Behavioral medicine addresses a range of biological, social and psychological influences that affect patients’ health. It teaches strategies that reduce symptoms of illness and improve ability to cope with it. This integrative approach leads to better outcomes than one focused solely on biological approaches.
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Perhaps nowhere is a behavioral medicine model more important than in those with gastrointestinal disorders, in which physical distress can trigger psychological symptoms and vice versa. Researchers believe this is due to “crosstalk” between the central nervous system and the enteric nervous system — the hundreds of millions of interconnected nerve cells located between the tissues in the digestive tract that are often referred to as our “second brain.” The enteric nervous system plays a key role in several physical illnesses as well as in emotional health.
“We’ve known of this brain-gut connection for a long time,” says Judith Scheman, PhD. “We commonly say things like ‘I have butterflies in my stomach,’ ‘That makes me sick,’ or ‘That was gut-wrenching.’”
Dr. Scheman is heading up a new behavioral medicine program embedded in Cleveland Clinic’s Digestive Disease & Surgery Institute. The program offers services that extend from preoperative care to dealing with such chronic conditions as irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD).
“I offer a range of therapies,” Dr. Scheman says, “and although such treatments require a time investment from patients initially, they may reduce the need for frequent doctor visits in the long run.”
Techniques to deal with anxiety, depression and stress
Dr. Scheman has a number of treatments designed to help patients modify stress-inducing thoughts and emotional discomfort. She teaches patients how changing their brains can change their bodies via stress modification, sleep hygiene, relaxation and cognitive therapy.
Surgical patients may be anxious about an upcoming operation. So Dr. Scheman has created relaxation recordings patients can download to smartphones for use before a procedure. These recordings can improve pain control and bolster the immune system to facilitate healing.1
For those coping with chronic conditions such as IBS, IBD, and gastroparesis, Dr. Scheman favors a group setting in which cognitive behavioral therapy (CBT) helps patients counteract negative thoughts, cope with overwhelming feelings, and initiate behaviors that promote health.
Sessions may address coping styles that have become self-defeating. IBD patients, for example, may fear stigma because of their frequent trips to the bathroom. This can lead to isolation, depression and anxiety, all of which make GI symptoms worse. CBT can help patients overcome this. Inaccurate medical beliefs and fears are also addressed, since the concern that something horrible is wrong internally increases pain and impedes coping.
Those with chronic GI symptoms may experience emotions such as anger about the disease, depression due to loss of life activities, and fear of the future.
Pain is common in patients with GI illnesses and the same brain chemicals responsible for depression and anxiety are involved with pain perception. “Pain causes emotional distress and painful moods amplify pain,” Dr. Scheman says.
Better outcomes for patients
Changing healthcare laws are requiring providers to focus more on outcomes and research shows that addressing biopsychosocial issues improves physical health outcomes.2 Studies clearly show that unresolved preoperative distress is associated with postoperative pain and delayed functional recovery.3
“I am currently working with patients who’ve recently had surgery,” she says. “I think that many of them might not need me now had I had the opportunity to work with them before surgery.”
1Lembo T. et al. Audio and visual stimulation reduces patient discomfort during screening flexible sigmoidoscopy. Am J Gastroenterol. 1998 Jul;93(7):1113-6.
2 Katon et al. The association of depression and anxiety with medical symptom burden in patients with chronic medical illness. Gen Hosp. Psych 2007 Mar-Apr;29(2):147-55
3Elkins et al. Hypnosis to manage anxiety and pain associated with colonoscopy for colorectal cancer screening: Case studies and possible benefits. Int J Clin Exp Hypn. 2006 Oct;54(4):416-31.