Medical Fatigue And IBD with Dr. AK Black

Medical care can be doing everything “right” and you can still feel wrecked, anxious, and trapped in a never-ending cycle of symptoms, appointments, and fear. That gap is where GI psychology lives, and it’s why we wanted Dr. Anna Katherine “AK” Black. AK is a licensed clinical health psychologist at GI Psychology, with a focus on gut-brain therapies, trauma-informed care, and medical fatigue in chronic illness.

We get into what clinical hypnosis actually is (no stage tricks, no mind control) and why gut-directed hypnotherapy has decades of research behind it for GI conditions. AK explains the gut-brain connection in plain language, including how stress can hijack the system, how visceral hypersensitivity turns the volume up on sensations, and why you can’t just tell your gut to “calm down” with conscious thoughts alone. We also talk about how fear and pain overlap, and why techniques that shift the nervous system toward parasympathetic regulation can change real physical symptoms.

Then we name the thing so many people feel but rarely hear described: medical fatigue. If you’ve ever canceled yet another appointment, struggled to keep up with meds and procedures, or felt judged as “noncompliant,” this conversation puts words to that burnout and offers practical next steps. We also cover trauma-informed care, what providers can do with better language and screening, and why integrated teams work best. AK shares resources and explains the Crohn’s & Colitis Foundation partnership group that combines community with skills like CBT and hypnosis.

Subscribe for more real talk about living with IBD, share this with someone who needs it, and please leave a rating and review so more people can find the show. What part of the gut-brain story hit closest to home?

Links: 

• Join the IBD Psychotherapy Group
• Info on Gut-Directed Hypnotherapy

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Transcript

Welcome To Bowel Moments

SPEAKER_00 0:00

Hi, I'm Alicia. And I'm Robin, and you're listening to Bow Moments, the podcast sharing real talk about the realities of IPD. Serve. This week we talked to Dr. Anna Katherine Black. She goes by AK. She is a licensed clinical health psychologist at GI Psychology. She has a special interest in clinical hypnosis, trauma-informed care, medical fatigue, and a lot more. We talked to her all about those things, and we also talked to her about the group that GI Psychology is running for people living with inflammatory bowel disease in conjunction with the Crohn's Clitis Foundation. We enjoyed this super interesting conversation with AK, and I know you will too. Cheers. Hi, everybody. Welcome to Bowel Moments. This is Robin. Hi, everyone. This is Alicia, and we are absolutely delighted to be joined by Dr. Anna Catherine Black and you go by Dr. AK. So we're gonna go with that instead. So thank you so much for being on the show, AK Black. We are so excited to have you.

SPEAKER_02 0:59

Thank you for having me. I'm very excited to be here.

SPEAKER_00 1:02

Well, we are so excited to hear your story and to learn about all the many things that we will talk to you about. But our first very unprofessional question for you is what are you drinking? I'm drinking hot chocolate today. Oh, that's lovely. Robin, what about you?

SPEAKER_01 1:13

I feel like you might also I'm also drinking hot chocolate. I know AK's in the south. You know I'm in the south. It's finally cold down here. We have to take advantage of it when we can.

How She Landed In GI Psychology

SPEAKER_00 1:22

I am actually drinking tea. So this is also like an immunity tea or whatever. It's got some stuff in it that's supposed to prevent me from getting sick. I figured it's not gonna hurt anything, right? So cheers, guys. Cheers. Cheers, cheers. Okay, Dr. Black, next question for you. What is your IBD story? What brings you into our community?

SPEAKER_02 1:39

So I am a licensed clinical health psychologist. Funny story how I got into psychology. I always liked the medical field, I always wanted to be in the healthcare setting, but I learned at a pretty young age that I have what I call a super sniffer, meaning that my my sense of smell is just very, very strong. And I that was not helpful. You know, I can I can talk about medical problems, I can, I can see medical problems, but if I start to smell them, um it's a problem for me. So I really enjoyed psychology because I could be in the medical side of things, particularly in health psychology. I could help patients where medicine alone doesn't always solve the problem. And so that's kind of how I got into psychology, into the health psychology in particular. I would say I kind of stumbled into GI psychology. I did a lot of work with patients who had chronic pain, a lot of just general health problems, diabetes, obesity. But I started to see more and more patients that had GI problems. And I realized this was a big problem. Like there's so many people who have GI problems, and there was really not much that was being done about it, particularly on the behavioral health side of things. So I did a little bit more exploring and I realized that there's a lot of amazing treatments out there that can help these patients, like as I mentioned, where medicine can't. And so that's kind of how I stumbled into the GI psychology side of things. Um, in terms of the IBD, I work with patients who have problems with gut brain interaction. And this often goes hand in hand with IBD. I provide gut-focused clinical hypnosis and cognitive behavioral therapy for GI conditions. So those gut brain therapies that are really evidence-based. Um, so that's kind of how I got in.

Clinical Hypnosis Without The Hype

SPEAKER_01 3:18

You said that you do hypnotherapy and CBT. How do you feel about hypnotherapy? Because I we ask, we always ask for a fun fact on our questionnaire. And I love that your fun fact was. And I feel like people in this space come to hypnotherapy like have similar feelings to you initially. So could you tell us a little bit about that?

SPEAKER_02 3:40

Yeah, so I came from a very strong CBT background, but I I think I I approached clinical hypnosis the way that most people do. That what I believed was what I saw on television, which is a glorified Hollywood version of more entertainment hypnosis. So when I first started to work at GI psychology and they said, you know, we want to train you in clinical hypnosis because the research is really strong. My first impression was, all right, well, I'm gonna, I'm gonna do more of the CBT side of things, and I might sprinkle in a little bit of clinical hypnosis. But the more I looked into the decades of research that suggests it's it's very effective for treating particular GI conditions. And I got into the weeds behind like what's the difference between entertainment hypnosis and clinical hypnosis. I realized it's it wasn't as woo-woo as I thought it was, because that was really my first impression. I thought, you know, there's someone's gonna be, I'm gonna be, you know, dangling a clock and making somebody bark or making somebody do something they don't want to do, this mind control, which is what is portrayed often in movies and or and that's just the idea that most people have is what I had going into it. And I share that with patients. I say, you know what, I I had similar expectations. This is what this is what I thought, and and let me tell you how this is different. Let me explain to you why clinical hypnosis is different. And now I'm completely on the other side. I prefer to do clinical hypnosis. Um, I still do CBT, but I enjoy using clinical hypnosis because it's it's faster, it's oftentimes more effective, and it strengthens some of that CBT approach. So I was actually just speaking with a colleague today about how I enjoy doing clinical hypnosis a lot more with my patients.

SPEAKER_00 5:15

I think it's super fascinating as well. We got into really we got some really interesting discussions about it. But I am curious, you know, like it you mentioned it works really fast, and and I know these are two completely different modalities, but we have the like EMR and we have the clinical hypnosis. Both seem to be similar in the approach of like it's sort of unlocking a little bit of your mind, right? So talk us through kind of the differences and are there, am I making this up? Are these similarities that I'm making up, or are there sort of some similarities in kind of how they work?

SPEAKER_02 5:43

So you broke a very beginning of that, but uh, did you say EMDR in clinical hypnosis? Is that what I heard you say? Yeah, so there are. In fact, it's depending on who you talk to, a lot of people will say that they share a lot of commonalities with clinical hypnosis. It's been along a little bit, it's been around a lot longer than EMDR. I think there's more research for clinical hypnosis, but you are one of the things that you're trying to do, and I don't, again, I can't speak that much about EMDR because I'm not trained in it, but with clinical hypnosis, you are you're trying to get a person to um an altered state of consciousness called trance, which is something that they're already able to do. We're just trying to get them there on purpose so that we can access parts of the body that they don't normally have access to. So for GI patients, it's trying to navigate that gut brain connection. So trying to turn activate the parasympathetic nervous system, trying to turn down the visceral hypersensitivity, which is just when things get all loud in the nervous system, trying to turn that down. We we can't just naturally use our conscious mind and say, all right, gut chill out. If we if we would, it'd be great. I wouldn't have a job, but we can't do that. We can't access that with our conscious brain. We have to be in this altered state of consciousness to be able to do that.

SPEAKER_01 6:57

Is that what helps with like chronic pain? Do you see like improvement there? Because I'm thinking about like actual physical symptoms, right? With IBD, you have a lot of physical symptoms, and it might not always be just pain in your gut, right? So I I'm not to make this about me, but I'm thinking about a time when I did have like a lot of physical pain, but I realized that it's probably because my body was used to having pain and I shouldn't be having pain, but every little thing was like, oh, that's supposed to be pain. And so it registered as pain. Is that something that this helps with? Absolutely.

SPEAKER_02 7:32

Oftentimes what starts to happen is exactly what you're describing is our body starts to interpret sensations that maybe aren't painful as painful. And a lot of that happens from fear. When we we think about anxiety, anxiety is about an external situation. Pain is our body's internal fear response. And so what can start to happen is if your body is always anticipating pain, it's always afraid of pain. Sometimes non-painful symptoms can become painful. So, like if you're sitting on a couch, you could probably feel the couch behind your back, right? That's a sensation that you can you could feel, but it's most of the time not painful unless your brain interprets that sensation as painful. So hypnosis is helpful because we help the brain recognize this is just a sensation. Well, there's also other techniques like somatic tracking that help the brain recognize this is just my body misinterpreting this signal. This is actually safe. And when you separate fear from pain, you just get a sensation.

SPEAKER_00 8:30

If somebody has never had hypnotherapy and you talk about kind of making the connection between brain and gut, what does that look like? If like, can you give us an example of like you if you had a patient sitting with you in your office? What are you saying to them to get them to start making that connection?

SPEAKER_02 8:47

I often start by showing them a diagram and explaining to them how the gut and the brain communicate, how this is actually a normal process. They communicate back and forth from the central nervous system, which is the brain and the spinal cord, and the gut, which has its own nervous system called the enteric nervous system. And they communicate back and forth. And in most cases, it's helpful. Like, for example, if I were to start talking to you about our hot our drinks, if I were to start to talk about our hot chocolate and think about drinking hot chocolate, your brain communicates a message down to your gut that tells your gut, hey, we're about to start drinking hot chocolate. Let's get prepared. So it's communicating in ways that can be helpful. It lets us know when we're hungry, it lets us know when we're full, it lets us know if we've eaten something, but we're not supposed to, and we need to get rid of it, or if we're sick and we need to clear the system. So there is a purpose for it. The problem is when that system gets hijacked, when it stuck gets dysregulated. And I go in and talk about all the things that can start to disrupt that gut brain connection. Stress. We were just talking about COVID. We were talking about the pandemic, we were talking about medical fatigue, all these things, these components start to interrupt that gut brain connection. Having an IBD diagnosis oftentimes can interrupt that gut brain connection. That stress on the body, that pain on the body can disrupt that good connection. And when the connection gets hijacked, a lot of things stop working the way that they're supposed to. And that's what creates that visceral hypersensitivity, oftentimes.

SPEAKER_01 10:11

We have not had anyone on to talk about medical fatigue and how it really can affect patients. And I have experienced it so many times throughout my 25 years. Can you talk a little bit about how you approach medical fatigue? How did you identify that this is a problem for patients? So, like helping patients to identify that that's what they're experiencing. And how did you understand that this is a real problem for patients with chronic illness?

SPEAKER_02 10:37

Yeah, that's really good questions. I think it's first helpful to kind of just identify what is it? What is medical fatigue? Because it was something that I didn't truly understand until I started working with patients with IBD who have to navigate that long-term engagement with the healthcare system. And the more I would see and talk to patients, they would just describe this just complete emotional exhaustion. I actually had one patient who um explained it as like running a marathon every day, but instead of running, you're the you're just navigating medical appointments and managing medications and tracking symptoms and worrying about your health, the complex care plants. I mean, there's so much that goes into it that constantly having to advocate for themselves over time. Their system, it's like if you were to actually run a marathon every single day, your body just gives out. And that's essentially what medical fatigue is. It's this emotional and cognitive burnout that comes from that long-term engagement in the healthcare system. And I think it's important. I'm seeing I was seeing it a lot in patients. And I was also, you know, part of what I do is I talk with other medical providers. So I talk with patients, GI providers, their primary care providers, to not only help the patient and coordinate care for the patient, but also to let other providers know, hey, there's gut brain therapy, this there's there's treatments that work. But when I started to talk more with providers, I recognized that a lot of them didn't truly understand it. They didn't get it because medical fatigue oftentimes can show up as patients who maybe aren't sticking to their medication plans. Maybe they're not engaging, maybe they're missing appointments, or they're not, they're not being upfront or truthful with their providers because it's just exhausting to try to navigate that conversation. Maybe they're not following their care plan. And that was when I realized this is something that needs to be addressed. Providers need to know that it exists, that it's it's very likely to exist with patients with IBD just because that's all they do. They run these marathons every single day and they're exhausted. It doesn't mean that they're not being compliant. It doesn't mean that they don't care and they don't want to get better. It means they need some more specialized treatment. And if we can identify that, if we can help educate providers that, hey, this exists, we can get them that referral earlier. You know, they can get that referral to the gut brain therapist or mental health support to improve the whole system because it's not just the body, but it's the mind and the body interaction as well.

SPEAKER_01 13:11

So, what are you seeing from patients experiencing medical fatigue? And how do you address that with them?

SPEAKER_02 13:17

There's there's a lot of different ways. Sometimes it may be educating the patient, like, hey, um, you're not actually depressed. This is likely what's going on. It's not that you don't want to get better, it's that you're exhausted and just validating, like it's hard. And what you're describing is it's okay that you're tired, and this is why you're tired. So sometimes it's just it's helpful for them to understand like what's wrong, because I think a lot of patients think, well, you know, I'm getting this message that I'm I'm being a bad student or I'm being a bad patient or whatever that may be. And that's not the message that needs to be sent. So validating, helping them, the psychic education, helping them understand what's going on. And then sometimes it may be problem solving. You know, is that can we talk with your provider to let your provider know what's going on? What do you need in this case? What can we do behaviorally to make some of those changes when it comes to maybe it's some some self-care that needs to happen a little bit more in terms of what are you doing to take time to help your nervous system rest? Are you practicing some of the hypnosis? Are you practicing these relaxation techniques? There's a lot of different things, ways that you can address that. But I I think the main thing is helping them to understand that that they're not the problem. They're not doing that intentionally. There's a real thing that that's happening.

SPEAKER_01 14:29

I mean, it's basically medical trauma. Absolutely. Do you feel like trauma-informed care, not in the behavioral health side, but in the medical health side, that that would help to alleviate some of this?

SPEAKER_02 14:39

What I hear from a lot of my patients is sometimes they don't navigating and and sometimes I can oftentimes it's almost like they're not intentionally, but the provider doesn't believe them or doesn't understand or is invalidating in some of the responses, maybe oftentimes communicating like it's just in your head. Or maybe they'll say, you know, your test actually came back and you're you're not in a flare. You're actually you're you're in remission, you're good. And then the the patient's saying, but why do I feel so exhausted? And that that sometimes can send the message that it's all on on in their head when it's not. And so dedicating providers to screen for that trauma-informed care, helping them understand the rates of how high that is, particularly in patients who have IBD, lets them be a little bit censor the way that they speak, the language that they use, the questions that they ask, understanding, you know, I just told this patient their scans came back clean. Why is this patient upset? Like providers don't oftentimes understand that side. So educating them about uh this trauma-informed care and how just having an IBD diagnosis itself can be traumatic. It's it can help that relationship.

SPEAKER_01 15:48

Yeah, I do think that we hear a lot of patients say that by the time they finally get a diagnosis, they're relieved because they finally got a diagnosis. But the trauma that goes along with hearing that you have a chronic illness and that that's that's what you have, even though you know now what it is, you have something that's not going away. There is no cure for. And it's relapsing, remitting, and it is on a spectrum. It's mild to moderate, moderate to severe, severe. So it I hate to say that it's kind of funny to me to think that people who are treating these patients don't understand how that can be a traumatic event in their life. Also, I want to kind of address medical trauma also and share a just a tiny little bit of my personal experience with medical trauma recently, because I've been living with IBD for more than half my life now. And I was originally diagnosed with ulcerative colitis, and then that changed to Crohn's disease after I had already been living with the disease for I don't know, 15, 16, 17 years. And then I had to have surgery in 2020. And after that surgery in 2020, like the past five years up until very recently, have been the worst five years of my disease course. For a few years, I was having to scope every three to four months. I had to get scoped. And so there were appointments in between that. My what I thought was Crohn's associated joint pain was actually diagnosed RA. So then I had to start seeing a rheumatologist and added methotrexate. And so I had so many doctors' appointments all the time. And my doctors are three hours away from me. I got to the point where I was canceling and rescheduling appointments because I just couldn't go to another appointment. I have a pillbox next to me that my husband watched me fill the last time I had to fill it. And he said, Do you have to take all of those? I'm like, okay, most of them are vitamins and minerals. But yes, I've actually worked with a dietitian. And based on my diet and based on my labs, these are the supplements that I have to take vitamin B, vitamin D, folic acid for the methotrexate. Like it's exhausting just setting up my meds for the next two weeks, like my pills. And that's not including the injections, the four injections. Like it's never ending. And even when I'm feeling good, I still have to take all of those pills. I still have to do the methotrexate every week and the Stellara once a month, and the vitamin B once a month, and the, I mean, that's a lot of injections and a lot of pills. So for somebody who is listening and experiencing medical fatigue, if what I'm describing to you sounds familiar or like you're finally being heard for the first time, please, please, please talk to your doctor about what you're experiencing and try to get support in some way. Even if if you don't have access to mental health support, talk to your doctor and maybe they can provide support. Maybe they have a case manager in their office, maybe something like that to help you get through this. Maybe you find a primary care who can act as like a wrangler for you in working with your specialist to schedule your appointments for you. After I had my surgery, I had, and in 2020, all of you know the story. It was very traumatic. I almost died. The my primary care doctor really, really stepped up and took care of a lot of coordinating with my specialists at the time so that I could, I didn't have to worry about the scheduling of it. I just had to worry about getting there. I didn't have to worry about the follow-up of it. I just had to worry about getting there. So there is a light at the end of the tunnel, but you do have to ask for help, which, as Alicia knows for me, is probably the hardest thing that I ever have to do. And the only way that I got through it is that's when I started therapy. Five months after my surgery, I started therapy. And I I would not have been able to come out of that medical fatigue that I was in if I hadn't had somebody that I could talk to and talk me through it. And I ended up doing EMDR, which we've done two shows about the EMDR. So you can go back and listen to those. But medical fatigue is a real thing, and don't let your doctor gaslight you into thinking that it's not. And doctors call it non-compliant patients if you're not following that. So yeah, I call them non-compliant doctors when they're not listening to their patients.

Medical Fatigue Versus Depression

SPEAKER_02 19:52

Absolutely. And what you're you're describing is is very it's I hear it all the time. And I hear it on both sides where doctors are saying, I don't know how to make this person follow their their plan. I don't know what's going on. And I'm hearing it from the other sides and the patient saying, I can't. Exactly what you described. I can't. Like it's just my system is overwhelmed. That sympathetic nervous system is in overdrive, and there's they really can't do those things at that moment. They have to learn, they have to, one, providers need to know stop calling them non-compliant and stop teaching and understanding and changing the language and getting them to the right people. But for the patient side of things, helping patients know you're not alone, we can help you. Like you said, your primary care provider, they helped you navigate the logistics side of things. And sometimes that was enough. It was one thing was able to give so that you could focus on all these other things that you just checked off. And that's what patients need to understand as well. And and providers, and and like what you were saying before, when in 2020, when all this, when that's you said that the the last five years has been the worst with your condition. And that's often we see that all the time, you know, anxiety and depression. I I think uh, and you you may know these these rates as well, but like one in three patients with IBD have an anxiety disorder. One in four have depression, and those rates go up when they're in an active flair. And we talked about the trauma aspect, just going through everything you just described, all those things are traumatic. The the symptoms, the the blood in your stool, the emergency surgeries, the the all of that is traumatic. And I think one of the things that we know is that if these things aren't being treated, the anxiety, the depression, the the trauma symptoms, the medical burnout, if they're not being treated alongside, patients don't do as well. We know that by treating these things, you're gonna reduce inflammation, you're going to improve quality of life. There's just so much that can be done.

SPEAKER_00 21:46

You mentioned depression, and you know, I'm curious because they look real similar. You know, you said that some doctors may have that patient in the office and they say, gosh, the person really is depressed. You're right. There it's so commonly co occurring with inflammatory bowel disease. Is how do you parse out which one is which? Or is it just you kind of make the assumption that if they have medical trauma, there's probably some depression going on as well? Tell me, tell me how those differ.

SPEAKER_02 22:09

I think sometimes calling it depression is is they may they do look very similar, but I have a lot of patients who will say, I'm not depressed, like I'm not sad. You know, that's not what's happening. I'm just exhausted. And so helping patients to understand what's the difference? What is what does depression look like? Is it just that you're unmotivated? Is it just that you're having trouble sleeping? Is helping them understand? Because I think sometimes it depends on the provider, but I've had some providers who like if a patient is crying, they're depressed. If a patient is having a hard day, they're depressed. And so I also want to educate that no, that's not. That's normal emotions. That's ups and downs, and that's okay. But helping patients, kind of teasing it apart, helping them to understand, well, what's great, what's contributing to this? You're still going to be treating a lot of it the same way, but you may be calling it different. And that's important for patients because if you're being told, hey, you're just depressed, maybe they are, but maybe we're calling it something different, helping them to understand why am I feeling this way? What's happening? What are the actual the symptoms that I'm experiencing? It's like the difference between saying I have gut problems versus I have Crohn's disease. Sometimes being able to call it something and accurately call it something can be helpful in and of itself.

SPEAKER_00 23:19

Helpful. That's helpful. And I think again, you can have both, and that's that's okay. I'm curious if you had a magic wand and you could make it so that providers had the right language to use and or had the right systems to be able to say, you know, it's not non compliance, it's medical fatigue. What would that look like?

SPEAKER_02 23:38

If I had a magic wand, it would be giving them more time. I think part of it's not you can't always blame the the medical the provider. It's the system that's set up. They're seeing so many patients that they just don't have the time to ask the questions. I think it's if it had a magic wand, it would be allowing the system to work differently so that they do have the time. It's not a five-minute rushed appointment with somebody that's different every time you go. It's more like how it is in the in in my side of things as a psychologist. I have the time to ask the right questions. I have the time to to figure it out, to see, okay, I see you're having a hard time with taking your medication. What's going on? And then getting that that that story. Sometimes there's some providers who will take that extra time to be able to do that. And then they're probably stressed on their end because they're backed up and their patients, other patients are mad for waiting. So it's not a perfect system. And I don't, again, I don't want it to sound like I'm pointing the finger only at the provider. It's the healthcare system that's kind of creating this problem. And so I guess that would be my my if I had that magic wand and I could do that. The other side would be just helping providers. And that's some of what we do at GI Psychology is we we give workshops to providers to say, hey, what are what is the right question? How would you ask this? If you're seeing this, instead of just saying, do this, I told you to do this, why aren't you doing this? And writing them off, saying, hey, giving them the right language, giving them the actual questions to ask so they can get a little bit deeper, and then saying, All right, this is out of my scope, but I know who to get you connected with. And I think that's that would be great if that magic wand worked that way.

SPEAKER_00 25:13

Agree. I think time is certainly a very scarce commodity in the healthcare system. And that is definitely changing the way everybody's practicing. And I don't think anybody that's a healthcare professional likes that. That's the sad part. And so yeah, it's like the whole system needs to rise up and be like, no, this isn't good care. You know, we need to be able to spend more time with patients. And then it allows you the opportunity to learn what does AK look like, you know, and what how does she respond to this that I know what you look like when you're in a place of fatigue or stress or whatever, instead of just, you know, next person in line. So I'm curious if for medical fatigue, do you see it being compounded if people have multiple diagnoses?

SPEAKER_02 25:54

Absolutely. In fact, that's oftentimes what I see with my patients who come in. Whereas maybe if it was, if we had treated the first part, the first problem, if they'd gotten to a mental health care provider first, and it was the first stop rather than the last stop, they wouldn't be so many of these comorbid conditions, medical and psychological conditions that that that go hand in hand. And so, yes, the longer that they've been running that marathon, the more races that they've run, the greater the likelihood of that medical fatigue. Um, so I am seeing that. And sadly, it's I'm seeing it younger and younger happening. You know, typically it's like you would expect to see it somebody who's 50, 60, 70 on the the other side of the spectrum. But I'm seeing it in kids. I'm seeing it in teenagers. I recently had a teenager with Crohn's who was just saying, I'm tired. I just want a diagnosis. I just want it to be done. I just want it, I just want it to end, even though that diagnosis is the beginning. In their mind, it was just, I just I need it to end. And that's the very beginning of this. So you can imagine the longer that somebody runs that race, the more burned out, the more exhausted their body, their emotions, their mind are gonna be.

SPEAKER_01 27:01

And you made a distinction on that guest questionnaire that you filled out, where like physical exhaustion and medical exhaustion are not the same thing. Like I'm physically exhausted because I don't get sleep, because I have a diagnosis, because I'm in a flair or whatever. I mean, it compounds, but the medical exhaustion is like a whole other level. Do you mind talking about that a little bit, like the how you see the differences play out?

Treating Burnout With CBT Skills

SPEAKER_02 27:26

And I I think a lot of times that's the language that patients will say is I'm tired. And there's a difference between being tired from not like you just described, not being able to having trouble sleeping, being tired from working long hours, from being a parent, from from having a full-time job, from being a student. There's difference between feeling sleep deprived or not having enough, getting enough food, fuel during the day, versus your body is exhausted. It cannot go anymore. The the nervous system has been revved up for so long, there's nothing left in the tank. And I think that's something that's important to distinguish the difference between because it's not always a quick, okay, we'll get some more sleep, which is oftentimes communicated. All right, you're tired, go to bed earlier. You're tired from work, okay. Well, take a break, take a sick day, take a mental health day. It's not enough to improve the the same level of exhaustion that's that's happening when you're you're describing this medical fatigue. So I think helping patients understand and recognize like I have patients who will come in and say, I get enough sleep. Like I'm doing the things that I'm supposed to do, but I'm still tired. And so to me, that indicates that somewhere along the line, somebody's not explaining the difference to them and explaining how those can be different and how it's not a quick fix. It's going to take some time. It's going, it's not just like I mentioned earlier, some self-care. That's not enough, right? Just self-care alone is not enough to be like, all right, I'm gonna do some self-care. No, it it's there's a little you gotta calm the nervous system. You've gotta make the environment change. And there's a lot of other techniques that that go into play with that.

SPEAKER_00 29:06

So is that a similar thing you would do to treat somebody with medical fatigue? So if somebody was again, patient walks in the door, you're like, actually, yeah, you're not depressed. You're just really, you know, overwhelmed by all the medical stuff that you have to deal with and you're feeling medical fatigue. What's the treatment protocol for that?

SPEAKER_02 29:21

Is there treatment protocol? And there's it's not like a cookie-cutter approach in terms of like, yes, this is what you have, this is what you need to do. I think it's a collection of things. I think it's it's understanding what is it? Is this something that we can help? Like a like what Robin was saying earlier. Like, is it that the logistics is overwhelming you? Is there something that we can problem solve it and help you navigate through that side of things? Is it that you don't have support available? Is it that you need to be connected to a community, whether it's a support group or whether it is someone in your in your environment who can help support you? It's also going to be let's do something that's actually going to help to reset that gut brain access, because that's one of the reasons why you're feeling so fatigued, is that your nervous system has been running a marathon and it needs to rest. And so giving them the techniques to do that, that's where the clinical hypnosis comes into play, the relaxation, the mindfulness, those things come into play. And also a lot of times it's helping them with the CBT as well. There's a lot of thought distortions that start to come up. You know, I'm the problem, I'm just not trying hard enough, or I'm not doing what my providers want me to do, or there's a lot of thought problems that start to come up. And so helping them to recognize that these distortions exist and let's let's help you to change that. Let's reframe the way you're talking about these things because it can feel hopeless, it can feel overwhelming, it can feel like completely, utterly exhausting. And so helping them to see are there some thought patterns that might be contributing to this? Can we change those years? This environment has contributed to this distorted thoughts. Um, so changing that behavior, but also the thoughts and the process as well.

SPEAKER_00 31:04

Yeah, I mean, I just I feel like medical fatigue is so real and so such a such a problem for our community because it is. It's so many things to deal with. It's multiple people, it's multiple procedures. And so I think this is it's helpful to hear all of this and helpful to hear that you know that people are not alone if they're starting to feel this. I think Robin, yeah, sharing your story of what that looks like for you is super helpful for our folks. You mentioned trauma-informed care, and we have definitely talked about it on the show, but I'm curious if you would be willing to do just kind of a vast overview/slash definition of trauma-informed care, just for anybody that may, those terrible people that have not listened to past shows, if you wouldn't mind helping them understand this.

SPEAKER_02 31:45

Trauma-informed care just means acknowledging and validating the patient's emotional experience, not just their physical symptoms. It means understanding how, as we talked about earlier, IBD, the experiences in and of themselves can be traumatic. Asking the right questions, validating their fear, frustration after repeated hospitalizations, being mindful of the language and the tone that you're using with patients, asking patients just simple questions. How do you feel about an upcoming procedure? Sometimes just somebody saying, you know what, this is hard. And I understand that. And this is a place where you can you can we can talk about it being hard. That's, I think, part of trauma-informed care, just being aware that these things are likely to lead to traumatic experiences, which can complicate treatment. So again, this approach is the purpose is to help reduce those avoidance behaviors, increase engagement with care, and improve overall outcomes in general, and getting them to the right people if that's outside of their scope. So I try to tell providers that I speak to that I don't expect you to be a therapist. But answering these questions, knowing what I do, knowing how to tell a patient, hey, I think you would really benefit from this gut brain therapy and doing it the right way can help them then get to the next place. Because I think what most often happens is a provider tries and it doesn't come out right. Maybe that we don't know how to practice it the right way, but it comes out as you need to go see a psychologist, you need to go see a therapist, which is not the right message that we want to send. We want to explain why, you know, what's going on, how they can help, not hey, I think you're crazy, go talk to this person. Because that's often the message that's sent. Oh God, 100%.

SPEAKER_00 33:24

Yeah. And I can't imagine how many times they've already heard, have you talked to a therapist? Have you talked to a psychologist? Have you talked to a psychiatrist already in the process of just getting diagnosed? Because, you know, especially women with gut problems, that's the prime, prime candidate for somebody to be like, oh, you're just not managing your stress well. So, you know, like I just that makes me I'm I'm I like angry, I'm proactively angry for these people, and it hasn't even happened yet. I think it's so important, and I I'm hopeful that this is something that's happening more in medical schools as people are starting to come up with this age of better understanding of trauma informed care. Is that happening? Do you know?

SPEAKER_02 34:01

I haven't seen it yet, but uh there's a lot of really great providers out there now who are, I don't know if they're learning it in medical school or they're just learning it on their own, but they're recognizing this more and more and they're trying, they're trying to educate. You know, they speak with me and they say, hey, tell me how to do this. Let's do a workshop. Let's, you know, I I want, I'm I'm almost scared to bring this up with a patient because I don't want them to take it the wrong way. And and that's like, great, let's fix that. Let's let's talk about this. Um, so I do think there is a shift that's changing. And I think the more we we, you know, y'all talk about it on podcasts, the more we we do outreach, the more we can help in that area, the better off the healthcare field's gonna be.

SPEAKER_00 34:40

Absolutely. You mentioned you do some training with with providers, you know, and about trauma-informed care, amongst other things. But in these workshops that you're doing with trauma-informed care, do you notice there's certain at certain aspects of what you're teaching that are like the light bulb moments for folks? Like what do they sort of go, oh, okay, hang on, that's it. What are you noticing in these trainings with the providers?

SPEAKER_02 35:00

I think a lot of them already know some of the research, that they they understand the research. It's just I don't know how to do it, right? I don't know how to talk to a patient. And so some of it it in the workshop, it may be this is a script, this is how you say it. Now let's practice it because it's almost like it's almost like kind of talking about poop, right? When we talk about poop, I have patients who come to me and they can't talk about poop, even though they've been talking about poop all over the time. The more you talk about it, the more you forget. Oh, yeah, it's hard to talk about poop because you just forget it. It's second language. Second that happens too in these workshops. The more they practice, the more they get comfortable with it, that exposure with it. It's oh, I don't I know how to do this. So I'm gonna bring it up more often. And that's also where we come in too. We we try not just with the workshops and the trainings, but trying on our side of things for the resources. You know, we have videos that you can share with a patient if you don't feel comfortable. We have handouts that you can share with a patient. We have blogs, we have all these things that are helpful, not just to educate the provider, but for patients too, because our our main goal is just to make sure that patients are aware that the treatments exist and they're getting access to it. Um, and not just patients, the whole world. We want the whole world to know. We want the providers to know, but also patients and and the public as well.

Trauma Informed Care And Referrals

SPEAKER_00 36:18

We have a provider that we've talked to, Dr. Jordan Shapiro, and he's very well versed in this. He's sought out education on trauma-informed care. And so it was interesting because he talked us through like he had a patient that had been sexually assaulted, sorry, trigger warning everybody, and how she was that was preventing her from being able to get a colonoscopy. And so he talked about all the things that he and his team did to make sure that he was kind of helping her make that experience as good as it possibly could be, including picking the playlist and coming in before everybody else and doing a lot of things. I mean, I think one of the things that feels overwhelming to me as a not provider is there's so much that can be traumatic. And how do you parse out the thing that is the thing that that's causing the the like potential issue with your patient? Like in this case, this woman's preventing, you know, avoiding preventative medical care. Or in some of our folks, it's you know, not going back to the hospital or you know, the because they had a really bad experience there. I mean, it feels overwhelming to me to be like, okay, there's trauma, but it really could be absolutely anything. And it may have nothing to do with their GI problem. It might have something to do with the car crash they had, and so now they can't drive themselves back the intersect by the intersection where they crashed near the hospital kind of thing. Like you don't know that. How do you figure that out? This is a huge question I'm asking you. How do you figure out people's trauma? How do you do it in a succinct way that isn't gonna re-traumatize somebody? You're feel free to solve that one, please.

SPEAKER_02 37:42

I think that's where it shouldn't be the medical provider's uh job. I think giving them the basics, the the screener, yeah, if you will, the hey, I need to be looking out for these things. If I suspect these things, how do I talk about them getting referred to somebody who will help me alongside? So we're not saying, hey, I'm sending you over here because I can't help you. We're saying this treatment's gonna work better if we do this in combination with what you're already doing here. And then getting them to the trained mental health therapist, hopefully a GI therapist, but doesn't have to be. But getting them to that person who is trained in that, helping them to understand. And it's not always something that you can do in the first session. You know, sometimes patients don't even know why. They're just like, I've had all these experiences, and it's like, this is I can't get on the bus. And I don't know why I can't get on the bus, but I can't get on the bus. And so sometimes it takes a little while to narrow it down. But that's why this integrative approach is so important and why healthcare providers need to work with mental health care providers along the way and dietitians. It needs to be an integrative approach, not just you only go to your primary care provider or you only go to your GI, your gastroneurologist, but it it works better if it's working as a team. And so I don't know if I answered your question because it's kind of complex and kind of hard to answer. But let's say I'm working with a patient on as their gastropsychologist, that's why it's important that I communicate not just with the patient, but I want to communicate with the gastroneurologist. I want to communicate with a primary care provider, I want to communicate with the dietitian. And I have patients sign these releases so that I can, so that we can identify it along the way and make sure that everyone's informed of how this might be impacting them. How, like you said, maybe it's they had trauma in the hospital. And so it's, I can do these things. I just can't go to the hospital setting to do it. So if you want, and that's actually happened before, it's like I can't go to the hospital right now, but if you want to do it outpatient. And so that's something that maybe a provider wouldn't have known had not been working with a therapist who then helped the patient and communicated that directly to the provider.

SPEAKER_00 39:46

Unfortunately, as we've talked about how we'd like to, you know, clone all of you, beautiful psychologists that work with our patient population, because there's not as many of you as there could be, there's already a bit of a problem with the number of mental health professionals in this country as it is. And when you take that and then you narrow it down to somebody who's GI specific, that makes it an even smaller pool. If somebody doesn't have the ability or privilege to be able to work with a somebody who is trained as a GI psychologist or even as a trauma-informed therapist, I would imagine most of them probably have that training. Are there tools for somebody who identifies that, hey, I can't get myself on the bus? Just I can't. Something's wrong. Is there a tool that somebody could use to start doing some like self-exploration that's not gonna be dangerous to them and open up a huge can of worms if they don't have the ability to work with a psychologist to start to dig into this a little bit? It feels a little dangerous. I'm not gonna lie. So I may maybe the answer is no.

SPEAKER_02 40:41

It depends on on what you're trying to help with. There's a lot of resources out there. You know, there's there's apps that that are out there. There's you know, even there's even hypnosis apps. I don't know if y'all you may be familiar with the Nerva app, there's the Calm app. There's so many apps out there. So it's it's better than nothing. It's something that they can do to help. And I would say go for it if that's something that you can do, but you can't get to a psychologist, or there's no psychologist, or there's no behavioral health specialist, or there's no mental health provider, you live in a rural area, uh, there's self-help books, there's things, there's podcasts, there's the the Crohn's and Colitis Foundation has amazing stuff. There's the the Gastro Girl podcast. There's a lot that there's available. Now, what I tell somebody to get a book and do trauma therapy on themselves, probably not. There's there's I would take other steps, but to say, hey, you can't have access to this, there's no hope. I don't think that's the case. Even talking to a psychologist or a behavioral help clinician who can then just say, hey, let me recommend this to you, let me recommend this book to you, let me recommend this resource to you. That's important too. And I think that can be done.

SPEAKER_00 41:45

You're right. If there's obviously gold standard is to go see somebody who's trained to be able to work with you, but there are there are some tools that are hopefully you know available to you. So that's that's helpful.

SPEAKER_01 41:55

We know that you work with Dr. Navidi and he's been on the show talking about this group that you're doing in collaboration in conjunction in partnership with the Crowns and Colitis Foundation. So, how is that going? It's going really well.

SPEAKER_02 42:05

Early results suggest that that patients are really benefiting. They are reporting reductions in um symptoms, reporting improvements in overall quality of life, reductions in stress, improvements in mood, feeling more connected. There's so many things that good that's coming from it. Um, so we're really excited about it and we definitely want patients to know about it, provided you know about it.

SPEAKER_01 42:28

I have definitely been to the website, curious about is I'm I'm not a joiner, aka. I'm not a joiner, I'm not a group person, but you said sometimes you need a group. So I don't know. Don't laugh at me, Alicia. I see you laughing over there. But it is interesting, right? To have those positive results. Community is one of the things that made the biggest difference early on. And I haven't been like close connected to community like this in a while. So that's why I'm like waffling. Is that something that I should do? Because I know that community is so important and makes such a big difference.

SPEAKER_00 43:02

I'm I'm sorry. That's aka I'm getting on, I'm I'm jumping in. Do it, Robin. I think that would be fantastic. Um and it is virtual, so you don't have to live in New York, you don't have to live in some specific place to do it. It's people kind of throughout the country, right?

SPEAKER_02 43:15

That's correct. And for it's 18 and up, so you you definitely are uh meet the criteria there. I have there's a lot of patients who that do not mean to go.

SPEAKER_01 43:25

My disease is older than 18 years old. My disease can drink alcohol. Okay. I'm definitely meet the criteria.

SPEAKER_02 43:32

But I I have a lot of patients who always say similar things. They say, you know, I don't know, I don't know about joining this group. I want to, but I have reservations. It's kind of a lot of the stuff is maybe a little bit personal, it's private. What how's that gonna, you know, show up in a group setting? And so I I think it's important to know the difference between this type of an IBD psychotherapy group versus just a hey, we're gonna come and we're gonna talk type of like support group. This group is more about while they're Is that opportunity to feel heard and validated and supported? We're also going to be learning skills. You're going to be doing some hypnosis. You're going to be doing some CBT. You're going to be doing those gut brain therapy, doing that in that setting. So it's it's more than just it's very educational. It's very skills-based therapy-based rather than just, oh, I got to come and share. I think I have a lot of patients who think about group as like AA, like I got to come and tell my personal story, and I don't want to do that. And it's like, no, no, no, that's not what we're doing here. So I think that's an important distinction as well.

SPEAKER_01 44:31

Thank you so much for making that distinction. But when people hear group, that's what they think, right? They think that traditional support group and share their story. So that's important. Now, now I'm really thinking about it. But unfortunately, it is time for me to ask you our last question. What is the one thing that you want the IBD community to know?

SPEAKER_02 44:47

I think you can't separate the mind and the body. These things are often overlooked in the GI world. And there's brain therapy, trauma-informed care. There's support groups, there's therapy groups. There is an answer. There's help for you. So if you're if you've been listening today and you resonate with a lot of what we've been talking about, talk to your provider. Join us on our website. Go to gisychology.com and you can learn more about what that looks like. I think that's really important that there's there's help available, oftentimes where medicine can't help.

SPEAKER_00 45:20

Oh, excellent point. Thank you so much. This was so much fun to talk to you and get to know more about your work and all the fantastic things you're doing over there at Jason GI Psychology. So thank you so much. We really appreciate it. Thanks to everybody else for listening. And cheers, guys. Cheers, everybody. Cheers. If you like this episode, please rate, review, subscribe, and even better, share it with your friends. Cheers.