Disorders of the Gut-Brain Interaction
We were at the point of removing his colon until our second opinion from Hopkins suggested we explore the brain/gut connection. His therapy has been an absolute game changer.
Gastro psychologists (aka GI Psychologists) and gut-brain therapists are experts in understanding the two-way connection between the brain and the gut. They have specialized training in evidenced-based treatments for IBS, functional nausea and functional abdominal pain (FAP), as well as Inflammatory Bowel Disease (IBD) and other gastrointestinal (GI) conditions. Even though GI pain and distress has a pervasive impact on individuals’ lives, too few people are aware that there are effective psychological treatments that can reduce or eliminate the physical and psychological distress.
GI Psychologists and gut-brain therapists collaboratively work with the patient and other providers to assess the bio-psycho-social aspects that are maintaining the GI distress. A targeted treatment plan to educate the patient and implement helpful coping and responses is then established. This most often includes a combination of Cognitive Behavioral Therapy (CBT) and Clinical Hypnosis (a.k.a. hypnotherapy). This treatment approach is often also helpful for any potential comorbid psychological conditions, such as anxiety, panic, and depression.
Gut-directed Cognitive Behavioral Therapy (CBT) and gut-directed hypnotherapy facilitate dramatic improvements in gastrointestinal symptoms among individuals with Disorders of the Gut-Brain Interaction (DGBI). They have also been shown to increase quality of life scores among people with complex health conditions, such as IBD. Thirty years of research, including randomized clinical trials, have demonstrated the significant advantages of these treatments with DGBIs, compared to usual medical care, education, antispasmodic and neuromodulator medications, as well as talk therapy. For the majority of patients with DGBIs, these treatments not only facilitate significant symptom reduction at the time of treatment (i.e., 80% of patients with IBS) but also long-term remission up to 5 years post-treatment (i.e., 68-85% of patients with FAP or IBS). A GI psychologist or gut-brain therapist works collaboratively with the patient and their other providers to establish a goal-oriented treatment plan that involves education, empathy, and skill building.
Many conditions involving GI pain fall into a category of Disorders of the Gut-Brain Interaction (DGBI), which were formerly called functional gastrointestinal disorders. These include conditions such as IBS and may involve a variety of symptoms like constipation, diarrhea, bloating, nausea, pain, and stomach upset. What has been demonstrated through robust scientific studies is that our psychology plays a powerful role in what goes on in our gut and there are certain disorders of the gut that tend to respond really well to specific psychological treatment.
When treating IBS, it is usually observed that there is a specific triggering event (i.e. illness, injury, or trauma) or some irritation in the gastrointestinal system. This event can prompt the brain to engage in increased scanning of the stomach for sensations (i.e. hypervigilance) and over-interpretation of bodily sensations (i.e. visceral hypersensitivity). When hypervigilance and visceral hypersensitivity become part of the bidirectional communication between the Central Nervous System (CNS) and Enteric Nervous System (ENS), a vicious cycle of pain and worry produce unhelpful thoughts and behaviors, which in turn produce more intense pain or symptoms. It is this pattern that maintains and intensifies the physical and psychological distress often associated with functional GI disorders.
Irritable Bowel Syndrome, often referred to as IBS, is part of a group of physical health conditions known as Disorders of the Gut-Brain Interaction (DGBI). Worldwide, there is a 40% prevalence of DGBI and 6-10% for IBS. Diagnostic Criteria for IBS includes recurrent abdominal pain over the last 6 months with at least 1 day/week in the last 3 months with two or more of the following reactions:
Difficulty or distress with defecation
Change in the frequency of stool
Change in the form/appearance of stool
A diagnosis of IBS or another gastrointestinal (GI) condition is typically made after:
A gastroenterologist’s clinical assessment
Minimal laboratory tests, and
When indicated, a colonoscopy and biopsy.
There are believed to be several factors that can contribute to the onset of IBS. These include a history of a GI infection (i.e. food poisoning) or stomach trauma, acute or chronic stressful life events, as well as a family history of GI distress. Secondary to these aspects, individuals can often develop hypersensitivity and hypervigilance which intensify and maintain the GI dysfunction associated with IBS.
A breadth of evidence continues to support Cognitive Behavioral Therapy (CBT) and hypnotherapy as a first line treatment for IBS. Although some patients may respond positively to standard medical treatments available through a physician, a growing number of patients with IBS are finding relief at the intersection of the mind and body.
Health psychotherapists, or more specifically providers of Gastro Psych, are specifically trained in the delivery of effective psychological treatments for a variety of GI disorders. Given that IBS falls within the grouping of Disorders of the Gut-Brain Interactions (DGBI), gastro psychotherapists are ideally suited to help patients facilitate a reduction in symptoms through education and skill building.