How Working With a Therapist Can Alleviate Inflammatory Bowel Disease Symptoms

When treating inflammatory bowel disease (IBD), taking care of your mental wellness is just as important as managing physical symptoms. Coping with the unpredictability, pain, and discomfort of ulcerative colitis or Crohn’s disease actually triggers stress, anxiety, and depression — things that can make symptoms worse. In fact, a study published in the journal Inflammatory Bowel Diseases in May 2022 found that nearly one-third of people with an IBD report symptoms of post-traumatic stress disorder. Those patients are less likely to be in remission and are more likely to be in and out of their doctors’ office.

Working with a psychologist or a mental health professional who specializes in digestive disorders can help manage the emotional side of life with an IBD. A therapist can assess you for trauma symptoms and also walk you through techniques that keep stress levels moderate and decide if medication could help.

“The role of a psychologist can be vast, with a patient who has an IBD and may be going through the grief process as they adjust to the overwhelming feelings of dealing with a chronic condition,” says Megan Riehl, PsyD, a gastrointestinal psychologist at the University of Michigan Health in Ann Arbor.

Dr. Riehl pointed out that stress does not cause IBD, but it can worsen symptoms, including pain, diarrhea, and frequent flare-ups, and make it more difficult to move toward remission.

How Your Emotions Can Affect Your Gut

The relationship between inflammatory bowel disease symptoms and stress is complex and less understood in IBD than in other conditions, like irritable bowel syndrome (IBS), according to Christina Jagielski, PhD, MPH, a gastrointestinal psychologist at the University of Michigan Health in Ann Arbor. While IBS may be managed with mindfulness and stress reduction, IBD requires medication to treat the inflammation in the GI tract.

“If you’re having symptoms, but you’re in remission, and the physical hallmarks of inflammation are not present, then it may be a dysfunction of the brain-gut axis,” says Riehl.

The brain-gut axis is a two-way system that sends biochemical signals from the brain to the intestines and vice versa. The signals that go back and forth affect memory, learning, attention, and emotional regulation.

The gut-brain axis may play a role in how your emotions affect your gut, according to the aforementioned Inflammatory Bowel Diseases study, highlighting that psychological stress was linked to longer recovery times and more frequent doctor visits. A review published in October 2022 in Alimentary Pharmacology and Therapeutics found that psychological stress often preceded an IBD flare.

And the inflammation in the gut has the potential to spread. A review published in August 2021 in the International Journal of Molecular Science looked at various studies that homed in on the molecular activity involved in the brain-gut axis. It found that inflammation in the intestines from IBD may travel through the central nervous system and up to the brain, causing both damage in the central nervous system and psychological distress.

That makes addressing mental health issues in people with IBD particularly important, because depression and anxiety have also been linked to disease recurrence and a reduced quality of life, says Dr. Jagielski.

“There are unhelpful thought behaviors associated with IBD,” she explains. “It can lead patients to focus on negative thought patterns, excessive rumination of their disease, and an avoidance of enjoyable activities. That’s when it’s important for a psychologist to help them see that their thought patterns are contributing to their suffering.”

RELATED: How Stress Affects Digestion

Ways to Reduce Stress if You Have an IBD

If you’re living with IBD and experiencing anxiety, depression, or stress, consider seeing a GI-specific mental health counselor in tandem with adhering to your prescribed medicines, says Jagielski.

Working with a psychologist can minimize the impact stress has on the gastrointestinal tract. It can also enhance patients’ ability to cope with the disease on a daily basis, adds Riehl. You may consider health psychology interventions, including:

• Cognitive behavioral therapy, also called talk therapy, helps people get out of the negative thought cycles they sometimes put themselves through and replace them with proactive behaviors. Riehl notes that it’s important to see a GI behavioral therapist because they are specifically trained to look at the brain, specific parts of the nervous system, and the mechanics of your digestive system to have a fuller understanding of how to work alongside GI issues.
• Gut-directed hypnotherapy uses guided meditation to help people achieve a state of deep relaxation by focusing their attention on calming images and verbal suggestions. Studies have shown this type of therapy can have a positive effect on the digestive system.

A study published in the May 2022 issue of Gastroenterology and presented at Digestive Disease Week that year looked at 60 patients with Crohn’s disease who had 12 weeks of cognitive behavioral therapy and mindfulness training while also taking their medicine and compared them with 60 Crohn’s disease patients who took medicine but did not have behavioral therapy. Researchers found that the therapy group saw a substantial reduction in pain and fatigue. The therapy group were also more likely than the control group to enjoy activities.

Another study, published in May 2022 in the Journal of Clinical Medicine, found that after eight weeks of acceptance and commitment therapy (ACT), a type of cognitive behavioral therapy, patients with IBD had reduced stress, increased engagement in activities they valued doing, and improved functioning. ACT practitioners guide a patient to turn their focus to the present moment. That way, the patient can recognize and accept thoughts and feelings as they arise so they can move forward with healing rather than dwelling on negative thought pattens.

“If you’re reluctant to seek treatment or you’re taking your medicine but afraid to work, or not enjoying life because you’re too worried about not being near a bathroom, it’s time to find a GI psychologist,” says Jagielski. “It doesn’t take long to see a real benefit to a psychological intervention.”

How to Find the Psychologist That’s Right for You

A limited number of health psychologists around the country specialize in treating gastrointestinal disorders, says Riehl, noting that they tend to be near urban centers or large academic medical centers.

“But there are more available, and it’s easier to meet one, through telemedicine,” she says. Both she and Jagielski emphasize the need to look for someone who has training in neurogastroenterology, not just cognitive behavioral therapy. Patients can also ask their primary care physician for a referral to a GI psychologist, says Riehl. Other great resources that Riehl and Jagielski recommend are:

• Rome Foundation
• Crohn’s & Colitis Foundation
• Association for Behavioral and Cognitive Therapies
• American Board of Professional Psychology
• American Psychological Association Practice Organization

Additional reporting by Kaitlin Sullivan and Jordan M. Davidson.