Report from Bruce D. Naliboff, PhD: Symptom Based Psychology for Functional Gastrointestinal Disorders
By: Bruce D. Naliboff, PhD
David Geffen School of Medicine, UCLA, Los Angeles, CA
Dr. Naliboff is the recipient of the 2007 IFFGD Research Award for Senior Investigator – Clinical Science. Dr. Naliboff is an innovator in human experimental studies of pain mechanisms, including his current work on visceral sensitivity in irritable bowel syndrome (IBS). He has made important contributions to our understanding of the critical role of the central nervous system in chronic visceral and somatic pain conditions and of mechanisms involved in visceral hypersensitivity, hypervigilance, and symptom specific anxiety. Other areas of interest include psychosocial moderators of symptom presentation and sex differences in pain responses.
Many studies show an increase in negative moods like anxiety or depression in those suffering from functional gastrointestinal (GI) and pain conditions. Are these psychological factors an important cause for the development and/or maintenance of symptoms in functional GI disorders? Or are they a result of maybe years of disrupted life activities and frequent periods of intolerable symptoms? As we will see, the unfolding story indicates that a better understanding of negative mood states has important implications for self-management as well as medical disease management of these disorders.
Symptom-specific Psychological Characteristics
Although increases in negative mood appear to be common in functional GI disorders and they clearly impact the quality of life of patients; our group is concerned that the standard psychiatric assessments do not capture very well the specific types of worries, fears, and thoughts that may characterize the negative moods of those with functional GI disorders. For example, individuals with IBS may not have symptoms of anxiety in general, but only in relation to GI related events or sensations (like meals, abdominal pain, or diarrhea), i.e. GI symptom-specific anxiety.
Symptom-specific Psychology and the Development of Functional GI Symptoms
One commonly asked question with regard to psychological issues in functional GI disorders is which comes first, the disturbed mood or the GI symptoms? There does not seem to be a simple answer to this question. In our research we have tried to highlight what we see as a bidirectional or interactive relationship between symptoms and psychological factors, especially symptom-specific psychological factors.
Neurobiology of Functional GI Disorders
Our view of functional GI disorders tries to understand how the big brain (in our heads) and the little brain (in our GI tract) influence each other to generate health, healing, or illness. At our Center we have been using new technologies to examine directly how the brain responds to GI sensations and conversely how the brain influences activity in the GI system. By using these novel techniques we hope to increase our understanding of these processes as well as to help to reverse the vicious cycle of emotions and GI symptoms.
Implications of a Symptom-specific Psychology for Treatment
If we accept that psychological responses, and especially symptom relevant psychological responses, play a role in the persistence and exacerbation of functional GI disorder symptoms, it would be important to try and target these responses as part of an overall treatment plan. At our Center, we have been interested in very specific ways to change symptom-specific anxiety and are currently testing even more targeted treatment approaches to help change the way the brain responds to sensations in the bowel using psychological techniques.