Heads or Tails: GI Psychology and IBD

Heads or Tails: GI Psychology and IBD
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Most of us have had butterflies in our stomachs, followed our gut instincts, made gut-wrenching decisions, or felt our stomachs drop upon hearing bad news. Why do we feel “sick to our stomach” when we experience psychological turmoil?

Neurons (nerve cells) line the gastrointestinal tract from the esophagus to the rectum. These cells make up the enteric nervous system. This “second brain” activates the gut’s muscular movement during digestion and controls secretions of digestive enzymes, mucus, bile, and stomach acid.

The brain and the enteric nervous system transmit messages via the vagus nerve. Scientists call this bidirectional communication the gut-brain connection or gut-brain axis. Emotions, as well as inflammation or infection, can impede communication between the brain and gut. When this happens, the scrambled brain signals cause the gastrointestinal system to malfunction.

Researchers have studied the gut-brain relationship in autism, schizophrenia, depression, anxiety, obesity, Alzheimer’s, Parkinson’s, irritable bowel syndrome, and inflammatory bowel disease (IBD).

The gut-brain connection and IBD

I first learned about the correlation between the brain and the gut when I read Dr. Michael D. Gershon’s “The Second Brain” shortly after I received my Crohn’s diagnosis.

Even before I had Crohn’s, a flood of stomach acid would burn the pit of my stomach and coat the back of my throat with sourness whenever I became angry or frustrated. Now, I might also experience diarrhea or a flare depending on the intensity or extent of these emotions.

While writing about depression and anxiety last week, I discovered that some psychologists specialize in treating IBD patients. This growing field of gastrointestinal (GI) psychology, also known as GastroPsych and psychogastroenterology, is a subspecialty of health psychology — the study of how biological, social, and psychological influences affect a patient’s well-being and healing.

A GI psychologist examines the patient’s IBD symptoms and current medical treatments along with their mental and emotional states. How the patient’s psychological and physical symptoms affect their relationships and life goals determines treatment.

Treating IBD with psychology

Some GI psychology techniques may require multiple sessions over time. Cognitive behavior therapy changes the patient’s thought processes and behaviors by teaching strategies or problem-solving techniques for coping with IBD-induced fatigue, stress, or anxiety. Acceptance and commitment therapy, a form of cognitive behavior therapy, focuses on developing skills that align the patient’s values with their behavior.

Through biofeedback training, the GI psychologist instructs the patient on recognizing and responding to physiological changes. For instance, a patient can master muscle control to prevent fecal incontinence or urgency or to alleviate constipation.

Hypnosis and guided meditation use sound and imagery to relax the patient. By shifting attention away from the source of physical or mental pain, these methods reset the gut-brain connection and normalize communication.

A GI psychologist can also teach the patient self-care methods, such as meditation. During meditation, the patient focuses his attention, opens his mind, and breathes rhythmically to calm the mind and body. By meditating, a patient can attain mindfulness. Mindfulness is awareness and acceptance of one’s current mental and physical state without judgment or avoidance. By not dwelling on the past, mindfulness allows the patient to move toward a goal.

Yoga and exercise add a physical element to treatment. Exercise releases endorphins, which block pain and elevate mood. It reduces adrenaline and cortisol, the body’s stress hormones, too. Furthermore, patients can build confidence and self-esteem from the results of physical activity.

I enjoy practicing martial arts because it combines physical endurance with mental concentration and acuity. Through focused and controlled breathing, I can center my chi, or energy. This not only relieves stress and depression, but also fatigue and muscle weakness.

Who should see a GI psychologist?

Not all IBD patients will need to see a GI psychologist. The Cleveland Clinic discourages referrals for patients with eating disorders or with extreme psychological or psychiatric issues unrelated to IBD. Patients who refuse to accept the role of mental health on their IBD or who don’t believe GI psychology will improve symptoms shouldn’t seek treatment, either.

On the other hand, newly diagnosed IBD patients may find value in speaking with a GI psychologist to manage life with an incurable disease and to learn skills to combat mental health problems they may experience on their journey. Patients whose IBD worsens or doesn’t improve after long-term medical treatment may also benefit. GI psychology is a good option for those who acknowledge their emotions exacerbate IBD symptoms or who want to explore a non-medicinal treatment.

Every IBD patient is different, and someone’s mental and physical status can fluctuate throughout their IBD journey. Maintaining an open dialogue and trusting relationship with our gastroenterologists can help us recognize if we need the expertise of a psychologist. Recommended by the Crohn’s and Colitis Foundation, the Rome Foundation’s GastroPsych Group helps IBD patients find a licensed GI psychologist.

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Note: IBD News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health providers with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of IBD News Today, or its parent company, BioNews, and are intended to spark discussion about issues pertaining to IBD.

Emmeline is a 47-year-old Crohn’s warrior and primary sclerosing cholangitis survivor. Her column encourages patients and caregivers to advocate for better healthcare and educates readers about her rare autoimmune diseases. She also freelances as a communication specialist, offering writing, editing, and graphic design services. Emmeline (an Auburn fan) and her husband Patrick (an Alabama fan) enjoy watching SEC football and spending time with loved ones in Austin, Texas. Thanks to a liver transplant in 2017, Emmeline is training for her third-degree black belt in the Korean martial art Mu Sool Won.
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Emmeline is a 47-year-old Crohn’s warrior and primary sclerosing cholangitis survivor. Her column encourages patients and caregivers to advocate for better healthcare and educates readers about her rare autoimmune diseases. She also freelances as a communication specialist, offering writing, editing, and graphic design services. Emmeline (an Auburn fan) and her husband Patrick (an Alabama fan) enjoy watching SEC football and spending time with loved ones in Austin, Texas. Thanks to a liver transplant in 2017, Emmeline is training for her third-degree black belt in the Korean martial art Mu Sool Won.

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