GI psychologists help navigate ‘complexities’ of various GI conditions, personalize care
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Gastrointestinal psychologists employ various treatments to help alleviate the distress associated with GI disorders.
In my practice, understanding the distinction between functional and organic GI conditions, and the evidence-based therapies available for each, shapes the treatment strategies I adopt.
Organic GI disorders, such as inflammatory bowel disease, link symptoms to structural or physiological changes that medical tests can identify. In contrast, functional GI disorders, now often referred to as disorders of gut-brain interaction (DGBI), present symptoms without a detectable physical cause in the GI tract based on currently available medical technologies. In both cases, a multidisciplinary approach is critically important to alleviate suffering and enhance a patient’s quality of life.
The practice of GI psychology focuses on improving patients’ responses to stress (including physiological arousal) and fostering healthy behaviors, since these factors can aggravate GI symptoms across different conditions. Importantly, these treatments usually integrate with those of other specialties as part of a broader GI treatment plan rather than stand alone.
Primary vs. complementary interventions
One way to classify our interventions is into primary and complementary categories1. Primary treatments aim to modify GI symptoms directly and are more commonly employed in DGBIs. For example, we might use stress reduction training to lessen the severity of pain symptoms in DGBI and do so alongside other treatment team members working to address nutrition and dysbiosis factors that may be at play. Oftentimes, DGBI presentations are those suited for primary and secondary intervention approaches based on the presence of psychiatric comorbidity.
Complementary treatments, on the other hand, aim to support patients in coping with the challenges that arise when managing a chronic or lifelong organic GI disease, such as enhancing coping skills in patients receiving long-term medications for IBD.
In managing organic GI diseases, I review with my patients that while psychological stress may not be the cause of the disease per se, it can affect subsequent inflammation and symptom expression, which is why we adopt it as a complementary approach. As with this example, complementary treatment approaches are in my experience well-suited to organic disease. For additional reading, Sarah Ballou, PhD and Laurie A. Keefer, PhD, provide a helpful review.
Evidence-based treatments
When making treatment recommendations, I commonly look to evidence-based treatments such as cognitive behavioral therapy (CBT), acceptance and commitment therapy, gut-directed hypnosis and other therapies like mindfulness-based stress reduction. I often try to match evidence-based strategies with presenting treatment targets. For example, CBT may help a patient manage symptoms of hypervigilance or anxiety related to chronic illness, while relaxation training or GI-directed hypnosis may help with chronic increased physiological arousal.
Beyond these, GI psychologists might also bring in other health psychology interventions they have been trained in. For example, if a patient struggles with sleep disturbances due to GI medications, I might include behavioral sleep medicine in their treatment plan. For behaviors specific to certain conditions, like reflexive regurgitation in rumination syndrome, habit-reversal training can be a good option. There are of course numerous additional approaches that may be of benefit that are not covered in the scope of this brief post.
Personalized care plans
In practice, I start with a foundation of evidence-based primary treatments for DGBIs and complementary treatments for organic GI diseases, then tailor the approach based on collaboratively derived treatment goals. This tailored approach ensures that we match treatment mechanisms to patients’ specific needs, providing a personalized plan for each patient.
I would be remiss if I didn’t also acknowledge the co-occurrence of organic and functional GI issues. For example, many patients with IBD may also experience symptoms of irritable bowel syndrome, demanding a flexible and modifiable treatment approach.
GI psychologists are committed to delivering personalized, evidence-informed care in an active and collaborative setting. The goal is to navigate through the complexities of GI disorders with interventions that can relieve symptoms and support patients’ overall well-being.
References:
- Improving Access to Behavioral Healthcare in Gastroenterology: A Levy Incubator Project. https://dartmouth.hosted.panopto.com/Panopto/Pages/Viewer.aspx?id=5d5f93fe-1e5e-47ca-9607-afa5012ea586. Accessed Nov. 15, 2023.
- Ballou S, et al. Clin Transl Gastroenterol. 2017; doi: 10.1038/ctg.2016.69.
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