Psychologist

Most people are familiar with the Central nervous system (CNS) and the autonomic nervous system (ANS), however few are aware of the gut’s own nervous system, the enteric nervous system (ENS). Although the ENS, regulates gut function and can operate independently of the CNS, it is important to know that constant communication occurs between the brain and the gut. The bi-directional communication between the brain and the gut occurs primarily via the 10th cranial nerve, also knowns as the Vagus nerve. Messages and signals between the brain and the gut are also communicated through neurotransmitters such as dopamine and serotonin as well as hormones. Serotonin is involved in both appetite and digestion as well as playing an important role in mood, memory and social behaviour. In other words, what happens in the brain effects the gut and vice versa.

When gut symptoms such as pain, nausea, reflux, bloating, diarrhea and constipation are not caused by identifiable structural or biochemical abnormalities such as cancer or inflammatory bowel disease, we refer to them as Functional Gastrointestinal Disorders. It is estimated that around 30% of the population live with some form of functional gut disorder. The most common FGID is Irritable Bowel Syndrome or IBS. The exact cause of FGIDs is unclear, but it is most likely a combination of genetic and environmental factors coupled with altered brain-gut interactions. In fact, Functional Gastrointestinal Disorders are increasingly referred to as “disorders of the brain-gut interaction”. An intestinal infection (gastroenteritis) or stressful life event may for example be a trigger for genetically predisposed IBS. Antibiotic use may trigger IBS due to altered gut flora and hormonal changes in pregnancy could worsen IBS symptoms and so on. This disturbance in the brain-gut interaction effects pain perception and pain modulation as well as gut motility, resulting in heightened sensitivity to pain accompanied by changes in bowel habits. Thoughts, feelings and stress can all have a significant impact on gut functioning and may trigger or worsen symptoms. The thought alone, of not finding a bathroom in time, may trigger symptoms. Children who e.g. worry about school, teachers and friendships often experience tummy pain.

Living with gastrointestinal concerns, whether functional, such as IBS, or organic, such as Crohn’s disease or Ulcerative Colitis, can often negatively affect a person’s functioning, psychological well-being and quality of life. Psychological care aims to reduce gut symptoms, anxiety and stress and improve mood, self-confidence and overall quality of life. Research tells us that a large number of people how experience gut issues also experience anxiety, stress and at times low mood. Brain-Gut psychotherapies work on the two related pathways targeting abdominal pain, visceral hypersensitivity (gut sensitivity) and gut motility (bowel habits) as well as facilitating improved coping, resilience and self-regulation skills. Evidence-based psychological techniques applied to gastrointestinal concerns include Cognitive Behavioural Therapy (CBT), Mindfulness based practices and Gut-Directed Hypnotherapy. These therapies have been found to improve the symptoms and psychological distress associated with GI concerns. Your GP, gastroenterologist, or other specialist may recommend a combination or medication, diet and psychological therapy.

The primary focus of treatment is the relationship between thoughts, feelings, physical sensations and behaviours. For example, clients learn to recognise and challenge unhelpful automatic thinking patterns, to engage in relaxation exercises and to change behaviours (i.e., avoidance and isolation) that may contribute to physical or psychological distress.

CBT used in the treatment of IBS, includes psychoeducation about the stress response and its relationship to gut symptoms, building insight into cognitive and behavioural responses to IBS symptoms and/or fear of symptoms, improve problem solving, pain and distress tolerance, reducing catastrophizing and decrease physical reactivity to stress.

There is strong evidence supporting the use of CBT as a first line therapy in IBS and it has been shown to reduce abdominal pain and improve diarrhoea and constipation, as well as reducing psychological distress and improving quality of life.

Medical hypnotherapy as practiced by Jessica Koch, is safe and you are in control at all times. Clients are made comfortable and gradually placed into a state of hypnosis or deep relaxation.
In this state the subconscious mind is more active than the conscious (critical) mind and we absorb information easier, such as the suggestions given for the control and normalisation of gastrointestinal functioning. Guided imagery and metaphors are used to help bring about change
and suggestions are aimed at reducing gastrointestinal symptoms, including but not limited to pain, visceral sensitivity and bowel habits.

Gut-Directed Hypnotherapy has been shown to be of superior efficacy to that of the low FODMAP diet.

There is evidence to suggest that stress is the number one predictor of acute IBD flare and as such stress reduction is an important part of IBD treatment. Treatment focus is also on coping with illness, improve positive mindset and offer supportive counselling as well as addressing any underlying symptoms of anxiety and/or depression. Gut-directed hypnotherapy in the treatment of IBD focuses on reducing inflammation and improving disease activity. It is also important to remember that a large number of people with IBD also have symptoms of at least one functional gut disorder, such as IBS. Gut-directed hypnotherapy can assist by reducing visceral hypersensitivity or the intense focus and awareness of gut sensations that can negatively impact pain perception, bowel habits and psychological distress.

Mindfulness focuses on the non-judgemental awareness and acceptance of the present moment and requires regular practice. Using e.g. relaxation and meditation, you practice a non-reactive mindset in daily activities with the goal to notice and accept physical and/or mental discomfort. A recent IBD study found mindfulness improved anxiety and depression and improved quality of life, compared with the control group. In IBS, mindfulness has been shown to decrease sensitivity to pain and related gut sensations as well as decrease catastrophic thinking related to symptoms.