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The brain helps to heal the gut

Overview: Researchers say that using psychological interventions such as CBT can help relieve anxiety and other symptoms associated with IBS.

Source: University of Pennsylvania

On the surface, the irritable bowel syndrome (IBS) subreddit is a den of ironic humor; the logo reinterprets the classic Reddit alien who feels uncomfortable in his tummy, scatological memes abound, and the most active members sit “on the porcelain throne”.

Joking aside, however, the online community is sharing stories of how the condition has tinged almost every aspect of members’ lives with shame and discomfort. In some cases, the resulting anxiety, depression, and avoidance can be debilitating, disabling, or even life-threatening.

“Spend 10 minutes on the IBS subreddit, and there will be at least one person who is suicidal, posting on that list and saying, ‘I can’t take this anymore. This has ruined my life,’” says Melissa Hunt, clinical psychologist at Penn’s Department of Psychology.

This is one of the reasons Hunt has spent nearly two decades studying and treating IBS, and why she has just published the second edition of her book “Reclaim Your Life from IBS,” which provides a proven treatment plan for people living with the IBS. suffer ailment.

A year after the first edition sold out, Hunt found copies selling for hundreds of dollars on eBay. In response to the question, she wanted to provide an update with more tools to aid in treatment, as well as an overview of the most recent developments in the field.

gut-brain connection

One of the most important advances is a better understanding of the mechanism of IBS, which is now characterized as a gut-brain interaction disorder, Hunt says. Gut signals that go undetected in individuals without IBS are instead relayed to and interpreted by the brain as pain or the urgent need to have a bowel movement. This can lead to anxiety, and the gut, which is lined with stress hormone receptors, responds by cramping and cramping.

“And then you go to the races with this positive feedback loop of increasing hypervigilance through the brain and then hypersensitivity in the gut,” Hunt says.

Symptomatically, IBS manifests as abdominal pain and either constipation, diarrhea, or alternating bouts of both, and by some estimates, as many as 15% of the population struggle with some form of the condition.

For those more prone to diarrhea, the fear of explaining frequent trips to the toilet or being too far away from an appropriate toilet can lead them to avoid social situations and eventually manifest as agoraphobia.

“People get incredibly paranoid: ‘I can’t go to a restaurant because I’ll have a seizure. I don’t want to get off the table and away from everyone, and what if the bathroom is occupied? It would be a disaster, so I should just stay home,” Hunt said. “Your life gets very small very quickly.”

The world-reducing nature of the condition, combined with frequent physical discomfort, can lead to despair. Many take extreme measures, usually in the form of dietary restrictions or multiple medications, in an attempt to reduce their symptoms.

However, even the effectiveness and side effects of many clinically prescribed interventions, such as laxatives or antibiotics, can vary. For example, a diet that often works well to treat IBS symptoms, called “low-FODMAP,” is so restrictive that adherence is virtually impossible unless patients can prepare each meal themselves, Hunt says. Counterintuitively, this diet can harm gut health by starving important gut bacteria, she says.

What these treatments all share is their focus on the “gut” side of the gut-brain interaction. Instead, Hunt focuses on the brain. She uses cognitive behavioral therapy to help patients reduce their anxiety and hypervigilance around gut sensations and encourages them to slowly expose themselves to foods and situations that they associate with their individual IBS symptoms.

She also teaches them to stop catastrophizing, falling into the mental trap that the worst outcome will be inevitable. This approach actually leads to a reduction in visceral hypersensitivity, allowing people to relieve symptoms while eating whatever they want.

“If half of what happens in IBS is the way the brain interprets those signals, then therapy that helps you reinterpret those signals in a different way will help,” Hunt says.

“That’s why talking about it will change their urgent diarrhea, which is hard to believe for some patients at first.”

Making treatment accessible

When Hunt initially tested and published a study of a low-intensity CBT treatment with limited but active therapist involvement, she was surprised by its effectiveness in reducing symptoms and improving quality of life, she says. . Several colleagues encouraged her to pursue larger studies and publish more on the topic.

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This shows the outline of a head and a brain

While more studies may look more prestigious, Hunt says she felt she could reach more patients and clinicians with a self-help book. So she wrote the first edition, which she tested with a randomized controlled trial, the gold standard for studying the effectiveness of a treatment.

This shows a man holding his belly
One of the most important advances is a better understanding of the mechanism of IBS, which is now characterized as a gut-brain interaction disorder, Hunt says. Image is in the public domain

As in the first study, the participating patients saw consistent improvements in their quality of life and IBS symptoms.

In the second edition, she examines the advances in treatment made over the past decade. She added a chapter on nutrition, examining recent research on restrictive diets and the ways healthy eating habits can help relieve symptoms.

She also delves into the benefits of exercise and non-judgmental ways people can motivate themselves in that area.

Hunt says she hopes the new edition will be helpful to patients and clinicians alike, including gastroenterologists and therapists.

Throughout the book, she offers more clinical anecdotes so readers can find a case that resonates, and she ends with two fake patient stories, showing how one might work through the text with and without a therapist.

Ultimately, Hunt says the book will give people like those on the IBS subreddit access to affordable, scientifically proven help.

“The real goal of treating IBS is to give people their lives back, not necessarily make the symptoms go away forever,” Hunt says.

“You can have GI discomfort from time to time — everyone has that — but you can still live a very rich, meaningful life.”

About this news about gut health and psychology research

Author: Luis Melecio-Zambrano
Source: University of Pennsylvania
Contact: Luis Melecio-Zambrano – University of Pennsylvania
Image: The image is in the public domain

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