For the past 20 years, the role of the clinical psychologist in the management of chronic digestive disease has evolved into the newly recognized field of psychogastroenterology. Like other specialties within behavioral medicine, psychogastroenterology focuses on the intersection of chronic medical diseases impacting the digestive system and their subsequent social and emotional impacts.
Research into the brain-gut axis continues to advance rapidly as our understanding of how the brain impacts gut function and vice versa, including the addition of the gut microbiome, identifies unique physiological pathways and patient phenotypes to better classify and treat digestive disease.
While science has quickly progressed, the number of clinicians specializing in this area has lagged behind considerably, creating a dearth of qualified professionals to meet the growing needs of digestive disease patients. As such, opportunities for clinical psychologists to work within the field of psychogastroenterology are immense.
Psychologists within psychogastroenterology treat patients living with chronic digestive diseases such as inflammatory bowel disease (IBD; Crohn’s disease, ulcerative colitis), irritable bowel syndrome (IBS), gastroparesis, celiac disease and gastroesophageal reflux disease (GERD).
There are psychologists embedded within gastroenterology clinics at university-based medical centers across the country, including Mount Sinai in New York, Northwestern University Feinberg School of Medicine, Stanford University and the University of Michigan. Others work within private practices in the community, often servicing overflow patients from the university centers or treating patients from private medical practices.
Most gastroenterologists appreciate the value of psychological services for their patients yet often struggle to connect with proper resources.
A key role psychogastroenterology therapists play is treating refractory symptoms of chronic digestive diseases through evidence-based treatments such as cognitive behavioral therapy and gut-directed hypnotherapy, both having multiple randomized clinical trials supporting their efficacy in several disease groups.
Since psychogastroenterology psychologists have their training foundations in clinical health psychology, they are engaged in similar tasks as those who work with patients with cancer, diabetes or cardiovascular diseases. Most commonly they help with adjustment to a chronic, lifelong disease, teach disease self-management skills, treat co-morbid anxiety or depression and help with medical treatment implementation and adherence.
Psychologists in this field also educate physicians on the brain-gut connection and how it impacts patient outcomes. A particularly important aspect of the work of a psychogastroenterology psychologist is to de-stigmatize the role of psychological stress in digestive disease and effectively communicate to patients that while their brain may be influencing their illnesses, their symptoms are not “all in their heads.” Unfortunately, stigma can be a barrier to patient engagement in psychogastroenterology services, but can often be mitigated with proper communication and support.
What types of patients come to a psychogastroenterology practice? Generally, irritable bowel syndrome and other disorders of gut-brain interaction (DGBI; formerly referred to as Functional GI disorders) are the most common referrals.
Irritable bowel syndrome impacts approximately 10 percent to15 percent of the U.S. adult population, making it one of the most common conditions seen in primary care and gastroenterology practices. Pharmacological treatment efficacy for IBS is modest (30 percent to 40 percent) and often targets symptoms versus the underlying mechanisms of disease.
Conversely, psychological interventions for IBS directly target the dysfunctional brain-gut connection believed to be perpetuating symptoms. As such, 60 percent to70 percent of patients report significant relief from their IBS symptoms after engaging in either CBT-IBS, mindfulness-based stress reduction or gut-directed hypnotherapy.
Due to the success of these interventions in both research and clinical practice, they are now applied across the digestive disease spectrum. For more information on gut-directed hypnotherapy, which requires specialized training to incorporate into practice, visit http://www.ibshypnosis.com/.
Unfortunately, as of 2019, the American Psychological Association does not recognize psychogastroenterology as a specialty. However, the Rome Foundation, a leading international organization dedicated to digestive diseases, established the Rome Psychogastroenterology group in 2018.
If a psychologist is interested in learning more about psychogastroenterology, connecting with the Rome group is the best place to start (https://romegipsych.org). Current gaps in access to psychogastroenterology care leave many patients struggling with chronic digestive disease and underscore the imperative need for more clinical health psychologists to consider psychogastroenterology as a specialty.
Tiffany Taft, Psy,D., is a clinical psychologist specializing in psychogastroenterology. She is director of psychogastroenterology research at Northwestern University Feinberg School of Medicine in Chicago and owns a group private practice, Oak Park Behavioral Medicine. Her email address is: firstname.lastname@example.org.