The Psychology Behind Irritable Bowel Syndrome

 

This post is written by a friend and colleague, Jessica Naftaly! She is currently a second year graduate student in a Clinical Psychology PhD program.

 

The Brain Gut Relationship in IBS

Approximately 11% of the population is affected by irritable bowel syndrome (IBS), a common functional gastrointestinal disorder that can significantly affect a patient’s quality of life.1 Functional gastrointestinal disorders can be difficult to diagnose as medical tests like blood tests and imaging scans cannot detect IBS.2 In fact, a diagnosis of IBS is IBS in textcommonly given when diseases that cause inflammation such as inflammatory bowel disease (IBD) are ruled out. IBS is thus mainly diagnosed through ruling out other diseases, and through physician use of specific diagnostic criteria called the Rome criteria.2 Since the diagnostic process can be somewhat subjective, patients with IBS tend to have high health care utilization and usually see multiple doctors before receiving a diagnosis. 3 The long process of receiving a diagnosis of IBS can be a frustrating experience for patients, on top struggling with a debilitating illness.

 

Psychology and IBS

Since IBS is difficult to diagnose, there is a limited understanding of how the brain and body interact in IBS (aka the mind-body connection). Research shows that stress makes IBS symptoms (e.g., abdominal pain, constipation, diarrhea) worse.4 Additionally, it is common for patients with IBS to also be diagnosed with anxiety and depressive disorders.1

 

Patients with IBS tend to report more frequent stressful events and have an increased reactivity to stress compared to people without IBS.4 For example, a patient with IBS who plans on going to a concert where there is little access to bathrooms, may be stressed and thus experience abdominal pain. This stressful event, however, may not be considered stressful for someone who does not have IBS.3 A patient with IBS may avoid going to the concert completely due to the fear of not having access to a bathroom. Although the patient knows that he/she is always able to find a bathroom when he/she goes out, this fear persists despite evidence that there will be bathroom access. This anxiety may even exacerbate IBS symptoms. Avoidance of attending the concert is an example of how a patient may cope with the abdominal pain and stress of going to the concert. Furthermore, avoiding the concert can contribute to depressive symptoms, feelings of social isolation, and guilt.3

 

The Brain and IBS

Researchers believe that there is a relationship between IBS and the brain, specifically through serotonin. Serotonin is an important neurotransmitter that is involved in mood regulation, sleep, pain, and motility in the GI system. Although some serotonin is located in the brain, guess where a majority of serotonin is located? You guessed right-the digestive tract.5 Research shows that patients with IBS may have different amounts of serotonin compared to healthy people, This could be why patients with IBS commonly also have anxiety disorders.5

 

Psychological Treatment and IBS

Medications like antidepressants are starting to be used as one form of treatment for IBS. Antidepressants can change the amount of serotonin in the body leading to a decrease in IBS in text twoIBS symptoms. Additionally, cognitive behavioral therapy (CBT) is a short-term treatment that involves the client and therapist (psychologist, counselor, social worker, etc) working together to address distorted thoughts and behaviors. Talking about these thoughts and behaviors can be helpful for patients with IBS.

 

We can use the example mentioned earlier (the patient with IBS avoiding the concert) as an example of how CBT can be used. In that example, the patient may have a cognitive distortion such as “I can’t go to the concert because I won’t make it to the bathroom.” The therapist would talk with the client about what evidence the client has that makes this thought true. Although many patients with IBS may have trouble making it to the bathroom, the therapist may find out that the client actually does make it to the bathroom on time but is constantly worried about not making it. The therapist may then have the client use thought records to help the client keep track of the accuracy of these thoughts. The therapist may also teach the client relaxation strategies, give the client homework, and help the client become more aware of inaccurate beliefs. Although talking with a complete stranger may seem scary, research shows that CBT is effective in decreasing IBS symptoms by improving patients’ coping strategies to manage stress and change cognitive distortions.3

 

Take home message: Although stress does not appear to cause IBS, there is a significant psychological component to IBS symptoms. Treatments like CBT and medications can be used to help decrease IBS symptoms. For more information on CBT please visit http://www.abct.org/Help/?m=mFindHelp&fa=WhatIsCBTpublic.

 

 

  1. Canavan, C., West, J., & Card, T. (2014). The epidemiology of irritable bowel syndrome. Clinical Epidemiology, 6, 71–80.
  2. Dalton, C. (n.d). UNC center for functional GI & motility disorders: Ask the expert: Question what is a functional GI disorder. Retrieved from https://www.med.unc.edu/ibs.
  3. Naliboff, B.D., Fresé, M.P., & Rapgay, L. (2008). Mind/body psychological treatments for irritable bowel syndrome. eCAM, 5(1), 41-50.
  4. Drossman, D.A., Camilleri, M., Mayer, E.A., & Whitehead, W.E. (2002). AGA technical review on irritable bowel syndrome. Gastroenterology, 123(6), 2108-2131.
  5. McLean, P.G., Borman, R.A., & Lee, K. (2006). 5-HT in the enteric nervous system: gut function and neuropharmacology. Trends in Neuroscience, 30(1), 9-13.

Pictures from: http://www.healthywomen.org/sites/default/files/ibs_0.jpg and http://www.gutfulofadhd.com/wp-content/uploads/2014/04/images.jpg

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Can I Start Occupational Therapy School with a Psychology Degree?

 

Written by Alisha Kriss

 

First, I’ll start by introducing myself and mentioning my educational background. My name is Alisha Kriss, and I received my Master’s Degree in Occupational Therapy and a Bachelor’s Degree in Psychology from Grand Valley State University in Michigan. Second, I wanted to thank Mike Mead for allowing me to share my viewpoints regarding the relationship between Psychology and the profession of Occupational Therapy.

I am not sure how familiar everybody is with the profession of Occupational Therapy, but typically, people either think we focus on hands, or that we help people find jobs (because of the term, ‘occupation’). This may be a surprise, but we actually are trained to do much more than that! I have discovered an easier way to think about the term ‘occupation,’ rather than thinking of it as another word for ‘job’ or ‘profession.’ We, as occupational therapists, focus on anything and everything that occupies a person’s time. We are trained to use a holistic perspective to assess how any disability, injury, or illness may be affecting individuals in their everyday life. A holistic perspective is non-judgmental and is interested in assessing multiple perspectives of an idea without presenting judgment. Does this sound familiar to anyone with a Psychology background? Well, it sounded familiar to me when I began Occupational Therapy school! I immediately realized that I had the talents and resources to implement this type of thinking with my clients, and it has been truly beneficial while working in the field. Because of my Psychology background, I am able to interpret individual behavior, respond appropriately, and help individuals feel comfortable in an open and non-threatening environment. Therefore, I can quickly build therapeutic relationships with my clients, and we can immediately begin working together towards maximizing their independence and safety post injury or disability.

An interesting fact that people may not realize about Occupational Therapy is that its history actually originates with mental health. Over a century ago, the profession of Occupational Therapy was established upon the belief of more humane conditions and treatments of individuals with mental illnesses (Christiansen & Haertl, 2014). Since then, occupational therapists have worked to develop and perfect treatment interventions for this population. Occupational therapists embody extensive knowledge of the physical, cognitive, social, and emotional barriers that interfere with everyday life for people with mental illnesses. Exemplifying a non-judgmental perspective is imperative while working in any healthcare field, especially when you are working with individuals in their most vulnerable state. If you have the talents to exemplify holistic and non-judgmental thinking from your Psychology background, and have a passion to help individuals gain their lives back after an injury or disability, then Occupational Therapy may be the right profession for you!

Christiansen, C.H., & Haertl, K. (2014). A contextual history of occupational therapy. In B.A. Schell, G. Gillen, & M.E. Scaffa (Eds.), Willard and spackman’s occupational therapy (12th ed.) (pp. 9-34). Philadelphia, PA: Lippincott, Williams & Wilkins.

National Suicide Prevention Week

This week, we have two colleagues of ours in the Psychological Clinical Science PhD program at NDSU guest writing for us.  It is National Suicide Prevention Week, which is a very important topic.  This post gives us a detailed look at how we may be able to prevent someone we know from dying by suicide.  If you wish to learn more about Brandon and Sam, please feel free to click the links below for access to their pages.  Also, please click here for printable handouts.

Brandon’s Twitter and website.  Sam’s website.

It is likely we all know someone who has attempted or died by suicide. It might be your sister, brother, mother, father, friend, child, grandparent, coworker, or even someone you just met. Suicide does not discriminate. It accounts for more years of life lost than any other disease following cancer and heart disease (CDC, 2013). The number of suicides reported in 2013 in the U.S. was over 41,000, which made it the 10th leading cause of death for Americans (CDC, 2013).

Suicide affects the individual involved along with their family, friends, and community. Suicide has the capability to impact everyone, but suicide prevention can do just the same. Anyone, anywhere can learn how to aid in suicide prevention efforts. Yes, that is true, YOU can make a difference and potentially save a life. September 7-13 is National Suicide Prevention Week. Yesterday, September 10, 2015, was World Suicide Prevention Day. It is a day set aside for remembering loved ones lost to suicide, showing support for survivors of suicide, and increasing awareness of suicide risk factors and prevention. Learning ways to help prevent suicide is a necessary factor in decreasing the amount of deaths by suicide. We often have the misconception that only professionals can help those who are suicidal. It is actually the case that most often professionals are not going to be the first person the person will reach out to, it is more likely it will be to a family member or close friend. We might be a stepping stone on the way to getting further help. This can be overwhelming.

When we have a person in our lives who we may suspect is feeling suicidal, it is hard to know what to do. Do we reach out to that person? Will they get upset with us for doing so? If I say something will it make it more likely to happen? What if they aren’t thinking about it? What should I look for? How can I help them? To help answer these questions and others that people may be having, this post will discuss warning signs that can precede a suicide attempt, common myths surrounding suicide, a 4-step plan for suicide prevention, and how we can use Facebook as a suicide prevention tool.

The American Foundation for Suicide Prevention (www.afsp.org) and Suicide Awareness Voices of Education (www.save.org) have identified common warning signs:

  • A very clear warning sign is when an individual is talking about or planning suicide. The person is talking about suicide via conversation, phone, text, or social media. The person may also be planning suicide or writing a suicide note.
  • Marked social withdrawal is often seen in individuals contemplating suicide. The person is spending much less time with social groups such as friends, family, religious groups, or clubs.
  • Agitation can increase when an individual is feeling suicidal. The person is much more flustered or on edge than usual.
  • Insomnia or sleeping all the time is common before a suicide attempt, especially in individuals who usually have a normal sleeping pattern.
  • Feelings of hopelessness can often be dismissed as someone being dramatic. However, an individual who is suicidal may really believe things about themselves and their life such as: things will never get better, there is no point in going on, or this life has no purpose.
  • Many intense negative emotions such as rage, uncontrolled anger, and seeking revenge are commonly witnessed preceding a suicide attempt.
  • Individuals may be engaging in dangerous activities without seeming like it really bothers them or without being worried about negative consequences.
  • Often times we will hear individuals who are thinking about suicide expressing that they feel trapped and that there is no way out.
  • We may see individuals using higher levels of alcohol and other drugs and may be doing this alone rather than with a group of friends.
  • A highly variable mood is something to take notice of. If the person is going through very intense and dramatic mood swings, it could be a red flag.

Okay, now we know some of the most common warning signs to pay attention to. Now what? Many people are already aware of the warning signs of suicide, but there some barriers getting in the way of using those warning signs to help prevent suicide. Some of the barriers come in the form of myths surrounding suicide. The following five myths are some of the most common surrounding suicide that might give us the wrong idea about how the process of suicide works and what we as friends and family are truly capable of.

Myth: Suicide is done without fully thinking.

  • Truth: Though the action is often impulsive, it is most often that this has been planned out for some time.

Myth: Once people decide to die by suicide, there is nothing you can do to stop them.

  • Truth: Most of the time, it is the pain that these individuals want to get rid of. It is less often that death is what they truly want. If we can help them alleviate the pain, we could save their life.

Myth: People who attempt suicide and survive will not attempt suicide again.

  • Truth: Just because their first attempt was not successful, does not mean the pain has gone away. When someone is in enough pain to be considering suicide, they may go through a great effort to attempt again. Many people often think that if the suicide is unsuccessful that it will ‘scare’ people away from doing it again. While this could be true for some people, research tells us that is not necessarily true for the majority.

Myth: You should never ask people who are suicidal if they are thinking about suicide or if they have thought about a method, because just talking about it will give them the idea.

  • Truth: By asking someone if they are thinking about suicide, you are going to learn more about their mindset and intentions. You will not increase the risk. This helps them to release some of the feelings that are distressing to them and validates that someone can tell they are going through a tough time.

Myth: When people who are suicidal feel better, they are no longer suicidal.

  • Truth: We often see a surge in mood and a sense of relief in those who have solidified a plan for suicide. They are looking forward to being pain free. This can be problematic of course, because those around the individual may think they have gotten better and maybe back off on stepping in when in reality that is the crucial time to intervene.

(To read about these myths and more, go to: http://www.suicide.org/suicide-myths.html )

Now we’d like to break our four step plan for preventing suicide. There are several wonderful plans available. We took a lot of ideas from several plans and broke it down into a four step plan that we felt was both accessible and memorable.

Step one is Act Immediately and Manage your Emotions. If you suspect that someone is suicidal, it can be easy to avoid the situation by assuming that they might just be seeking attention, that someone else will help them, or that they would go to a professional if it was serious. This is the time to reach out. Ask the person directly if they are having thoughts about suicide. It is now that you might be most likely to panic, ignore, or dismiss the idea that this individual might be suicidal. Manage these emotions as best you can. It is natural to feel this way. Don’t blame yourself, but try to remember that this person might be in a life or death situation. Don’t be afraid to seek extra help, be it in the form of another friend, trust person, or a professional.

Step two is Express Concern and Assess Risk. It is important for you to express sincere concern for the individual by letting them know you are here for them and you care for them. Something to remember is that you want them to do most of the talking. So when you are expressing your concern, keep it sincere and concise and let them let you know how they are doing, feeling, etc. If they seem like they are not really saying whether or not they are considering suicide, ASK! Another common myth surrounding suicide is that asking about it will increase the chances of it happening. This is not the case. By asking you are directly showing your concern and validating that you can clearly see that they are struggling. Lastly, you need to assess for safety. This could mean removing harmful devices such as weapons, getting the person to a safer place, and staying with them or finding someone reliable to stay with them if you are unable.

Step three is Take Action. Together, discuss and decide on what steps you can take together to keep this individual safe. By involving the individual in this process you can help to demonstrate empathy, which helps the individual to feel understood. Even this immediate effect can be a relief for them. Beyond that, by involving them in the process you make it more likely that they will adhere to the steps that you discuss together. Throughout this discussion, try to consider their two minds. Sometimes the individual may be experiencing some ambivalence about whether or not they actually want help. It is vital that you remember that keeping them safe is your main priority. Sometimes individuals will be hesitant to let someone know that they have a friend who might be suicidal. This is often because they do not want their friend to get mad at them for telling on them or betraying them or something like that. If you save your friend’s life, they will forgive you. It is okay to seek outside help. These situations can be confusing and overwhelming. Don’t be ashamed to ask for help. Lastly, plan for a future together. Get them talking about things that they want to do, or that you can do together. This kind of talk can help the suicidal individual to resolve their ambivalence and decide to get the help that they need.

Step four is Look After Yourself and Follow-Up. Step 4 is an ongoing step. We want you to remember to stay involved with the individual. Make sure you are checking in on them without hovering, help them set up or take them to appointments if they so desire, keep a constant connection so they know they have someone to reach out to, etc. Also important, but often forgotten, is that you need to take care of yourself. Having someone close to you considering ending their life or attempting to end their life is a very emotional experience and something you may need to process for awhile. There are support groups and other resources for those who are close to people who have died by or attempted suicide. Not only will these types of resources help ensure your own well-being but they may also provide additional suggestions as to how to best prevent future suicides and ways to stay involved.

Lastly, we’d like to tell you about an awesome new feature that Facebook has implemented. Those of us on Facebook have probably all seen the option where we can ‘report’ something. It used to be pretty limited as to the ways Facebook allowed you to describe the content you were reporting, but now there are actually a lot of choices as you can see on the slide. One of those choices involves reporting suicidal posts. Many individuals in today’s age use social media as their main outlet for voicing things going on in their lives, one of which may be thoughts about themselves. If you see a post you are questioning, Facebook now gives you the option to try to intervene. The first thing you have to do after clicking report is to say that this post is about you or a friend. Then you will be able to select the option of violence or harmful behavior. That option provides even more criteria to select such as ‘self-harm’ or ‘suicidal content’.

After you have reported that you might be concerned about one of your Facebook friend’s posts, Facebook sends them a message. The first point of contact tells them that a friend thinks that they might be going through something difficult and might be concerned. It shows the user the post in question and assures them that everything they do within this module will be kept private. After they click continue, they are given a couple of options. The first is to Talk to Someone. Facebook connects them with either a friend or a helpline worker who can help talk them through the situation. Otherwise they can choose to Get Tips and Support. This is an option designed to help them learn how to work through the situation using simple tips. The user is forced to complete this module before Facebook will allow them to return to the normal Facebook timeline. Often times Facebook is a great way to share pictures of your cat or food. However, we think that this is a wonderful addition that truly has the potential to save lives.

In closing, we hope that this post helped to introduce you to some new information about suicide. Suicide has the potential to affect anyone, either directly or indirectly. We also think it is important to keep in mind that no matter what you do, sometimes suicide happens. It isn’t anyone’s fault. But the bright side is that anyone is also able to do their part to help to prevent suicide. If you encounter a situation where you think that someone might be experiencing suicidal thoughts, please feel free to use these steps to look after them AND yourself as much as you are able.

Weight Based Victimization

This week, we have a guest writer! Brittany is in her third year in the Psychological Clinical Science PhD program here at NDSU. Her research interests are how emotions and self regulation influence eating disorders. For access to her blog, Significantly Public, click here for their Facebook page and here for their WordPress site.

Obesity now affects over 35% of American adults, with another third of adults considered overweight. The public is generally quite aware that this is a problem affecting our health as a nation and as individuals. But what do we do about it?

Weight-based victimization (commonly referred to as ‘fat shaming’) is when others make comments about an overweight person’s body with the intent to affirm thinness as the desired ideal. In children, weight-based victimization often comes from peers (e.g., students rank overweight children as less likeable than normal weight peers, push/hit them, exclude them), but it also comes from families (restricting their food intake while allowing other siblings to have seconds, calling them names, comparing them to other children). Since obesity has been increasingly common in recent years, researchers predicted that weight-based victimization would decrease due to normalization. They found the opposite; students who are overweight now face even more bullying than students who were overweight in 1961.

Many people, well-intending or not, think that making these comments will help motivate overweight people to lose weight. In reality, weight-based victimization is associated with an increase in the likelihood (by 2.5 times) that an overweight person will become obese in the future. Since this is an association and not an experiment, we can’t be sure that the victimization is what caused people to gain weight, but some think that the distress associated with it could cause overeating. This emotional type of overeating is very close to binge eating, which is overeating accompanied by a sense of loss of control. Studies have found an association (again, not an experiment) between bullying and the development of binge eating disorder, which is the most common type of eating disorder.

All in all, it is possible that weight-based victimization (i.e., fat shaming) leads victims to develop eating disorder symptoms. Some may even develop an eating disorder as a result. If you or anyone you know may be struggling with binge eating disorder or another eating disorder, don’t hesitate to seek support here: http://www.nationaleatingdisorders.org/neda-support-groups. People of all shapes and sizes develop eating disorders; treatment is not just for those who are underweight.

Gray, W. N., Kahhan, N. A., & Janicke, D. M. (2009). Peer victimization and pediatric obesity: A review of the literature. Psychology In The Schools, 46(8), 720-727. doi:10.1002/pits.20410

Striegel-Moore, R. H., Dohm, F., Pike, K. M., Wilfley, D. E., & Fairburn, C. G. (2002). Abuse, bullying, and discrimination as risk factors for binge eating disorder. The American Journal Of Psychiatry, 159(11), 1902-1907. doi:10.1176/appi.ajp.159.11.1902

Sutin, A. R., & Terracciano, A. (2013). Perceived weight discrimination and obesity. Plos ONE, 8(7), doi:10.1371/journal.pone.0070048