Diffuse the stress of travel by helping GI patients prepare, communicate fears
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Travel is a common part of life that we often take for granted — from simple acts of running errands and commuting to work to the bigger trips of visiting out-of-state loved ones and experiencing life-changing moments of world travel.
Travel, in all of its forms, can be especially stressful when you have to tote the extra luggage of gastrointestinal conditions on every trip you take. Unfortunately, checking that bag at the gate is not an option, which is where my work as a GI psychologist comes in.
Using evidenced-based practices I work with patients with a variety of GI conditions and help them gain the skills to overcome the anxious distress, stress and pull towards avoidance that arise in the face of the inevitability of travel.
Unpacking the logistics
In the hefty luggage that is a GI condition, one of the most common features is anxiety, which typically begins the minute a trip works its way into possibility. It includes unpacking the logistics: What should I eat? When should I eat it? How will this impact my system? Should I arrive early? What airplane seat should I get? What is the maximum amount of time between rest stops? Can I bring medication? What will I eat when I get there? What activities are we planning, and can I even do them?
Then come the what ifs: What if I have an accident? What if my abdominal pain is so intense that I miss the trip? What if TSA takes my medication? What if others judge me or I annoy my seatmate? What if I miss my flight because I’m in the bathroom? What if the other people I travel with hate me by the third bathroom stop?
No matter what kind of travel, there are different — and potentially difficult — situations that patients will face. At times, the thought of confronting these challenges leads many to avoid travel at all costs. While this may provide immediate relief, the cost of avoidance can be high.
Part of the work is learning how to navigate travel with this GI luggage and not fear that its contents will tumble out. Easier said than done, right?
It sounds simple to say, “Well, just hop on the plane,” or “Hey, you can do this! If you have an accident on the train, it’s not a big deal.” I can feel my patients’ eyes rolling from here.
While these less-than-helpful but well-meaning suggestions come from a loving place, it’s more helpful to start by considering our resources and how we can smoothly wheel the bag as opposed to dragging it with us allowing it to hit us in the ankles.
Bring in the team
Depending on the length and distance of the trip, it may be beneficial for patients to talk to their medical team and insurance company about options while traveling. A physician may be able to prescribe to a pharmacy at the patient’s destination if a stay becomes longer than planned or if a medication is lost. Insurance may still cover those prescriptions.
Similarly, patients should speak with their insurance company about options for emergency care, should they require it on a trip, and alert whomever they are traveling with about the plan for unexpected care.
Patients should also take time for themselves and consider their needs. Here are some examples I’ve heard:
- “I need my travel companion to not make a big deal if I run to a bathroom, because that makes me feel embarrassed.”
- “I need my friend to know that I am not able to be as spontaneous in eating, and there are certain foods I need at the house.”
- “I need to stop at least once an hour in the car, and I may need us to pull over suddenly.”
- “I may need rest breaks during activities.”
- “I want my friends or family to do things without me without guilt or apologies. I feel bad when I am holding them back.”
The next step is communicating these concerns. Ideally it is best to have these conversations sooner rather than later. It is far easier to clearly express our needs and boundaries when we are calm and have our thoughts together as opposed to in the midst of a difficult situation when emotions can become heightened, thoughts scatter, and we are juggling handling the situation while trying to clearly communicate. Of course, at times the unexpected will occur and, in these instances, asking for help from others, or communicating in the moment can become necessary.
Regardless of whether a patient is communicating prior to travel or in a moment of immediate need, what and how much they share with others is completely up to them. It is always their right to have privacy. However, companions, staff, or support systems are less able to help, empathize, understand, or meet needs if they are unaware.
Plan with effective problem solving
In addition to the team, patients can use their problem-solving skills to create practical plans to feel more comfortable while traveling. I typically recommend that patients think through their symptoms, consider what will make them feel the most at ease and use this insight to create a plan. This will look different for each patient, but common examples include packing medications in a carry-on, so there is no chance it will get lost and packing a few extra days-worth, in case plans unexpectedly change. Some patients also consider bringing bathroom sprays for close quarters, large water bottles to stay hydrated and extra clothing or bathroom wipes for easy clean up in the event of messy symptoms.
Food, water and taking medications are often an additional source of worry as patients weigh how these may affect their bodies and impact their travel. Although patients may choose to avoid certain triggering foods, patients should eat and drink something, as sudden withholding can lead to upset stomach. patients should also avoid skipping medications unless it is recommended by their providers.
Bringing in support, and creating plans are skills that can help patients feel more comfortable and prepared, however, it is impossible to foresee and prepare for everything.
With this in mind patients also benefit from increasing their self-efficacy and attaining coping skills for uncomfortable emotions. In this next section I’ll share some of the common interventions and tools that I use with patients in therapy to do just that.
Lean into anxiety
I often tell my patients that anxiety is like a scary movie. The best scary movies are old ones, where your imagination can run wild with what a monster might look like. Newer movies use special effects and more often than not, when you see the monster, it’s really more comical than frightening. The effects just don’t live up to your imagination.
Similarly, when we lean into our anxiety and face it, we can take that power back, looking at the special effects for what they are. For example, what if a patient has an accident? Likely they would just clean themselves up. What if they can’t be spontaneous? Maybe they stay in or watch a movie with a friend.
Leaning in allows us to see the breadth of resources we have, our strengths and our innate ability to handle even the wildest of monsters our anxiety creates.
The Lazy Susan
One way of facing the fear of difficult emotions such as shame, embarrassment or guilt is a tool I call the Lazy Susan. I ask patients to turn the situation around: If someone was in the stall next to them and let out a considerable fart, retching vomit or the worst smell, what would they think? If they saw someone running through an airport at full speed, what would they think? How about if their loved one asked to stay in instead of going out? Most often, patients respond with understanding, empathy and compassion.
This tool allows patients to distance themselves from the situation and increase their awareness of compassion for others. It’s a reminder that if this is how they would think or feel, why is it so impossible that someone else would give them that same kindness and compassion?
At times, I will have a patient who admits to judging others or being annoyed by a loved one. I first have to highlight that this is human nature; I have yet to meet a single human who has not been annoyed or had a judgmental thought — myself included. My typical follow-up is to ask how long that judgement stuck with them. The average answer is no more than a few moments. It’s natural to judge and react with a wrinkle inside, but our compassion for others and lack of lasting memory works in our favor as well.
As human beings we are often harder on ourselves than we are on others. It goes a long way to remind ourselves of the compassion we give, so we can deservedly turn it back toward ourselves.
Reality checks
One of the best ways to show patients the reality of what we discuss in therapy is to live it. This is also known as exposure.
Typically, these exposures are tailored to each individual I work with, working our way from less anxiety-provoking to the most anxiety-provoking. For the purpose of this article, I will use a common fear that I have used this exercise for: accessing public bathrooms.
I have worked with many patients who live with the fear of being unable to access a restroom in a new location. So, that is exactly what we work on. I tell the patient to go to a public place and ask to use the restroom at various locations. Most patients return to my office not only surprised at the availability of restrooms, but also with the realization that they did not need one as often as they feared.
Of course, it may be best to try this type of exercise with a mental health professional who can work on tailoring activities and processing the outcomes. I would never advise anyone do something that would put them in true physical danger. However, if patients are able to find something they can safely try, these exercises can provide a great deal of relief and insight.
I also ask patients to recall their lived experiences as a means of challenging anxious distress. I encourage them to think about the last time they had a flare up and how they handled it. Or how they handled the last time a “what if” came true. Is it possible that they could react similarly in the future?
This tool is also helpful when facing fear of judgement. Patients might think there is a spotlight on them, when in fact most people are wrapped up in their own realities. I often ask patients to reflect on situations based on the fears they come in with: Could they recall how many people used the bathroom around them or how often the last time they were at a restaurant? When they were in the bathroom, did they notice what others around them were doing? Typically, the answer is no.
Sometimes, patients tell me they are not sure, and this presents a great opportunity for a lived reality check, in which I ask them to pay attention next time they go out. When we discuss the experience in the next session, patients often tell me they completely forgot, never noticed or, if they did notice, they didn’t think of it again until our session.
The fear of travel — and the pull to avoid it at all costs — is something that is commonly experienced by GI patients. However, through support, problem solving, increased self-efficacy and using tools to cope with difficult emotions patients can set themselves up for success in traveling even with the GI luggage along for the ride. Remind your patients that they are not alone in this experience and are not crazy for it. If their fear becomes too much to face alone, encourage them to find someone who can help.
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