Living the life you want with IBD. Pat Howe, LMSW, LMFT Inflammatory Bowel Clinic Gastroenterology, Spectrum Health

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2 Living the life you want with IBD Pat Howe, LMSW, LMFT Inflammatory Bowel Clinic Gastroenterology, Spectrum Health

3 Holistic health - WHO Health: State of complete physical, mental and social well-being, not the absence of disease or infirmity Good health and wellness: Degree one feels positive and enthusiastic about oneself and life 3

4 [SHMG Pat Howe, LMSW IBD CCFA presentation] Living the life you want with IBD You have a diagnosis of IBD? IBD is something you have it is not who you are! Your identity is yours to own and define Emotional self care critical in management of your disease 4

5 Putting the pieces together Don t lose yourself in the medical management process You are in the center of the care! Self-care while managing disease is THE difference between thriving or surviving

6 Making time really? 6

7 How dare you! 7

8 Bi-directionality of the GBA Gut Largest producer of serotonin, a neurotransmitter that relays distress signals from our gut to our brain Gut pain registers in the brain Brain Life challenges/stress connect to gut pain

9 How it works

10 Feelings and your gut People with IBD v non IBD Two times greater chance of struggle with anxiety/ sadness Women four times higher chance struggling Anxiety/depression 10

11 Seasons of hard life - worry Missing school or work Accidents Accommodation needs Expensive medications How to share with others Am I accepted Can I be intimate Bathroom logistics Well meaning people 11

12 Caring for someone with IBD Oh you must feel so much better SURE So great you re out of hospital now get on with life RIGHT Great you will be back at full speed in no time! 12

13 Warning Sign!. 13

14 Negative thoughts I won t be accepted by people I won t be able to go out I am abnormal I will be fired I will make a fool of myself I cannot have a normal life 14

15 Stress hurts 15

16 IBD life with unpredictability Can cause us to: Stop making plans Live in isolation Feel like giving up How we think about ourselves and our lives shape how we expect others to see us! 16

17 Don t believe everything you think! Cognitive Behavior Therapy Believing something does not make it true Even if We believe it strongly Feel certain we are right 17

18 We are not superhuman! 18

19 Tools for healthy living Healthy coping skills How we think - Interrupting negative thoughts (CBT) Controlled diaphragmatic breathing Progressive Muscle Relaxation Relaxing Imagery Pain management techniques Computer assisted apps e.g. 19

20 Check list - cognitive distortions All or nothing thinking Emotional reasoning Over-generalization Should statements Discounting the positives Labeling yourself Jumping to conclusions Personalization Mind-reading Mental filter Fortune telling Magnification or Minimization 20

21 Negative Thinking = Negative Feelings Sadness Fear Anger Unhappy Apprehensive Annoyed Upset Worried Frustrated Sad Anxious Irritated Discouraged Nervous Aggravated Miserable Scared Angry Depressed Terrified Furious Hopeless Petrified Enraged 21

22 Self-care balance score-card 22

23 Chicken or the egg.? 23

24 Changing negative thinking Life Scenarios: Work meetings Family: Well meaning questions Logistics: Eating out, movies, parks 24

25 Relaxation tips Breathe, meditate, relax Take one thing at a time Good sleep and rest Hobbies Make friends share feelings Support groups Give in occasionally Go easy with criticism 25

26 Deep Diaphragmatic Breathing Breathe in slow 5 seconds. Notice air filling lungs. Hold 5 seconds. Should last longer than ordinary breath. Breathe out slowly 5-10 seconds Repeat the breathing process until you feel calm ~ 3-5 times 26

27 Progressive muscle relaxation Tensing and relaxing the muscles progressively Working down to your feet and toes Tense your muscles for about five seconds Relax for 30 seconds, and Repeat 27

28 Guided visual imagery Technique for healing, stress relief and personal development. Improves mind-body health. Lowers blood pressure, cholesterol and glucose levels Heightens short- term immune cell activity. 28

29 Why use these techniques? Heart rate/blood pressure Muscle tension Blood Hands/feet Energy and motivation Concentration Immune system Stress hormones 29

30 Changing negative thinking Life Scenarios: Work meetings Family: Well meaning questions Logistics: Eating out, movies, parks 30

31 Your busy but don t forget YOU Life can be complex and stressful for everyone Managing Crohns/Colitis can make life more challenging Listen to your body Know your limits Know when to ask for help

32 Knowing when to seek help New IBD diagnosis Difficulty coping flares Overwhelming stress Lingering sadness or anxiety Feeling alone Trouble sleeping Persistent pain Others concerned for you

33 Let s review Know your strength Know your limits Know what you need Know where to get it If you are unsure ask Don t wait till things get out of control

34 Navigating to calm waters 34

35 Resources Online Reference CBT and Mindfulness Practices - Books Clinical Challenges and Complications of IBD, Miguel D. Regueiro, Jason M.Swager, 2013 Reclaim your life from IBS, Melissa Hunt, PHD, 2016 Cognitive Therapy With Chronic Pain Patients, Aaron Beck, Carrie Winterowd & Daniel Gruener, 2003 Cognitive Therapy of Anxiety Disorders: Science and Practice, Aaron Beck & David Clark 2013

36 References Cryan, J. F., & Dinan, T. G. (2012). Mind-altering microorganisms: the impact of the gut microbiota on brain and behaviour. Nature reviews neuroscience, 13(10), De Palma G, Collins SM, Bercik P, Verdu EF. The microbiota gut brain axis in gastrointestinal disorders: stressed bugs, stressed brain or both? The Journal of Physiology. 2014;592(Pt 14): doi: /jphysiol Dinan, T. G., Stilling, R. M., Stanton, C., & Cryan, J. F. (2015). Collective unconscious: how gut microbes shape human behavior. Journal of psychiatric research, 63, 1-9. Liu, R. T. (2017). The microbiome as a novel paradigm in studying stress and mental health. American Psychologist, 72(7), 655. Marques, Tatiana & Cryan, John & Shanahan, Fergus & F. Fitzgerald, Gerald & Paul Ross, R & G. Dinan, Timothy & Stanton, Catherine. (2013). Gut microbiota modulation and implications for host health: Dietary strategies to influence the gut-brain axis. Innovative Food Science & Emerging Technologies /j.ifset Palma, G., Collins, S. M., Bercik, P., & Verdu, E. F. (2014). The microbiota gut brain axis in gastrointestinal disorders: stressed bugs, stressed brain or both?. The Journal of physiology, 592(14), Srinath, A. I., Walter, C., Newara, M. C., & Szigethy, E. M. (2012). Pain management in patients with inflammatory bowel disease: insights for the clinician. Therapeutic advances in gastroenterology, 5(5),

37 Thank you Pat Howe, LMSW Image Source: pixabay.com Free for commercial use, no attribution required 37

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