What is a GI psychologist? Although those of us who identify as GI psychologists often find ourselves explaining what that means to our colleagues, it is exactly what it sounds like: we are psychologists specializing in working with people who have GI conditions. We alternate between academic descriptors “psychogastroenterology” and “gastropsych,” representing the natural marriage of the worlds of psychology and gastroenterology.
Who ARE GI Psychologists?
We are clinical psychologists with a generalist training in the assessment and treatment of psychiatric disorders, and specialized training in the subspecialty of health psychology.
Health psychology is the study of the interplay of psychological, biological, social and cultural factors affecting physical health and illness. An important way to distinguish health psychology from clinical psychology is that health psychologists are not primarily treating psychiatric disorders and mental illness.
In practice, health psychologists assess patients using a biopsychosocial approach, and deliver evidence-based treatments targeting health behaviors and managing aspects of living with a medical condition. Although this may include treating anxiety and depressive symptoms, treatment interventions primarily focus on behavioral skills to reduce physical symptoms and enhance coping and resilience.
More and more evidence support that these behavioral interventions lead to better health outcomes, including decreased illness symptoms, less health care utilization and improved quality of life. Health psychologists are becoming more common as embedded team members across medical subspecialties and settings (inpatient, outpatient, primary care). In fact, health psychology and pediatric health psychology each have professional organizations and divisions within the American Psychological Association.
Fortunately, the field of gastroenterology has recognized the benefits of psychological interventions for digestive health (now referred to as brain-gut psychotherapies) and the inclusion of psychologists on GI teams is increasingly becoming a standard of care. In fact, the gut has been deemed “the second brain” and recent research has highlighted the gut-brain axis and its critical role in the overlap of GI disease and psychological symptoms.
What Does a GI Psychologist Do?
Whether we work alongside a medical team in a GI clinic, or in an outpatient behavioral health practice, we assess and treat patients with an evidence-based, holistic lens that integrates biology and psychology. In our initial intake, we focus our assessment on current physical and emotional symptoms, illness status, medical treatments, ways symptoms interfere with daily functioning, the role of stress and the person’s goals for quality of life. This individualized, tailored assessment of symptoms and goals shapes our treatment plan to match the patient’s priorities.
Common presenting problems include disrupted sleep, chronic pain, fatigue, pervasive worries, avoidant behaviors due to GI symptoms, anxiety around food and eating because of dietary restrictions and an overarching dissatisfaction with how health interferes with personal goals across areas of functioning, including work, school, family relationships, and friendships.
Brain-gut psychotherapies are grounded in cognitive behavioral therapy (CBT), the most evidence-based therapy approach in psychology. Within CBT treatments, we prioritize relaxation strategies to directly target the arousal of the autonomic nervous system, which affects the gut-brain axis.
Especially in the cases of chronic pain and disorders of gut-brain interaction (eg, irritable bowel syndrome), various factors have contributed to a dysregulation of the nervous system to cause brain and gut signals to misfire. This results in hypersensitivity to pain and other gut sensations (eg, digestion), which become highly bothersome to the affected individuals. Years of research have demonstrated the effectiveness of using gut-directed hypnotherapy for IBS and IBD to decrease these visceral sensitivities so common in chronic GI conditions.
As central as relaxation strategies are to treatment (eg, diaphragmatic breathing, meditation, gut-directed hypnotherapy), targeting thoughts and behaviors also plays an essential role. We often challenge negative thought patterns that contribute to maintenance of problematic symptoms and encourage behaviors to align with quality of life goals.
How Do I Find a GI Psychologist?
Now that you know who we are and what we do, you may want us in your life. It’s excellent timing because the ROME Foundation has a #gastropsych committee dedicated to expanding the reach of GI psychology. There is a new and growing national directory of providers who have training in GI psychology.
If you can’t find a GI psychologist in your region, we recommend looking for mental health providers who have experience in chronic medical illness. The skills and approaches often easily generalize across types of medical conditions and symptoms.
If you are a behavioral health provider interested in gaining expertise in GI, the ROME Foundation has several educational opportunities, including workshops around the country and upcoming web-based video curriculum. You can find current opportunities and many great resources on ROME’s website.
- Emily Edlynn, PhD
Follow on Twitter: @DrEmilyEdlynn
Knowles SR, et al. Psychogastroenterology for Adults: A Handbook for Mental Health Professionals. 2019. Routledge; London.
ROME Foundation GastroPsych Directory. www.RomeGIPsych.org. Accessed January 17, 2020.