What IBS, Crohn's Disease & GI Disorders Have To Do With Coping Skills

Health psychologists have begun treating gastrointestinal disorders that are strongly affected by stress, including irritable bowel syndrome (IBS), Crohn's disease, functional heartburn, functional dyspepsia and ulcerative colitis.

Biochemical signaling between the brain and the GI tract, known as the brain-gut axis, can have a major effect on gastrointestinal disorders. The normal stress of everyday life can aggravate certain GI conditions. And in a vicious cycle, worrying about or dwelling on severe pain, constipation, diarrhea and other GI symptoms can make the symptoms worse, which in turn increases the stress, said Sarah Kinsinger, PhD, ABPP, a Loyola Medicine health psychologist who specializes in treating GI disorders.

Dr. Kinsinger offers behavioral treatments specifically designed to target brain-gut pathways. These treatments teach patients coping strategies to manage symptoms and reduce stress. She provides cognitive-behavioral therapy, an evidence-based treatment for irritable bowel syndrome. She also offers behavioral relaxation techniques, including diaphragmatic breathing (also known as belly breathing or deep breathing) and gut-directed hypnotherapy.

In many patients, psychological or behavioral interventions can be more effective than medications, Dr. Kinsinger said. She usually sees patients for five to seven sessions, and the treatments typically are covered by insurance.

"It is very gratifying to see patients get better after in some cases suffering for many years," Dr. Kinsinger said. "Psychological and behavioral interventions do not cure their disease, but the treatments can provide patients with safe and effective coping mechanisms and greatly reduce the severity of their symptoms."

For some conditions, such as IBS, psychological and behavioral treatments can be the primary treatments. For other conditions for which there are effective drugs, such as Crohn's disease and ulcerative colitis, psychological and behavioral treatments can be effective adjuncts to medications.

Dr. Kinsinger earned a PhD degree in clinical psychology from the University of Miami and completed a health psychology fellowship at the University of Illinois Medical Center at Chicago. She is board certified in clinical health psychology by the American Board of Professional Psychology.

This article originally appeared on Science Daily.

A Must Read For People in Pain: 'Explain Pain'

If I could make only one recommendation to individuals living with chronic pain, it would be to read the book Explain Pain by David Butler and Lorimer Moseley.

Directed at both clinicians who work with chronic pain patients and patients who live with chronic pain, Explain Pain shows how the discoveries of modern pain science can be put to practical use. Written in understandable language with a touch of lighthearted humor, Butler and Moseley take a complex subject and make it possible for the average person to understand and use. One client remarked that she thought it would be hard to read and was delighted that she did not find it difficult at all. 

Pain education can help

Research has demonstrated that pain education can help to reduce chronic pain. For instance, a recent study by the army followed 4,325 soldiers over a two year period and found that one session of pain education could help lower the incidence of low back pain. Understanding how pain works is not a magic bullet that will make pain go away immediately, but it can help to take some of the fear and anxiety out of the experience which can then begin to help alter the experience. With time, thinking a little differently about pain can lead to more successful strategies for reducing, limiting, and eliminating pain.  

Pain is useful and should not be ignored. Pain is a protective mechanism generated by the brain in response to perceived threat. However, when pain is chronic and there is no direct or immediate threat to the body, understanding how the body can get "stuck" in pain can suggest ways to help it get "unstuck." 

Butler and Moseley provide some amazing stories to illustrate the surprising discovery that pain is not directly related to tissue damage. While this concept may, at first, seem odd and difficult to grasp, they produce convincing evidence to support this idea. Consider this: a paper cut produces very little tissue damage, yet can cause a lot of pain. A soldier can get shot in battle, yet not realize he is injured until he is off the battlefield. Amputees may experience phantom limb pain in tissue that no longer exists. How does that happen? The part of the brain that corresponded to the amputated limb can still generate the sensation of pain, even after the limb is gone.

Pain can be influenced by context. If everyone around us seems to be in pain, we may also expect to be in pain. Athletes involved in vigorous sports ignore impacts that would upset most of us because to them it's all part of the game. In that context, it is expected and not a threat. 

Butler and Moseley describe how pain is generated by the nervous system. Understanding that pain is generated by the brain, rather than by damaged tissues, does not mean that pain is "all in your head" and should be ignored or dismissed as imaginary. In fact, understanding that pain is the body's alarm system highlights the importance of treating pain so that the alarm system does not become oversensitive. 

The book describes what happens in different systems of the body and how they may be affected by pain. Normal responses to painful stimuli are contrasted with what happens when the responses become altered. The influence of our thoughts and beliefs is examined for the role it can play in chronic pain.

Practical suggestions

The last few chapters of Explain Pain suggest practical tools that can be used to manage chronic pain. Using "the virtual body" is explained, as is the use of graded exposure to break the association between particular movements and pain and to cultivate successful movement without pain. 

Pain education should be part of every client or patient's rehabilitation.Explain Pain provides an excellent model for pain education.

One of my clients suffered for many years with a painful chronic condition and found this book immensely helpful. Although she had seen many doctors and therapists, she had never been given any pain education. After reading this book, she asked, "Why didn't anyone tell me this?" My response was, "They didn't know." Although Explain Pain was first published in 2003, pain science is still only slowly finding its way to practitioners. 

Since I've begun studying pain science, I've incorporated information the information presented in Explain Pain into my practice. It has been a useful tool for helping clients get out of pain and feel in control of their lives once again.

Additional resources

I've posted a fifteen minute TED Talk by Lorimer Moseley on Why Pain Hurts in a previous post. There is also, in the same article, a forty-five minute lecture to a professional audience for those geeky folks who want to understand details about the biology of pain. Recently, I've found a twenty-five minute video by Moseleywhich has become a favorite because he addresses how we think about conditions like herniated discs and how our thinking can feed and perpetuate fear, anxiety, and pain. If you watch only one of these videos, this is the one I recommend. These videos are educational and entertaining. Moseley, who is both researcher and clinician, has a charming Australian accent and a great sense of humor. Imagine Crocodile Dundee giving an introduction to pain science and you'll get the picture.

For more information about understanding pain, I also suggest the following: 

Painful Yarns by Lorimer Moseley (stories to help understand the biology of pain)

Also, check out this article about understanding how pain works by Paul Ingraham of SaveYourself.ca. 

Cory Blickenstaff, PT, has put together some useful videos of "novel movements." Here are links to the ones on the low back, neck, and hand, wrist, forearm, and elbow. 

This article originally appeared massage-stloius.com and was written by 'Ask the Massage Therapist'.
 

The Science of Yoga - What Research Reveals

In a world that demands substantive clinical research evidence to support different approaches to health care, yoga is gaining attention. Despite rapid advances in medical technology and continuing pharmaceutical research into using medication to relieve symptoms, in the past few years we have seen a significant growth in research addressing the impact of yoga on health and wellbeing.

To mark World Yoga Day on Sunday, we have collected some of the latest research into yoga in a virtual special issue.

Yoga is an ancient practice; it has been associated with cultural, religious and physical activity for more than 2,000 years. Its practitioners have asserted its effect on balancing emotional, physical and spiritual health for decades, but only recently has there been a move to substantiate these claims through research. So far, the result has been definitive, significant evidence of the broad-ranging benefits of yoga, both as a treatment and as a preventative form of medicine and health care.

The health benefits of yoga

In this technological age, health care paradoxes abound. Computerization, designed to facilitate daily life, carries with it a demand to be externally connected to events at all times. In doing so, paradoxically, we become alienated from reflecting personally upon body, mind and spirit. Use of pharmacological medication can assuage some of our symptoms, but this approach can also mean that we can carry on as normal with our busy lives, reducing our ability to monitor and focus on our personal health and wellbeing.

At a time when technology and drugs dominate the way we live our lives, it is refreshing that yoga not only persists but that researchers are taking the time to explore exactly how this practice can help us. In a climate focusing upon evidence-based medicine, it is important to be able to substantiate clinical claims made for any therapy, and yoga is no exception. We need to know who would benefit from a therapy, contraindications of use and the extent to which specific medical issues that can be ameliorated by a particular therapy.

Journals like Complementary Therapies in Clinical Practice frequently publish research on yoga. Recent papers have focused on practicing yoga to reduce essential hypertension and anxiety during pregnancy, its effect on regulating heart rhythm, the connection between yoga and changes in brain wave activity, the improvement of core stability and balance, and relief of post-partum depression.

Highlights of the special issue

To assess the potential of yoga poses for training and rehabilitation, the authors of this study examined the muscle activation patterns in selected trunk and hip muscles. Before this figure, they explain: "In the Downward facing dog pose ( Fig. 2a), the EOA showed significantly higher activity than RAU and RAL (p < .018). In the Upward facing dog pose ( Fig. 2b), the LT and EOA produced significantly higher muscle activities than RAU and RAL (p < .019). In the High plank pose ( Fig. 2c), the EOA produced significantly greater electrical activity than all other muscles (p < .001). In the Low plank pose ( Fig. 2d), the EOA produced significantly higher activity level than RAU, RAL and GM (p < .001)." (Source: Meng Ni et al, "Core muscle function during specific yoga poses," Complementary Therapies in Medicine, February 2014)

We have selected papers that give us an insight into the health benefits of yoga, reflecting the growing evidence-based research into this practice. It seems apparent that yoga may provide broad ranging healthcare benefits for mind and body. It may be practiced to maintain health, reduce particular symptoms, commonly associated with skeletal pain, and assisting in pain relief and enhancing emotional wellbeing.

In her review, Dr. Tiffany Field, Director of the Touch Research Institute at the University of Miami, provides a fascinating overview of the effect of yoga on anxiety and depression, pain, cardiovascular, autoimmune and immune conditions and on pregnancy.

In research looking more closely at the effect of yoga on anxiety, Dr. M. Javnbakht and colleagues from the Psychiatry Department of Islamic Azad University in Iran showed that participating in a two-month yoga class can significantly reduce anxiety in women with anxiety disorders. In their paper published in Complementary Therapies in Clinical Practice, the researchers say this “suggests that yoga can be considered as a complementary therapy or an alternative method for medical therapy in the treatment of anxiety disorders.”

Another study, published in Complementary Therapies in Medicine, examined the effect of yoga on lower back pain. Dr. Padmini Tekur and colleagues from the Division of Yoga & Life Sciences at the Swami Vivekananda Yoga Research Foundation (SVYASA) in India carried out a seven-day randomized control trial at a holistic health center in Bangalore, India, with 80 patients who have chronic lower back pain. They assigned patients to one of two groups – yoga therapy and physical therapy. Their results showed that practicing yoga is more effective than physical therapy at reducing pain, anxiety and depression, and improving spinal mobility.

Yoga also reduces stress in pregnancy, according to research published in Complementary Therapies in Clinical Practice. Svetlana Bershadsky and colleagues from the Department of Psychology and Social Behavior, University of California, Irvine tested the effect of yoga on 51 pregnant women, looking at their levels of the stress hormone cortisol and their mood before and after a yoga session.Their results showed that practicing yoga while pregnant can reduce stress, improve mood and even reduce postpartum depression symptoms.

What’s next for yoga?

Yoga challenges the “mores” of modern day life, providing us with a return to simply being, watching the world around us and an awareness of the impact of this world upon ourselves. In the prevailing Western economic system, should yoga ever become a therapy alleviating many of our illnesses, anxieties or distressing emotions, it will have a fight on its hands to become a dominant therapy. Unlike pharmaceutical medications, yoga cannot be packaged in a box or simply taken mindlessly, nor can it be marketed in huge batches to make enormous profit.

Instead, yoga offers something else: reconnecting with ourselves and learning to see ourselves, and our reactions to the world around us, from a different perspective. It takes emotional and spiritual strength to reflect inwardly and directly address personal conflicts, anxieties, hopes and fears, and understand how we respond to them. It also takes time to learn how these states of mind impact directly on physical wellbeing, and how we can change this.

Research into yoga continues to reveal the health benefits it can have, supporting the case for its use in health care. Through randomized trials, reviews and other studies, we are learning more about the effect yoga can have on different aspects of our physical and mental health. Regular yoga practice can increase our awareness about how our body actually feels, with all its aches and pains, and help us restore balance.

Yoga isn’t as simple as taking a pill, but mounting evidence suggests it’s worth the investment of time and effort. Ultimately, in order to benefit from the positive health effects of yoga, we need to be mindful of the present: this moment, now. In such a non-stop world, that, surely, has to be a good thing.

This article originally appeared on Elsevier.com and was written by Denise Rankin-Box.

It's Official: Yoga Helps Depression

Evidence keeps stacking up that yoga is a boon for both physical and mental health conditions. Now, a small new study from Boston University finds that taking yoga classes twice a week may help ease depression, thanks in part to deep breathing.

The study, which was published in the Journal of Alternative and Complementary Medicine, included 30 people from ages 18 to 64 with clinical depression, who either were not taking antidepressants or had been on a steady dose for at least three months. Half of the participants were assigned to take a 90-minute Iyengar yoga class three times per week, as well as four 30-minute sessions at home each week. People in the other group took two group classes and three at-home sessions every week.

A small new study from Boston University finds that taking yoga classes twice a week may help ease depression, thanks in part to deep breathing

Iyengar yoga classes emphasize alignment, precise postures and controlled breathing. The classes taught in the study also included 20 minutes of slow, gentle breathing, at a rate of five inhales exhales through the nose per minute.

After about three months, most of the people in both groups had lowered their scores on a depression-screening questionnaire by at least 50%. Not surprisingly, more yoga was better; those who took three classes per week had lower depression scores than those who took two per week.

But since many participants mentioned that the larger time commitment was challenging, the researchers actually recommend two classes per week, saying that the regimen still comes with meaningful benefits.

That yoga seems to be effective is good news for people struggling with depression. Lead author Dr. Chris Streeter, associate professor of psychiatry and neurology at Boston University School of Medicine, says that the practice has far fewer side effects and potential drug interactions than mood-altering medications. The most common complaint reported in the study was a small one—temporary muscle soreness—and one participant experienced distressing thoughts while practicing breathing exercises at home.

Some people who haven't responded to traditional treatments might do well with yoga, because unlike antidepressant drugs, yoga and deep breathing target the autonomic nervous system, Streeter says. “If your autonomic nervous system is balanced out, then the rest of the brain works better,” she says. Research shows that 40% of people on antidepressants do not recover fully from depression, says Streeter, which puts them at increased risk for a relapse. “Getting that 40% all the way better is a really important goal. Instead of adding another drug, I would argue that yoga is another thing you can add to the treatment regimen that might help.”

More research is needed to determine how yoga stacks up against other treatments. (A larger trial comparing yoga to walking is underway, the study notes.)

While Iyengar yoga is generally considered to be a safe practice for people of all levels, it's not the only type with health benefits, Streeter adds. “It depends on who the person is and what they’re looking for,” she says. For now, what's clear is that the type with the most health benefits will be whichever kind you stick with.

This article originally appeared on time.com and was written by Amanda MacMillan