Gastrointestinal disorders of all kinds are exacerbated by stress and are also stressful. Irritable Bowel Syndrome (IBS) is a highly prevalent (approximately 10% of the general population but up to 30% of psychiatric treatment seeking individuals) disorder of gut-brain (or central-enteric) interaction that is highly co-morbid with anxiety disorders and depression and shares conceptual overlap with panic disorder, agoraphobia, social anxiety and ARFID. It also leads to considerable disability and distress. Managing these patients effectively requires a good conceptual understanding of the biopsychosocial and cognitive underpinnings of IBS as well as the kinds of avoidance behaviors (both obvious and subtle) that maintain and often exacerbate both symptoms and disability. General CBT skills are essential but incorporating GI specific phenomena (like bowel control anxiety and fear of food) are also important. There is significant empirical evidence supporting the use of CBT in treating IBS, including multiple RCTs.
The inflammatory bowel diseases (IBD), such as Crohn’s Disease and ulcerative colitis, have clear biological pathophysiology, but share some of the same symptoms and can lead to heightened risk for secondary IBS in a subset of patients. In addition, many IBD patients experience shame, avoidance and social anxiety about their condition.
This workshop will cover what is known about the etiology and symptoms of IBS, how IBS patients present in clinical practice; IBS in the context of co-morbid panic and agoraphobia, social anxiety disorder, ARFID and depression; formulating appropriate treatment goals and basic cognitive and behavioral strategies for treating IBS, including IBS that is comorbid or secondary to a more serious IBD. Case material reflecting patients along a spectrum of severity will provide for lively discussion and acquisition of new skills and techniques. Audience participation, clinical questions and role-playing will be welcomed, leading to interactive, experiential, in-depth training. Application of evidence-based psychotherapies to chronic GI disorders is now referred to as psychogastroenterology. Unfortunately, there are very few providers trained in GI informed psychotherapy. We desperately need more skilled clinicians to treat this large and underserved population. ADAA’s membership is an obvious target audience, since they bring solid CBT skills and need only acquire an understanding of GI specifics.
Post-workshop, participants will be invited to complete a series of reflection questions to help consolidate learning and reduce barriers to applying new knowledge and skills to their clinical practice. (See Bennett-Levy, J., & Padesky, C. A. (2014). Use it or lose it: Post-workshop reflection enhances learning and utilization of CBT skills. Cognitive and Behavioral Practice, 21(1), 12-19.). In addition, participants will have the opportunity to take part in case consultation sessions post-workshop to get guidance from the presenter on applying the skills to specific patients in their practice.
The presentation will cover:
Diagnosis and differential diagnosis of chronic GI disorders.
Etiological models of IBS and quality of life impairment in the IBDs (including biological factors, such as the impact of stress hormones and the microbiome on the functioning of the GI system, centrally mediated pain processing issues that lead to visceral hypersensitivity, cognitive factors such as catastrophizing and behavioral factors such as avoidance).
Treatment options, including dietary modifications (which are the most common approach utilized by IBS patients in the community), gut directed hypnosis, stress management and CBT including a substantial exposure component.
Several hypothetical cases will be presented with “choice points” built in allowing participants to practice applying new knowledge and skills. Finally, the presenter will solicit questions and participation from audience members, especially regarding case consultation. Role playing may be used to demonstrate effective CBT approaches with the audience member “playing” their patient.
Course Objectives
At the conclusion of this course, participants will be able to:
- Describe the etiology, prevalence, symptoms, complications and medical treatment options of both irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) in order to work effectively with these patients.
- Develop a case conceptualization that integrates GI disorders with any co-morbid mood or anxiety disorders, including the unique cognitive distortions and behavioral avoidance strategies (especially fear of incontinence and dietary restrictions) that tend to maintain and exacerbate distress and disability in GI disorders.
- Use a standard CBT approach with anxiety disorders to treat GI patients effectively, including collaborating successfully with gastroenterologists and considerations about medication.
Instructional Level
This CE program is free to Kaiser Permanente employees.
Instructional Methodology
Lecture
Audio/Visual
On-Line Presentation
Continuing Education Information
Kaiser Permanente Northern California Mental Health Training Programs is approved by the California Psychological Association, Office of Professional Development, to sponsor continuing professional education for psychologists in California.
Kaiser Permanente Northern California Mental Health Training Programs designate this live activity for 3 hours continuing education credits for the above-identified licensed professionals.
Refund and Attendance Policy
The seminars mentioned above are Free of charge to Kaiser Permanente Employees and Trainees.
IMPORTANT NOTICE: Those who attend the program in full and complete the appropriate evaluation form will receive CE credits. Please note that credit will only be granted for those who attend the entire lecture.
