Fight IBS with behavioral therapy

Kevin Yu think back to the terrible year his stomach was holding him "prisoner". There was constant pain, the constant need to use the toilet from the moment he woke up until he went to bed.

"The only times I felt really good was when I was sleeping or sleeping on the toilet," said the 38-year-old.

Yu also had a bad reflux and a "steady build up of gas" in her stomach. "All these really strange diseases," he said. The pain was so aggravated that Yu eventually went to the emergency room.

"The doctors could not understand anything," said the telecom product manager.

GI specialists at the University of Pennsylvania collected blood, stool samples and endoscopy; everything is negative.

"My doctor said, 'We do not see any physical signs that something is wrong with you,' which was good news, but I did not see it as good," he said. Yu said.

"They finally came to me and said," Kevin, we think you're in this big bucket of patients we're just calling irritable bowel syndrome, "or irritable bowel syndrome.

IBS is a chronic disease characterized by pain in the stomach, diarrhea or constipation or alternating between the two. According to the National Institutes of Health, it affects about 12% of Americans, or nearly one in eight people.

IBS treatments failed, doctors sent him to therapy

The doctors prescribed the drug Yu for the SCI. They also asked him to limit his diet to foods less likely to produce gas, known as low FODMAP.

"I literally did not eat anything for six months, except for rice and potatoes, basically." But, Yu said, rushes to the toilet continued, as did the pain.

That's when Yu's doctors said they wanted to try something new.

They suggested to Yu to see a psychiatrist who was working with their GI department. The psychiatrist suspected that Yu's stomach problems could be solved, in part, with an antidepressant.

Yu was extremely stressed at the onset of symptoms in 2015.

He had started a new job and worked at least 12 hours a day. Yu and his wife were in the middle of renovating their new home and they had tried, without success, to have a baby.

Yu recalled that the psychiatrist had told him, "Maybe you have IBS, but it's largely the link between your brain and your stomach."

A week after taking the antidepressant, Yu said, "I have noticed a dramatic change in my constant need for stool."

The psychiatrist suggested that Yu begin to see a clinical psychologist at the University of Pennsylvania, Melissa Hunt, specializing in cognitive-behavioral therapy for the treatment of chronic disorders of the IG.

Fight or flight: the intestine-brain connection

Yu had a breakthrough on her first visit with Hunt.

"It was like drinking water in a fire hose," Yu said. "I learned a lot."

Hunt explained what stress could cause to your stomach. "When you're anxiously excited and your body goes into a fight or flight mode, many biological processes occur, including increased heart rate, blood pressure, and breathing, increased sweating, increased muscle tension, and gastrointestinal discomfort, "she said.

Hunt explained that gastrointestinal discomfort may include "spasmodic cramps of the bowel" that will lead to urgency and the immediate need to go to the bathroom – in other words , diarrhea.

Stress can also lead to constipation, Hunt said, because muscle tension affects the pelvic floor and the sphincter muscles.

"Every time I'm under duress, I begin to realize that I'm squeezing my stomach," Yu said.

"When I looked into my life, I began to realize how much there was a connection between my brain and my stomach."

Deep breathing, fight against "catastrophic thinking", burning stress energy

During Yu's first therapy session with Hunt, they did some deep breathing exercises.

Deep breathing calms the nervous system and reduces anxiety.

"So, I take a deep breath and she says," Kevin, do you see how you take all the air out of your chest, and none of that goes to your stomach? You almost want to inflate your stomach. "

As his breathing deepened, what is called diaphragmatic breathing, "not only did I feel calmer, but I felt a sense of serenity that I had not felt for a long time."

Yu moves when he remembers that day, three years ago. "I had tears in my eyes.

"At that time, I realized that breathing was the best way to calm my anxiety and help calm me when I was in this state of great distress," Yu said.

Hunt asked Yu to practice deep breathing every day. She said to him, "It can be walking, watching TV, focusing on your breathing."

"I would say that in less than two or three weeks, I really started buying," said Yu. "When I suffer a lot, the pain goes from nine or ten to four or five. It was remarkable.

To worry about the pain has aggravated the pain

Although breathing alone helped, there were several other pieces of the puzzle. When Yu's stomach hurt, it sent him into a psychological fall.

He described his thought process as follows: "Oh, no! It's the end of the world. I will not be able to go to work. My employer is going to be disappointed. My wife will be disappointed that I can not help at home. "

Psychologists call this "a catastrophic thought".

"It was almost cyclical that my stomach would cause anxiety and yet my anxiety added to further discomfort," Yu said.

This is an important factor in the IBS system, said Hunt. It is called "visceral hypersensitivity".

"The pain signals from the intestine are amplified inappropriately," she said. It's like a feedback loop.

"If I was uncomfortable with gas, it was" I had a stomach ache ". If I had lactose intolerance, it was "I had a stomach ache," Yu said.

In just a few sessions, Hunt taught Yu how to be less anxious when he felt pain.

Hunt asked Yu, "Do not say it hurts. Say, "I feel bad on time".

Yu began to interpret the signals of hunger, anxiety and pain caused by the gases differently. "My mind begins to distinguish," OK, I know it's not painful; oh, it's hunger "or" I'm just a little stressed right now ".

Hunt also encouraged Yu to increase her physical activity to reduce the stress caused by flight or combat.

In recent months, Yu did not find the time to train as he did when he was younger. Instead, he played with his daughter (who was born during his therapy) and kicked the ball with his dog. Even gardening has made a difference for him.

The house version for IBS also works

Yu's success in cognitive behavioral therapy for IBS is not unique. Dozens of studies show its effectiveness in patients with IBS. Researchers at Harvard University examined 13 of them in a meta-analysis.

Patients who tried psychological approaches exhibited an improvement in their digestive symptoms superior to that of patients receiving only conventional medical treatment.

One of the most compelling studies has been published this year. This is the largest non-drug clinical study on federally-funded irritable bowel syndrome. The study found that more than 60% of patients reported a substantial improvement in their gastrointestinal symptoms in just four or fewer visits to the psychologist, in addition to working from home. They practiced deep breathing and worked to change their tone of self so as not to disrupt events and other known triggers.

They also learned to "improve their flexibility in how they approach problems," said Laurie Keefer, principal investigator of this study.

Keefer is a gastrointestinal health psychologist and director of psycho-behavioral behavior research at Mount Sinai School of Medicine.

"We ask patients to write their stressors so that they can look at them a little more objectively," she said. "These homework is really at the heart of this type of therapy. When they look at their stressors, they challenge their approach to them. "

For example, people write their worst fears and how they feel. Then the patient examines this fear objectively. What is the probability that the worst case scenario will occur? Often, this is unlikely to happen. If this happens, the patient writes how he will manage it so that there is a manageable plan.

"People continued to benefit a long time after stopping the intervention. We found that patients were still doing very well after one year of follow-up. "

Keefer said many people were reluctant to consult a psychologist because of the stigma that still surrounds the treatment. Trying these methods at home also reduces expenses.

"Access to therapists performing this type of treatment is very limited," she said, but the study shows that learning some of these methods for practicing at home is effective.

"I'm doing very well today"

Yu has been experiencing IBS contractions for the first time for three years. Today, he rarely suffers. He regularly practices deep breathing, both when he feels the onset of stress and when he watches TV or relaxes. He continues reprogramming his thoughts and negative reflections on himself. "Something as simple as a simple stream of thought can really dramatically change your life," Yu said.

"I'm back to live my life. I reach out to my friends, "he said.

"I'm no longer in my twenties. I can not face the world anymore. I had to step back to do things one at a time. I am not Superman. "