Session: CBT for Chronic GI Disorders (They’re More Common than You Think!)
Workshop 2 - CBT for Chronic GI Disorders (They’re More Common Than You Think!)
Friday, November 17, 2023
8:30 AM – 11:30 AM PST
Location: 404 (Entiat), Level 4
Earn 3 Credit
Keywords: Health Psychology, Treatment Development, Anxiety Level of Familiarity: All Recommended Readings: Kinsinger SW. Cognitive-Behavioral therapy for patients with irritable bowel syndrome: current insights. Psychol Res Behav Manag
2017;10:231–7., Shah K, Ramos-Garcia M, Bhavsar J, et al. Mind-body treatments of irritable bowel syndrome symptoms: an updated meta-analysis.
Behav Res Ther 2020;128:103462., Yeh H-W, Chien W-C, Chung C-H, et al. Risk of psychiatric disorders in irritable bowel syndrome-a nationwide, population-based,
cohort study. Int J Clin Pract 2018;72:e13212., Hunt, M. (2021). Coping with Crohn’s and Colitis: A Patient and Clinician’s Guide to CBT for IBD. Routledge: Taylor and Francis Group, New York, NY., Hunt, M. (2022). Reclaim Your Life from IBS: A Scientifically Proven CBT Plan for Relief Without Restrictive Diets, Second Edition, Routledge: Taylor and Francis Group, New York, NY.
Associate Director of Clinical Training University of Pennsylvania Philadelphia, Pennsylvania
Gastrointestinal disorders are exacerbated by stress and are also stressful. Irritable Bowel Syndrome (IBS) is a highly prevalent (approximately 10% of the population) disorder of gut-brain interaction that is highly co-morbid with anxiety disorders and depression and shares conceptual overlap with panic disorder, agoraphobia, social anxiety and ARFID. It also leads to considerable disability and distress. Managing these patients effectively requires a good understanding of the biopsychosocial and cognitive underpinnings of IBS as well as the kinds of avoidance behaviors that maintain and exacerbate both symptoms and disability. General CBT skills are essential, but incorporating GI specific phenomena (like bowel control anxiety and fear of food) are also important. There is significant empirical evidence supporting the use of CBT in treating IBS. The inflammatory bowel diseases (IBD: Crohn's Disease and ulcerative colitis), have clear pathophysiology, but share some of the same symptoms and can lead to heightened risk for secondary IBS. In addition, many IBD patients experience shame, avoidance and social anxiety about their condition. This workshop will cover what is known about the etiology and symptoms of IBS, how IBS patients present in clinical practice; IBS in the context of co-morbid panic and agoraphobia, social anxiety disorder, ARFID and depression; formulating appropriate treatment goals and basic cognitive and behavioral strategies for treating IBS, including IBS that is comorbid or secondary to a more serious IBD. Case material reflecting patients along a spectrum of severity will provide for lively discussion and acquisition of new skills and techniques. Audience participation, clinical questions and role-playing will be welcomed, leading to interactive, experiential, in-depth training. Application of evidence-based psychotherapies to chronic GI disorders is now referred to as psychogastroenterology. Unfortunately, there are very few providers trained in GI informed psychotherapy. We desperately need more skilled clinicians to treat this large and underserved population. ABCT's membership is an obvious target audience, since they bring solid CBT skills and need only acquire an understanding of GI specifics.
Outline: • Prevalence, etiology, presentation and psychiatric co-morbidity of both Irritable Bowel Syndrome and Inflammatory Bowel Disease. • Cognitive (e.g. catastrophizing) and behavioral (e.g. agoraphobic avoidance and dietary restriction) factors that exacerbate distress and disability. • How to modify standard CBT for depression and anxiety disorders to address GI specific issues including bowel control anxiety, ARFID, shame and secrecy.
Learning Objectives:
At the end of the session, the learner will be able to:
Identify when GI symptoms are causing or exacerbating distress and disability in treatment seeking psychiatric patients.
Develop a case conceptualization that integrates GI disorders with any co-morbid mood or anxiety disorders.
Identify the unique cognitive distortions and behavioral avoidance strategies (especially fear of incontinence and dietary restrictions) that tend to maintain and exacerbate distress and disability.
List the real complications, medication adverse effects and sociobehavioral complexities faced by patients with IBD.
Modify the standard CBT approach to treat GI patients effectively, including collaborating successfully with gastroenterologists and considerations about medication.
Long-term Goals: Always ASK about GI symptoms with every new patient and incorporate GI symptoms into your case conceptualization.
Long-term Goals: Include GI specific knowledge in treatment planning and intervention.