# Question Why See A Psychologist When The Diagnosis Is Ibs?



## eric (Jul 8, 1999)

FYI, thought this is good info for this forum.Question Why see a psychologist when the diagnosis is IBS?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


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## 20004 (Feb 27, 2007)

My doctor sent me to a psychologist 2 years ago when I was very depressed with my IBS and finding life overwhelming. Maybe we were not well suited but the psychologist made me feel like a miserable whiner who needed to face up to life and get on with it. We initially tried to address the IBS but his advice was to take double the immodium I would normally take for a given situation to see if it would reduce the fear significantly - I guess this was a type of CBT, but taking 8 immodium just meant I didnt go at all for a week then it returned and around we went again and when I voiced my opinion that I didnt think this was a positive way forward he interpreted it as my not wanting to find a cure. I never actually asked him but I dont think he had ever had a patient with my problems. I learnt a little about the cycles of anxiety and low self esteem but no tools on how to break the cycles. I guess I learnt I have IBS because I am an anxious person with low self esteem who has directed my anxiety to my bowels due to some childhood experiences - but I already knew all of this. I also learnt that I didnt want to talk to anyone about it again because there was no help to be had! At one point I nearly left my husband because I was so emotional. Anyway thats just my story I am sure lots of other people have had success.On a more positive note I am on day 53 of Mike's tapes and I have had some ups and downs along the way but overall feel much more relaxed. Even if the tapes do not cure the IBS I will feel it was a worthwhile journey as I think it has gone a long way to undo the guilt I felt for having this problem. Mike talks to you like he really cares and empathises. Everything is so calm and relaxed that I look forward to my session everyday. They have also proved to me that I am willing to try and find a cure and just need the tools to help me do that.


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## eric (Jul 8, 1999)

kikicat, I am happy to hear the tapes are working for you and they will continue too. Your halfway through so that is a good sign. On the seeing a psychologist, they really have to know and have treated IBS really.I had the same thing happen to me where I saw one and she had migranes, so she knew about a chronic problem, but nothing really about stomach problems. She didn't teach me anything, it was all me talking. She could have taught me relaxation techniques and such, so its important to see the right therapist and one who knows about and works with IBSers, like the person that wrote this article. If I saw one again I would bring this into them before they started and say these are things I want to learn and know about.


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## cookies4marilyn (Jun 30, 2000)

I am so happy for you Kikicat that you are having some good thoughts with Mike's program - I felt the same way - I actually cried when I listened to it, because finally, I felt that he knew just what I was going through. We do have a real physical problem, and while stress can bring on IBS symptoms, it really isn't necessarily the cause - my symptoms just "came upon me" and then became more and more frequent and more and more severe as time went on - then came the stress of worrying over the IBS attacks!Hang in there, and know that you can feel better and we are all here for support...All the best to you.


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