Can a Gastropsychologist Help With Inflammatory Bowel Disease?

Receiving treatment from a mental health professional can be an important part of a care plan for people with inflammatory bowel disease (IBD). In fact, there is a small but growing number of specialists among psychologists called gastropsychologists, that focus on treating patients with gastrointestinal diseases and who have special training.

Inflammatory bowel diseases (Crohn’s disease, ulcerative colitis, and indeterminate colitis) are incurable diseases that primarily target the digestive system. Some of the common signs and symptoms of IBD include diarrhea, weight loss, abdominal pain, and fevers. However, the digestive problems only tell part of the story of what it’s like to live with IBD. 

IBD is associated with stigma about “bathroom” disorders, which leaves patients feeling isolated, often finding it challenging to discuss their health with others. Further, the signs and symptoms may keep people with IBD from participating in activities outside their homes, and limit their ability to go to work and school. The isolation can become profound and lead to a host of emotions, as well as contribute to depression and anxiety. However, it’s not common for people with IBD to be referred to a mental health professional for treatment. 

This article will address why addressing mental health is an important part of treating IBD and how a gastrointestinal (GI) psychologist can help.

Anxiety and Depression in IBD

Anxiety and depression are closely associated with IBD, although it’s not thought that these conditions are a cause of the disease. Instead, it’s thought that all the difficulties that come along with being diagnosed and living with these diseases lead to the development of mental health factors. Further, symptoms of anxiety and depression may then negatively affect IBD. This is known as a bi-directional effect.

One study used a clinical scale called the Hospital Anxiety and Depression Scale (HADS) to determine the levels of anxiety and stress in 103 people living with ulcerative colitis and 101 people living with Crohn’s disease. The study also included 124 people who were the healthy control group. What the researchers found was that anxiety and depression scores on the HADS were higher for those living with IBD than they were for the healthy control.

In addition, the study found that certain factors were different between ulcerative colitis and Crohn’s disease. In ulcerative colitis, anxiety was tied to perceived stress and a new diagnosis, while depression was associated with stress, being in the hospital, and active disease. For those living with Crohn’s disease, anxiety was also associated with perceived stress but further included abdominal pain and lower socioeconomic status. Depression in this group was also associated with perceived stress and aging.

What Is a Gastropsychologist?

A gastropsychologist (also called a GI psychologist or a gastropsych) is a clinical psychologist that has specialized training in health psychology. In health psychology, training focuses on how physical health or an illness has an effect on a person’s mental health. This includes covering a number of aspects surrounding disease, including how it affects people from a psychological standpoint, as well as from a social and a cultural perspective.

The primary focus of a health psychologist is taking care of the mental health of people with physical conditions and less so those who experience psychiatric disorders. Issues that a GI psychologist may help their patients with include sleep issues, chronic pain, fatigue, and digestive specific concerns such as disordered eating or dietary restrictions.

Seeing a GI Psychologist for IBD

The brain and the digestive system are in communication with one another. This gut-brain connection can become disrupted and cause challenges with digestion. For those who live with IBD, digestive symptoms may cause psychological stress or anxiety, which in turn may lead to more symptoms. This can create a pattern that is difficult to break without some kind of intervention. Seeing a mental health professional for treatment may help, and a GI psychologist has special training in addressing the special concerns of people who live with digestive disease.

An initial consultation is often the first step in getting started with a GI psychologist. During the consultation, the psychologist can learn more about the issues that need to be addressed and determine if GI psychology will be helpful. Part of this consultation may include some questions to learn more about any gastrointestinal symptoms and how it affects quality of life. It could also include some questionnaires that help in understanding more about symptoms of anxiety, depression, or other mental health concerns.

If everyone is ready to get started, the psychologist will put together a plan of action. How many appointments are needed and how long a duration they’ll be spread over will differ from person to person. In many cases, there could be between six and eight appointments scheduled to start. This is because most interventions are skills-based and can be completed in that timeframe. If more sessions are needed, they’ll be added. In some cases, people may come back from time to time for additional sessions to deal with problems as they come up, such as if there’s a new diagnosis, or the disease activity worsens, or if there’s a need for surgery or other treatments that can be of concern.

Cognitive-Behavioural Therapy

One method that may be used by psychologists to help people with IBD is cognitive-behavioral therapy (CBT). CBT is used as a treatment for a wide range of conditions, including anxiety, depression, and other mental health issues. Through the use of CBT, a psychologist and a patient work together to address problem areas and find solutions.

At the core of CBT is the reframing of thought patterns. This can include recognizing unhelpful thought processes, working through them, and learning to redirect those thoughts and to calm the mind. CBT might be further personalized by a therapist to address the individual needs of a client.

In IBD, CBT might be used in a variety of ways. One small study looked at using CBT for the treatment of fatigue, which is a common symptom of IBD. Fatigue in IBD is common yet not well understood and there are few treatments available to address it. In this study,10 people with IBD who completed all eight CBT sessions had improvement in their quality of life up to a year after the study ended. Researchers on this study call for a larger pilot study and then, if good results are seen, a randomized controlled trial.

Another study looked at using an IBD-specific form of CBT to improve quality of life. There were two groups of 59 patients with IBD included, and each group received CBT but one group received it right away and the other group received CBT after a wait of three and a half months. Patients had to complete five or more CBT sessions to be included in the analysis. Researchers found that the CBT had an effect on both groups of patients. They found that patients reported an increased quality of life (using the IBD Questionnaire), as well as decreased scores for depression and anxiety (using HADS).

One form of CBT that has been studied in IBD is called acceptance and commitment therapy (ACT). In one study, 122 people with stable or mild IBD underwent an eight-week program of ACT or received their usual care (which did not include ACT). What the researchers found was that those who were part of the ACT group saw their stress level decrease and a decrease in depression when compared to the group that didn’t receive therapy. However, there wasn’t an effect noted on anxiety levels.

Gut-Directed Hypnotherapy

“Hypnotherapy” may conjure images from pop culture of hypnosis as a parlor trick. However, gut-directed hypnotherapy is an effective, evidence-based treatment methodology that can help people who live with digestive disease. For some people, the nerve endings in their digestive system react more strongly to stimuli. This can result in symptoms such as abdominal pain, diarrhea, or constipation.

During gut-directed hypnotherapy, a licensed psychotherapist helps a patient relax and then begin to address the issues that are affecting digestion through guided imagery. This could take place over a series of between seven and 10 weekly or bi-weekly sessions, which may be between 30 and 60 minutes long. In between, patients are often given audio recordings to listen to or other homework that helps advance the skills that are being learned during therapy sessions. 

One study looking at gut-directed hypnotherapy in people who live with ulcerative colitis. One group underwent gut-directed hypnotherapy while another group received one-on-one talk therapy. The results showed that those who took part in the gut-directed therapy were able to go longer between flare-ups (the estimated time was approximately two and a half months). The authors concluded that hypnotherapy is likely to be of benefit for patients with mild-to-moderate ulcerative colitis, especially in light of the fact that most patients do not receive any mental health interventions.

Studies have shown that gut-directed hypnotherapy is also helpful for use in treating irritable bowel syndrome (IBS). While IBS is a very different condition from IBD, it’s estimated that as many as 50% of people with IBD also live with IBS, and therefore might see a benefit from this treatment. Research shows that the benefits of gut-directed hypnotherapy can last anywhere from 1 to 5 years in up to 83% of patients with IBS. It’s not yet understood exactly how gut-directed hypnotherapy works to treat IBS but it may be helpful for those patients who live with both IBD and IBS.

Finding a Therapist

Finding a therapist can seem like a challenge, especially when treating IBD and associated problems can take up so much time. However, finding a qualified therapist and having them become part of the IBD team can yield so much benefit both in quality of life and in disease activity.

There are several places that patients can start looking for a therapist. The first is to ask at the gastroenterologists’ office to see if they have a relationship with a therapist and can make a referral. If that’s not an option, it’s possible to find a therapist by using the practitioner finders from a professional psychologist society:

• Association for Behavioral and Cognitive Therapies
• American Board of Professional Psychology
• American Psychological Association Practice Organization
• Rome Foundation Gastropsychologist Directory

Some people may find that the first therapist they talk to is not the one with which they continue on and receive treatment. It may be necessary, if at all possible, to talk to a few different therapists to find the one that has the best fit. Most therapists will schedule an initial “get to know each other” session, usually at no cost, to determine if a good working relationship can be established. It’s understood that not every therapist is going to be able to work with every patient.

A Word From Verywell

It is extremely difficult to study the effects of psychological interventions. One reason is that there’s no ability to use a placebo or to blind the patient or their physician to the intervention. Patients will know when they receive therapy, unlike with medical treatments where a “sugar pill” can be given and only the researchers would know who received that versus who received the medication being studied.

Further, psychogastroenterology is an emerging field. People who live with IBD may not be aware that there are professionals who specifically work with the interplay between gut health and mental health and some of their doctors might not know this either. 

It’s often thought that therapy is something that goes on long-term but that’s not always the case. In many situations, meeting with a GI psychologist is for the short-term, with occasional touchpoints in the future if needed. There are often clear goals for therapy: it is not talk therapy that goes on indefinitely. People with IBD should have their mental health addressed and seeing a gastropsychologist may be the best way to improve quality of life and ensure that stress and anxiety are managed.