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With CBT for IBS is the focus upon treating the IBS syptoms (i.e. with IBS-D trying to build up tolerance to the discomfort to avoid going as regularly to the toilet etc) or is it treating the depression/anxiety etc that is often co-occurrs with this disorder (this kind of gets to the chicken/egg argument about whether anxiety causes IBS or IBS causes anxiety)?
 

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For me it wasn't about building tolerance to my pain. (I had more issues with that than with urgency).It actually worked better in the clinical trial I was in for the patients who were NOT depressed, so it isn't just treating depression or anxiety and nothing more than that (although both of those can be treated with CBT).Your brain and your body interact. How your brain/mind reacts to the body and what signals it sends back can help ramp up symptoms or help calm them down.I think of it more like biofeedback to lower your blood pressure or make your hands warm up or cool down. Or when my nervous system took a day or two to tell a newly healed nerve in one of my fingers to knock it off. (it was screaming in pain with everything that touched it, even the lightest of touches). There are various feedback loops where nerves get information about what is an appropriate response or not.So it isn't just about learning to ignore your symptoms and pretend they do not exist. It is about figuring out which thoughts and behaviors tend to send the "calm down" signals to the nerves in the gut and which ones send the "ramp it up" signals.For example. If I get a bad pain the thought "this will pass soon" tends to calm it down and make it go away. Thinking "it will never go away" tends to tell my brain to tell the gut to keep sending pain signals because in some way it thinks I want more of that information so it ramps up the part of the nervous system that goes looking for the pain (mind or body).So distraction and focusing the thoughts on other things can be part of the toolbox, but that isn't so you are pretending the symptoms aren't there. It is so the symptoms actually get less.
 

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As far as I know it is good for all the symptoms.I didn't find my urgency issues (while not my main issue) remained even though the pain went away. Although I did find holding it when I was having urgency was one way to trigger the pain.I wasn't able to complete the manometry at the beginning of the study (which tends to trigger urgency as well as pain) but I was able to easily complete the manometry study at the end of the three months.I don't recall the study I was in finding any specific symptom it didn't help with and most people have multiple problems even when there is one that is the most bothersome.
 
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