In my last post about Crohn’s I mentioned that the adaptation of some type of relaxation program might be beneficial in the treatment of Crohn’s disease. There has been promising research in this field and the connection of gastrointestinal dysfunction and psychological disorders.
According to Collins(1), stress response is a healthy way of letting somebody respond to a threat. If however the stress response is linked to an inflammatory stimulus it enhances the response to an inflammatory stimulus independent of the release of hypothalamic corticotropin-releasing factor (CRF) or arginine vasopressin. These observations help us to understand the development of inflammatory disorders including inflammatory bowel disease (IBD) and post-infective Irritable Bowel Syndrome (IBS).
Now we can weave together these stories and see how stress management can affect the outcome on IBD and IBS.
In 1991, Guthrie et al.(2), did a study of 102 patients on the effects of a treatment group exposed to psychotherapy, relaxation training, and the control group continuing standard medical treatment alone. Three months into the study the treatment group had much greater improvement as compared to the control group based on physician’s and patient ratings. Constipation was however unaltered.
Interestingly, a positive prediction of success included among other things, intermittent pain exacerbated by stress. We will take a look at an article from the British Medical Journal in just a second, tying IBS and possibly Crohn’s disease to stress, especially psychological stress. The authors of the above study concluded that psychological intervention, read “stress management,” could be effective for two thirds of IBS patients who are unresponsive to medical treatment.
Now to the article in the British Medical Journal (3):
Strong evidence is presented that patients with IBS have also a psychiatric disorder. This compares to patients with an organic gastric condition such as peptic ulcers, inflammatory bowel disturbance and healthy controls. In fact, in IBS, psychiatric disorders are prevalent two to three times more. This suggests a strong correlation between a psychological disorder and IBS.
Role of Stress
Full two thirds of patients with IBS experienced a major social stressor such as bereavement, marital separation, broken family relationships before onset of symptoms. Success of Psychological Treatment Patients with irritable bowel syndrome were assigned to groups of stress management or pharmacological treatment. (4) The short term response was similar, at six months follow up, patients randomized to psychological treatment had significantly better responses, while patients receiving strictly drugs returned to initial symptom levels. Again, suggesting that the main problem in IBS is psychological.
15% (fifteen percent) of patients with IBS are non-respondent to bulking agents, antispasmodics etc. Most of these patients respond very well to dynamic psychotherapy or hypnotherapy and the reduction of bowel symptoms is preceded by the reduction of psychological factors indicating a clear link. (2)
Hence recognizing psychological factors in IBS and IBD (Crohn’s) could lead to a more satisfactory treatment such as prescribed by Ramsey (4), in which small groups of patients met for six weekly sessions. These sessions helped patients to understand stress, the nature of the disorder; to learn the techniques of Progressive Muscle Relaxation (I talked about that earlier), problem solving, the importance of diet, and fitness. Psychological treatments seem to have much better long term results than the pharmacological approach. (2, 5)
I hope this shows again that there is a clear connection between the body and the mind and if we understand the one, we can positively impact the other, and vice versa, without the use, or minimal use of toxic pharmacology.
(1) Collins, S. Stress and the Gastrointestinal Tract. IV. Modulation of intestinal inflammation by stress: basic mechanisms and clinical relevance. Am J Physiol Gastrointest Liver Physiol 280: G315-G318, 2001.
(2) Guthrie E., et al. A Controlled Trial of Psychological treatment for the Irritable Bowel Syndrome. Gastroenterology (1991):100:450
(3) Creed F. Psychological Treatment is Essential for Some. British Medical Journal (Dec 17, 1994) v309 n6969 p1647(2)
(4) Rumsey N. Group Stress Management Programmes versus Pharmacological Treatment in the Treatment of the Irritable Bowel Syndrome. In: Heaton K., Creed F., Goeting N., eds. Towards Confident Management of Irritable Bowel Syndrome. Lyme Regis: Duphar. (1991):33-9
(5) Heaton K. What Makes People with Abdominal Pain Consult their Doctor? In: Creed F., Mayo R., Hopkins A. eds. Medical symptoms not explained by organic disease. Royal Colleges of Psychiatrists and Physicians. London (1992):1-8