Addressing the psychological impacts of inflammatory bowel disease
Psychologist Melissa Hunt and gastroenterologist Chung Sang Tse and colleagues have found that cognitive behavioral therapy reduced disability for patients with Crohn’s disease and ulcerative colitis and that psychologists with no prior gastrointestinal experience could learn to deliver this therapy effectively.
3 min. read
This time of year is stressful for many people, but it can be particularly challenging for those with gastrointestinal issues, as concerns about food triggers and bathroom accessibility can heighten anxiety.
People with inflammatory bowel diseases (IBD), such as Crohn’s disease and ulcerative colitis, frequently experience not only physical symptoms—such as diarrhea, pain, and fissures or fistulas—but also the psychological burden of living with a chronic disease, says Perelman School of Medicine gastroenterologist Chung Sang Tse. Inflammatory symptoms can exacerbate psychological distress causing anxiety, depression, agoraphobia, and PTSD, which in turn can trigger physical symptoms.
Melissa Hunt, associate director of clinical training in Penn’s Department of Psychology, says people with gastrointestinal disorders may be too embarrassed to tell even close loved ones what they’re going through.
Penn Today spoke with Tse and Hunt about their research on the use of cognitive behavioral therapy (CBT)—a psychotherapy that targets inaccurate thoughts and maladaptive behaviors—to reduce IBD-related disability.
IBD-related disability refers to restrictions in work, school, or leisure activities or the inability to do activities at all, Tse explains, and up to half of adults with IBD experience moderate-to-severe IBD-related disability.
Hunt trained five clinical psychologists at Penn’s Center for the Treatment and Study of Anxiety to deliver CBT for IBD through teletherapy, which the psychologists provided to urban and rural patients in Philadelphia, Tennessee, Arizona, Wisconsin, and Rhode Island. The training was completed with a manual that Hunt wrote, which includes a primer on IBD, an overview of psychiatric comorbidities with IBD, treatment approaches, and case studies.
Hunt says one example of a treatment approach would be to have patients go into stores with no public restroom and ask something like, “I’m so sorry, this is a medical emergency. Can I please use your restroom?” Such exercises in exposure therapy, Hunt says, can help people build confidence.
Training psychotherapists in effective techniques
In a paper published in Behaviour Research and Therapy, Hunt and Tse show that CBT-trained clinical psychologists with no prior IBD experience could adhere to the IBD-CBT manual and deliver therapy well, and that fidelity to teaching deep diaphragmatic breathing was associated with greater reductions in disability.
Deep diaphragmatic breathing is a relaxation technique that Hunt says engages the parasympathetic nervous system and improves digestion. “It can actually reduce cramping and urgency, which increases people’s confidence about their ability to go out and about in the world,” she says.
Hunt is building off this work by supervising a new gastrointestinal psychology rotation as part of the Clinical Psychology Internship Training Program, housed in the Department of Psychiatry in Penn Medicine. The rotation, which will educate clinical psychology Ph.D. trainees on helping patients with both IBD and irritable bowel syndrome (IBS), is getting its first intern in January.
Hunts says that unlike IBD, IBS is a disorder of gut-brain interaction and does not respond well to traditional medical management, so she argues that psychotherapy should be the frontline treatment for most IBS patients. Referrals for the intern will come through Penn Medicine’s Division of Gastroenterology.
“The goal is to start to show proof of concept in gastroenterology that for particular folks with irritable bowel syndrome, we may be able to substantially reduce medical utilization and allow the gastroenterologists to spend more time with the patients—like IBD patients—who need pharmacological and surgical management,” Hunt says.
Melissa Hunt is the associate director of clinical training in the Department of Psychology in the School of Arts & Sciences at the University of Pennsylvania.
Chung Sang Tse is an assistant professor of medicine in gastroenterology in the Perelman School of Medicine at Penn.
The other co-authors on the first study referenced are Brittaney Bonhomme, Lily A. Brown, Robert Kuehnel, and James D. Lewis of the University of Pennsylvania; Hannah Fiske and Chien-Hsiang Weng of Brown University; Alandra S. Weaver of the Crohn’s & Colitis Foundation; Samir Shah of Gastroenterology Associates; Raymond K. Cross of the Melissa L. Posner Institute for Digestive Health & Liver Disease at Mercy Medical Center; Sasha Taleban of the University of Arizona; Megan Lutz and Sumona Saha of the University of Wisconsin; and Sara N. Horst of Vanderbilt University.
This research was supported by the Crohn’s & Colitis Foundation (grant 977927) and the National Institutes of Health (P30DK050306).
The other co-authors on the second study referenced are Camilla Bui, Alana Davis, Ray Siddiqi, Lily Suh, Venus Tian, and Ella Yang of the University of Pennsylvania.
This research was supported by the Crohn’s & Colitis Foundation (grant 977927).
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