Can Cognitive Behavioural Therapy Help People with Interstitial Cystitis?

If you are someone diagnosed with Bladder Pain Syndrome (BPS), also popularly known as Interstitial Cystitis (IC), getting through a day itself can feel like a battle. This is because this condition can cause chronic pain in your abdomen, bladder, urethra, or pelvic region, along with urgency to urinate and frequent trips to the bathroom, affecting your day and even making you struggle to get a peaceful sleep.

Understanding the Condition

As it is a chronic condition, it might linger for months or even years. The exact cause of this condition is not yet well understood. One of the many theories is that this condition can result from inflammation and nerve issues in the bladder. Not only that, but additional factors like stress, diet, and hormones can make it worse.

If you have IC/BPS, your doctor will most likely focus on treating it based on its symptoms with medications or other procedures like bladder instillation and intravesical Botox injections. However, unfortunately, to cure this condition, there is no standard or single treatment strategy that works for all. Therefore, it requires a combination of different approaches, including lifestyle changes, medications, and bladder procedures, to fully recover from IC.

The Emotional Burden of BPS/IC

Only when we get sick do we realise how important health is. If you have BPS/IC, your day-to-day life could be emotionally and physically draining. When you're in constant pain and worried about needing to go to the bathroom, it can affect your mental well-being, leading to anxiety, stress, and even depression. To make things worse, these emotional problems may worsen your physical symptoms, thereby creating a vicious cycle that you desperately want to relieve yourself from.

However, even when we're visiting doctors and getting medications or treatment procedures, the role of mental health in managing this condition is often neglected. That's why adding mental health care, like cognitive behavioural therapy (CBT), could be a game-changer for IC/BPS patients.

Cognitive Behavioural Therapy

What is Cognitive Behavioural Therapy? It is a structured form of psychotherapy that assists patients in recognising unhelpful thoughts and behaviours and substituting them with healthier ones. CBT has long been proven effective for mental health issues like anxiety, depression, and chronic pain.

Through cognitive behavioural therapy, you will have the ability to identify negative thinking patterns and apply useful strategies to better manage stress and emotions and enhance your coping mechanisms. It's not just about talking about feelings; it gives you tools to change how you think and act, which in turn helps you feel better.

Clinical Evidence Supporting CBT for IC/BPS

A study published by researchers in Taiwan reveals promising results regarding the role of CBT in managing IC/BPS.

The study included 60 individuals, mostly women, having a diagnosis of IC/BPS for at least a year. Despite earlier therapies, all of these people continued to struggle with moderate to severe anxiety. These individuals were randomly assigned to receive either bladder treatment only or cognitive behavioural therapy along with bladder treatment.

The bladder treatments included intravesical hyaluronic acid instillation, botulinum toxin injection, platelet-rich plasma injections, and oral medicines (including pain relievers, anti-inflammatories, and antimuscarinics).

Individuals in the CBT-receiving group received CBT sessions that lasted around 50 minutes weekly for eight weeks by a licensed psychologist alongside the bladder treatment. These CBT sessions covered mental health education, relaxation techniques, emotional regulation, positive thinking, behavioural change tools, and stress management strategies. The researchers investigated overall treatment satisfaction (called Global Response Assessment or GRA) as well as anxiety levels (using a scale called Beck Anxiety Inventory or BAI), depression, pain levels, and urinary symptoms of these two groups.

What Was Discovered by the Study?

The outcomes demonstrated that CBT had a significant impact. According to the study, CBT worked well in:

Reducing anxiety — At eight and twelve weeks, the CBT group's anxiety levels were noticeably reduced. In this group, anxiety levels often decreased from moderate to mild.

Improved treatment satisfaction — According to the GRA score, patients in the CBT group felt that their general health had improved.

Better mental coping — Patients reported feeling better despite minimal improvement in bladder symptoms, indicating that mental stress played a significant role in their experience of the illness.

Greater resilience — Patients in the cognitive behavioural therapy group reported being more hopeful and more able to cope with daily life.

On the other hand, there was little improvement in anxiety and general satisfaction in the group that just underwent bladder therapy. Although the study evaluated the effectiveness of cognitive behavioural therapy, it's crucial to understand that no bladder function, such as urine flow or bladder capacity, was directly altered by this treatment. CBT was most effective when used in conjunction with medical therapy rather than alone, and it helped lessen emotional distress, which made symptoms simpler to manage.

Another study conducted by a team of scientists at Tennessee, US, also investigated the role of CBT in managing IC/BPS. This randomised controlled study also assessed the effectiveness of an 8-session CBT programme that was particularly created for IC/BPS and delivered via telemedicine. Urinary symptom reductions were comparable across the CBT and control groups; however, the CBT group reported a higher proportion of treatment responders and considerably better overall satisfaction (Patient Global Impression of Change). Genitourinary symptoms, pain severity, and pain interference were all significantly reduced in those who reacted favourably. These results underline the potential for CBT administered via telemedicine to enhance IC/BPS outcomes.

The Psychological Component of IC/BPS

By addressing the psychological and emotional aspects of bladder pain, CBT could benefit individuals with IC/BPS. When you are taught how your emotions, stress levels, and thoughts could influence your symptoms, you begin to better understand the connection between your mind and body. CBT sessions can introduce you to practical tools like breathing exercises, relaxation techniques, and stress management strategies; also, you could learn how to observe and track your thoughts and feelings.

The emotional support and encouragement you may receive from this could play a key role in helping you feel more confident and in control. Together, these components can help reduce anxiety, ease symptom burden, and improve overall quality of life. Therefore, CBT is a useful and effective supplement to medical therapy in managing IC/BPS.

Sources

1. Yu W-R, Jhang J-F, Chen B-Y, Ou S-R, Li H-M, Kuo H-C. Multimodal Treatment with Cognitive Behavioral Therapeutic Intervention Plus Bladder Treatment Is More Effective than Monotherapy for Patients with Interstitial Cystitis/Bladder Pain Syndrome—A Randomized Clinical Trial. J Clin Med [Internet]. 2022 [cited 2025 Jul 11]; 11(20):6221. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9604893/.

2. Chand SP, Kuckel DP, Huecker MR. Cognitive Behavior Therapy. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [cited 2025 Jul 11]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK470241/.

3. Fenn K, Byrne M. The key principles of cognitive behavioural therapy. InnovAiT: Education and inspiration for general practice [Internet]. 2013 [cited 2025 Jul 11]; 6(9):579–85. Available from: https://journals.sagepub.com/doi/10.1177/1755738012471029.

4. McKernan LC, McGonigle T, Vandekar SN, Crofford LJ, Williams DA, Clauw DJ, et al. A randomized-controlled pilot trial of telemedicine-delivered cognitive-behavioral therapy tailored for interstitial cystitis/bladder pain syndrome. Pain [Internet]. 2024 [cited 2025 Jul 14]; 165(8):1748–60. Available from: https://journals.lww.com/10.1097/j.pain.0000000000003188.

   
   

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