Psychological Treatments in Functional Gastrointestinal Disorders

A Primer for the Gastroenterologist

Olafur S. Palsson; William E. Whitehead

Disclosures

Clin Gastroenterol Hepatol. 2012;11(3):208-216. 

In This Article

Which Patients Should Receive Psychological Treatment?

Psychological treatment is neither necessary nor reasonable for most FGID patients. A substantial proportion, especially those with relatively mild symptoms, gain sufficient symptom relief from the usual medical care provided in gastroenterology and primary care practices. The extra healthcare costs and substantial time and effort that psychological interventions require may not be warranted for those individuals. However, in our opinion psychological treatment should generally be considered for 2 types of patients: (1) patients who continue to have moderate or severe symptoms after 3–6 months of medical management and (2) patients whose case presentation suggests that stress or emotional symptoms are likely to be exacerbating gastrointestinal symptoms or impairing coping with illness.

Not all patients within these 2 categories are equally well suited for referral. Individuals who do not recognize or are unwilling to accept that stress or psychological symptoms influence the severity of their gastrointestinal symptoms will not be likely to follow through with such treatment. Patients with disabling psychiatric symptoms or thought disorder may have difficulty complying with a psychological treatment regimen for FGIDs and could require treatment with psychotropic medications prescribed by a psychiatrist. Patients who are very unmotivated to assume an active role in managing their own health condition may also do poorly with psychological treatment, which requires considerable effort and work during a number of sessions with a therapist.

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