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Brain-Gut Psychotherapies for Non-Psychologists

Brain-Gut Psychotherapies for Non-Psychologists. Laurie Keefer, PhD. Disclosures. Scientific advisor and small equity owner for MetaMe Health Consultant to: Pfizer, Lucid Technologies Research funding from: Pfizer, Abbvie Rome Foundation Board of Directors.

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Brain-Gut Psychotherapies for Non-Psychologists

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  1. Brain-Gut Psychotherapies for Non-Psychologists Laurie Keefer, PhD

  2. Disclosures • Scientific advisor and small equity owner for MetaMe Health • Consultant to: Pfizer, Lucid Technologies • Research funding from: Pfizer, Abbvie • Rome Foundation Board of Directors

  3. The Big 5 Brain-Gut Psychotherapy Targets • HPA Axis (Efferent) Targets • Hyperarousal • Impaired autonomic function • Visceral (Afferent) Targets • Attentional bias/Hypervigilance • Visceral sensitivity • Extraintestinal symptoms • Centrally-mediated targets • Hypoalgesia/Hyperalgesia • Somatization • Cognitive-Affective Targets • Symptom-specific fear or avoidance • Catastrophizing • Inflexibility • Complex behavioral targets • Trauma/Early adversity • Opioid seeking • Disordered eating • Toileting behaviors Oudenhove L. et al. 2016 Biopsychosocial aspects of FGIDs, Gastroenterology; 150, 1355-1367

  4. What brain-gut psychotherapies are available?

  5. Description and Evidence Base for Brain-Gut Psychotherapy

  6. Gut-Directed Hypnotherapy is not just Relaxation! Palsson, Hypnosis treatment for Gut Problems. Eur Gastro Hep Rev 2010;6(1):42-46

  7. The Efficacy of Hypnotherapy in the Treatment of Irritable Bowel Syndrome: A Systematic Review and Meta-analysisH.H. Lee, Y.Y. Choi and M-G Choi, NGM, 2014; 20: 152-62 Subtype Agnostic!!! abdominal pain constipation diarrhea

  8. Cognitive-Behavior Therapy remediates maladaptive approaches to benign GI symptoms The Basis of CBT-GI • Believes that people have specific skills deficits in how they think, respond to or feel • Aims to teach new, more adaptive skills or ways of thinking about or approaching symptoms • CBT is a theoretical orientation not just a set of techniques • Based on a collaborative relationship with therapist and requires patient engagement • Often includes homework between sessions • Can be highly personalized Am I overestimating the chance of disaster? Would I be able to handle the worst case scenario? What would I say to a friend? Is this worth developing stomach problems over? Is there anything I can do about it?

  9. Impact of CBT on IBS Symptom Severity IBS-SSS means by trial arm. Lackner et al. CGH 2018 Hazel Anne Everitt et al. Gut 2019

  10. CBT for IBS using interoceptive exposure to visceral sensations CRASKE, M.G. ET AL., BEHAVIOUR RESEARCH AND THERAPY 49 (2011) 413-421.

  11. Summary • Brain-gut psychotherapies target DGBI symptoms, not psychological disorders • Treatments are tailored to each patient to address the skills deficits thought to be driving his/her symptoms and may include a combination of modalities • Treatment is typically short-term and can be delivered in as few as 4-7 sessions and in multiple forms (online, telephone, group) https://romegipsych.org

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