors. They play a fundamental role in whether we choose to do something for joy or because of fear.


But just because we have this thought pattern, doesn’t mean we have to act on the thoughts. Cognitive Behavioral Therapy (CBT) is one way to retrain our brains to support a happier, healthier, and more fulfilling life.


What is Cognitive Behavioral Therapy (CBT)?


Cognitive Behavioral Therapy (CBT) is a type of treatment that connects our thoughts, emotions, and behaviors. It includes principles and activities such as questioning fearful thoughts, trying out new activities or behaviors, and practicing grounding techniques such as breathing to help us be more present.


The main goal of CBT is to reframe negative thought patterns into more positive or productive ones, which will ultimately result in taking better actions in difficult moments or challenging diseases such as inflammatory bowel disease (IBD).


As Healthline explains, this type of therapy is different than others, because it’s intended for shorter-term treatment, taking anywhere from a few weeks to a few months to start seeing results.


CBT: Techniques to Try


CBT is most effective when guided by a certified and trained therapist. It can also be used and practiced alone or in combination with other therapies.


Psychologist and CBT expert Kristen Lindgren, Ph.D., from the University of Washington Medical Center, suggests that you assess yourself before starting CBT at home. Are you the type of person who needs to be accountable to a therapist? Be realistic with yourself and seek out therapeutic treatment when needed.


If you’re good at being self-taught, and successful at trying methods on your own, try out these CBT methods. Just keep in mind that it takes time to change thought patterns and behaviors so be gentle with yourself as you give them a go.



Shift Your Perspective


A technique called cognitive restructuring can help change negative or unhelpful thoughts. It can challenge some of the automatic beliefs that pop into your head. As a result, it can help change your actions and potentially improve your mood.


Give it a Try:

The next time you feel anxious or low, pause and ask yourself what you’re thinking about, what happened earlier, or what emotions may be causing you to feel this way. Identify the automatic thought and see if you can reframe it.


IBD Example:

Automatic thought (AT): “I have IBD so I’ll never get better“.

Reframed thought (RT): “I have IBD but changing some small habits may help me feel better.



Rebalance Your Thoughts


Many mental struggles involve thoughts or predictions that influence your behavior. But these aren’t always accurate thoughts. Maybe you had a bad experience in the past and your brain now wants to make decisions based on fear or avoidance. As a result, you may be missing out on something that you really enjoy.


Give it a Try:

Ask yourself what “evidence” you have for this thought. Is it actually true even though you can’t predict the future? Are you just basing it off of an assumption for what will happen?


IBD Example:

Automatic thought (AT):  “I can’t go to that party. My friends will be mad when I leave early.”

Reframed thought (RT):  “How do I know for sure that they will be mad? Maybe I should ask them in advance and see if it would bother them.



Avoid Black and White Thinking


All-or-nothing thinking is a cognitive distortion (an exaggerated or irrational thought pattern). The analogy describes thoughts that are based on extremes versus their true complex nature.


The American Psychological Association also coins this as dichotomous or polarized thinking. It’s the tendency to think in extremes. Such as: “I’m the top employee at work” or “I am a failure that should be fired.”


The root of black and white thinking may be associated with the fight-or-flight response which at it’s core, and in the appropriate context, is a way to help us survive. But thinking in black and white as a habit can interfere with your mental health, career, and relationships.


Give it a Try:

According to Healthline, a few ways to work towards the “grey” area include separating what you do from who you are, listing options, practicing reality reminders, and checking in with what other people think.


IBD Example:

Automatic thought (AT): “My partner thinks they know what’s best for me and my condition but they’re wrong. I should break up with them.”

Reframed thought (RT):Perhaps I should ask them to clarify exactly what they meant. Even though this annoyed me, they may have my best interest in mind.”



Be Mindful


Have you ever experienced thoughts that seem to be on repeat? Maybe you’re stressing about work or something you said, when you’re trying to go to sleep. Or maybe you’re thinking about what’s coming next and completely miss out on the current enjoyable moment.


Give it a Try:


Ask yourself if your emotions or thoughts are reflecting what’s going on in the present moment. If the answer is no, try to tune into your senses. What’s happening around you? What do you see, hear, smell, etc.


Take a few deep breaths and feel your feet on the floor or your body on the chair. Embrace the stillness by embracing the art of doing nothing.


IBD Example:

Automatic thought (AT):  “I have so many meetings tomorrow! What if I have a flare-up and I have to use the toilet?!

Reframed thought (RT):(take a few breaths) I’m in bed now and there’s no telling how I’ll be feeling tomorrow. I can’t predict that. What’s best now, is if I try to get some sleep.”



What the Studies Say: CBT for IBD


Increasing awareness of automatic thoughts can help you manage stress, and as a result, potentially improve symptoms of gut disorders.


Research suggests that irritable bowel syndrome (IBS) specific CBT, that’s given over the phone or online, is even more effective in relieving symptoms than current standard CBT care.


What this means is that online support, such as NoriHealth, can be extremely helpful when added to professional medical and therapeutic care.



Please note: this article is for educational purposes only and intended to be used in addition to a comprehensive medical treatment plan. Nori is not a trained CBT professional, but many principles within the 6-week program are based on CBT techniques.



This article has been written by Lisa Booth, registered dietitian and nutritionist, and co-founder of Nori Health. Content is based on her professional knowledge, and our collection of 100+ scientific research study papers.