It is undeniable that receiving a diagnosis of inflammatory bowel disease (IBD) can be frightening, daunting and sometimes overwhelming for a person. Nevertheless, it is not just the disease severity that can determine the outcome for the person, but also their psychological coping strategies. The notion that our coping strategies can overcome external circumstances is not a new concept. For example, the Greek philosopher Epictetus (A.D. c. 55 – 135) is quoted as saying “Men are disturbed not by things, but by the view which they take of them” as well as “We cannot choose our external circumstances, but we can always choose how we respond to them.” Whilst there is no doubt that being told you have Crohn’s disease (CD) or ulcerative colitis (UC) is scary, it is important to know there are things you can do psychologically to overcome them.
THE MIND BODY CONNECTION
People often talk about the “mind-body” connection but what do they mean by this? What they mean is that the health of your body can affect the health of your mind and vice versa. We know that IBD can increase your risk for impaired mental health because people with IBD are more likely to be anxious or depressed than people without IBD. What is also interesting is that those experiencing psychological stress, anxiety and depression often seem to say that they have flares of their IBD around times of stress. Some scientific literature supports the notion that IBD is more likely to flare around times of stress although it is unclear whether IBD causes the stress or if the stress causes the IBD; some research has shown that stressful life events do not precede flares and so there is a high likelihood they coincide as opposed to stress causing IBD flares. Nevertheless, if a person also has irritable bowel syndrome (IBS), which is a functional bowel disorder, on top of their IBD, stress is highly likely to play a role in their bowel symptoms. This is because IBS is known to be linked with stress; of note is that the IBS and IBD combination is not uncommon. The link between IBS and stress suggests that improvements in bowel symptoms from stress reduction are more due to functional improvement in bowel function and less due to reduction of IBD inflammation per se. The other factor to bear in mind is stress can cause us to act in unhealthy ways. For example, stressed people may smoke, eat poorly, and forget to take their medication because they are stressed. It is much easier to behave healthily when there is not chaos going on around us. Therefore stress reduction techniques can be useful because they can help us cut out the behaviours that worsen our IBD (especially medication non-adherence).
It’s important to remember that stress is relative to us as individuals. Our ideas of stress differ from one to another and so do our coping mechanisms. Overall, stress reduction will certainly not make IBD worse and may improve the IBD patient’s disease journey in some cases. Therefore, stress reduction techniques like yoga, meditation, or even a beach holiday are certainly worth trying!
WHAT EFFECT CAN IBD HAVE ON PEOPLE'S QUALITY OF LIFE?
This is a really good question. For a start, what is quality of life? Quality of life is an overall holistic measure of physical and mental health and has a lot to do with whether your disease (1) holds you back from going to work, school, or social events, (2) affects you physically in terms of pain or energy, and (3) affects you psychologically. For example, if a person can go
to work fulltime, is not experiencing pain, and is mentally stable, they will have high quality of life; if they cannot work, have a lot of pain, and have depression they will have low quality of life. The bad news is that having IBD has, on average, a negative influence on quality of life compared to not having IBD; the good news is that those whose disease is in remission seem to have a normal quality of life. Therefore, if you can get your disease under control using medication, diet, surgery, and other techniques, you can be “normal.”
CAN TENSION AND ANXIETY CAUSE IBD?
The short answer to this question is “No.” IBD is a physical disease caused by physical processes and it has never been convincingly demonstrated that anxious or depressed people are more likely to be diagnosed with IBD. Nevertheless, having anxiety or depression with your IBD probably does not help with the disease journey once IBD is diagnosed. Therefore, it is best to have depression or anxiety treated if you have one of them with your IBD.
A couple of good resources for depression specifically are:
Depression Helpline 0800 111 757, free text 4202 (to talk to a trained counsellor).
Need to Talk? Free call or text 1737
to talk to a trained counsellor, any time.
Lifeline 0800 543 354
For counselling and support.
Youthline 0800 376 633
free text 234, or email firstname.lastname@example.org (for youth, whãnau and friends).
free text 5626 (for young people)
A good IBD-specific resource for IBD patients wanting to attend to the psychological side of their disease is; http://www.tameyourgut.com/.