As an inflammatory bowel disease (IBD) patient, I talk a lot about mental health and how it works in conjunction with my IBD and other chronic illnesses. Over the course of the last 10 years I have seen a shift (albeit a slow one) that is starting to see the benefit of nurturing the mind/body connection. Basically what that means is that a happy body means a happy mind and vice versa. I often found when I was severely depressed that my body would often follow suit and would have problems with recovery or healing; also, when I was post-op for a surgery or when my body was very sick, my mental state was never at its best. These things ARE connected, and our medical professionals are starting to see the value in treating both together.
A few years ago, I had the privilege of meeting Megan Riehl, Psy.D., out of the University of Michigan IBD center. Dr. Riehl is a clinical psychologist who specializes in working with GI patients. How cool is that? I was so fascinated that this job even existed, and even more excited that clinics are starting to see how important it is to treat both mind and body.
Because Dr. Riehl’s job is so cool and so important, I wanted to interview her to show patients that there are doctors out there who believe in treating the whole patient, not just the body part.
JZ: Can you explain a little bit about your job and what makes it unique?
MR: I am a clinical psychologist with specific training and specialization in gastroenterology. As a GI psychologist, I have the opportunity to work with patients who have chronic and acute GI conditions to aid with managing disease, learning adaptive coping and stress management skills. I am on faculty in the GI department at the University of Michigan, which allows our GI patients to have comprehensive care with their gastroenterologist and myself. Our GI department acknowledges the challenges of having a bowel disease and has valued the mental health and behavioral health aspects of well rounded care. I am fortunate to provide care for patients who are newly diagnosed with IBD as well as for those who have had complications and/or stressors that can exacerbate their disease and would like support in management.
JZ: Why is your specific position so important yet understaffed?
MR: At present, we are one of very few places in the country who offer patients an opportunity to work with a fully integrated GI psychologist. In locations where there is a GI psychologist, the waits are long and the demand is great, which indicates that patients need more GI specialists. Patients benefit most when a psychologist is trained in GI conditions and at this time there are not many opportunities for psychologists to get this training. At the University of Michigan we are expanding our GI Behavioral Health program and beginning to offer this training to meet the needs of our patient population.
JZ: Why did you choose to focus on IBD patients?
MR: I initially worked with patients with functional bowel and esophageal conditions and over time recognized that very similar treatment plans could be beneficial for patients with IBD. Given that stress can exacerbate IBD symptoms, I found it rewarding to offer patients who may be feeling hopeless, anxious or depressed, tools to implement that they have some control over (i.e. relaxation skills, hypnosis, cognitive behavioral interventions). Working with people who have IBD also gives me an opportunity to aid patients in gaining skills to better manage the uncontrollable and unpredictable aspects of their disease. With these skills, I have watched patients become more confident and engaged with aspects of life outside of the disease.
JZ: What do you think is the most common mental health problem you see in IBD patients?
MR: Anxiety stems from unknowns and lack of control. Given the nature of IBD, anxiety is a very common mental health concern for this patient population. Additionally, when someone is not feeling well for long periods of time it can lead to depression. Common causes for depression are that the person feels misunderstood, they are missing parts of life that others their age are enjoying and the pressure of medical bills, appointments and how to manage it all while ill.
JZ: Would you say that IBD patients have unique mental health struggles or that chronic illness patients in general share some unique challenges?
MR: Patients with IBD sometimes face feeling that their illness is invisible to people outside their home or immediate family (i.e. could be sick and having diarrhea all night, but is able to put some make up on and take their child to school the next day and another parent can see them, think they look great, and inquire about why they aren't volunteering more often... which can cause major guilt and sadness). Another difference for patients with IBD is that the symptoms can be perceived as embarrassing; therefore the person may be less likely to discuss their struggles and symptoms with others. There tends to be more stigma associated with IBD and therefore people are less likely to feel support from those in their community. Whereas, someone with cancer or diabetes see their disease well publicized and talked about often. In therapy, I work with patients to learn language to speak openly about their disease and work to de-stigmatize IBD issues. This can be incredibly empowering for the patient.
JZ: Should all chronic illness conditions have specialists for mental health?
MR: I certainly don't think it would hurt. Therapy can be beneficial for people who have no chronic conditions. Having support during a challenging time can make that time more tolerable and hopefully, less challenging.
JZ: What do you recommend to someone who is really struggling with their mental health?
MR: Start talking. If someone is depressed, tasks that many take for granted (i.e getting out of bed in the morning) can be challenging. If you don't know where to start, or starting feels too hard, begin by asking a loved one to help you. When you open up to someone else, your struggles may feel slightly less burdensome. The kind words, love and support of someone who cares about you can be an excellent step in the right direction. They may help you locate a psychologist in your community who specializes in health conditions, anxiety and/or depression. Getting connected with others who have IBD can also be beneficial, but be careful how much time you spend online... attending in-person programs and events through your local IBD community can build valuable relationships.
JZ: Why is talk therapy such an effective treatment for depression and other mental health issues?
MR: While friends and loved ones can offer advice and support, they are not trained professionals who know how to treat mental health conditions. A psychologist or mental health professional will use evidence-based interventions and treatment to address depression, anxiety and other aspects of mental health. The treatment plan is tailored to the needs of the individual and often can provide mood improvements in a short period of time. Additionally, a mental health professional can assess for whether medication management may also be warranted and can provide information about treatment options.
JZ: What would you tell someone who is unsure if therapy is a good option for them?
MR: Give it a try. While it can be scary to seek out therapy, once you find a good fit with a mental health professional, you will likely wonder why you waited so long. If you have had a bad experience, don't give up!! All therapists are different and can offer different types of treatment and perspective. It takes an incredible amount of courage to seek out therapy, but the benefits can be life changing.
JZ: Is there any research that exists about mental health and GI patients that includes information about how therapy can be beneficial?
MR: Research is happening and it is also a growing area of interest in the GI and psychology worlds… This [link in the previous sentence] is a newer study which shows that research in the area of mental health treatment and IBD is being done...this is very important and a step in the right direction. We need more robust research in this area, but I believe it is coming. I published and presented an abstract at Digestive Disease Week in 2016 with my current research indicating that patients with IBD were benefiting from individualized behavioral health treatment just as much as patients with functional bowel disorders. My work is ongoing, but one goal is to encourage IBD patients to seek treatment if they need it, encourage gastroenterologists to be more proactive in recommending GI behavioral health treatment and to de-stigmatize seeking out this form of therapy.
JZ: I want to sincerely thank Dr. Riehl for her time, and more importantly for her commitment to helping IBD patients with their mental health. This is an area that has historically been ignored by many medical professionals, and I sincerely hope that we are turning over a new leaf with a lot of help from doctors like Dr. Riehl!
Comparison of Quality of Life and Treatment Response in IBS and IBD Patients Undergoing GI-Focused Behavioral Health Interventions. Riehl, Megan E. et al. Gastroenterology, Volume 150, Issue 4, S443
Jackie is an ulcerative colitis patient and the founder and Executive Director of Girls With Guts. Since diagnosis, she has been blogging her IBD journey at Blood, Poop, and Tears. Jackie has worked hard to become a strong voice in the patient advocacy community, and pays it forward as Social Ambassador of the IBD HealthCentral Facebook page.