Understanding the Link Between Mental Health and Gastrointestinal Difficulties
by Dr. Amber Cohen Psy.D., C.Psych.
While chronic gastrointestinal difficulties are a serious physical condition, the mind-gut connection also plays a significant role in the symptoms associated with gastrointestinal difficulties (such as IBS, IBD, Chron’s, Colitis, etc.).
The mind-gut relationship
The mind (our thoughts and mood) and gut functioning have a strong relationship. The central nervous system (the brain and spinal cord) and the enteric nervous system (the gut’s nervous system) are in constant communication about our digestion, thoughts, emotions and appetite. The mind-gut communication is channeled through neurotransmitters, which are chemical messengers that impact and regulate mood, sleep, appetite and sex drive. While it has been historically believed that these chemicals were produced in the brain, current research shows they are largely produced in the gut. In particular, 95% of our body’s serotonin can be found in our gut! Consequently, our emotional well-being is closely linked to the health of our gastrointestinal tract.
While your symptoms are certainly real and not imagined, gastrointestinal difficulties and anxiety are often comorbid. Research indicates two types of relationships between chronic gastrointestinal difficulties and anxiety. One is that anxiety and stress activate problems with digestion. When we experience emotional stress, stress chemicals get released into the gut which negatively impact our digestion. The second relationship is that any medical difficulty, such as chronic gastrointestinal difficulties, can trigger anxiety.
Gastrointestinal difficulties significantly impact many areas of one’s life (i.e., work, family, and social functioning) which can also induce stress.
Understanding the Link Between Mental Health and Gastrointestinal Difficulties
The impact of mental health on digestive conditions rests on a continuum. On one end, there may be some mild stress responses, and on the other end, there is chronic health anxiety. Health anxiety is the experience of ruminating about a threat to your health, which can then trigger your anxiety response. Even for those who do not meet the criteria for a psychological disorder diagnosis, people with gastrointestinal difficulties often have associated fears and worries that are directly related to their symptom experience.
Many people with chronic gastrointestinal difficulties suffer for years before being correctly diagnosed. Just the experience of engaging in countless medical tests is anxiety producing – it is a significant time commitment, which is disruptive to one’s life and there is the uncertainty of what the results will bring. Additionally, symptom flare-ups can be traumatic. Especially the first, worst, or most recent symptom experience. Common fears people with chronic gastrointestinal difficulties experience are:
The uncertainty of when symptoms will arise.
Shame or embarrassment about symptoms.
New or busy situations where one is unsure how they will be able to manage their symptoms.
Discomfort in tight fitting clothing.
Not wanting to eat in social situations.
Making sure one has their “kit” at all times. (i.e., fresh underwear, medications, wipes, etc.)
Worries about forming new relationships (i.e., dating, colleagues, friends, etc.)
Anxiety about eating and food choices.
These fears are rational, because when we experience trauma, our brains are wired to protect us by scanning everything in our environment and bodies to ensure safety. Brain vigilance helps warn us that the experience may be happening again so we can prepare to survive. Therefore, with anxiety about gastrointestinal difficulties, technically your brain is working correctly, but too much of anything can be problematic. Too much body scanning and overthinking is no different – if you are always looking for a problem, you can trigger a problem.
The Link Between Chronic Gastrointestinal Difficulties and Low Mood
Gastrointestinal difficulties also often coexist with low mood. With so many factors to manage, it can be incredibly overwhelming. Common negative impacts on mood are:Feeling isolated and alone with our symptoms.
Lower confidence due to body image concerns and/or symptom flare-ups.
Avoiding physical and emotional intimacy, which then contributes to feeling more isolated.
Disengaging from social activities that were previously enjoyed.
The experience of chronic pain and discomfort.
The experience of feeling low energy.
Feeling hopeless and/or helpless about the future.
Discomfort with spontaneity.
Fatigue at having to read through every ingredient.
Sadness about missing social occasions.
How to Optimize Gut-Mind Health
Cognitive Behavioural Therapy (CBT)
Engaging in CBT treatment with a therapist will allow you to tailor a treatment plan that is specific to your unique needs and goals. Here are some of ways that CBT can help:
Having a safe and supportive space to understand the relationship between your mental state and your gastrointestinal symptoms.
Learning self-regulation strategies that increase both physical and mental relaxation.
Understanding and managing ineffective thought and behavioural patterns in order to improve mood and relieve stress.
Training in flexible problem solving to feel more confident when coping in stressful situations.
5 Self-Help Coping Strategies
Relaxation Techniques: This can be any strategy that works to relax your mind and body by bringing mindful awareness to the present. Some examples could be: visual or breathwork meditations, mindful stretching, having a warm bath, or drinking a cup of tea. If you have specific gastrointestinal symptoms, think about what relaxation techniques can target that area. Perhaps try a visualization that focuses on your stomach, or pick stretches that soothe that area.
Exercise: Exercise is incredible for our mental and physical wellbeing, but it is important to choose physical movement you actually enjoy and works for your body. Moving your body intuitively - whether that is by running, walking, dancing, etc. can help reduce stress, boost your mood, and support your gut.
Self-Talk: The way you speak to yourself matters! Be mindful of your thoughts and try to meet yourself with compassion and kindness. Self-criticism can exacerbate stress, so if you practice changing your thoughts, you will be able to better support your mind-gut health.
Self-Care: Self-care is all about doing the things that make us feel confident, nurtured, and joyful! Choose easy, inexpensive ways to nurture yourself. Some examples are: listening to or playing music, engaging in arts or crafts, reading, or being outdoors and enjoying nature.
Seek Support: You are not alone in your experience! Experiencing and managing chronic gastrointestinal difficulties can be incredibly frustrating and lonely. It is important to find individuals who can provide support. This can be through confiding in friends or family, seeking out support groups with similar gastrointestinal concerns, or speaking to a professional. Feeling connected and supported by others can help your nervous system feel at ease and improve confidence, which will ultimately support your mind-gut connection.
Dr. Amber Cohen’s areas of clinical interests include the mind-body connection, anxiety, depression, and trauma. Dr. Cohen owns a holistic wellness therapy practice comprised of Psychologists, Psychotherapists, Social Workers, Registered Dietitians, and a Naturopathic Doctor. Psychological therapy at The Cohen Clinic focuses on evidence-based strategies that help clients build effective coping skills and reach their highest potential.
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