# Question Why see a psychologist when the diagnosis is IBS?



## eric (Jul 8, 1999)

FYI UNC "Digest""Ask the ExpertStephan R. Weinland, PhDQuestion Why see a psychologist when the diagnosis is IBS?Many people experience distress and anxietywhen their doctor makes a recommendation thatthey see a psychologist. This reaction often comes from the belief that a referral to a psychologist carries with it assumptions about symptoms being â€œall in your headâ€ or the result of â€œmental illnessâ€.These are two of the biggest misconceptionsabout the practice of psychology in a medicalsetting, and they can often stand in the way ofpatients achieving a meaningful reduction insymptoms. In this column, I hope to dispel someof these misconceptions around psychology in amedical setting, and in doing so communicate afew of the benefits you might be able to achievein working with a psychologist to address yoursymptoms of IBS.First things first, your physical problems arereal! If your doctor gives you a recommendationto meet with a psychologist it does not meanthat the symptoms are â€œall in your headâ€ or theresult of â€œmental illness.â€ Your experience ofIBS is likely to be debilitating to you, and it can have wide ranging effects on your loved ones,yourself and activities that you want to engage in. Psychologists and physicians work together, with the understanding that the mind and body are connected. If you are feeling ill and having many symptoms of IBS, you may also experience an increased level of stress and discomfort. This stress and discomfort contribute to a cycle of worsening symptoms that can spiral into more severe IBS. Psychologists and physicians worktogether with you to interrupt that cycle and help you learn to decrease the number and severity of your symptoms.Psychologists that work in medical settingsoften specialize in a field of psychology knownas â€œBehavioral Medicineâ€. This specializationfocuses on thoughts, feelings and behaviors thatget in the way of effective coping with biomedical symptoms, and also focuses on teaching you and those around you good self-care behaviors. One question you might be asked when you come into our office is â€œWhat steps are you taking to take care of yourself?â€ Increasing the number of good self-care behaviors that you are implementingis often a great place to start in addressing your symptoms.Sometimes patients with IBS are dealingwith a heavy burden of past life stresses andcircumstances. While talking about these eventscan occasionally be beneficial, it does not needto be the focus of therapy for you to see progress.Often, learning to implement good sleep, hygiene, stress reduction, and other coping strategies for dealing with situations can go a long way in making you feel more in control of your symptoms, rather than feeling like IBS is controlling you. Increasing your control over symptoms is another one of the steps towards improvement in your IBS.Often, people experience distress related toproblems and difficulties that arise around their IBS symptoms rather than from the IBS symptoms themselves. For example, occasionally patients with IBS get anxious when leaving the house or any â€œknownâ€ environment because of a fear of becoming incontinent. Over time, this fear grows and fewer places and activities are deemed â€œsafeâ€, resulting in a withdrawal from previously enjoyed activities. This fear or â€œanticipatory anxietyâ€ is part of a vicious cycle that can actually make your symptoms worsen or even contribute to an episode of incontinence. Through discussion andindividually developed behavioral exercises, apsychologist can help you reduce these fears andre-engage in activities that you have wanted toengage in, thereby helping you break the viciouscycle of your symptoms.Psychologists also work with you to examinebehaviors, thoughts and feelings that are getting in the way of effective coping with your IBS symptoms. Just like physicians, our ultimate goal as psychologists is to make ourselves unnecessary.We do this by helping you develop your own skills that can allow you to handle challenging situations more effectively by yourself. If you are living with a medical diagnosis, chances are that you are already getting a lot of â€œadviceâ€ from everyone around you. In all likelihood, a psychologist will not give you â€œadviceâ€; instead, he or shewill work with you to develop your own plan foraddressing the symptoms that are bothering you.Treatment plans and directions are establishedcollaboratively with the overall goal of helpingyou see your symptom picture improve.So how does psychology work? There is no magic.IBS is a diagnosis that involves sensitization of nerve endings in the GI tract. This sensitization can occur from a number of different sources (infection, inflammation, significant stress, or chronic activation of the autonomic nervous system). This sensitization has the effect of turning up the volume on your symptoms. One way that psychologists can work with you is toteach you ways of slowing down your autonomicnervous system, using tools of progressivemuscle relaxation, guided imagery, focusedconcentration, or even biofeedback. Essentially,learning and practicing these behaviors hasthe effect of turning down the volume on yoursymptoms, and it can go a long way to giving youincreasing numbers of low symptom days.IBS is a chronic condition. There is no magical pill that will take away your symptoms or turn back the clock to the time â€œbefore this all started.â€ Because of this, the ultimate focus of treatment with a psychologist is minimizing the debilitation and discomfort you feel as a result of your symptoms.Just because a disease process is chronic or longstanding does not mean you have to suffer with it.Working with a psychologist is one way to accessa range of new tools for living with your IBS.In conclusion, IBS is multi-determined and canbenefit from being addressed using a multidisciplinary treatment approach. Working with a psychologist is just one part of that treatment approach, and it has been shown to be an effective addition to traditional biomedicaltreatment. Using a combination of the tools andplans discussed in this column, patients can seea significant reduction in their symptoms. Pleasefeel free to contact me if you have any questions about seeing a psychologist when the diagnosis is IBS â€" http://www.med.unc.edu/ibs


----------

