A growing body of evidence suggests an interesting overlap between the gut, the brain and emotional state. Chronic digestive disorders such as IBS are thought to occur when the enteric nervous system (gut) and the central nervous system (brain) do not ‘communicate’ properly with each other. Serotonin is a neurotransmitter (a chemical messenger) which impacts mood, sleep and appetite. Interestingly, almost all of the body’s serotonin can be found in the gut and the rest is found in the brain. Emotional state is therefore connected in some way to the gut.
A recent study found that a majority of patients with functional Gut conditions also had coexisting psychological conditions (eg anxiety and depression). Another found that patients with chronic digestive disorders (such as IBS) have higher levels of psychological distress and experience a lower quality of life than the general population.
Individuals with IBS may become particularly anxious about Gut-related events (eg bowel movements, abdominal cramps and mealtimes), also known as Gut symptom-specific anxiety. Because an individual may become hypervigilant to their symptoms, they may experience increased fear and arousal in relation to them. Thinking about symptoms becomes a trigger for anxiety, and the body’s resulting stress response can either make symptoms appear or make them worse. This thought cycle therefore becomes a self-fulfilling prophecy. As a result, gastroenterologists might aim to manage IBS by using psychological therapies in an attempt to reduce symptoms by lowering the body’s stress response.
Psychogastroenterology is the term used to describe the science of applying psychological principles, techniques and therapies to help manage chronic digestive disorders, such as IBS. Its aim is to help patients better manage their symptoms, and may be used in combination with other treatments, such as medication. The main techniques used are cognitive behavioural therapy (CBT), relaxation therapy and hypnosis.
CBT aims to modify certain thoughts and behaviours so that they are more conducive towards achieving a positive psychological state. Sessions are carried out with a qualified healthcare professional and typically require a regular commitment over a set period of time. New data suggests that remote CBT using video or telephone consultation may be superior to office-based therapy in patients with moderate-severe IBS.
Relaxation therapy involves diaphragmatic breathing exercises and progressive muscle relaxation to help calm the body’s stress response. If the body’s stress response can be reduced then hopefully this can decrease the severity of symptoms an individual experiences and therefore decrease Gut symptom-specific anxiety.
Hypnosis, despite being a controversial subject in the medical community (due to an historical lack of controlled evidence), has shown to be an effective treatment for IBS for some individuals. Sessions challenge patients to progressively relax their thoughts on IBS symptoms by using calming imagery and sensations. It can bring about improvements in physical and mental wellbeing.
Although we do not know whether psychological distress is the cause of IBS or indeed a symptom of IBS, it is clear that there is good reason for gastroenterologists to address the psychological aspect of IBS when considering a patient’s treatment plan.
For more information, please contact Dr Adam Harris.