Positive Psychological Gut-Brain Behavior Therapy Shows Early Benefit for IBS

New research is shedding light on the potential benefit of a remotely delivered, positive psychological-based gut-brain behavior therapy for improving psychological and irritable bowel syndrome (IBS)-related outcomes.1

The intervention, coined Well-being in IBS: Strengths and Happiness (WISH), is a novel, 9-week, manualized, phone-delivered, IBS-specific positive psychological intervention to promote greater positive psychological wellbeing and improved health-related quality of life (HRQoL) and IBS symptoms. Findings from this proof-of-concept trial highlight its feasibility, acceptability, and early benefits for IBS symptom severity, IBS HRQoL, depression, GI symptom-specific anxiety, pain catastrophizing, avoidant/restrictive eating behaviors, physical activity engagement, and resilience.1

Classified as a disorder of gut–brain interaction, IBS is thought to arise from complex interactions between biological, psychological, and social factors. Existing treatments focus primarily on alleviating symptoms rather than achieving cure. Brain–gut behavior therapies may offer a promising treatment option for IBS, but current approaches do not benefit all patients.1,2

“Interventions to boost positive psychological wellbeing in IBS have not yet been investigated and represent a much needed area of future research,” Elizabeth Madva, MD, an associate program director for the residency at the Massachusetts General Hospital site and a co-director of the residency’s Clinician Educator Program, and colleagues wrote.1

To address this, investigators developed WISH, a 9-week remote intervention that aims to improve IBS symptoms by specifically targeting the promotion of greater positive psychological wellbeing. It consists of 9 weekly positive psychological exercises focused on cultivating gratitude, personal strengths, and sense of purpose/meaning, which were completed independently and later reviewed in weekly phone sessions with a study interventionist.1

In the present randomized waitlist-controlled proof-of-concept trial, investigators sought to examine WISH's feasibility, acceptability, and preliminary effects on key psychological and IBS-related outcomes.1

Adult participants ≥ 18 years of age with a diagnosis of IBS meeting Rome IV criteria were recruited from an urban academic medical center between March and December 2022 via GI clinician referral and the institution's research patient data registry. Exclusion criteria included limited English proficiency, lack of telephone access, cognitive deficits limiting participation, and current manic episode, psychosis, or active substance use disorder that would limit participation.1

A total of 22 eligible adults were randomized, stratified by gender and IBS subtype, to the intervention (n = 12) or waitlist-control (n = 10) groups. After waiting for 9 weeks with continued treatment as usual, waitlist-control participants repeated a second set of baseline self-report measures and then completed the WISH intervention.1

The primary outcome was feasibility, assessed by the proportion of total positive psychological exercises and associated phone sessions completed. Acceptability was assessed with weekly ratings of ease and utility of each exercise on 10-point Likert scales.1

Among the study cohort, the mean age was 50.6 (range 19 to 79) years, 55% (n = 12) were female, and most identified as White (86%; n = 19). Of the 22 randomized participants, 18 (82%) completed 100% of the intervention, and 85% of all exercises were completed across participants, which investigators noted was above their a priori feasibility thresholds of 70% and 65%, respectively.1

Of note, the WISH sessions also met investigators’ a priori acceptability threshold, with mean ease scores of 7.2 (95% CI, 6.70 to 7.75) and utility scores of 7.6 (95% CI, 7.14 to 8.01) on 0–10 Likert scales, respectively.1

On average, each positive psychological exercise led to a 1.22-point increase in happiness (6.05 pre-intervention; Standard deviation [SD], 1.77 vs 7.28 post-intervention; SD, 1.60; t = 12.17; P <.001) and a 1.05-point increase in optimism (6.20 pre-invervention; SD, 1.84 vs 7.24 post-intervention; SD, 1.68; t = 11.43; P <.001).1

Compared to the waitlist-control group, the WISH intervention resulted in modestly greater improvements in key psychological outcomes including resilience (B = 0.30; d = 0.39), depression (B = −1.50; d = −0.43), GI symptom-specific anxiety (B = −6.67; d = −0.36), and pain catastrophizing (B = −3.26; d = −0.32). Notably, WISH also achieved greater improvements in IBS symptom severity (B = −23.20; d = −0.20), IBS HRQoL (B = 2.67; d = 0.12), avoidant/restrictive eating behaviors (B = −7.48; d = −0.69), and physical activity engagement (B = 396.70; d = 0.27).1

Of the 18 participants who completed the WISH intervention across both groups, 11 (61%) no longer met Rome IV criteria for IBS after program completion (95% CI, 0.36 to 0.83).1

“WISH's effects will subsequently need to be confirmed in a larger, randomized controlled trial powered to detect between-group differences in outcomes,” investigators concluded.1 “If effective, WISH has the potential to improve key IBS-related outcomes and to fill a critical care gap for this chronic, high comorbidity condition associated with substantial healthcare costs, impaired function, and reduced quality of life.”

References

1. Madva EN, Huffman JC, Castillo C, et al. A Randomized Waitlist-Controlled Trial of a Positive Psychology Intervention for Irritable Bowel Syndrome: The WISH Proof-of-Concept Trial. Neurogastroenterology & Motility. https://doi.org/10.1111/nmo.70146

2. American College of Gastroenterology. Irritable Bowel Syndrome. Accessed August 29, 2025. https://gi.org/topics/irritable-bowel-syndrome/