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 population) 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 (IBDs), 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. PBTA's membership is an obvious target audience, since they bring solid CBT skills and need only acquire an understanding of GI specifics.
CE Learning Objectives (see below for more)
Following this presentation, participants will be able to:
- Describe case conceptualization steps for working with comorbid mood and anxiety symptoms in chronic GI disorders
- Describe two ways CBT is modified in work with people with GI disorders comorbid with anxiety symptoms, including care collaboration with gastroenterologists and their teams.
Schedule (see below for additional information from presenter)
Hour 1) How to 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.
Hour 2) How to modify the standard CBT approach to anxiety disorders to treat GI patients effectively, including collaborating successfully with gastroenterologists and considerations about medication.
About Presenter
Melissa G. Hunt is a licensed clinical psychologist and serves as the Associate Director of Clinical Training in the Department of Psychology at the University of Pennsylvania. She is a Fellow and Diplomate of the Academy of Cognitive Therapy and a member of the Rome Foundation Psychogastroenterology working group.
She conducts research on the best approaches to stress management, and into the causes and treatment of depression, anxiety disorders and chronic GI disorders. As a clinical scientist, her emphasis is on translating basic psychological science into treatments that are effective, acceptable, and accessible to patient populations, including evidence based and empirical supported self-help books and smart phone apps. In particular, she focuses on identifying and helping people correct the underlying factors (e.g. unhelpful beliefs and maladaptive avoidance) that lead to reduced quality of life, impairment and distress, particularly factors that exacerbate chronic health problems and make them harder to cope with.
In addition to her research and teaching, she maintains an active private practice in clinical psychology in which she specializes in cognitive-behavioral treatment with patients with chronic GI disorders, as well as co-morbid mood, anxiety, obsessive-compulsive, and trauma disorders. She is the author of two evidence-based, empirically supported self-help books that make CBT accessible to patients with IBS and IBDs and has collaborated on developing an app that provides CBT for IBS. She has also published numerous research papers, including a number of randomized controlled trials testing the efficacy of self-help treatments for patients with GI disorders.
Target Audience
This presentation is intended for licensed mental health professionals and advanced graduate student trainees seeking licensure and with some clinical experience. The instructional level of this presentation is Beginner.
Continuing Education
- Philadelphia Behavior Therapy Association is approved by the American Psychological Association to sponsor continuing education for psychologists*. Philadelphia Behavior Therapy Association maintains responsibility for this program and its content.
- This program provides two (2) hours of CE credits.
- PBTA is also an authorized provider of CE credits for Professional Counselors, Marriage and Family Therapists, and Clinical Social Workers licensed in the state of Pennsylvania.
- ZOOM VIDEO LINK WILL BE SENT TO REGISTRANTS, WITHOUT OUTSTANDING BALANCE, 2 DAYS BEFORE & MORNING OF EVENT
- Full attendance with video display is required to obtain CE credit for this program. APA guidelines do not permit PBTA to issue partial CE credits. No refunds are provided for CE programs. No exceptions allowed.
- * PBTA does not currently offer CE to practitioners licensed in the state of New York.
- All events are Eastern Time Zone
- Contact PBTAcontinuingeducation@philabta.org if you need any learning accommodations no later than one week before event.
Additional information covered in this training:
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.
