Anxiety About Inflammatory Bowel Disease Makes Flare-Ups Come More Quickly

Inflammatory bowel diseases are notoriously difficult to manage in social situations. Diseases such as Crohn's disease and ulcerative colitis take their toll in chronic fatigue and achy joints, which are bad enough, but also with:

• Urgent diarrhea which tends to occur after eating larger than normal portions, such as at a celebratory meal.
• Nausea and vomiting after eating certain foods or even after thinking about or talking about certain foods, especially in Crohn's disease. A bad experience with a food leaves a strong memory that can be activated by the odor of the food or conversations about the food.
• Intense abdominal cramps. It isn't just that IBD causes diarrhea. It causes diarrhea with severe abdominal cramps. The pain from these cramps can literally take your breath away, cause you to break out in a sweat, and even pass out, at precisely the time you need to be racing to the bathroom.

These symptoms are a major problem in daily life. However, anxiety and depression make them worse.

Scientists Explore the Relationship Between Anxiety, Depression, and IBD

A number of studies have found that people who have IBD also tend to have anxiety and depression. A lingering question has been whether IBD causes anxiety and depression or anxiety and depression cause IBD. A study at the University of York in the United Kingdom recently looked at this question.

Dr. Antonina Mikocka-Walus and her colleagues reviewed the literature and found that some studies seemed to find a relationship between psychiatric illness and IBD and others do not. Her research team attempted to resolve the ambiguity in research findings by studying 405 Swiss IBD patients across time to determine whether a causal relationship exists.

The researchers found that 20.2 percent of their study participants could be diagnosed with clinical depression, and 37.5 percent suffered from generalized anxiety disorder. At the baseline, however, there wasn't any clear relationship between having anxiety or depression and having inflammatory bowel disease. IBD didn't cause anxiety or depression, and anxiety or depression didn't cause IBD, because there was no statistically significant relationship between them.

However, people who had IBD and also anxiety and/or depression suffered flareups of IBD more often. There was a stronger relationship between depression and IBD flareups than there was between anxiety and IBD flareups. The researchers theorize that this could be because depressed people don't follow doctor's orders precisely, however, not that depression necessarily is a manifestation of a gut-brain relationship that also causes IBD.

If Anxiety and Depression Make IBD Worse, Does Treating Anxiety and Depression Make IBD Better?

IBD researchers have looked into the possibility that part of what people who have Crohn's disease or ulcerative colitis need is psychological support. The results of psychological interventions are mixed:

• Computerized training to reduce anxiety levels helps some people to a modest degree, but only as long as the training continues.
• Face to face psychotherapy doesn't change the course of IBD or affect symptoms, but patients feel they have a higher quality of life when they get it.

There was, however, one form of psychotherapy that seems actually to improve IBD.

Gut-Directed Hypnotherapy Relieves Inflammatory Bowel Disease Symptoms

Hypnotherapy has been used with success in treating symptoms of cancer, HIV, rheumatoid arthritis, chronic pain, and fibromyalgia. In recent years, doctors have been trying "gut-directed" hypnotherapy as a treatment for IBD.

What makes hypnotherapy "gut-directed"? A gut-directed hypnotherapy session begins like almost any other hypnotherapy session. Patients are invited to lie down, relax, and to release tension from all of the muscles of their body, beginning at the top of the head and relaxing all the way down the body, or beginning with the feet and relaxing muscles up the body. As the patient becomes more and more relaxed, the hypnotherapist introduces post-hypnotic suggestions such as these, paraphrased from an actual gut-directed hypnotherapy session:

"As you sit and relax and allow your whole body to be at ease, something powerful and healthy is happening inside you, focusing on your intestinal tract. Your intestines are becoming healthier and whole, resistant to inflammation, much less sensitive to stress. You can visualize this change happening inside your right now as a wave of medication flowing from your mouth all the way down your digestive tract. It coats the lining of your intestinal tract and prevents toxins and bacteria from leaking into the rest of your body. It stops bleeding and allows any ulcerations inside your digestive tract to heal more quickly. Picture it now. Picture the bacteria and toxins bouncing of the walls of your digestive tract harmlessly, bouncing off this protective coating that now covers your entire digestive tract, protecting you from infection and pain."

The hypnotherapist continues to read these suggestions for about half an hour, and then the patient is bought back to a normal state of consciousness. Typically patients receive seven weekly sessions and are dismissed from treatment.

Does gut-directed hypnotherapy really work?

• Gut-directed hypnotherapy has been used in treating irritable bowel syndrome, non-cardiac chest pain, delayed stomach emptying (gastroparesis), and peptic ulcer disease. 
• The results of a full course of seven to ten sessions of gut-directed hypnotherapy relieve symptoms for up to seven years.
• A single session of gut-directed hypnotherapy, in one study, reduced the release of substance P, histamine, and interleukin-13 and serum levels of interleukin-6. All of these are substances that cause inflammation that drives inflammatory bowel disease.

Gut-directed hypnotherapy is not a cure for IBD. However, in a group of IBD patients who averaged one to two flareups per year, participating in gut-directed hypnotherapy with a doctor performing the hypnotherapy resulted in an average of two to three months longer between flareups. Anxiety and depression can accelerate flareups, but hypnotherapy can at least delay them.

READ Post-traumatic stress disorder (PTSD): Does Hypnosis Treatment Helps?

Does this mean that if you just stop worrying about IBD it will go away? It does seem to be necessary to feel that you will stay in remission from IBD actually to stay in remission from IBD, but there isn't a convenient "worry switch" you can just turn off to get rid of the disease. That's why hypnotherapy with a medical hypnotherapist is often the answer. The primary benefit of this hypnotherapy is likely to be a reduction in pain and muscle spasms, although hypnotherapy can also help with a feeling that the digestive tract is "blocked." However, the shortest relapse-free period after gut-directed hypnotherapy for IBD was 78 days, with nearly 70 percent of patients free of IBD for a full year. Very few other treatments work this well.