Gut-Brain Connection

How could a behavioral medicine specialist 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 a person's 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 people with GI disorders might benefit from seeing a behavioral medicine specialist?

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

• People 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.)
• People whose stress or emotional factors are worsening their GI symptoms.
• People who are interested in non-drug treatment of their functional GI symptoms.
• People newly diagnosed with chronic GI illnesses, such as Crohn’s disease, ulcerative colitis, chronic pancreatitis and gastroesophageal reflux disease (GERD).
• Any person needing assistance with coping with chronic, uncomfortable GI symptoms.

What types of people with GI disorders should NOT be referred to a behavioral medicine specialist?

People who are not good candidates include:

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

What types of behavioral medicine treatments are available to people with GI disorders?

Several types of psychotherapies may help ease persistent gastrointestinal distress or at least help people learn to cope with such symptoms. These treatments include:

Relaxation therapy. This approach uses several techniques to help people relax and reduce their reaction to stress. Techniques include progressive muscle relaxation, visualization and restful music. Research suggests that these therapies are most effective when combined with cognitive behavioral therapy (CBT).

Cognitive behavioral therapy (CBT). The goal of this approach is to help people with GI disorders change their thoughts, behavior and emotional response as well as learn coping skills to better manage anxiety and stress.

Gut-directed relaxation training. This is a combination of deep relaxation with positive suggestions focused on GI function. An example would be a person placing hands on his/her abdomen while being asked to feel warmth and imagine they had control over their GI function. This approach may be helpful for people whose symptoms occur even without obvious stress.

Biofeedback. This treatment technique teaches a person how to control automatic body responses. An example would be learning how to control heart rate or temperature with the assistance of an electronic device that provides feedback on these functions. Research has shown that biofeedback, in combination with other stress and illness management techniques, has produced positive health effects.

Are there other benefits to behavioral medicine treatments besides helping ease GI symptoms?

There is evidence that as stress, anxiety and physical symptoms improve with treatment so do mood and quality of life. Also, although treatments may require greater time input by people with GI disorders initially -- both in the clinic and on their own -- there is the benefit of less frequent physician visits, medical procedures and medications.

Are visits with a behavioral medicine specialist for GI disorders covered under health insurance?

It’s always wise to check with your insurance carrier before you receive care. However, it’s important to note that some behavioral medicine treatments provided by a behavioral medicine specialist can be billed under a person's medical insurance using health and behavior billing codes.