GI psychology a ‘rewarding partnership’ for both patients, providers
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It is wonderful to see the topic of gastropsychology featured in this month’s Healio Gastroenterology cover story. The piece highlights the benefits of providing brain-gut psychotherapies as integrated care for patients with chronic digestive conditions and discusses both the progress we have made and the challenges we face implementing this approach.
I have been specializing in gastropsychology since 2009 and am thrilled to see how much the field has grown since that time. Not only has there been a huge increase in the number of providers in clinical practice, but there is greater acceptance of the practice as a legitimate specialty. Physicians are more willing to embrace gastropsych as part of their clinical management approach and are even advocating for dedicated gastrointestinal psychology positions within their institutions.
I also see how patients are more receptive and open to considering brain-gut psychotherapies as an adjunctive approach to their GI care. With increased attention to gastropsych in the media, more patients are learning about these interventions online and coming into clinic visits requesting referral to a GI psychology provider.
Another area of tremendous growth in our field is the recognition that these interventions can be effective at treating the full spectrum of chronic digestive conditions. We have known for decades that psychological treatments are extremely helpful for irritable bowel syndrome, but now we are seeing how these same approaches — like cognitive-behavioral therapy and medical hypnotherapy — can also improve symptoms and quality of life for patients with esophageal conditions, functional dyspepsia and structural disorders, such as inflammatory bowel disease or chronic pancreatitis.
Many of the same mechanisms that contribute to symptom exacerbation in IBS, including central pain amplification or autonomic nervous system dysregulation, can also contribute to symptom exacerbation in the stomach or esophagus and can be targeted by our brain-gut psychotherapies. Further research is needed on the effectiveness of gastropsych interventions for some of these understudied studied conditions, which presents an exciting opportunity for our field.
The Rome Foundation’s GastroPsych division was established by me and Laurie Keefer, PhD, in 2017. We had both been practicing as GI psychologists for several years and saw a need to formalize this subspecialty within psychology. At the time, there were only a handful of GI psychologists practicing at academic medical centers around the country, working in isolation for the most part. There was a need to connect and enhance collaboration between these professionals, which is why we set out to build this group.
A primary mission of our organization is to provide education to mental health providers on evidence-based interventions for GI populations. As the cover story illustrates, one of the greatest barriers to care is the limited number of gastropsych providers. To address this, the Rome Foundation has developed educational programming specifically for mental health professionals on how to implement evidence-based psychological treatments for GI disorders. We now have more than 30 hours of continuing education for psychologists via on-demand learning and have ongoing case conferences and consultation groups that are offered as well. We feel that training more providers and providing this “home” for GI psychologists is key to moving the field forward.
Another opportunity for growth is further education for GI providers on how to assess and refer patients to a GI psychologist. Although we have made great strides in this area, many gastroenterologists and nurse practitioners remain reluctant to incorporate gastropsych into their practice. In some cases, this is due to lack of exposure and training — it is an unfamiliar approach.
The partnership between the gastroenterologist and GI psychologist can be very rewarding, but its success relies on learning to communicate with patients about the brain-gut connection and the rationale for referral. Physicians may be hesitant to discuss stress or emotional factors, feeling as though they are being intrusive or that it will be ill-received by the patient. However, providers often find that patients are eager to discuss these topics and in fact feel relieved when their physician opens this discussion and draws a connection between the mind and the gut. Open dialogue can strengthen the patient-provider relationship, which leads to greater trust and receptiveness about a gastropsychology referral.
As Tiffany H. Taft, PsyD, describes in the cover story, integrated GI psychology can relieve stress from physicians. Many patients struggle with chronic, refractory symptoms that leave them feeling anxious and frustrated. With these interventions, not only do patients have better outcomes, but gastroenterologists have another tool in their toolbox.
- For more information:
- Sarah Kinsinger, PhD, ABPP, is director of Behavioral Medicine for Digestive Health at Loyola University Medical Center in Chicago.
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