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Fight IBS with behavioral therapy

(CNN) –Kevin Yu thinks back on the horrible year that his belly held him "prisoner". There was constant pain, the…

(CNN)
Kevin Yu thinks back on the horrible year that his belly held him “prisoner”. There was constant pain, the unremitting pursuit of using the bathroom from the moment he woke up until he went to sleep.

“The only time I really felt OK was either when I was sleeping or sleeping in the toilet,” said the 38-year-old.

Yu also had poor reflux and a “constant gas build-up” in the stomach. “All these very strange diseases,” he said. The pain got so bad, Yu ended up on ER.

“Doctors could not figure out anything” said the telecommunications product manager.

GI specialists at the University of Pennsylvania drew blood, took pallet samples and performed an endoscopy; Everything came back negative.

“My doctor said,” We do not see any physical signs of something wrong with you, “which was good news, but I did not look so good, Yu said.

“Eventually, they just came to me and said,” Kevin, we think you are in this big bucket of patients we only notice as IBS, “” or irritable bowel syndrome.

IBS is a chronic condition that is marked by stomach pains, diarrhea or constipation or alternating between both. It affects an estimated 1

2% of Americans or nearly one in eight people, according to the National Institute of Health.

IBS treatments failed, doctors sent him for therapy

Doctors prescribed Yu medications for IBS. They also had him restrict his diet to foods that are less likely to produce gas, known as low FODMAP.

“I literally eat nothing for six months but basically rice and potatoes.” But, Yu said, the constant rushes to the toilet continued, and that made the pain.

That’s when Yus doctors said they wanted to try something new.

They suggested that Yu see a psychiatrist who worked with his GI department. The psychiatrist suspected that Yus’s stomach problems could be helped, in part, with an antidepressant.

Yu had been under a huge amount of stress around the time the symptoms began in 2015.

He had started a new job and worked for at least 12 hours a day. Yu and his wife were in the midst of a hard renovation at their new house, and they had successfully tried to get a baby.

Yu recalled that the psychiatrist said to him, “Maybe you have IBS, but much is the connection between your brain and your stomach.”

One week after taking antidepressants, Yu said: “I noticed a dramatic change in my constant need for bowel movements.”

The psychiatrist suggested that Yu start seeing a clinical psychologist at the University of Pennsylvania, Melissa Hunt, who specializes in cognitive behavioral therapy for the treatment of chronic GI disorders.

Fight or flight: Gut brain connection

Yu experienced a breakthrough on his first visit with Hunt.

“It was like drinking water from a fire hose,” said Yu. “I learned a lot.”

Hunt explained to him what stress might make for your stomach. “When you get excited and your body is in a fight or air condition, a variety of biological processes, including increased heart rate, blood pressure and breathing, increased sweating, increased muscle tension and GI discomfort occur,” she said.

Hunt explained that GI discomfort may include a “spasmodic cramps in the intestine” which leads to urgent and immediate need to go to the bathroom – in other words diarrhea.

Stress can also lead to constipation, Hunt said, because muscle tension affects the pelvic floor and sphincter muscles.

“Every time I’m very hard, I started to realize that I squeezed my stomach,” said Yu.

“Looking back on my life, I began to realize how much it was between my brain and my stomach.”

Deep breathing, fighting catastrophic thinking, burning power energy

During Yus first therapy session with Hunt, they did some breathing exercises.

Deep breathing calms down the nervous system and reduces anxiety.

“So I take a deep breath, and she says,” Kevin, you see how you take all the air in your chest, and none of it comes to your stomach? You almost want to blow up your stomach. “

When his breath became deeper, so-called membrane breathing, “I not only felt calmer, I felt calm, I did not feel long.”

Yu becomes emotional as he remembers that day three years ago. “I had tears that poured out of my eyes.

“At that moment, I realized that breathing was the right way to calm my anxiety and to calm me when I’m in that state of serious distress,” said Yu.

Hunting asked Yu to practice the deep breath every day. She told him, “It may be while you go while sitting and watching TV, just focus on your breathing a little.”

“I would say within two or three weeks is when I really started buying it,” said Yu. “When I’m in pain, it takes pain down from a nine or 10 down to a four or five.” It was remarkable. “

Concerned about the pain made the pain worse

Although breathing alone helped, there were several other parts of the jigsaw puzzle. When Yu’s belly was going to hurt, he sent him to a psychological tail.

He described his thought process like this: “Oh no! This is the end of the world. I will not be able to go to work. My employer will be disappointed. My wife will be disappointed that I can not help around the house. “

Psychologists call it “disastrous thinking”.

“It was almost cyclical that my stomach would cause anxiety and yet my anxiety was to add extra discomfort,” said Yu.

It’s a big factor in IBS, Hunt said. It is known as “visceral hypersensitivity.”

“Pain signals from the intestine are improperly improper,” she said. It’s like a feedback loop.

“If I had any discomfort in the gas it was” my stomach hurts. “If I had lactose intolerance, it was” my stomach hurts, “said Yu.

In a few sessions, Hunt Yu taught how he was less keen when he felt pain.

Hunting asked Yu, “Do not say it hurts. Say,” I feel discomfort right now. “”

Yu began to interpret signals of hunger, anxiety and gas pain differently. “I’m going to understand,” OK, I know there’s no pain, oh, it’s hunger “or” I’m just a little stressed right now. “”

Hunting also encouraged Yu to increase his physical activity to burn away the stress response from battle or flight.

In recent months, Yu could not find time to practice as he did when he was younger. Instead, he played with his daughter (who was born during his treatment) and threw the ball with his dog. Even gardening made a difference for him.

Homemade version for IBS works also

Yus’s success with cognitive behavioral therapy for IBS is not unique. Dozens of studies show their effectiveness in IBS patients. Harvard University researchers reviewed 13 of them in a meta-analysis.

Patients who attempted psychological based approaches had greater improvement in their digestive symptoms compared to patients who received conventional medical treatment only.

One of the most convincing studies came out this year. It is the largest federally funded nondrug clinical trial for irritable bowel syndrome and included over 400 IBS patients. The study showed that more than 60% of patients reported significant improvements in their GI symptoms on just four or fewer visits to the psychologist, as well as doing the work at home. They practiced deep breathing and were working on changing themselves for not disastrous events and other known triggers.

They also learned to “improve their flexibility in approaching problems,” said Laurie Keefer, a major researcher for that study.

Keefer is a GI health psychologist and head of psychopathy research at Mount Sinai School of Medicine.

“We ask patients to write down their stressors so they can look a little more objectively on them,” she said. “That homework really is an important part of this type of therapy. When they look at their stressors, they challenge their approaches.”

For example, individuals write their worst fears and how they think about them. Then the patient investigates the fear objectively. How likely is the worst scenario to happen? Often it is unlikely that it will happen. In the event that it happens, the patient writes how to handle it so that there is a manageable plan.

“People continued to benefit long after they had stopped intervention. We found that patients were still doing really well in one year’s follow-up.”

Keefer said that many people are reluctant to see a psychologist because of a stigma still surrounding treatment. Testing these methods at home also lowers at the expense.

“There is very limited access to therapists who do this kind of treatment,” she said, but the study shows that it is effective to learn some of these methods to practice at home.

“I’m doing well today”

It’s been three years since Yu first became known by IBS. Today, he seldom suffers. He regularly breathes deeply, both when he is feeling stressed and watching television or chilling out. He continues to work on reprogramming his thoughts and negative self-esteem. “Something that’s as simple as thinking thinking can really only change your life drastically,” said Yu.

“I’m back outside to live my life. I reach out to my friends,” he said.

“I’m not in my 20’s anymore. I can not take the world anymore. I had to take a step back to do things one at a time. I’m not Superman.”

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