More Than Just a ‘Gut Feeling’: The Value of The Biopsychosocial Model to Inflammatory Bowel Disease.
Your gut knows when something is wrong, you get that sick feeling in the pit of your stomach that you just can’t switch off. For those with Inflammatory Bowel Disease (IBD) it’s more than just a ‘gut feeling’, as psychological distress such as stress or anxiety can trigger the reoccurrence of symptoms. For those of you that don’t know, IBD is autoimmune disease characterised by chronic inflammation of the gastrointestinal tract. Bowel related symptoms of IBD such as urgency, incontinence and frequency can lead to psychological disorders such as anxiety and depression. Not to mention the distress that results from the unpredictability of flares, embarrassment and stigma that is often associated with IBD. So why for many years have the psychosocial factors of this ‘stress related illness’ been overlooked?
For almost twenty years studies have argued that psychological services should be integrated with IBD treatment. However, a recent study highlighted that IBD patients are still expressing the need for a more holistic approach that combines dieticians, psychological and counselling services into IBD care! This is something that the biopsychosocial model can provide as it combines biological, psychology and social factors to explain illness. Support for this comes from psychological interventions significantly reducing symptoms of anxiety in IBD patients and improvements exhibited across symptomology, effectiveness of treatments, service utilisation and patient satisfaction. Therefore, it was recommended that gastroenterologists and psychologists should work together to create a treatment plan unique to each patient.
You might be thinking, if the biopsychosocial approach to IBD has such positive results, why isn’t it routinely used within the NHS? Theoretically, it looks like the perfect plan, however it isn’t plausible in the current economy. For example, one study taught the biopsychosocial model via a year-long educational program to health care providers, which would have been time consuming and costly — something the NHS doesn’t have the funding for. Moreover, if the model isn’t applied with caution, it is at risk of patient blaming, which could cause further psychological distress. Few gastroenterologists even have access to psychologists and if they do, not all patients want psychological therapy for a physical illness. This suggests it isn’t only physician’s attitudes that needs to change, but the public’s too.
However, the benefits of the biopsychosocial model far outweigh the short term costs and criticism. The need for further education of health care providers should not be viewed as a hindrance, as education is essential for treatments to develop. The model also predicts that some symptoms could be improved without the use of costly medication that often has negative side effects. Additionally, studies have found that the biopsychosocial approach to IBD is effective and feasible! An IBD clinic in Australia successfully integrated psychosocial screening and psychotherapy, and emphasised that a biopsychosocial approach is essential to maximise patient engagement and benefits. As there is no current cure of IBD, the biopsychosocial model offers hope, as it suggests that individuals may be able to regain some control of their life or at least improve their psychological wellbeing.
Now, I’m not suggesting that psychological therapy will reduce all symptoms of IBD or even work for everyone. What I am suggesting is that it is no longer enough to just focus on the physical symptoms of IBD. Therefore, it is time to start listening to your gut when it comes to IBD, as it is clear that the biopsychosocial model will help provide the patient centred care that is long overdue!
