What Is a Gastrointestinal Psychologist — and Should You Have One for Ulcerative Colitis?

When Sam Jactel, a Boston-based entrepreneur, received an ulcerative colitis (UC) diagnosis in 2014, he had access to some of the best doctors in the city. And yet he still had trouble coping with his diagnosis. “As you can imagine, being told you have an incurable disease is a bit of a shock to someone’s system,” he says.

Jactel soon sought help from a gastrointestinal (GI) psychologist — a mental health professional who specializes in treating the anxiety and depression that can occur in patients who have chronic digestive diseases, such as IBD. His experiences led him to found Ayble Health, an app that offers gut health–related dietary advice, health coaching, and more. “Over the years, my psychologist has helped me see my condition as a source of strength rather than embarrassment,” he says. “[They’ve also] helped me feel comfortable speaking about my condition on my own terms and feel like I was in control of my condition rather than the other way around.”

The field of GI psychology is growing. Today, more IBD departments and treatment centers employ specialists who can teach their patients how to cope with the condition. “We help address GI-specific anxiety or worry about your symptoms and can help optimize resilience and the use of healthy coping skills,” says Megan Riehl, PsyD, a GI psychologist and clinical director of the GI behavioral health program at the University of Michigan in Ann Arbor.

Sometimes, people seek the help of a GI psychologist when they’re first diagnosed, says Dr. Riehl. But even if you’ve been living with IBD for years, you can still benefit from seeing a psychologist. “You may learn strategies to help you relax your body, develop healthy lifestyle behaviors, and manage stress,” Riehl says.

Another time to seek out a specialist is if your UC symptoms are having a significant negative impact on your quality of life — for example, causing you to skip activities that you might otherwise enjoy or to miss meals (or fear eating altogether) because eating may trigger pain or discomfort, says Dr. Simons.

• Life stress makes symptoms worse.
• You have extreme worry about the effects of your symptoms.
• You’re finding it hard to understand your treatment plan or IBD itself.
• Your medication isn’t doing what it should.
• You find it challenging to relax.
• You have anxiety or depression due to IBD symptoms.
• You don’t feel like you have access to a strong support network.

Studies have examined the role that two types of treatment involved in GI psychotherapy can play in IBD management: gut-directed hypnotherapy and cognitive behavioral therapy (CBT).

Gut-Directed Hypnotherapy

Cognitive Behavioral Therapy

Because IBD tends to flare up and subside in cycles, you may only need to see a GI psychologist when your symptoms are acting up. “If you’re going through something very difficult, that’s probably a time for you to reconnect with us,” says Simons. It’s also common to work with a GI psychologist for a short period and then come back later — even years later — during particularly stressful times.

How do you know whether you should see a GI psychologist versus a general psychologist? If your UC symptoms are the biggest cause of your stress, you may benefit most from a GI psychologist. If you’re experiencing more overall stress, you may want to see a general psychologist. But you don’t have to see just one or the other. “Often, people see both simultaneously,” says Simons.

GI psychologists can’t write you a prescription, but they work closely with your other doctors and can let your primary care physician know if you may be a candidate for antidepressant medication, says Simons.

• Rome Foundation, a nonprofit organization dedicated to supporting individuals with gut disorders
• American Psychological Association
• National Register of Health Service Psychologists
• Association for Behavioral and Cognitive Therapies

If you see a GI psychologist who is part of a larger medical center, your health insurance provider may cover their service. However, Simons says that private practitioners don’t always accept insurance.

You can also connect with a GI psychologist via telehealth. Just as it would when working with a GI psychologist in person, it takes time to notice benefits from working with apps. “We would want them to engage regularly with the app — daily or almost daily — for at least six to eight weeks to get the most benefit out of that treatment,” Simons says.

“Working with a GI psychologist is an incredibly powerful tool for managing ulcerative colitis,” Jactel says. “It helps retrain the communication that happens between the mind and the gut and can equip you with skills that promote long-term emotional resilience in order to manage what is a lifelong condition.”

Simons seconds these thoughts. “It usually makes a tangible impact on a patient’s symptoms and quality of life. That’s really the big reason there’s so much demand for them: People’s lives get better.”

• If inflammatory bowel disease (IBD) symptoms are affecting your day-to-day life, or stress from daily living is triggering symptoms, a gastrointestinal (GI) psychologist may be able to support you as a member of your care team.
• GI psychologists use methods, including gut-directed hypnotherapy and cognitive behavioral therapy, to address symptoms, challenge unhelpful thought patterns and behaviors, and help you learn healthy coping skills.
• GI psychologists are not always easy to find. Ask for a referral from your gastroenterologist, or consider using an online directory to locate one near you.