Psychological Intervention For Gastrointestinal Disorders

Psychological Intervention for Gastrointestinal Disorders
 Psycho education:-
Indicate that the GIDs are very real and the intestine is overly responsive to a variety
of stimuli such as food, hormonal changes, medication, and stress.
Pain resulting from spasm or stretching of the gut, from a sensitive gut, or both, can
be experienced anywhere in the abdomen and can be associated with changes in GI
function leading to symptoms (eg, patient greater responsibility and control regarding
the treatment, and improve pain tolerance.)
 Brief Psychodynamic Psychotherapy:-

Svedlund, Sjodin, Ottosson, and Dotevall (1983) reported one of the first controlled
trials of psychotherapy for IBS. In 101 patients recruited from a medical clinic, they
compared standard medical care (bulking agents, anti-spasmodic and tranquilizing
medications) to standard medical care plus brief (10 sessions) psychodynamically
oriented psychotherapy,
focused on the identification of stress and emotions contributing to bowel
symptoms and then the development of effective coping strategies. The results
indicated that the psychotherapy condition was more effective than that of standard
medical care on reducing reports of abdominal pain, bowel dysfunction,and somatic
complaints. Interestingly, symptoms of anxiety and depression improved similarly in
both conditions.
 Hypnotherapy:-
Hypnotherapy is a state of unusual concentration on the suggestions of the therapist
and a willingness to follow their instructions.
Whorwell et al have reported well constructed controlled trials of hypnotherapy in

IBS.
The technique is focused around a specific “gut directed” hypnosis protocol

where the patient is taught to assert control over gut function and imagery whilst
in an hypnotic state.
Patients are given a simple account of intestinal smooth muscle physiology and
hypnotised in a standard manner.
The patient is then requested to place their hand on the abdomen and to sense both a
positive feeling of abdominal warmth and increased control over gut function.
During hypnosis, visualisation is also employed, using the analogy of a gently flowing
river and a gently flowing bowel to reinforce a positive bowel image.
general relaxation and mental imagery focused on warmth and relaxation of the gut
and abdominal area, specifically, to a medication placebo and physician support.
Cognitive Behavioral Therapy:
 CBT is based on the theory that maladaptive thoughts are the causes of psychological
symptoms such as anxiety and depression, which in turn cause or exacerbate physical
symptoms.
 An example would be a patient who believes that eating in a public place will
always cause them to have diarrhea and other embarrassing symptoms (a catastrophizing
maladaptive thought), which might lead the patient to both avoid social interactions (self
defeating behavior) and to become anxious when dining in a restaurant.
The anxiety and autonomic arousal caused by this maladaptive thought may actually trigger
diarrhea.
The therapist aims to help the patient recognize maladaptive thoughts and self-defeating
behavior patterns that are adversely affecting life functioning, symptom experience, and
mental wellbeing.
Therapy tasks commonly include increasing awareness of the association between

stressors, thoughts, and symptoms; examining and correcting irrational beliefs; countering
automatic negative thoughts; observing and problem-solving factors that exacerbate
symptoms; and identifying and adopting alternative, more effective coping strategies to
handle challenging life situations and deal with gastrointestinal symptoms.
 Stress Management: learning effective stress management techniques may be beneficial

for your disease outlook and may decrease the severity of your gastrointestinal symptoms.
Here are some helpful suggestions to manage stress.
 Eat a well-balanced diet: - Good nutrition is the key to both good physical and mental
health. Inadequate nutrition increases stress on your body and decreases its ability to heal.
Choose foods wisely and, in addition to reducing stress, your body will love you for it!
 Become a better breather by learning to breathe more slowly and deeply from your
abdomen. Stress can cause shallow breathing, which means that your body won‟t get
enough oxygen to fully relax unless you consciously make an effort to breathe deeply.
 Watch your „self-talk‟ because much of our anxiety is self-induced, meaning that we
often get ourselves wound up worrying about worst-case scenarios or blowing small
incidents out of proportion.
 Monitor your negative thoughts to see how often you fret about things such as making
mistakes or losing your job. Try to substitute a negative thought with a positive, but
realistic one.
 Get physical because exercise is a well-known tension reducer. Take care to increase
exercise slowly and assess your body‟s tolerance to this as you do. Use caution though, as
high-impact exercises might exacerbate gastrointestinal symptoms in persons with
gastroesophageal reflux disease (GERD), hiatus hernia, Crohn‟s disease, and ulcerative
colitis.
Become a better time manager so time doesn‟t manage you. Many of us underestimate
the amount of time it will take to do something, which means we‟re often running late.
Try keeping a time management log for a week to get a better idea of how much time
various tasks actually take.
 Learning to say no is a very good idea. Thinking you can „do it all‟ creates unnecessary
pressure. Learn how to set boundaries for yourself. Politely, yet firmly, turn down
additional responsibilities or projects for which you don‟t have the extra time or energy.
 Take time out for yourself. Our minds and bodies require a certain amount of variety or
else our overcharged nervous systems will keep speeding right into the next day. Try to
take at least one day off each week to do something you really enjoy, whether it‟s
reading, listening to music, or just hanging out with friends
 Have a good belly laugh. Laughter is a natural stress reliever that helps to lower blood
pressure, slow your heart and breathing rate, and relax your muscles.
Relaxation therapy:- Given that IBS is a disorder of brain-gut and mind-body

interactions, many individuals find symptom relief and an improved sense of
wellbeing when they incorporate simple relaxation techniques into their daily lives.
Although stress is inevitable, if not managed well, it can become detrimental to one‟s
physical and emotional health. Thus, a regular practice of deep relaxation is
associated with several health benefits including:
 a reduction of generalized anxiety,
 increased energy levels and productivity,
 improved concentration and memory,
 improved sleep,
 decreased fatigue,
 increased sense of self-confidence, and
 reduced muscle tension.
Biofeedback Therapy:-
 Biofeedback is a behavioural technique that uses visual or auditory cues to teach patients
to alter physiological responses. With biofeedback, physiological events which are not
normally appreciated by the patient are sensed by a technological interface and amplified
to give the subject visual or auditory feedback.
 The biofeedback loop is based on the polygraph (“lie detector”) which monitors tiny
changes in electodermal conductivity occurring in response to stress and relaxation.
 Changes in cutaneous electrical activity are electronically transformed into a
computerised animation of the gut shown on the computer screen. This animation
can be controlled by the patient who learns to manipulate the computerized
representation of bowel movement using a combination of mental and physical
relaxation.
 In a study of computer aided gut directed biofeeback, 40 IBS patients who were
refractory to conventional treatment underwent 4 half hour biofeedback sessions. Eighty
percent of the patients learned to achieve progressively deeper levels of relaxation, and in
50%, the technique was reporte helpful in controlling bowel symptoms.
Diet:-
Eating causes rhythmic contractions of the colon. Normally, this may cause a person to have
a bowel movement 30 to 60 minutes after a meal. In a person with IBS, the urge to defecate
may come sooner and may be accompanied by pain, cramps, and diarrhea.
 Many people say their IBS symptoms are triggered by eating certain foods.
As a result, treatment includes figuring out which foods are the culprits and avoiding them
when you eat.
Changes in diet reduce IBS symptoms in 50 to 70 percent of people.
Foods that commonly trigger IBS symptoms include:
 Dairy products
 Caffeine
 Fatty foods
 Vegetables, like beans or broccoli, that cause gas
 Foods containing the sweeteners sorbitol and fructose
 Wheat cereals
 Alcohol
Before changing your diet, take note over the course of several days which foods seem to
cause problems. You may want to consult a dietitian to help you adhere to healthful eating
strategies, such
as:
Drinking six to eight glasses of water a day, especially if you have diarrhea. Drinking
carbonated beverages can increase discomfort from gas.
Eating more fiber. Dietary fiber often helps reduce IBS symptoms in both patients who
have constipation as well as those who have diarrhea. Whole-grain breads and cereals,
fruits, and vegetables are good fiber sources. Starting a high-fiber diet may cause gas and
bloating for a few weeks.
Fiber supplements such as bran, psyllium derivatives, or polycarbophil (20 to 30

grams/day) may help relieve constipation and may also reduce diarrhea.
Eating smaller meals more often or eating smaller portions.
Large meals can cause .cramping and diarrhea.
Consuming probiotics, such as yogurt or acidophilus supplements. Some patients find

they help reduce symptoms. Research suggests that adding "good" bacteria may help
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Psychological Intervention for Gastrointestinal Disorders

 Brief Psychodynamic Psychotherapy:-

Whorwell et al have reported well constructed controlled trials of hypnotherapy in

The technique is focused around a specific “gut directed” hypnosis protocol

Therapy tasks commonly include increasing awareness of the association between

 Stress Management: learning effective stress management techniques may be beneficial

Relaxation therapy:- Given that IBS is a disorder of brain-gut and mind-body

Changes in diet reduce IBS symptoms in 50 to 70 percent of people.

Foods that commonly trigger IBS symptoms include:

Fiber supplements such as bran, psyllium derivatives, or polycarbophil (20 to 30

Eating smaller meals more often or eating smaller portions.

Large meals can cause .cramping and diarrhea.

Consuming probiotics, such as yogurt or acidophilus supplements. Some patients find

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