Inflammatory Bowel Disease and Mental Health

Looking after your mental health is an important part of living with Inflammatory Bowel Disease (IBD).  People with IBD are at an increased risk of experiencing mental health problems such as depression and anxiety.  Additionally, these psychological problems can make IBD harder to manage.

Biopsychosocial management of IBD

When we think about how IBD is managed, the primary focus is on the physical aspects of disease:

• Inflammation
• Symptoms
• Medications
• Surgery

But people with IBD also commonly experience emotional and psychological concerns related to their IBD.  Examples include:

• Stress
• Fear
• Sadness
• Adjustment difficulties
• Low self-worth
• Body dissatisfaction
• Disordered eating

And there is also the impact on a person’s social health and functioning to consider:

• Social limitations
• Relationships
• Isolation
• Stigma
• Sexual functioning

Mental health and IBD

The stats look grim: about one third of people with IBD experience high distress, increasing to two thirds when the disease is active.  For those in remission, people with anxiety are twice as likely to experience a flare than those without anxiety.  Psychological problems are associated with worse disease outcomes, including more frequent flares, greater severity of disease, more presentations to emergency, more hospital admissions and, in Crohn’s Disease, more surgery.

Regardless of what is happening with your underlying disease activity, it is also worth noting that psychological factors can make your symptoms worse.  For example, worry and stress can affect the digestive system, thereby exacerbating abdominal pain, urgency and other gut symptoms.

Mental health and physical health are closely connected, therefore it makes sense that a problem in one area can affect a problem in the other.  Looking after mental health is therefore an important part of looking after your IBD.

Psychological treatment

It’s not all bad news! There are things you can do to help maintain good mental health. Psychological treatment is useful in IBD patients who have mental health problems (such as anxiety or depression), want to develop healthier habits (e.g. quitting smoking), need assistance in IBD self-management, or have functional symptoms (such as Irritable Bowel Syndrome) in addition to their IBD.

Here are a couple of examples of the types of psychological treatment that you might experience if you do seek help:

Cognitive Behaviour Therapy (CBT)

Cognitive Behaviour Therapy is one of the main treatments for people with psychological disorders such as anxiety and depression.  In IBD, CBT has been found to improve mood (in the short-term) and increase mental quality of life. CBT is based on the idea that how we think and behave influences how we feel. In CBT you are taught to identify and change unhelpful patterns of thinking and behaviour, and learn practical skills and strategies to help you cope.

Hypnotherapy

Hypnotherapy is based on the idea that the hypnotic state of mind is more open to and accepting of suggested changes. It is characterised by an altered state of consciousness, heightened focus and internal absorption.  The positive suggestions provided in gut-directed hypnotherapy are about improved gut health, healing and functioning.

Hypnotherapy is an established treatment for Irritable Bowel Syndrome and other functional gastrointestinal disorders, but currently there is minimal research into its usefulness for IBD. A pilot trial into the use of hypnotherapy for Crohn’s Disease is currently being conducted at the Royal Adelaide Hospital.  You can contact the researchers at this email if you are interested in finding out more about the study and participation: Health.RAHGASTROENTEROLOGYSTUDY@sa.gov.au.

Where to get support

There are many places to get support if you’re struggling. You can always self-refer to a psychologist or go to your GP for assessment and referral.  Under a Mental Health Care Plan (MHCP) or a Team Care Arrangement (TCA) you may be eligible for rebated psychological treatment sessions; speak to your GP about whether you are eligible for one of these options.

Your IBD specialist or GP may be able to assist with recommendations for psychologists who have experience working with people with IBD, or health psychologists who are trained in working with people with chronic health conditions.  You can also visit https://www.psychology.org.au/Find-a-Psychologist, conduct a google search, or ask any IBD community you may be connected to.

Online options

As well as in-person support, you can also access some self-directed programs online, with the following two options developed specifically for people with IBD:

Tame your gut is a 10 week program developed by the IBD Clinic at the Royal Adelaide Hospital.

Mind over gut is a 5 week program developed by Associate Professor Simon Knowles, Researcher and Clinical psychologist at Swinburne University.

Support groups

Crohn’s and Colitis Australia run support groups in most states and territories, where you can connect with like-minded people to be reminded that you’re not alone.

Support numbers

Sometimes you may not be able to access treatment right in your time of need. The following services offer phone counselling and online chat options:

• Lifeline – 13 11 14
• Beyondblue – 1300 22 4636

If you are in crisis, please call mental health triage for emergency support – 13 14 65

Resources

Some great books on how the mind-gut connection works:

• IBD and the Gut-Brain Connection: A patient and carer’s guide to taming Crohn’s Disease and ulcerative colitis, by Dr Antonina Mikocka-Walus,
• The Mind-Gut connection: How the hidden conversation within our bodies impacts our mood, our choices and our overall health, by Emeran Mayer, MD
• Gut: the inside story of our body’s most underrated organ, by Guilia Enders

Speak with your GP, gastroenterologist and IBD about your mental health. They are there to help and can assist you in finding suitable treatment when you need it.

Contributed by Taryn Lores