Megan Riehl, PsyD, is a prominent GI psychologist at the University of Michigan who has lectured extensively around the country in the area of psychogastroenterology and is considered a leader in her field. Her clinical expertise spans the field of gastroenterology from patients with motility disorders like IBS, to those with chronic gastrointestinal diseases like IBD, and Celiac Disease. Dr. Riehl is the clinical program director of the GI Behavioral Health Program at Michigan Medicine where she has a full-time clinical practice, leads GI behavioral health training, and provides peer consultation. Her research and clinical expertise has led to several peer-reviewed publications, book chapters, and invited commentaries on well-known media publications and websites.
What is Psychogastroenterology?
Digestive conditions can be incredibly difficult to manage and can require a multidisciplinary team. Psychogastroenterology is an emerging field that focuses on applying scientifically-based psychological principles and techniques to GI conditions. Incorporating brain-gut psychotherapies into routine GI care is now considered best practice in the management of digestive conditions. The treatment offered by a GI psychologist is tailored to each individual to aid in the management of their health. Sessions are typically short-term in nature (5-10 sessions), present-focused and can aid in improving the frequency, duration, and severity of symptoms. As a GI psychologist, I use evidence-based behavioral interventions to improve gut-brain dysregulation common in patients living with IBS and IBD, such as cognitive behavioral therapy or gut-directed hypnotherapy. Treatment can help with GI-specific anxiety or depressive symptoms. GI behavioral health treatment isn’t recommended for people with moderate to severe mood disorders unrelated to health.
Food Fears and Anxiety
Given the complexities of digestive conditions, a GI psychologist may help with anxiety-related to the uncontrollable nature of GI symptom flare ups, medical decision making, creating healthy lifestyle changes, and improving stress management. There’s also a growing body of literature looking at the role of food-related anxiety given that some patient’s symptoms are driven by dietary triggers. Many of my patients have worked with a registered dietitian skilled in helping them implement the low FODMAP diet. Treatment goals include identifying food triggers and then working to liberalize their diet again. However, for some, reintroducing foods can present challenges and we may need to work as a team to address the food-related anxiety. When food fears impact a patient’s ability to meet nutritional needs, greater clinical attention may be needed as the patient might be suffering from avoidant/restrictive food intake disorder or ARFID.
The ability to relax and clear your mind is a helpful coping skill for managing life’s stressors. However, if you have many stressors, such as those that can be associated with having a chronic disease or pain, you may have some difficulties with relaxation. You may even wonder, “where would I begin?” Your breath is a wonderful place to begin when it comes to relaxation. There are many advantages to learning how to diaphragmatic breathing (i.e. belly breathing, deep breathing). Here are just a few:
- Lowers heart rate and blood pressure
- Decreases muscle tension
- Oxygenation of your blood
- Brings warmth to the hands and feet
- Increases energy and motivation
- Improves concentration
- Strengthens the immune system
- Reduces stress hormones
- Activates the relaxation response of the body (reversal of the stress response)
- Can be easily implemented, doesn’t require medication and won’t cost you a thing
The activation of the diaphragm through diaphragmatic breathing, allows for a gentle massage of the internal organs (intestines and stomach). This can aid with abdominal pain, urgency, bloating, and constipation.
For those that experience diarrhea and urgency, use diaphragmatic breathing in those moments of panic (i.e. “I MUST get to the bathroom immediately”) to aid with calming down your digestive tract.
For those with constipation, use diaphragmatic breathing while sitting on the toilet attempting to have a bowel movement. The relaxed breathing can aid with calming and massaging your system, which may lead to a more complete bowel movement. Below is a video demonstration of diaphragmatic breathing.
My Experience and Helping Others
I find the work that I do as a GI psychologist to be incredibly rewarding. At times, I’m working with patients who have felt hopeless about their life with a digestive condition or that others believe their symptoms are “in their head.” By providing patients with information about the intricate relationship between the brain and the gut and the ability to learn strategies to improve this relationship, they begin to feel validated, hopeful, and motivated.
If you’ve been curious about how a GI psychologist may fit into your treatment team, you can check the Rome Foundation Psychogastroenterology Directory for a provider near you. If there’s not one near you (yet), you can use Psychology Today to search for a mental health provider by your zip code, narrowing the search to those who specialize in chronic illness and anxiety and use cognitive behavioral therapy. Remember that it’s important to have a good therapeutic rapport with your mental health provider, so it can take some time to find the best person for you.