How do you decide when to refer for gut-directed psychotherapy versus start pharmacotherapy in newly diagnosed IBS with prominent anxiety symptoms?

Pharmacotherapies like antispasmodics, antidiarrheal medications, or tricyclic antidepressants can be used to treat a specific symptom of IBS (e.g., diarrhea or abdominal pain). Gut-directed psychotherapy targets the entire gut-brain axis in dysfunction, treating multiple symptoms at once, as well a...