“I am eternally grateful to have my life back”

A client’s journey with therapy to overcome the debilitating symptoms of IBS

For as long as I can remember I always had a ‘dodgy stomach’. I knew I was probably visiting the bathroom more than most and I was prone to occasional bouts of diarrhoea and loose stools. However, it didn’t impact my life greatly. I never gave it too much thought or worried about it and it didn’t stop me from living a regular lifestyle.

Unfortunately, this changed dramatically when I was about 20 years old. One evening I was listening to my girlfriend telling me about her day when she mentioned her friend who suffered from IBS, a term I had never heard before. She spoke about how they were on the bus when this friend suddenly became very panicky and ‘needed to get off right now and find the nearest toilet or she would have an accident’.

Within a couple of weeks, I noticed these very situations were becoming more frequent for me. Basically, the sudden and urgent need to use the bathroom, it felt as though I had lost control of my bowel function. When I needed to go, I needed to go and had a very small window to find a toilet. While this was something that occurred occasionally throughout the years it had never happened so regularly or with such severity. I became terrified of being caught in a situation where there was no toilet available. This was obviously causing huge anxiety and stress and it had completely taken over my life.

Fast forward a couple of months, my condition had deteriorated so much that I had become extremely anxious about everyday situations. Car journeys, playing sports, work, social occasions became a nightmare. When travelling any journey over 10 minutes I would plan the route to see what available toilet stops there might be on the way. I only felt comfortable travelling with family and the closest of friend and even then, it was nerve-wracking. I completely avoided bus journeys. I was working in construction at the time so I would be constantly anxious where the next job would be and whether there would be a toilet on site. On nights out I would keep one eye on the toilets and the crowd in case I would be caught short. I would feel trapped in situations like getting a haircut because I was terrified of having to leave the barber’s chair running for a toilet with half a haircut and my barber cape flailing after me.

Perhaps the hardest part of this whole situation was the embarrassment and shame. Having to try to explain to people why I couldn’t do the simplest of things with them. I remember having to explain to team managers that I couldn’t travel on the bus with the rest of the team, explaining to work bosses why I had to travel on my own, explaining why I couldn’t go for a round of golf or a long walk in a quiet area and so on. People just couldn’t understand it and I can understand why, it wasn’t easy to explain. Why would anyone be afraid of a 15-minute car journey? And what difference does it make if they are in the bus or travelling in the car behind? What a strange and irrational fear to have.

This continued at its most severe for a period of approximately 2 long and miserable years. The following 3 or 4 years were difficult but having emigrated to Canada I was often forced to take risks and slowly regained my confidence, and the physical symptoms seemed to have improved, although the fear was always there. Eventually I was in a relatively good place again I had returned home and now was regularly sharing a 2-hour commute, travelling on buses and playing sports without major interference. It was still affecting my life and confidence but it had definitely become more manageable.

At this point 8 years had passed since the initial flare up; I looked back at the flare up in disbelief at how I let it get such a hold on me and I cringed at my anxiety about the smallest of journeys etc. I remember often thinking to myself ‘that was crazy, how did I let it get so out of hand? How was I so petrified of everyday life? Thank God that horrible period is over. I was so miserable.’ I was so grateful it was behind me and grateful to be living a normal life again. I never ever expected it to resurface as I believed it was a challenge that I overcame so therefore it had lost its power or control over me.

This is why I found the most recent flare-up (approx. 3 years ago, and 12 years since my initial flare-up) so frustrating. It resurfaced slowly; the occasional uncomfortable car journey coupled with the physical symptoms I experienced previously.  Within a few months I had deteriorated rapidly, and my physical symptoms were much more frequent and much more severe than before. Urgent loose bowel movements became a daily occurrence my confidence was slowly eroding when one day driving to work, I felt the sudden and urgent need to use the toilet. I had to double back and race for home certain I wouldn’t make it, thankfully I made it in time, but this felt like a seminal moment where I was 100% back in the misery I had escaped years ago.

I should mention at this point, that I never had the ‘worst case scenario’ (not making it to a toilet on time) happen in all the years I suffered, nor did I suffer any severe trauma at that the time of or immediately preceding any of the flare-ups. In fact, the two periods before each flare up were quite stable so I cannot pinpoint any explicit link to the flare ups. I should also point out that, while this may read as a lot of groundless anxiety about something that never materialised, my worries were justified as I was enduring urgent bowel movements every day for a period of 9 – 12 months and my fear was always ‘what if this happens in a situation where I do not have immediate access to a toilet?’

I cannot emphasise how difficult and dark this period was. I was severely depressed, I felt unable to work so did not return after Covid, my social life was literally non-existent, I was single and felt I would never be able to meet someone again and even if I did how could I do anything with them? How could I explain my situation? I hated myself for being weak and ‘defective’. I was so angry ‘why was this happening to me and nobody else?’, ‘why can’t I get on top of it?’, ‘is it ever going to settle?’. I was undertaking many different routes to recovery at this point including restrictive diets and medication. These diet restrictions were severe and for one particular diet I removed gluten, dairy, sugar, beef, pork, potatoes, bananas, eggs. I was also taking an array of supplements to improve gut health. The restrictive diet and supplements made me feel even more depressed. I was depriving myself of the foods I always loved to eat and even worse, I wasn’t seeing any results.

As mentioned at the beginning, I had consulted with a psychotherapist for general anxiety issues that I felt I had been putting off and in need of resolving. It might seem this contradicts my comment on being stable preceding the flare ups, but these issues were not severe depression or anxiety, more like nagging issues I felt I should try to address. By the time I was assigned to my therapist I had become severely depressed and anxious due to the stomach issues, so they naturally began to take over the bulk of our conversations. I was living in an everyday hell by this point total despair, hopelessness, isolation and depression.

My therapist and I spent some time at the beginning discussing how much of my condition I thought was mental/physical and we looked at the evidence for both. Usually, I would get a little testy when people would suggest it was purely mental (my therapist never made this assumption) my argument would be If it was totally mental why is my stomach always upset even in situations of comfort?’ e.g. sitting at home watching TV and suddenly having to rush to the toilet. This was a discussion that continued throughout the therapy sessions, but from quite early on we made a list of situations where I would feel the most anxious.

 

The list included:

• Car journeys/stuck in traffic
• Playing sports
• Road trips with friends/partner
• Long walks
• Shared bus journeys
• Holidays
• Being stuck anywhere where there wasn’t a toilet

Around this time, I felt I was at rock bottom and isolating in fear wasn’t making any difference, so I was prepared to just ‘roll the dice’. I targeted returning to work. As I had avoided car journeys as much as possible in the months preceding, this was the first challenge. Before each journey we would discuss the possible scenarios. I would write predictions of what I thought would happen. For example:

• 30% I will feel extremely anxious but make it to work
• 40% I will need to stop to use the bathroom
• 30% I won’t make it to work/need to turn around

For the first couple of weeks and months these journeys were extremely anxious and difficult because, although I was making it to work, my physical conditions were still the same, so the fear was still the same. Each week I would discuss with my therapist, the fears and predictions I had logged each morning them contrasting them with the actual outcomes. This took months of uncomfortable anxious journeys, racked with doubt but each day I forced myself to leave the house no matter how I felt. Over time I eventually started to feel a little more confident, the predictions  slowly started to look a little more positive.

This evidence became a crucial tool in providing some confidence and comfort in me. When a future challenge was presented to me, we would refer to the evidence recorded from previous challenges. What is the evidence to suggest this fear will happen? What is the evidence to suggest otherwise? By now I had pages and pages of observations of how I felt physically and mentally before a challenge, how I expected the challenge to go and the actual event that followed.

After a couple of weeks of returning to work, I used the confidence gained from the work commute to target other areas of my life, returning to sport, going out at weekends and trips away. It is important to note while I began to regain confidence I was still absolutely terrified of these new targets, and didn’t feel as though I was doing well enough yet but I persevered and trusted the process that had got me to this. We would prepare for these challenges by discussing each scenario. Visualising the scene.. who was there? what I could see? what I could hear? what I could feel? I found this to be extremely helpful in both preparing me for a challenge and providing comfort and confidence in the moment.

By visualising the scenarios, they felt a little less intimidating when they arose. For example, I would visualise the moments before a rugby match as this was a time of huge stress and anxiety. I would visualise where I was standing on the pitch, who was beside me, who was in front of me, where was the referee, what were the other players, coaches and spectators doing. When the match came around, I was surprised at the familiarity and comfort the visualisation work brought to me..  My mind wasn’t racing, I wasn’t constantly checking in on my stomach, I felt more grounded and present.

We followed this preparation template for the challenges that came. The following summer I began going out at weekends, sharing taxis and drives, went on a stag weekend, attended a wedding as best man and made some short road trips around the country. While this was huge progress and I was delighted at how far I had come, my physical symptoms were still there, a constant weight that stopped me from feeling real success. I should mention that the physical symptoms and subsequent anxiety brought about by the flare-up robbed me of a lot of the joy of these occasions. The stag and wedding felt more like chores in the weeks leading up. I was so angry I couldn’t enjoy them properly. Of course, I enjoyed them when there and was able to relax to some degree but the week before a big challenge I was in despair. Everybody would be talking about the event and how much they were looking forward to it while secretly I was just hoping I’d be brave and lucky enough to make it.

I mentioned this to my therapist regularly and he used the analogy of a seed being planted in soil and being cultivated with water and sunlight. The seed being my confidence, the soil my physical body and the experiences and challenges were the water and sunlight. He suggested it may take time for my body’s health to catch up with the confidence gained from facing challenges. As it turned out, he wasn’t far wrong. I just kept going, facing challenge after challenge, and using the confidence gained for the next one.

As I write this a year later, I feel I have regained my life. I am bringing my therapy sessions to a close and my therapist and I decided to look back on my list of fears/targets from three years ago. When we discussed them, I realised I had achieved each and every item on the list. I cannot stress enough how unattainable these targets felt when I wrote them three years ago. I could not even imagine being on a bus again or going on holiday or a date. While three years is a long time, and I am so grateful to have regained my confidence and self-worth.

As mentioned along with therapy, I had undertaken alternative approaches. I had worked with doctors, gastroenterologists, nutritionists to no avail. The only approach I believe may have been beneficial is hypnotherapy. I did not notice any huge change from it initially as I was told to expect but I believe it may have worked alongside my CBT sessions with my therapist. I was already making huge progress thanks to my sessions with my therapist by the time the hypnotherapy began so I believe the two approaches coincided well and possibly accelerated my full recovery. If I were to break it down I would say my recovery is a result of:

CBT – 80%

Hypnotherapy – 10%

Willpower/resilience/ 10%

As mentioned, I was convinced that this time the problem was 100% physical, so I did not hold much hope for the therapy solving it. I can see now how much the therapy contributed to where I am now. My therapist excellently balanced being a source of support and understanding while motivating and encouraging me to achieve my goals. We took time in each session to decide what the next appropriate challenge could be, we would not agree until we both believed it was an adequate, achievable goal that I could undertake, this was a huge factor in my recovery as I knew the challenges could be achieved but that I would have leave my comfort soon to achieve them and this is where the learning and recovery happens.

I would never have taken the ‘risks’ or challenges that allowed me to recover if I had not begun the therapy. I would never have seen the pages and pages of evidence I recorded. I would never have looked at the evidence for my fears and the evidence for my hopes. I would never have pushed myself as much. I would never have seen a bigger picture. I would never have learned so much about myself and life in general. I would 100% never have recovered as quickly and effectively. I am eternally grateful to have my life back.

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