This article is by Savannah Snyder from Canada.
Photo by Karolina Grabowska from Pexels.
Medical trauma is an experience many of us are all too familiar with, whether that be from your diagnosis story, undergoing certain procedures, or just through the experience one faces while dealing with a chronic illness that is as unpredictable and serious as IBD.
CCYAN fellows spent a Saturday morning with the talented Dr. Tiffany Taft talking all things medical trauma. Dr. Taft is a licensed clinical psychologist with specialized training in chronic medical illnesses. She is an associate professor studying the social and emotional impacts of digestive disease and has been a part of the division of gastroenterology and hepatology. Along with this impressive resume, Dr. Taft is a fellow IBD warrior and has Crohn’s Disease.
Dr. Taft’s lecture on medical trauma was an eye-opening experience explaining the medical field of mental health and digestive diseases. To give some background in the field, psychologists first began looking at digestive diseases in 1995, with the first real controlled study focusing on cognitive therapy and self-help support groups in the treatment of irritable bowel syndrome. In 2020, the Rome Foundation GastroPsych was developed. The Rome Foundation is an independent not for profit organization that provides support for activities designed to create scientific data and educational information to assist in the diagnosis and treatment of Disorders of Gut Brain Interactions. The overall mission is to improve the lives of people with functional GI Disorders. Unfortunately, there are not a lot of professionals in mental health interested in this area. Within chronic illness, the main focus is on obesity, cancer, and other areas.
Post-Traumatic Stress Disorder
Post-traumatic stress disorder is a psychiatric disorder that may occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, terrorist attack, war/combat, or assault or who have been threatened with death, sexual violence, or serious injury. Subcategories of symptoms for PTSD include trauma, intrusion, such as nightmares or flashbacks, avoidance, negative alternations in cognitions and moods, and marked alterations in arousal and reactivity including feeling on edge and a high heart rate. However, within this definition, there is no mention of chronic illness. Due to this, within the mental health field, post trauma stress caused by chronic illness is referred to post-trauma stress rather than post-traumatic stress disorder.
Inflammatory Bowel Disease – Post Traumatic Stress
There are currently four studies in IBD research surrounding mental health. In 2 survey studies, the first study found 40% of people with IBD have symptoms of PTSD. Comparing this to the rate at which war veterans have PTSD is at 10-20%, the study was redone to ensure there was no bias. In the second study, 797 patients in IBD partners database with the Crohn’s and Colitis Foundation were surveyed and similar statistics were found. The study revealed that 25% of participants experienced PTSD symptoms, a rate higher than we would ever want to see. The highest symptoms felt were nightmares, flashbacks, re-living trauma, feeling keyed up and on edge, and avoiding situations.
Furthermore, it was shown that women are more likely to experience negative symptoms than men are. Also, it is shown that non-white and Hispanic individuals are more likely to experience negative symptoms. Additionally, those with a college education are more likely to experience more symptoms, which can be a marker of socio-economic status in the US. Overall, it is very evident that patients in privileged groups tend to have less post-traumatic stress symptoms.
Dr. Taft reviewed a regression model with staggering results showing that there may be a connection between the post-traumatic stress symptoms such as re-experiencing, increased arousal, avoidance, and full IBD-related post-traumatic stress and hospitalizations and surgery.
Brain Gut Connection
Dr. Taft discusses the possibility that post-traumatic stress in IBD could affect disease, but more research will need to be completed. An interesting question posed is whether people with IBD are more susceptible to post traumatic stress because of their gut microbiome make up. It was shown that war veterans with PTSD had similar qualities in their microbiome as those with IBD. Overall, Dr. Taft was concerned that their microbiome could have changed because of the theory of the stress response and effects of extreme stress happening in PTSD on the immune function. A potential future study in this field surrounds treating people with IBD that have post-traumatic stress and see if their microbiome changes with treatment. This study would provide amazing resources to the IBD community and be an addition to the path of new treatment options.
Treatments & Medications
As of 2021, there are no treatment options for IBD-PTS that have been tested, but it is known how to treat PTSD. The following therapies are very effective for PTSD: cognitive processing therapy (CPT), prolonged exposure therapy (PET), written exposure therapy (WET), eye movement desensitization and reprocessing (EMDR), and trauma focused cognitive behavioural therapy (TF-CBT). Medications used for PTSD are anti-depressants. There are no specific PTSD medications available, and the best outcome with medication is when it is combined with therapy.
Grounding Techniques
Dr. Taft ended off this informative zoom with grounding techniques. Grounding is an amazing way to work through active distress from PTSD. When you engage all 5 senses, you bring your brain back to the present and stop re-experiencing that traumatic event. Although this will not cure your PTS, it is a vital skill that can help although it will take some time and practice to be effective. Some great ideas include listening to music, tossing a ball in the air, holding a piece, eating something sour, or smelling an essential oil.
5-4-3-2-1 Trick:
5: Acknowledge FIVE things you see around you
4: Acknowledge FOUR things you can touch
3: Acknowledge THREE things you hear
2: Acknowledge TWO things you can smell
1: Acknowledge ONE thing you can taste
Overall, this was a very informative session where us fellows learned about the reality of medical trauma in IBD patients and the crucial need for further research in this field. If you want to hear more about Dr. Taft, check out her twitter @DrTiffTaft.