Dianne (Diploma in Wellness Coaching Skills, NHS WELLBEING COACH, 2011)
The aim of this assignment is to discuss how relaxation can help patients in their treatment with Irritable Bowel Syndrome (IBS). People with IBS are looking for alternative self-management treatments options as well as conventional medical management. Many people with IBS find that self-management can help with their symptoms and also give them more control over their lives. Relaxation therapy is just one area that can help clients manage their symptoms. Personal interest and my own knowledge in relaxation techniques have prompted the author to focus on this area.
Irritable bowel syndrome is a chronic condition. It is characterized by diverse symptoms including abdominal pain, altered bowel function (increased bowel frequency, constipation), and bloating, abdominal distension, the sensation of incomplete evacuation, and the increased passage of mucus The National Institute for Clinical Excellence (NICE 2010). Although there is no cure for IBS (Nice 2010) recommends management to include diet, standard drug treatment which generally entails a symptom-directed approach with drugs aimed at the pain, constipation, and diarrhoea, and stress management. NICE (2010) suggest that changing your diet is a key way to control the symptoms of IBS. However, there is no “one size fits all” diet for people with IBS. The National Centre for Complementary and alternative medicine(CAM) suggests people can control their symptoms with diet and medication however some find that their symptoms persist despite these treatments, or the medication they take can worsen symptoms.
People with IBS get so fed up with the lack of help they get from usual medical treatments they are willing to try complementary and alternative medicine (CAM) to see if this approach works for them(Kennedy, Rogers & Robinson 2003). Behavioural therapy has been shown to relieve some IBS symptoms in most people who try it. This broad term covers a variety of therapies, including relaxation therapy, hypnosis cognitive behavioural therapy and traditional psychotherapy (Blanchard et al 1993).
Many people with IBS are practising relaxation techniques to help with their symptoms. Relaxation therapy is a technique that can slow your heart rate, lower blood pressure, slow breathing rate increase blood flow to the muscles and relieve muscle tension (Laurel Alexander 2011) Relaxation therapy can help patients by reducing the physiological effects of stress and anxiety. Relaxation techniques can include progressive muscular relaxation, diaphragmatic breathing, guided imagery, hypnosis, yoga and meditation (Drossman et al 2009). Relaxation therapy is the simplest form of psychotherapy. The premise is that if the response to stress contributes to IBS, reducing autonomic stress responses by relaxation will reduce symptoms induce a feeling of well-being and increased confidence which will allow people with IBS to feel more able to control the condition (NICE2008).
Relaxation can be taught using audio tapes and there are many readily available which people with IBS can access (Jones et al 2000).) In Manchester where the Author lives there are many relaxation programmes and courses for people who want to practice relaxation and learn the techniques at a small cost. At the local leisure centres, there are programmes for people to learn yoga. Clients can obtain relaxation CDs from the public health department which is based at the local library, free of charge. Books can also be purchased or clients can join the local library. Relaxation therapy is easy to learn and inexpensive and this makes it a very viable product.
Van der Veek et al. (2007) conducted a study and found that brief relaxation training significantly improved symptom severity, general health perception, and reduced service utilization in patients with IBS. It also increases the number of symptom-free days and improves general health satisfaction immediately after therapy. Blanchard et al (1993) recommend that it is important to recognize that standard medical care, which is provided to all patients, is essential in treating IBS and cannot be replaced by relaxation therapy alone. He suggests that dietary advice, which is considered the mainstay in IBS treatment, may improve symptoms considerably, especially in patients who report symptom deterioration after a meal. Reviews of biofeedback and relaxation therapies suggest a positive effect on the control of IBS symptoms, but the evidence is limited and not sufficient to make recommendations (NICE 2010).
In the author’s last role clients who suffered from stress, pain IBS, depression, and anxiety were taught different types of relaxation i.e. diaphragmatic breathing, progressive muscle relaxation, guided imagery and meditation. Patients on the programme practised in a group session and then were given a CD to practice at home. At the beginning of every session, clients were asked to discuss what benefits they found. Blanchard et al (1993) support this he states that relaxation in groups showed promising results as a group intervention for IBS. From the authors experience the clients that practised the relaxation techniques on a regular basis got the full benefit and it helped to reduce their stress and pain levels. Many clients were reluctant to try relaxation and it was difficult getting them to look at alternative options as they were too set in their ways.
From the author’s own experience, the relaxation she found the most benefit from was practising the imagery relaxation technique. Most clients had their own preference for the type of relaxation they found the most benefit from. Clients should try a variety of relaxation techniques to find out which one they prefer.
Conclusion
Relaxation does have a place in helping patients control their symptoms of IBS, especially in reducing stress and anxiety which can exacerbate symptoms of IBS. Many patients with IBS are looking at alternate treatments, what works for one person may not work for another, however, I would recommend that patients with IBS should try relaxation as another symptom control for their IBS. Patients have their own ways of managing their symptoms and relaxation is another tool that they could use. It is debatable whether relaxation therapy would work solely on its own to reduce IBS symptoms, but it could be used with other self-management techniques and medical management.
REFERENCES
- Alexander L, (2011) How to Incorporate Wellness Coaching into Therapeutic Practice. London. Singing Dragon.
- Blanchard EB, Greene B, Scharff L, Schwarz-McMorris SP.(1993) Relaxation training as a treatment for irritable bowel syndrome. Biofeedback Self Regul ;18(3):125-32.
- Drossman DA, Creed FH, Olden KW, Svedlund J, Toner BB, Whitehead WE. (1999)Psychosocial aspects of the functional gastrointestinal disorders. Gut1999;45(Suppl 2):II25-30.
- Jones J, Boorman J, Cann P, Forbes A, Gomborone J, Heaton K, Hungin P, Kumar D, Libby G, SpillerR, Read N, Silk D, and Whorwell P (2000) British Society of Gastroenterology guidelines for the management of the irritable bowel syndrome, Gut, 47 Suppl 2:ii1-19.
- Kennedy A, Robinson A, & Rogers A. (2003) Incorporating, Patients’ views and experiences of life with IBS in the, Development of an evidence-based self-help guidebook. Patient Education and Counselling 50 (3):303-310.
- National Collaborating Centre for Nursing and Supportive Care. Commissioned by National Institute for Health and Clinical Excellence (2008)
- Clinical practice guideline for irritable bowel syndrome.
- www.nice.org.uk/nicemedia/pdf/CG061NICEGuideline.pdf. National Institute for Clinical Guidelines 2008.
- Van Der Veek, P. P. J., Van Rood, Y. R. & Malcsee, A. A. M. (2007), Clinical trial: short- and long-term benefit of relaxation training for irritable bowel syndrome. Alimentary Pharmacology & Therapeutics, 26: 943-952. doi: 10.1111/j.1365-2036.2007.03434.
- The National Centre for Complementary and Alternative Medicine
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