July 24, 2023 • 19 mins
Episode 5 of Visceral features Alyse Bedell, PhD, GI psychologist, who discusses the ways in which Crohn’s disease and ulcerative colitis can impact mental health and personal well-being. Dr. Bedell shares research to help patients understand how IBD relates to anxiety, depression, and other mental health challenges, and how to harness the mind-body connection to help manage pain and symptoms.
Written and produced by Anna Gomberg. Edited and mixed by Mike Collins-Dowden. To access other podcast episodes and learn more about research to treat, prevent and cure digestive diseases, please visit www.giresearchfoundation.org.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
If you're not thinking about your mind in your process of coping with your IBD, then
(00:07):
you're neglecting an important area that's also impacting your body.
Thank you so much for joining us today for this episode of Visceral, the podcast from
the GI Research Foundation.
My name is Anna Gomberg, and with me today we have Alyse Bedell, who is our GI psychologist
at the University of Chicago Medicine.
Dr. Bedell is an assistant professor of psychiatry and behavioral neuroscience, an assistant professor
(00:33):
of medicine, and is the director of our Psychogasterontology program.
She has many, many areas of expertise, including behavioral medicine and helping with chronic
disease symptom management and is a practitioner of cognitive behavioral therapy.
She is a graduate of Northwesterns-Veinberg School of Medicine, and we are just so thrilled
(00:53):
that she is with us today and every day at the Digestive Diseases Center.
Welcome, Dr. Bedell.
Thank you so much for having me, Annie, looking forward to talking to you today.
Wonderful.
Well, we're just so thrilled for you to share your expertise with us.
So I'm aware that there are some connections between mental health and well-being and inflammatory
(01:14):
bowel disease.
Would you like to share a little bit about what those connections are and how having IBD
and mental health are related?
Absolutely.
So I think probably, you know, when we think about mental health and IBD, we could think
about depression, so symptoms of depression and symptoms of anxiety.
For folks, actually, might not be familiar with what those terms mean because, actually,
(01:38):
many people aren't.
We use those terms every day, but sometimes without knowing exactly what they mean.
Depression can include a lot of different symptoms, but some of the most common would
be feeling down, sad, having a low mood, or a term called anhedonia, which is just a
fancy term that means you're not really getting enjoyment in things anymore, or you really
(02:00):
have no motivation to do things that you used to enjoy.
So that's kind of a snapshot of what depression looks like.
Anxiety also is comprised of a few different factors.
It can include that kind of physiological sensation of being restless or keyed up or
chitry, it can include a more cognitive component, so worry is one component of anxiety, and
(02:21):
it can include behavioral manifestations like avoiding things because you're anxious or
maybe overly engaging and reassurance seeking because you're anxious.
So just to have a little bit of a background on what those two terms mean.
So both depression and anxiety have been really widely shown across research that they are
(02:41):
much more common among folks with IBD.
So of course rates do vary widely across studies, but in general we can think about symptoms
of depression affecting about 20 to 30% of patients with IBD.
We can compare that to the general US population of about 5 to 10% of folks being affected
by symptoms of depression.
(03:02):
Then we look at anxiety.
Anxiety affects about 30% of folks with IBD compared to about 20% of the general US population.
And actually it's good to keep in mind that those are kind of low figures on IBD because
that's really looking at folks across all stages of the disease.
If we were to only look at folks with active ulcerative colitis or Crohn's disease, those
(03:26):
rates are actually a lot higher.
So they'd be exceeding 50% of people with active IBD would be struggling with pretty
significant symptoms of depression and anxiety.
Wow.
And do we have any idea of what drives that association, what makes those differences
happen?
So it's a really good way of thinking about the mind-body connection and the fact that
(03:48):
we're aware that it probably works both ways, where things that are going on in the brain
probably impact the body and may drive depression.
And things in the body may also drive factors in the brain.
So as a psychologist, my role when I'm working with patients is to understand what I can
(04:10):
of both, but primarily to understand factors associated with a person's thoughts and behaviors
that might really drive depression and to help a person be able to optimize those.
But there's also an important area of research that is looking at the reverse.
It's looking at factors that might be more specific to changes in the body that could
(04:31):
occur along with IBD that may actually increase the likelihood or the severity of depression.
So I would say that this is a growing area of research, but we do know that there are
folks, so I'd say there's actually a study that was a pretty monumental study that happened
recently that actually tracked folks who did not have IBD and folks with depression were
(04:53):
actually more likely to go on to develop IBD.
Wow.
Interestingly, being on an antidepressant medication was actually shown to be protective
in developing IBD.
So that is kind of hard to argue with when you see research like that coming out.
Our institution is also working on this as well as other institutions trying to understand
(05:15):
these types of mechanisms where the IBD itself, the mechanisms of the IBD may actually set
a person up for developing depression or anxiety.
We are looking into this, other institutions are, but I would say that is right now the
less understood pathway.
What we understand better is more so where my role is, which is an understanding that
(05:38):
living with a chronic and unpredictable disease like inflammatory bowel disease causes changes
in the way a person thinks and behaves, of course, and that those changes in thinking
and behaving can set a person up to develop chronic mental health conditions like depression
anxiety.
So we know it goes both ways, but at this point we are really in some of the earlier
(06:01):
but exciting stages of the research where we're trying to understand some of those factors,
physiological changes in the body that might set a person up to develop mental health conditions.
That's incredible.
And so interesting that that which would seem to be, I think that we would understand the
first path that you described is more straightforward.
If you don't feel well and you can't participate in the activities that you care about and you
(06:24):
are suffering in work or in your social environment, or as we hear from our patients often, we
are just worried and anxious about how we feel every day.
Am I going to be okay?
Am I going to feel bad and worrying and being anxious about just symptom management?
It would seem that that would impact one's mental health, but the idea that we're finding
out that there might be something that goes sort of the causal relationship could be bi-directional
(06:50):
is very interesting and perhaps cyclical or however else that might play out.
More research needed as always.
What can patients do to improve their mind-body connection and experience of IBD symptoms
given this complex relationship?
I mean, the first thing that I would say is just for people with IBD to be aware of how
(07:11):
many factors can influence not only their mental health, but also their overall well-being.
I do find oftentimes in my practice that folks with IBD are understandably very focused on
medications and diet and the things that can feel a little bit more tangible and the things
(07:31):
that might get talked about more in their medical visits, but recognizing that their
well-being is also significantly impacted by their mental health.
And so again, just being aware actually of that previous conversation that we had that
your mind and your body are intricately connected.
So you really are, if you're not thinking about your mind in your process of coping
(07:54):
with your IBD, then you're neglecting an important area that's also impacting your body.
More specifically, I would say that recognizing that our gut and our brain are connected is
also important because many folks with IBD, even when in remission, can go on to experience
more chronic symptoms, symptoms like urgency or fatigue, continuing to have abnormal bowel
(08:21):
movements.
And those can be very confusing symptoms for people because maybe their last colonoscopy
actually looked really good, their blood work is looking normal, and yet they're still not
feeling well.
And so recognizing actually that, again, these more brain factors or psychosocial factors
can actually drive some of those symptoms as well, and that can be really good to discuss
(08:43):
with someone like me, a GI psychologist, but you should also discuss it with your gastropyrologist.
And some of our gastroenterologists, we spoke last time with Benjamin Levy, who was talking
a little bit about the overlap between irritable bowel syndrome and IBD and how there's overlap
in these two conditions.
And irritable bowel syndrome is a syndrome of exclusion, and a lot of the symptoms that
(09:06):
you've mentioned are part of it, and people can have both.
And there are lots and lots of psychological impacts that influence the development and
disease course of IBS and help.
And really, people's stress level really impacts IBS, people's overall mental health, their
sleep, all of these things go into that as well.
(09:26):
But yes, when you are feeling well or when you're feeling poorly, but your diagnostics
say you don't have active disease right now, that can be really frustrating, I think, for
patients and confusing.
Absolutely.
So I would totally agree with that.
So I think it's just such an important thing.
If someone is blessed enough that they can get into a position where they're in remission
and all of those other markers and all those other tests are looking good, that's great,
(09:52):
that baseline, that's great, right?
But then I think being able to assess, but do I feel well emotionally?
Do I feel well physically?
And if not, we don't want to end there.
You want to keep that conversation going.
And so as Dr. Levy, it sounds like, was mentioning, it's completely true that so many people with
IBD do have this overlapping, what I kind of consider like a more of a brain gut phenomenon
(10:16):
where these symptoms are really being driven by this miscommunication that's happening
between the gut brain axis.
And of course, of course, it commonly happens because that communication has been significantly
altered from the months or years of inflammation that a person's body has been experiencing.
(10:37):
So I would say to that and tools that we use really commonly for irritable bowel syndrome
or IBS are also quite effective for working with patients with IBD who are experiencing
those symptoms.
What are some of those tools?
I know that we've talked about them in the past, but what are the things that people
can use?
What are the boots on the ground, if you will?
(10:57):
Yeah, so for people that have access to working with the GI psychologist or a health psychologist
with that specific GI training, we use cognitive behavioral therapy that's specifically adapted
for GI conditions and we specifically adapt it for IBD as well.
And what that, just to not shell what that means is that we are really trying to understand
a person's thoughts, so cognitions and behaviors, the things that a person does or does not
(11:22):
do and how those actually impact the both gut symptoms itself and impact a person's
mental and emotional well-being.
And if we can understand the ways in which those thoughts and behaviors are serving a
person well and the ways that they might not be serving a person well, a mental health
provider can actually help a person little by little shift those thoughts and shift those
(11:45):
behaviors to actually help them work better.
It might seem surprising, but those are some of the things that actually change the communication
and our gut brain access that can actually improve symptoms.
The other evidence-based treatment that we have in psychogestroneurology is gut-directed
hypnotherapy.
I always kind of start by saying it's not actually as weird as it sounds.
(12:07):
I was going to say, tell me more.
Medical hypnosis has actually been used for decades and decades.
Hygienotherapy was actually developed for that purpose of paid management.
So in health psychology, it's still a tool that we use in our toolbox.
And it's been really well-studied and irritable bowel syndrome, but there has been some research
(12:28):
as well in applying this therapy and inflammatory bowel disease.
And it can be really helpful, not only for helping a person just improve their ability
to feel that they can cope with and manage their disease, but also in actually reducing
the symptoms themselves.
And so especially when we think about those symptoms that a person may experience when
they're in remission, but they're continuing to struggle and medications aren't really
(12:52):
staying on top of it, really both CBT and gut-directed hypnotherapy can be very helpful
tools.
And I use these every day with my patients with IVV.
And they're ones that I think people also just really enjoy learning.
It gives them a bit more control, something that they can do in addition to taking their
medications or whatever else is on their treatment plan.
(13:15):
That's amazing.
All right.
So I'm going to maybe think about antidepressants and anti-anxiety medications.
I'm going to get some CBT.
I'm going to think about gut-directed hypnotherapy.
What about some of the other complementary therapies that we've talked about like yoga
and meditation?
How do those things impact the mind-body connection and our experience of IBD symptoms?
(13:36):
Yeah.
And at this point, again, those are areas that are still growing in terms of research
and unfortunately research in some of these areas are hard to do and not as well-funded.
But I think in general, I see many people that really appreciate using those more complementary
treatments as well.
I think something like yoga is just in its essence a mind-body type of practice.
(14:01):
I think if you're doing it right, it should be meditative as well.
Even if you're getting really good exercise, it should be a meditative practice.
And then it is also really good exercise and our bodies really appreciate stretching.
They appreciate strength-building and flexibility.
And something that I also see among all of my GI patients, not just IBD, is that many
(14:24):
folks who experience digestive problems hold a lot of tension in their belly and in their
pelvic floor.
Maybe because of pain, because of discomfort, there can be this tendency to guard and it
can be difficult to unlearn that tendency.
And so things like stretching, like yoga practice, can be really helpful in just learning how
(14:46):
to relax those muscles, which can actually also be helpful in improving overall GI symptoms.
That is wonderful.
That's really good to hear because the complexity is there, but all of those things are things
that I have certainly had patients say have really helped them in their day-to-day lives.
So I think that's, I'm not a practitioner, but I lead our support group.
(15:07):
And so we have certainly a lot of back and forth about what is helpful, what is helpful
just in terms of symptom relief and feeling like you're in charge of your body and your
wellness.
So it's great to hear that there's at least some evidence base for that, if not as much
as we'd like.
As a takeaway, what would you want to tell every patient with IBD in terms of their mental
(15:31):
health?
What is one thing that you would want them to do?
What's the one message you would like to share with your patients or with potential patients
or people who are living with IBD in regard to their mental health?
I think just a recognition for a stock that they're not alone.
I think similarly in my work, not only with individual patients, but also doing some group
(15:51):
work, it's like the most powerful thing to hear is that you're not the only one that's
struggling with some of these mental health concerns or having some of these broader psychosocial
concerns like problems with sleep, problems with sexual dysfunction, problems with body
image that, unfortunately, these can come along in the trajectory of living a lifetime
(16:12):
with IBD.
Not for everyone, not for every time, but I would say the majority of people are struggling
with at least a few of these factors.
So I think recognizing you're not alone, it's not unusual, but also recognizing that there
is help when it comes to treatment of let's even say depression and anxiety.
We do have very effective treatments for that, whether it is medications like antidepressants
(16:36):
that by the way can be helpful for both depression and anxiety.
Those can be wonderful tools to add to a person's toolbox.
And so even though I'm not a prescriber of medications, I'm very supportive of people
going and getting an evaluation with their primary care provider or a psychiatrist to
see if those might be options.
Those can be very helpful.
(16:57):
But also, cognitive behavioral therapy and a few other different types of psychological
therapies are also very effective in treating both depression and anxiety.
And if you have access to be working with someone, even for a few sessions who has some
of that IBD specific experience, that can be really helpful in just understanding what
(17:19):
are some of the specific factors related to the IBD that might be driving the depression
and anxiety.
Even if then that treatment might need to be continued with a mental health provider
that is more specialized in treatment of depression and anxiety.
I make those referrals a lot too.
And again, I would just say that maybe finally, just remembering that mental health is sometimes
(17:41):
a bit more of a narrow scope, but even just thinking about psychosocial factors more broadly,
social factors that can include mental health, but also social factors like stress and stigma.
And like I mentioned before, body image and sexual functioning, that these are all important
factors when we are just considering the whole person beyond the disease living at IBD.
(18:06):
Absolutely.
That's such a good message and such a wonderful place for us to conclude this discussion because
it is, it's your whole life, right?
This disease impacts your whole life and it is your whole person.
So being mindful of that as you are pursuing your treatment and on your journey is so useful.
(18:26):
Dr. Bedelll, you are a wealth of wisdom.
I am always so delighted to speak with you and to have you on our team.
I don't know how you do it.
And I hope that we are going to continue to expand the GI behavioral health resources
that we have for folks because I think everybody should have an appointment with you when they
start coming to the University of Chicago for their IBD care.
(18:51):
Thank you so much for coming and for being with us today.
Thank you so much for having me.
It was a delight as always.
Thank you for listening to this episode of the podcast, Visceral, from the GI Research
Foundation.
This episode was written and produced by me, Anna Gomberg, and edited and mixed by the
incredible Mike Collins-Dowd, who also composed our theme music.
We hope you will join us next time.
(19:12):
Until then, to access other podcasts and to learn more about research, to treat, prevent,
and cure digestive diseases, please visit the website at giresarchfoundation.org.
That's giresarchfoundation.org.
If you're not thinking about your mind in your process of coping with your IBD, then
(00:07):
you're neglecting an important area that's also impacting your body.
Thank you so much for joining us today for this episode of Visceral, the podcast from
the GI Research Foundation.
My name is Anna Gomberg, and with me today we have Alyse Bedell, who is our GI psychologist
at the University of Chicago Medicine.
Dr. Bedell is an assistant professor of psychiatry and behavioral neuroscience, an assistant professor
(00:33):
of medicine, and is the director of our Psychogasterontology program.
She has many, many areas of expertise, including behavioral medicine and helping with chronic
disease symptom management and is a practitioner of cognitive behavioral therapy.
She is a graduate of Northwesterns-Veinberg School of Medicine, and we are just so thrilled
(00:53):
that she is with us today and every day at the Digestive Diseases Center.
Welcome, Dr. Bedell.
Thank you so much for having me, Annie, looking forward to talking to you today.
Wonderful.
Well, we're just so thrilled for you to share your expertise with us.
So I'm aware that there are some connections between mental health and well-being and inflammatory
(01:14):
bowel disease.
Would you like to share a little bit about what those connections are and how having IBD
and mental health are related?
Absolutely.
So I think probably, you know, when we think about mental health and IBD, we could think
about depression, so symptoms of depression and symptoms of anxiety.
For folks, actually, might not be familiar with what those terms mean because, actually,
(01:38):
many people aren't.
We use those terms every day, but sometimes without knowing exactly what they mean.
Depression can include a lot of different symptoms, but some of the most common would
be feeling down, sad, having a low mood, or a term called anhedonia, which is just a
fancy term that means you're not really getting enjoyment in things anymore, or you really
(02:00):
have no motivation to do things that you used to enjoy.
So that's kind of a snapshot of what depression looks like.
Anxiety also is comprised of a few different factors.
It can include that kind of physiological sensation of being restless or keyed up or
chitry, it can include a more cognitive component, so worry is one component of anxiety, and
(02:21):
it can include behavioral manifestations like avoiding things because you're anxious or
maybe overly engaging and reassurance seeking because you're anxious.
So just to have a little bit of a background on what those two terms mean.
So both depression and anxiety have been really widely shown across research that they are
(02:41):
much more common among folks with IBD.
So of course rates do vary widely across studies, but in general we can think about symptoms
of depression affecting about 20 to 30% of patients with IBD.
We can compare that to the general US population of about 5 to 10% of folks being affected
by symptoms of depression.
(03:02):
Then we look at anxiety.
Anxiety affects about 30% of folks with IBD compared to about 20% of the general US population.
And actually it's good to keep in mind that those are kind of low figures on IBD because
that's really looking at folks across all stages of the disease.
If we were to only look at folks with active ulcerative colitis or Crohn's disease, those
(03:26):
rates are actually a lot higher.
So they'd be exceeding 50% of people with active IBD would be struggling with pretty
significant symptoms of depression and anxiety.
Wow.
And do we have any idea of what drives that association, what makes those differences
happen?
So it's a really good way of thinking about the mind-body connection and the fact that
(03:48):
we're aware that it probably works both ways, where things that are going on in the brain
probably impact the body and may drive depression.
And things in the body may also drive factors in the brain.
So as a psychologist, my role when I'm working with patients is to understand what I can
(04:10):
of both, but primarily to understand factors associated with a person's thoughts and behaviors
that might really drive depression and to help a person be able to optimize those.
But there's also an important area of research that is looking at the reverse.
It's looking at factors that might be more specific to changes in the body that could
(04:31):
occur along with IBD that may actually increase the likelihood or the severity of depression.
So I would say that this is a growing area of research, but we do know that there are
folks, so I'd say there's actually a study that was a pretty monumental study that happened
recently that actually tracked folks who did not have IBD and folks with depression were
(04:53):
actually more likely to go on to develop IBD.
Wow.
Interestingly, being on an antidepressant medication was actually shown to be protective
in developing IBD.
So that is kind of hard to argue with when you see research like that coming out.
Our institution is also working on this as well as other institutions trying to understand
(05:15):
these types of mechanisms where the IBD itself, the mechanisms of the IBD may actually set
a person up for developing depression or anxiety.
We are looking into this, other institutions are, but I would say that is right now the
less understood pathway.
What we understand better is more so where my role is, which is an understanding that
(05:38):
living with a chronic and unpredictable disease like inflammatory bowel disease causes changes
in the way a person thinks and behaves, of course, and that those changes in thinking
and behaving can set a person up to develop chronic mental health conditions like depression
anxiety.
So we know it goes both ways, but at this point we are really in some of the earlier
(06:01):
but exciting stages of the research where we're trying to understand some of those factors,
physiological changes in the body that might set a person up to develop mental health conditions.
That's incredible.
And so interesting that that which would seem to be, I think that we would understand the
first path that you described is more straightforward.
If you don't feel well and you can't participate in the activities that you care about and you
(06:24):
are suffering in work or in your social environment, or as we hear from our patients often, we
are just worried and anxious about how we feel every day.
Am I going to be okay?
Am I going to feel bad and worrying and being anxious about just symptom management?
It would seem that that would impact one's mental health, but the idea that we're finding
out that there might be something that goes sort of the causal relationship could be bi-directional
(06:50):
is very interesting and perhaps cyclical or however else that might play out.
More research needed as always.
What can patients do to improve their mind-body connection and experience of IBD symptoms
given this complex relationship?
I mean, the first thing that I would say is just for people with IBD to be aware of how
(07:11):
many factors can influence not only their mental health, but also their overall well-being.
I do find oftentimes in my practice that folks with IBD are understandably very focused on
medications and diet and the things that can feel a little bit more tangible and the things
(07:31):
that might get talked about more in their medical visits, but recognizing that their
well-being is also significantly impacted by their mental health.
And so again, just being aware actually of that previous conversation that we had that
your mind and your body are intricately connected.
So you really are, if you're not thinking about your mind in your process of coping
(07:54):
with your IBD, then you're neglecting an important area that's also impacting your body.
More specifically, I would say that recognizing that our gut and our brain are connected is
also important because many folks with IBD, even when in remission, can go on to experience
more chronic symptoms, symptoms like urgency or fatigue, continuing to have abnormal bowel
(08:21):
movements.
And those can be very confusing symptoms for people because maybe their last colonoscopy
actually looked really good, their blood work is looking normal, and yet they're still not
feeling well.
And so recognizing actually that, again, these more brain factors or psychosocial factors
can actually drive some of those symptoms as well, and that can be really good to discuss
(08:43):
with someone like me, a GI psychologist, but you should also discuss it with your gastropyrologist.
And some of our gastroenterologists, we spoke last time with Benjamin Levy, who was talking
a little bit about the overlap between irritable bowel syndrome and IBD and how there's overlap
in these two conditions.
And irritable bowel syndrome is a syndrome of exclusion, and a lot of the symptoms that
(09:06):
you've mentioned are part of it, and people can have both.
And there are lots and lots of psychological impacts that influence the development and
disease course of IBS and help.
And really, people's stress level really impacts IBS, people's overall mental health, their
sleep, all of these things go into that as well.
(09:26):
But yes, when you are feeling well or when you're feeling poorly, but your diagnostics
say you don't have active disease right now, that can be really frustrating, I think, for
patients and confusing.
Absolutely.
So I would totally agree with that.
So I think it's just such an important thing.
If someone is blessed enough that they can get into a position where they're in remission
and all of those other markers and all those other tests are looking good, that's great,
(09:52):
that baseline, that's great, right?
But then I think being able to assess, but do I feel well emotionally?
Do I feel well physically?
And if not, we don't want to end there.
You want to keep that conversation going.
And so as Dr. Levy, it sounds like, was mentioning, it's completely true that so many people with
IBD do have this overlapping, what I kind of consider like a more of a brain gut phenomenon
(10:16):
where these symptoms are really being driven by this miscommunication that's happening
between the gut brain axis.
And of course, of course, it commonly happens because that communication has been significantly
altered from the months or years of inflammation that a person's body has been experiencing.
(10:37):
So I would say to that and tools that we use really commonly for irritable bowel syndrome
or IBS are also quite effective for working with patients with IBD who are experiencing
those symptoms.
What are some of those tools?
I know that we've talked about them in the past, but what are the things that people
can use?
What are the boots on the ground, if you will?
(10:57):
Yeah, so for people that have access to working with the GI psychologist or a health psychologist
with that specific GI training, we use cognitive behavioral therapy that's specifically adapted
for GI conditions and we specifically adapt it for IBD as well.
And what that, just to not shell what that means is that we are really trying to understand
a person's thoughts, so cognitions and behaviors, the things that a person does or does not
(11:22):
do and how those actually impact the both gut symptoms itself and impact a person's
mental and emotional well-being.
And if we can understand the ways in which those thoughts and behaviors are serving a
person well and the ways that they might not be serving a person well, a mental health
provider can actually help a person little by little shift those thoughts and shift those
(11:45):
behaviors to actually help them work better.
It might seem surprising, but those are some of the things that actually change the communication
and our gut brain access that can actually improve symptoms.
The other evidence-based treatment that we have in psychogestroneurology is gut-directed
hypnotherapy.
I always kind of start by saying it's not actually as weird as it sounds.
(12:07):
I was going to say, tell me more.
Medical hypnosis has actually been used for decades and decades.
Hygienotherapy was actually developed for that purpose of paid management.
So in health psychology, it's still a tool that we use in our toolbox.
And it's been really well-studied and irritable bowel syndrome, but there has been some research
(12:28):
as well in applying this therapy and inflammatory bowel disease.
And it can be really helpful, not only for helping a person just improve their ability
to feel that they can cope with and manage their disease, but also in actually reducing
the symptoms themselves.
And so especially when we think about those symptoms that a person may experience when
they're in remission, but they're continuing to struggle and medications aren't really
(12:52):
staying on top of it, really both CBT and gut-directed hypnotherapy can be very helpful
tools.
And I use these every day with my patients with IVV.
And they're ones that I think people also just really enjoy learning.
It gives them a bit more control, something that they can do in addition to taking their
medications or whatever else is on their treatment plan.
(13:15):
That's amazing.
All right.
So I'm going to maybe think about antidepressants and anti-anxiety medications.
I'm going to get some CBT.
I'm going to think about gut-directed hypnotherapy.
What about some of the other complementary therapies that we've talked about like yoga
and meditation?
How do those things impact the mind-body connection and our experience of IBD symptoms?
(13:36):
Yeah.
And at this point, again, those are areas that are still growing in terms of research
and unfortunately research in some of these areas are hard to do and not as well-funded.
But I think in general, I see many people that really appreciate using those more complementary
treatments as well.
I think something like yoga is just in its essence a mind-body type of practice.
(14:01):
I think if you're doing it right, it should be meditative as well.
Even if you're getting really good exercise, it should be a meditative practice.
And then it is also really good exercise and our bodies really appreciate stretching.
They appreciate strength-building and flexibility.
And something that I also see among all of my GI patients, not just IBD, is that many
(14:24):
folks who experience digestive problems hold a lot of tension in their belly and in their
pelvic floor.
Maybe because of pain, because of discomfort, there can be this tendency to guard and it
can be difficult to unlearn that tendency.
And so things like stretching, like yoga practice, can be really helpful in just learning how
(14:46):
to relax those muscles, which can actually also be helpful in improving overall GI symptoms.
That is wonderful.
That's really good to hear because the complexity is there, but all of those things are things
that I have certainly had patients say have really helped them in their day-to-day lives.
So I think that's, I'm not a practitioner, but I lead our support group.
(15:07):
And so we have certainly a lot of back and forth about what is helpful, what is helpful
just in terms of symptom relief and feeling like you're in charge of your body and your
wellness.
So it's great to hear that there's at least some evidence base for that, if not as much
as we'd like.
As a takeaway, what would you want to tell every patient with IBD in terms of their mental
(15:31):
health?
What is one thing that you would want them to do?
What's the one message you would like to share with your patients or with potential patients
or people who are living with IBD in regard to their mental health?
I think just a recognition for a stock that they're not alone.
I think similarly in my work, not only with individual patients, but also doing some group
(15:51):
work, it's like the most powerful thing to hear is that you're not the only one that's
struggling with some of these mental health concerns or having some of these broader psychosocial
concerns like problems with sleep, problems with sexual dysfunction, problems with body
image that, unfortunately, these can come along in the trajectory of living a lifetime
(16:12):
with IBD.
Not for everyone, not for every time, but I would say the majority of people are struggling
with at least a few of these factors.
So I think recognizing you're not alone, it's not unusual, but also recognizing that there
is help when it comes to treatment of let's even say depression and anxiety.
We do have very effective treatments for that, whether it is medications like antidepressants
(16:36):
that by the way can be helpful for both depression and anxiety.
Those can be wonderful tools to add to a person's toolbox.
And so even though I'm not a prescriber of medications, I'm very supportive of people
going and getting an evaluation with their primary care provider or a psychiatrist to
see if those might be options.
Those can be very helpful.
(16:57):
But also, cognitive behavioral therapy and a few other different types of psychological
therapies are also very effective in treating both depression and anxiety.
And if you have access to be working with someone, even for a few sessions who has some
of that IBD specific experience, that can be really helpful in just understanding what
(17:19):
are some of the specific factors related to the IBD that might be driving the depression
and anxiety.
Even if then that treatment might need to be continued with a mental health provider
that is more specialized in treatment of depression and anxiety.
I make those referrals a lot too.
And again, I would just say that maybe finally, just remembering that mental health is sometimes
(17:41):
a bit more of a narrow scope, but even just thinking about psychosocial factors more broadly,
social factors that can include mental health, but also social factors like stress and stigma.
And like I mentioned before, body image and sexual functioning, that these are all important
factors when we are just considering the whole person beyond the disease living at IBD.
(18:06):
Absolutely.
That's such a good message and such a wonderful place for us to conclude this discussion because
it is, it's your whole life, right?
This disease impacts your whole life and it is your whole person.
So being mindful of that as you are pursuing your treatment and on your journey is so useful.
(18:26):
Dr. Bedelll, you are a wealth of wisdom.
I am always so delighted to speak with you and to have you on our team.
I don't know how you do it.
And I hope that we are going to continue to expand the GI behavioral health resources
that we have for folks because I think everybody should have an appointment with you when they
start coming to the University of Chicago for their IBD care.
(18:51):
Thank you so much for coming and for being with us today.
Thank you so much for having me.
It was a delight as always.
Thank you for listening to this episode of the podcast, Visceral, from the GI Research
Foundation.
This episode was written and produced by me, Anna Gomberg, and edited and mixed by the
incredible Mike Collins-Dowd, who also composed our theme music.
We hope you will join us next time.
(19:12):
Until then, to access other podcasts and to learn more about research, to treat, prevent,
and cure digestive diseases, please visit the website at giresarchfoundation.org.
That's giresarchfoundation.org.
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