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

## TL;DR

Many people with bowel disorders believe cognitive behavioral therapy (CBT) could help, but access and cultural factors limit its use.

## Contribution

The study reveals sociocultural and access barriers to CBT use in bowel disorders of gut–brain interaction.

## Key findings

- 70.2% of participants believed CBT could be helpful, but barriers like cost and lack of trained professionals exist.
- Participants with non-DGBI GI diseases were more likely to be offered CBT than those with DGBI.
- Black participants were more willing to try CBT, while non-White, non-Black individuals were less likely to perceive it as helpful.

## Abstract

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.

It is not known if other factors beyond access‐related limitations hinder utilization of cognitive behavioral therapy (CBT) for patients with bowel disorders of gut–brain interaction (DGBI).Many adults with bowel DGBI perceive CBT as potentially beneficial, yet barriers including apprehension, underutilization by providers, and limited availability of time and resources may preclude its use. Sociocultural factors may also influence patients' perspective of CBT.Strategies to expand access, promote earlier referrals, and enhance culturally competent care represent potential pathways for increasing integration of CBT into the management of bowel DGBI.

It is not known if other factors beyond access‐related limitations hinder utilization of cognitive behavioral therapy (CBT) for patients with bowel disorders of gut–brain interaction (DGBI).

Many adults with bowel DGBI perceive CBT as potentially beneficial, yet barriers including apprehension, underutilization by providers, and limited availability of time and resources may preclude its use. Sociocultural factors may also influence patients' perspective of CBT.

Strategies to expand access, promote earlier referrals, and enhance culturally competent care represent potential pathways for increasing integration of CBT into the management of bowel DGBI.

In an online survey, 70% of adults view cognitive behavioral therapy (CBT) as helpful. Cost, access, and time constraints are barriers. Those with bowel disorders of gut–brain interaction (DGBI) are familiar with CBT, but only those with non‐DGBI gastrointestinal diseases are more frequently offered CBT than controls.