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Harvard Commentaries
35320
Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School


Minding Your Mind Minding Your Mind
 

Stress and Your Stomach


October 24, 2011

By Michael Craig Miller M.D.

Harvard Medical School



Functional gastrointestinal (GI) disorders are stomach problems that have no clear cause. They affect up to two out of every three people at some point in their lives.

Examples are persistent, unexplained constipation, heartburn not related to gastroesophageal reflux, and irritable bowel syndrome. Women are affected more often than men. These disorders cause pain, bloating, or some other physical discomfort. They can cause embarrassment as well.

Biological, psychological and social factors are linked to the development of functional GI disorders. Stress, in particular, can play a role.

The biological relationship between stress and the functioning of the GI system is fairly well established. Stress can trigger and worsen gastrointestinal symptoms. But the connection goes the other way, too: GI distress can cause stress.

Psychological therapies, alone or in combination with other treatments, can help treat functional gastrointestinal disorders.

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Is the GI System a Second Brain?

Breathing, heartbeat, blood pressure and body temperature are regulated through nerve networks known collectively as the autonomic nervous system. This complex set of circuits extends from the brain to all the major organs of the body. It has two major branches. One branch triggers the "fight or flight" stress response. The other manages what some biologists call the body's "rest and digest" activities.

One set of nerve circuits in the autonomic nervous system regulates the GI tract. This sub-system is called the enteric nervous system. It is sometimes referred to as a "second brain" because it relies on the same types of nerve cells and chemical messengers that are found in the brain. One of its jobs is to sense when food enters the gut. In response, nerve cells lining the GI tract signal muscle cells to move food along for digestion. At the same time, the enteric nervous system sends information about the digestive process back to the central nervous system.

This "brain-gut axis" helps explain why researchers are interested in understanding how stress might cause digestive problems. In an emergency, when a person depends on the fight-or-flight response for survival, digestion slows or even stops so that the body can divert all its energy to facing the threat. If a person is stressed all the time, however, the fight-or-flight response is always turned on. This can interfere with digestion, leading to GI symptoms.

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Psychotherapy Options

Research suggests that several psychotherapies may help ease these kinds of gastrointestinal problems — or at least help people cope with such symptoms.

  • Cognitive behavioral therapy (CBT) – The therapist helps the person change unhelpful thoughts and behavior, while teaching coping skills for managing stress and anxiety. In one large study involving adults with functional gastrointestinal disorders, CBT was significantly better than patient education at improving overall symptoms and well-being. CBT may be most useful for learning to cope with persistent gastrointestinal distress. It is less helpful for pain relief.
  • Relaxation therapy – This includes several techniques to help people relax and limit overreactions to stress. Techniques include progressive muscle relaxation, visualization and restful music. Studies show that it is effective for functional gastrointestinal disorders when it is combined with CBT.
  • Hypnosis – "Gut-directed hypnotherapy" is a technique that uses deep relaxation together with positive suggestions that are focused on gastrointestinal function. It can help reduce symptoms that occur even without obvious stress. The person with distress is asked to place her hands on her abdomen and imagine a feeling of warmth and a sense of control over GI function. In a study of this approach, symptoms significantly improved in the hypnotherapy group when compared with a control group of people receiving supportive psychotherapy. Another study suggested that benefits of gut-directed hypnosis may last for years.

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Calming Your Head and Your Gut

It's worth taking the mind-body connection seriously if you have stomach distress.

Some of the treatments described here are widely available. Some techniques are easy to try on your own. It makes sense that easing stress could be helpful for a person with GI symptoms.

And that leads us back to some very basic health advice, such as maintaining a healthy diet, getting regular exercise and enough sleep, and using any of the well-known relaxation techniques. No one can eliminate all stress. It's probably not even a good idea to try. But you can use some of these tools to keep your stress at a healthier level. Your GI tract may thank you.

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Michael Craig Miller, M.D., is editor-in-chief of the Harvard Mental Health Letter and an assistant professor of psychiatry at Harvard Medical School. Dr. Miller has an active clinical practice and has been on staff at Beth Israel Deaconess Medical Center for more than 25 years.

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