Perceived Utility of Cognitive Behavioral Therapy in People With Bowel Disorders of Gut-Brain Interaction

Cognitive behavioral therapy (CBT) is an effective but underutilized treatment for bowel disorders of gut-brain interaction (DGBI). We aimed to examine attitudes and perceptions toward CBT in adults with and without bowel DGBI or other gastrointestinal (GI) diseases.

We conducted an online survey on perceptions and experiences related to CBT. Presence of bowel DGBI was determined using Rome IV criteria. Responses were compared across individuals with bowel DGBI, other GI diseases, and controls, and between individuals with different types of bowel DGBI including irritable bowel syndrome (IBS), functional constipation (FC), and functional diarrhea (FDr). Associations between psychosocial factors and perceptions of CBT were examined.

Of 770 participants (268 with bowel DGBI), 70.2% reported CBT could be helpful. Barriers included lack of trained professionals, cost, and time or effort. Participants with bowel DGBI were more familiar with CBT (OR = 1.72, p < 0.001), but no more likely to have been offered CBT than controls. Those with other GI diseases had 4.3-times higher odds of having been offered CBT. Attitudes toward providers recommending CBT and overall receptiveness to CBT did not differ among groups. Non-White, non-Black individuals were less likely to perceive CBT as helpful (OR = 0.61, p = 0.01), while Black participants were more willing to try CBT (OR = 1.73, p = 0.003). Participants with FDr were more likely to report CBT could be helpful than those with IBS (OR = 2.62, p = 0.035).

Despite similar perceptions, patients with bowel DGBI are less frequently referred for CBT than those with other non-DGBI GI diseases. Sociocultural differences may also influence beliefs. Strategies for access expansion, early referrals, and culturally competent care will be essential for effectively integrating CBT into bowel DGBI management.