This workshop covers 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 and/or social anxiety disorder, formulating appropriate treatment goals and basic cognitive and behavioral strategies for treating IBS, including IBS that is comorbid or secondary to an underlying IBD. Case material reflecting patients along a spectrum of severity will also provide for lively discussion and acquisition of new skills and techniques.
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) functional bowel disorder that is highly co-morbid with anxiety disorders and depression and shares considerable conceptual overlap with panic disorder, agoraphobia and social anxiety. 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. 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 heighted risk for IBS in a subset of patients. In addition, many IBD patients experience shame, avoidance and social anxiety about their condition.
1) How to develop a case conceptualization that integrates GI disorders with any co-morbid mood or anxiety disorders.
2) What unique cognitive distortions and behavioral avoidance strategies (especially fear of incontinence and dietary restrictions) tend to maintain and exacerbate distress and disability in GI disorders.
3) How to modify the standard CBT approach to anxiety disorders to treat GI patients effectively, including collaborating successfully with gastroenterologists.
Melissa G. Hunt, Ph.D. 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 (academyofct.org), and is proud to have served as a frequent program committee member for the Anxiety and Depression Association of America (ADAA.org). Her primary research interests are in the domains of behavioral health and stress management, with a particular emphasis on individuals with 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. In particular, she focuses on identifying the underlying patient factors that lead to reduced quality of life, impairment and distress, particularly factors that exacerbate chronic health problems and make them harder to cope with, and then creating, testing and disseminating self-help treatments. In addition to her work at Penn, she also has an active private practice in clinical psychology in which she utilizes cognitive-behavioral therapy, augmented by schema therapy, imaginal rescripting, mindfulness and yoga in the treatment of mood, anxiety, obsessive-compulsive, trauma, and chronic health disorders.