FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2967881738> ?p ?o ?g. }

• W2967881738 endingPage "293" @default.
• W2967881738 startingPage "290" @default.
• W2967881738 abstract "Chronic gastrointestinal (GI) disorders not only are linked to significant patient challenge, but these conditions can be impacted greatly by psychological distress, both exacerbating and exacerbated by GI symptoms per se. Significant psychological overlap exists, especially among patients with functional GI conditions (disorders of brain-gut interaction) with remarkably 50%–94% psychiatric comorbidity.1Lydiard R.B. Falsetti S.A. Experience with anxiety and depression treatment studies: implications for designing irritable bowel syndrome clinical trials.Am J Med. 1999; 107: 65S-73SAbstract Full Text Full Text PDF PubMed Scopus (88) Google Scholar The disease burden of organic GI conditions, such as ulcerative colitis, can be further magnified by a patient’s repertoire of coping skills and comorbid mental health diagnoses.2Click B. Ramos Rivers C. Koutroubakis I.E. et al.Demographic and clinical predictors of high health care use in patients with inflammatory bowel disease.Inflamm Bowel Dis. 2016; 22: 1442-1449Crossref PubMed Scopus (58) Google Scholar In fact, patients with chronic digestive disorders manifest higher rates of psychological distress, have lower quality of life than the general population,3Hauser W. Janke K.H. Klump B. Hinz A. Anxiety and depression in patients with inflammatory bowel disease: comparisons with chronic liver disease patients and the general population.Inflamm Bowel Dis. 2011; 17: 621-632Crossref PubMed Scopus (124) Google Scholar and some 38% can even experience active suicidal ideation related to GI symptoms.4Miller V. Jones H. Whorwell P.J. Hypnotherapy for non-cardiac chest pain: long-term follow-up.Gut. 2007; 56: 1643Crossref PubMed Scopus (21) Google Scholar While it may be intuitive to refer those in greatest distress for GI or psychological services, benefit can occur for patients with a wide spectrum of both mental health and medical presentations, including GI diagnoses ranging from ulcerative colitis to gastroesophageal reflux disease.5Kinsinger S.W. Ballou S. Keefer L. Snapshot of an integrated psychosocial gastroenterology service.World J Gastroenterol. 2015; 21: 2219-2840Crossref Scopus (28) Google Scholar Despite growing empirical support, GI or psychological services are often underutilized.6Keefer L. Palsson O.S. Pandolfino J.E. Best practice update: incorporating psychogastroenterology into management of digestive disorders.Gastroenterology. 2018; 154: 1249-1257Abstract Full Text Full Text PDF PubMed Scopus (87) Google Scholar Research supports effective psychological treatments for varying GI disorders, with numerous randomized controlled trials demonstrating a marked reduction in GI symptoms, as well as an overall improvement in quality of life and emotional well-being.7Palsson O.S. Whitehead W.E. Psychological treatments in functional gastrointestinal disorders: a primer for the gastroenterologist.Clin Gastroenterol Hepatol. 2013; 11: 208-216Abstract Full Text Full Text PDF PubMed Scopus (96) Google Scholar Understanding psychogastroenterology, including identifying appropriate patients for this service, can help increase patient utilization of psychological treatments with the goal of reducing GI symptoms, improving overall emotional health, and ultimately decreasing the high health care costs of this population. Arguably one critical step in successful GI or psychological care is the initial referral, including identifying appropriate patients for services. Physicians may astutely refer patients in overt psychological distress, as well as those patients who do not meet a DSM-5 diagnosis, such as major depression or generalized anxiety; both can reap benefits from working with this subspecialty.5Kinsinger S.W. Ballou S. Keefer L. Snapshot of an integrated psychosocial gastroenterology service.World J Gastroenterol. 2015; 21: 2219-2840Crossref Scopus (28) Google Scholar Palsson and Whitehead7Palsson O.S. Whitehead W.E. Psychological treatments in functional gastrointestinal disorders: a primer for the gastroenterologist.Clin Gastroenterol Hepatol. 2013; 11: 208-216Abstract Full Text Full Text PDF PubMed Scopus (96) Google Scholar recommend providers refer patients who continue to experience moderate to severe GI symptoms after 3–6 months of care, who exhibit overt psychological distress, or manifest medical symptom exacerbation, which is congruent with formal guidelines by the American Gastroenterological Association and American College of Gastroenterology. However, not every patient is appropriate for psychogastroenterology treatment, and certain patient factors may unfortunately act as a barrier to treatment. For example, patients with poor health stewardship, or those who avoid an active role in therapy, are far less likely to find therapeutic success. Similarly, those who are unwilling to acknowledge the identified impact of psychological symptoms on overall physical health, including GI symptoms, are expected to have a poor prognosis.7Palsson O.S. Whitehead W.E. Psychological treatments in functional gastrointestinal disorders: a primer for the gastroenterologist.Clin Gastroenterol Hepatol. 2013; 11: 208-216Abstract Full Text Full Text PDF PubMed Scopus (96) Google Scholar However, patients also can refer themselves directly for psychological care, especially when they have some initial level of awareness about psychological overlap with brain-gut interaction. Following referral, whether from medical practitioners, or from patients directly, psychological evaluation will typically commence with medical record review and a detailed psychological intake interview. This typically encompasses history taking of multiple arenas, including medical, social, educational, occupational, relational, and psychological domains, as well as stress or challenge areas and coping approaches with assessment of patient strengths. Many psychologists include formal assessment with validated psychological instruments to measure aspects of patients’ symptoms or functioning, such as measures of depression, anxiety, health concerns, pain perception, coping, substance use, compliance, health care provider relations, etc. Following initial assessment, feedback with treatment planning will ensue, and GI psychological care typically engages with interdisciplinary collaboration, by design. At this time, patients and providers can confer on recommended next steps in care, which commonly include: psychiatric medication optimization, continued medical care including GI symptom management, neuropsychological testing battery (eg, with cognitive changes), physical therapy or biofeedback, and ongoing psychological treatment, which can include specific techniques such as cognitive behavioral therapy (CBT) and gut hypnosis. This can be a helpful point in time to communicate again with the referral source, share the follow-up that has occurred to date, and identify the outcome of the evaluation with treatment recommendations. Several challenges are inherent in this evaluation process. Patient insight is attempted to be groomed with psychoeducation at initial assessment, coupled with administration of psychological techniques of normalization, validation, and empowerment, which are especially critical if GI patients arrive to psychological encounter burdened with stigma, or worse, interpret physicians as disbelieving or even pathologizing them by virtue of referring them for the very care intended to help treat the symptoms they find bothersome. This miscommunication unfortunately can occur often before the moment of initial psychological contact, which predisposes patients to guardedness, despite efforts to provide alignment and psychoeducation for the patient, including communication that the old model of conceiving symptoms to be dichotomously medical or psychological is far outdated. However, for appropriate referrals, including patients who are open to learning the bidirectional pathways joining medical and psychological realms, psychological assessment and treatment can provide critical information to guide treatment planning, modify symptoms, and improve coping and quality of life. Further, empirically supported therapies, including CBT and hypnosis, have been shown to significantly reduce both GI symptoms and comorbid psychological distress.8Levy R.L. Olden K.W. Naliboff B.D. et al.Psychosocial aspects of the functional gastrointestinal disorders.Gastroenterology. 2006; 130: 1447-1458Abstract Full Text Full Text PDF PubMed Scopus (378) Google Scholar Compared with mixed groups of control conditions, psychological therapies were effective at improving both mental health (đ = 0.41, P < .001) and daily functioning (đ = 0.43, P < .001) in GI patients. GI symptoms have also been found to improve in psychotherapy groups compared with mixed control groups among patients with irritable bowel syndrome (IBS) (đ = 0.69).9Laird K.T. Tanner-Smith E.E. Russell A.C. et al.Short-term and long-term efficacy of psychological therapies for irritable bowel syndrome: A systematic review and meta-analysis.Clin Gastroenterol Hepatol. 2016; 14: 937-947Abstract Full Text Full Text PDF PubMed Scopus (80) Google Scholar Further, psychotherapy has been shown to have a significant effect on symptoms of anxiety (đ = 0.37, P < .001) and depression (đ = 0.29, P < .001).10Laird K.T. Tanner-Smith E.E. Russell A.C. et al.Comparative efficacy of psychological therapies for improving mental health and daily functioning in irritable bowel syndrome: A systematic review and meta-analysis.Clin Psychol Rev. 2017; 51: 142-152Crossref PubMed Scopus (85) Google Scholar By far, CBT has been researched more than any other form of psychological treatment. CBT is a short-term, collaborative therapeutic model that addresses the relationship among one’s thoughts, emotions, and behaviors. The goal of therapy is to understand the impact maladaptive cognitions has on emotions, which ultimately can contribute to maladaptive behaviors, and GI psychology works to apply this framework to GI-related distress, whether stemming from medical symptoms per se, the physiological and psychological impact of stress (including on gut symptoms), or a cyclical combination of both dynamics. After gaining further insight into this relationship as it pertains to the patient, the therapist and patient work together to modify relevant behaviors and thoughts that may impact their perception of challenges and coping. Major components of CBT often include psychoeducation, relaxation strategies, cognitive restructuring, and exposure techniques.11Kinsinger S.W. Cognitive-behavioral therapy for patients with irritable bowel syndrome: Current insights.Psychol Res Behav Manag. 2017; 10: 231-237Crossref PubMed Scopus (53) Google Scholar CBT has been shown to be specifically effective for GI symptoms, with randomized control trials demonstrating superior CBT outcomes vs other forms of treatment, including antidepressant medications, stress reduction treatment, and supportive psychotherapy. Research has shown that CBT significantly reduces GI symptoms and improves overall quality of life.7Palsson O.S. Whitehead W.E. Psychological treatments in functional gastrointestinal disorders: a primer for the gastroenterologist.Clin Gastroenterol Hepatol. 2013; 11: 208-216Abstract Full Text Full Text PDF PubMed Scopus (96) Google Scholar CBT has been shown to produce the greatest improvements in daily functioning compared with relaxation therapy alone (Qb = 8.44, P = .004).10Laird K.T. Tanner-Smith E.E. Russell A.C. et al.Comparative efficacy of psychological therapies for improving mental health and daily functioning in irritable bowel syndrome: A systematic review and meta-analysis.Clin Psychol Rev. 2017; 51: 142-152Crossref PubMed Scopus (85) Google Scholar Further, CBT was found to be superior in improving GI symptoms, emotional health, or quality of life compared with mixed control groups among 26 randomized controlled trials, although the majority of the studies focused on patients with IBS.7Palsson O.S. Whitehead W.E. Psychological treatments in functional gastrointestinal disorders: a primer for the gastroenterologist.Clin Gastroenterol Hepatol. 2013; 11: 208-216Abstract Full Text Full Text PDF PubMed Scopus (96) Google Scholar Laird et al10Laird K.T. Tanner-Smith E.E. Russell A.C. et al.Comparative efficacy of psychological therapies for improving mental health and daily functioning in irritable bowel syndrome: A systematic review and meta-analysis.Clin Psychol Rev. 2017; 51: 142-152Crossref PubMed Scopus (85) Google Scholar conducted a meta-analysis assessing the comparative efficacy of various psychological therapies when treating IBS patients and found that CBT was utilized in 21 different trials, compared with the 4 trials that evaluated hypnosis. There were no significant differences found in daily functioning between CBT and hypnosis (Qb = 3.069, P = .080), and CBT, hypnosis, and psychodynamic therapies were found to be comparable in improving overall mental health (Qb = 1.85, P = .603).10Laird K.T. Tanner-Smith E.E. Russell A.C. et al.Comparative efficacy of psychological therapies for improving mental health and daily functioning in irritable bowel syndrome: A systematic review and meta-analysis.Clin Psychol Rev. 2017; 51: 142-152Crossref PubMed Scopus (85) Google Scholar While research supports hypnosis, relaxation therapy, biofeedback, and psychodynamic therapies in treating certain GI disorders, these studies are few in number compared with the breadth of studies evaluating CBT.7Palsson O.S. Whitehead W.E. Psychological treatments in functional gastrointestinal disorders: a primer for the gastroenterologist.Clin Gastroenterol Hepatol. 2013; 11: 208-216Abstract Full Text Full Text PDF PubMed Scopus (96) Google Scholar Demonstrated efficacy of psychological techniques for different GI conditions is summarized in Table 1.Table 1Randomized Controlled Trials Supporting Psychological Therapies for Gastrointestinal DisordersEmpirically Supported InterventionRCTsGI PopulationsCBT6Keefer L. Palsson O.S. Pandolfino J.E. Best practice update: incorporating psychogastroenterology into management of digestive disorders.Gastroenterology. 2018; 154: 1249-1257Abstract Full Text Full Text PDF PubMed Scopus (87) Google Scholar30IBS, IBD/Crohn’s disease, functional dyspepsia, non-cardiac chest pain, gastroesophageal reflux disease, rumination disorder, supragastric belchingBiofeedback7Palsson O.S. Whitehead W.E. Psychological treatments in functional gastrointestinal disorders: a primer for the gastroenterologist.Clin Gastroenterol Hepatol. 2013; 11: 208-216Abstract Full Text Full Text PDF PubMed Scopus (96) Google Scholar12Fecal incontinence, pelvic floor dyssynergia constipation, Levator ani syndrome, pediatric constipationHypnosis6Keefer L. Palsson O.S. Pandolfino J.E. Best practice update: incorporating psychogastroenterology into management of digestive disorders.Gastroenterology. 2018; 154: 1249-1257Abstract Full Text Full Text PDF PubMed Scopus (87) Google Scholar11IBS, IBD, heartburnRelaxation Training7Palsson O.S. Whitehead W.E. Psychological treatments in functional gastrointestinal disorders: a primer for the gastroenterologist.Clin Gastroenterol Hepatol. 2013; 11: 208-216Abstract Full Text Full Text PDF PubMed Scopus (96) Google Scholar6IBSPsychodynamic therapy7Palsson O.S. Whitehead W.E. Psychological treatments in functional gastrointestinal disorders: a primer for the gastroenterologist.Clin Gastroenterol Hepatol. 2013; 11: 208-216Abstract Full Text Full Text PDF PubMed Scopus (96) Google Scholar3IBSCBT, cognitive behavioral therapy; GI, gastrointestinal; IBD, inflammatory bowel disease; IBS, irritable bowel syndrome; RCT, randomized controlled trial. Open table in a new tab CBT, cognitive behavioral therapy; GI, gastrointestinal; IBD, inflammatory bowel disease; IBS, irritable bowel syndrome; RCT, randomized controlled trial. As a sample of these treatment paradigms, an illustration is offered from direct clinical experience at our medical center. Our psychology team is trained in implementing various efficacious treatment models for GI patients, including hypnotherapy and biofeedback, but primarily utilizes CBT. A sample of 40 GI or psychological patients was collected in 2018 to assess change between sessions 1 and 2 on 4 dimensions: depression, anxiety, somatic symptom preoccupation, and pain or physical symptom discomfort. The Patient Health Questionnaire-9 gauged depression, while the Generalized Anxiety Disorder 7-item scale measured anxiety (both well-validated instruments to assess psychological symptoms in medical settings). Somatic symptom preoccupation was assessed with a scaling question, in which patients rated cognitive focus on medical symptoms (1 = rarely, 10 = consuming rumination). Finally, pain assessment was combined with patient perception of overall physical symptom discomfort with a similar 10-point rating scale. An important consideration when viewing both figures is the overall goal of psychological treatment, along with the course of therapy. First sessions are designed for assessment and establishing therapeutic rapport. Given complexities with symptom range and severity, as well as frequently stigmatized dynamics, initial appointments commonly require more than 60 minutes for standard psychiatric interviews, and further time is required to introduce psychoeducation not only as an early effort to instill hope, but also to provide rationale for the psychological referral, and to facilitate the patient’s decision to return to care. This is typically a challenge in psychotherapy, exacerbated by commmon patient expectation for medically-oriented solutions to what they commonly perceive to be problems of physical origin, and thus, presumably, treatment. Additionally, patients commonly undergo several physician appointments and extensive testing before psychological introduction, and continued focus on symptoms while undergoing testing (which commonly with functional or brain-gut dysfunction disorders is negative) both can compound patient distress and health-related anxiety. Thus, the patient may require additional effort from the psychologist to understand their experience and orient them to the role of psychological evaluation for GI distress without blame or stigma. Subsequently, the majority of the first therapeutic session is dedicated to providing psychoeducation on the brain-gut interaction. For those patients who are less open to the concept that psychological factors can exacerbate GI symptoms, providing the rationale for treatment may take precedence over implenting initial interventions. Therefore, it is not unexpected to observe only a subtle shift in affective symptoms between session 1 and 2, particularly if the patient has a long-standing history of psychological distress. We often recommend patients address more general mental health concerns in concurrrent local psychotherapy as we continue to work in GI or psychological care toward reducing GI symptoms, as well as accompanying distress and somatic symptom preoccupation. Even after 1 session, on average these patients have endorsed a decrease in anxiety, depressive, and physical discomfort or pain symptoms, as well a more marked decrease in overall preoccupation with symptoms, as described subsequently. An additional dynamic impacting treatment is the changing demand for GI psychological services. With increasing awareness of the GI or psychological interface, and the possibility of successful treatment, demand for treatment has grown. Recent publication on a model of integrated GI or psychological care highlighted 118 patients evaluated in 15 months at a regional academic medical center, an average of <8 patients/mo. In 2018 in a similar setting, our primary GI psychologist completed 782 psychological encounters (or >65/mo), which demonstrates increased referral facilitation, as well as openess on the part of both referring providers and patients alike. However, especially in busy medical treatment center settings with higher referral sources and patient demand, this also adds increasing time pressure on available appointment slots for GI or psychological care. This dynamic may inadvertently allow for accelerated patient expectation and symptom severity to develop between points of care, thus increasing burdens on the patient and provider to actively engage patients in treatment, raise awareness of the possibility of improved symptoms (both medical and psychological), and begin to groom change in an increasingly compressed timeframe. Despite these complex challenges, as can be seen in Figure 2, patients in our sample experienced an early decrease in both physical symptom discomfort and overall somatic preoccupation with GI symptoms declining between the first and second session of psychological contact, with some 30% reduction in health preoccupation by the second visit. This is directionally suggestive of successful efforts to validate and reorient concerns about stigma, and further educate patients on the viability of treatment for the brain-gut pathway, provided sufficient patient openness to facilitate psychological care.Figure 2Average patient change from session 1 to session 2 in physical discomfort/pain (7.0 to 4.71) and somatic symptom preoccupation (4.75 to 3.79).View Large Image Figure ViewerDownload Hi-res image Download (PPT) Research has demonstrated the benefit of psychological treatments for patients struggling with GI disorders. However, patients demonstrating severe psychological symptoms and high distress levels are not the only patients who may likely benefit from GI psychological care. Rather, many patients without comorbid mental health diagnoses can also benefit from working with GI or psychologist, but it is important to identify patient factors that can function as a barrier to treatment.12Kinsinger S.W. Ballou S. Keefer L. Snapshot of an integrated psychosocial gastroenterology service.World J Gastroenterol. 2015; 21: 2219-2840Crossref Scopus (16) Google Scholar These include poor health stewardship, refusal to take an active role in psychotherapy, and low insight on the relationship between physical and emotional health. However, among patients who are appropriate for referral, working with a GI or psychologist can not only help to reduce psychological distress, but also effectively improve GI symptoms, as well as patient coping and overall quality of life.7Palsson O.S. Whitehead W.E. Psychological treatments in functional gastrointestinal disorders: a primer for the gastroenterologist.Clin Gastroenterol Hepatol. 2013; 11: 208-216Abstract Full Text Full Text PDF PubMed Scopus (96) Google Scholar The growth of this area of health psychology is also affording a new frontier of research opportunities, with early pioneering work leading the way for continued investigation, and collaboration among psychogastroenterology specialists increasingly occurring across national sites for clinical and academic medicine. With increasing awareness of the benefits available with psychological care, ideally resources will keep pace with demand to help make GI or psychological care more widely available for further treatment application and investigation." @default.
• W2967881738 created "2019-08-22" @default.
• W2967881738 creator A5025624665 @default.
• W2967881738 creator A5058868199 @default.
• W2967881738 date "2020-02-01" @default.
• W2967881738 modified "2023-09-26" @default.
• W2967881738 title "Roles and Impact of Psychologists in Interdisciplinary Gastroenterology Care" @default.
• W2967881738 cites W2026509081 @default.
• W2967881738 cites W2047018762 @default.
• W2967881738 cites W2050119353 @default.
• W2967881738 cites W2072111446 @default.
• W2967881738 cites W2125035146 @default.
• W2967881738 cites W2132338564 @default.
• W2967881738 cites W2215411395 @default.
• W2967881738 cites W2301827667 @default.
• W2967881738 cites W2554313249 @default.
• W2967881738 cites W2736992720 @default.
• W2967881738 cites W2786247075 @default.
• W2967881738 doi "https://doi.org/10.1016/j.cgh.2019.07.067" @default.
• W2967881738 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/31401360" @default.
• W2967881738 hasPublicationYear "2020" @default.
• W2967881738 type Work @default.
• W2967881738 sameAs 2967881738 @default.
• W2967881738 citedByCount "3" @default.
• W2967881738 countsByYear W29678817382022 @default.
• W2967881738 crossrefType "journal-article" @default.
• W2967881738 hasAuthorship W2967881738A5025624665 @default.
• W2967881738 hasAuthorship W2967881738A5058868199 @default.
• W2967881738 hasConcept C126322002 @default.
• W2967881738 hasConcept C17744445 @default.
• W2967881738 hasConcept C199539241 @default.
• W2967881738 hasConcept C2779473830 @default.
• W2967881738 hasConcept C512399662 @default.
• W2967881738 hasConcept C71924100 @default.
• W2967881738 hasConcept C90924648 @default.
• W2967881738 hasConceptScore W2967881738C126322002 @default.
• W2967881738 hasConceptScore W2967881738C17744445 @default.
• W2967881738 hasConceptScore W2967881738C199539241 @default.
• W2967881738 hasConceptScore W2967881738C2779473830 @default.
• W2967881738 hasConceptScore W2967881738C512399662 @default.
• W2967881738 hasConceptScore W2967881738C71924100 @default.
• W2967881738 hasConceptScore W2967881738C90924648 @default.
• W2967881738 hasIssue "2" @default.
• W2967881738 hasLocation W29678817381 @default.
• W2967881738 hasOpenAccess W2967881738 @default.
• W2967881738 hasPrimaryLocation W29678817381 @default.
• W2967881738 hasRelatedWork W1904867238 @default.
• W2967881738 hasRelatedWork W2011583128 @default.
• W2967881738 hasRelatedWork W2143385156 @default.
• W2967881738 hasRelatedWork W2570231282 @default.
• W2967881738 hasRelatedWork W2897706120 @default.
• W2967881738 hasRelatedWork W3003357671 @default.
• W2967881738 hasRelatedWork W4229027305 @default.
• W2967881738 hasRelatedWork W4311204580 @default.
• W2967881738 hasRelatedWork W4313327108 @default.
• W2967881738 hasRelatedWork W4368617522 @default.
• W2967881738 hasVolume "18" @default.
• W2967881738 isParatext "false" @default.
• W2967881738 isRetracted "false" @default.
• W2967881738 magId "2967881738" @default.
• W2967881738 workType "article" @default.