How could a psychologist help me with my gastrointestinal (GI) problem?

The conditions of anxiety and stress provide a simple example. Anxiety and stress are psychological concerns. We know that gastrointestinal (GI) problems can create anxiety and stress. We also know that anxiety and stress can make GI problems worse. It’s been shown that psychological treatment techniques can help ease GI distress or at least help a person cope with their GI symptoms.

Researchers are learning more and more about the connection between different parts of our body’s nervous system. People are most familiar with the body’s central nervous system, which is made up of the brain and spinal cord. This network of nerves, neurons (nerve cells), and neurotransmitters (chemicals that help pass along nerve cell signals) extends from the brain to all the major organs of the body.

There is also a lesser known part of our body’s nervous system located in our gut. It’s called the enteric nervous system. The enteric nervous system’s network of nerves, neurons, and neurotransmitters extends along the entire digestive tract – from the esophagus, through the stomach and intestines, and down to the anus. Because the enteric nervous system relies on the same type of neurons and neurotransmitters that are found in the central nervous system, some medical experts call it our “second brain.” The “second brain” in our gut, in communication with the brain in our head, plays a key role in certain diseases in our bodies and in our overall mental health.

Excitement in the field of gut-brain research

This “crosstalk” in communication between the brain and digestive system is opening up new ways to think about diseases. Not only do the gut and the brain communicate through the nervous system, but also through hormones, and the immune system. Microorganisms in the gut help regulate the body’s immune response. Medical researchers who are studying depressive symptoms, Parkinson’s and Alzheimer’s disease, autism, amyotrophic lateral sclerosis, multiple sclerosis, pain, anxiety and other “neuro” conditions are beginning to look at what is going on in patients’ guts. Researchers who are investigating ulcers, constipation, and other GI conditions also now have a reason to focus on aspects of brain functioning.

What are some examples of how the network of neurons in our gut and brain communicate with each other?

There are several familiar examples. When a person feels danger, the “fight or flight” response of the central nervous system is triggered. At the same time, the enteric nervous system’s response is to slow down or stop digestion. This is done so that more of the body’s energy can be diverted to the situation causing the threat. The fear of public speaking also causes the digestive system to either slow down or speed up depending on the GI disorder and can cause abdominal pain, diarrhea, and other symptoms. Emotions, feelings of excitement, or nervousness can cause the familiar churning in the stomach – the so-called “butterflies in your stomach” feeling. The gut-brain connection works in both directions too. For example, GI problems can create anxiety and stress.

What types of GI patients might benefit from seeing a psychologist?

Patients with a wide array of GI conditions can benefit, including:

  • Patients with moderate to severe functional symptoms who have not responded to medical management. (“Functional” GI conditions are ongoing or recurring problems that interfere with the function of the GI tract. “Functional” conditions are not tumors, masses, or chemical abnormalities.)
  • Patients whose stress or emotional factors are worsening their GI symptoms.
  • Patients who are interested in non-drug treatment of their functional GI symptoms.
  • Patients newly diagnosed with chronic GI illnesses, such as Crohn’s disease, ulcerative colitis, chronic pancreatitis, and gastroesophageal reflux disease (GERD).
  • Any patient needing assistance with coping with chronic, uncomfortable GI symptoms.

What types of GI patients should NOT be referred to a psychologist?

Patients who are not good candidates include:

  • Patients who have significant psychological symptoms that are not related to their GI condition.
  • Patients who have current severe psychiatric symptoms (suicidal ideation, psychotic disorder, obsessive-compulsive disorder).
  • Patients who have an active eating disorder.
  • Patients who have little awareness or acceptance of the role of stress on their GI condition.
  • Patients who are not highly motivated to try psychological treatment.

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