GI Psychologists for Ulcerative Colitis

When Sam Jactel, a Boston-based entrepreneur, was diagnosed with ulcerative colitis (UC) in 2014, he had access to some of the best doctors in the city. And yet, he still had trouble coping with his diagnosis.

“As you can imagine, being told you have an incurable disease is a bit of a shock to someone’s system,” he says.

Jactel isn’t the only person to feel this way. The symptoms of ulcerative colitis — fatigue, nausea, vomiting, weight loss, and diarrhea — can take a toll on your body and mind. A study published in May 2021 in The Lancet Gastroenterology & Hepatology found that up to 1 in 3 people with inflammatory bowel disease (IBD) have anxiety, and 1 in 4 have depression.

What’s more, when a person’s IBD is active, those rates tend to increase, according to the study. This may be partly due to inflammation in the body, which can be transmitted from the intestines to the brain, according to research published in November 2021 in Gut Microbes.

Jactel soon sought help from a gastrointestinal (GI) psychologist — a doctor who specializes in treating the anxiety and depression that can occur in patients who have chronic digestive diseases, such as IBD. His experiences led him to found Ayble Health, an app for people with IBD that offers dietary advice, health coaching, and more.

“Over the years, my psychologist has helped me see my condition as a source of strength, rather than embarrassment,” he says. “[They’ve also] helped me feel comfortable speaking about my condition on my own terms and feel like I was in control of my condition, rather than the other way around.”

What GI Psychologists Do

The field of GI psychology is growing, and today more IBD departments and treatment centers employ specialists who can teach their patients how to cope.

“We help address GI-specific anxiety or worry about your symptoms and can help optimize resilience and the use of healthy coping skills,” says Megan Riehl, PsyD, a GI psychologist and clinical director of the GI behavioral health program at the University of Michigan in Ann Arbor.

Alleviating the symptoms of anxiety and depression can also help keep UC in remission, says Madison Simons, PsyD, a GI psychologist at Cleveland Clinic’s Digestive Disease & Surgery Institute.

Sometimes, people seek the help of a GI psychologist when they’re first diagnosed, says Dr. Riehl. But, even if you’ve been living with IBD for years, you can still benefit from seeing a psychologist. “You may learn strategies to help you relax your body, develop healthy lifestyle behaviors, and manage stress,” Riehl adds.

Another time to seek out a specialist is if your UC symptoms are having a significant negative impact on your quality of life — for example, causing you to skip activities that you might otherwise enjoy or miss meals (or fear eating altogether), because doing so may trigger pain or discomfort, says Dr. Simons.

How Do GI Psychologists Treat IBD-Related Stress?

Two types of treatment have been studied extensively for GI psychotherapy. The first is gut-directed hypnotherapy, in which the GI psychologist brings you into a very deep state of relaxation and then asks you to imagine that you are free of abdominal pain and other discomfort.

A study published in the journal Alimentary Pharmacology & Therapeutics found that people with UC who received gut-directed hypnotherapy were able to prolong their remission by 78 days. Of the people who received hypnotherapy, nearly 70 percent maintained remission for a year, compared with only 40 percent of those who didn’t receive hypnotherapy.

The second tool is cognitive behavioral therapy (CBT), which helps the brain perceive and respond to UC symptoms in a more positive, accepting way. A study published in December 2021 in the journal BMC Gastroenterology found that CBT has shown short-term positive psychological effects on people with IBD, but more research is needed on its long-term effects.

Because IBD tends to flare up and subside in cycles, you may only need to see a GI psychologist when your symptoms are acting up. It’s also common to work with a GI psychologist for a short period and then come back later — even years later — during particularly stressful times.

“If you’re going through something very difficult, that’s probably a time for you to reconnect with us,” says Simons.

How do you know whether you should see a GI psychologist versus a general psychologist? If your UC symptoms are the biggest cause of your stress, you may benefit most from a GI psychologist. If you’re experiencing more overall stress, you may want to see a general psychologist. But, you don’t have to see just one or the other. “Often, people see both simultaneously,” says Simons.

GI psychologists can’t write you a prescription, but they work closely with your other doctors and can let your primary care physician know if you may be a candidate for antidepressant medication, says Simons.

How to Find a GI Psychologist

Start by asking your gastroenterologist for a referral to a GI psychologist in your area or searching for one online by visiting the Rome Foundation, a nonprofit organization for people who have gut disorders.

If you see a GI psychologist who is part of a larger medical center, their services may be covered by health insurance. If they have a private practice, they don’t always accept insurance, says Simons.

You can also connect with a GI psychologist via telehealth.

Just as it would when working with a GI psychologist in person, it takes time to notice benefits from working with apps. “We would want them to engage regularly with the app — daily or almost daily — for at least six to eight weeks to get the most benefit out of that treatment,” Simons says.

“Working with a GI psychologist is an incredibly powerful tool for managing ulcerative colitis,” Jactel says. “It helps retrain the communication that happens between the mind and the gut and can equip you with skills that promote long-term emotional resilience in order to manage what is a lifelong condition.”

Simons seconds these thoughts. “It usually makes a tangible impact on a patient’s symptoms and quality of life. That’s really the big reason there’s so much demand for them: People’s lives get better.”