IMID Symptoms—Beyond the Physical

“From anxiety to depression, immune mediated inflammatory disease (IMID) patients need help managing their condition’s psychological effects in addition to the physical manifestations,” Sarah Ballou, MD, said at the Interdisciplinary Autoimmune Summit (IAS) virtual session. She reviewed effective ways to evaluate the mental health of individuals with IMIDs, with advice on when to recommend cognitive behavioral therapy, among other evidence-based interventions.

Dr Ballou is a clinical health psychologist and the director of the GI Psychology Service and Assistant Professor of Medicine at Beth Israel Deaconess Medical Center/Harvard Medical School. Her research interests include evaluating the psychosocial impact of chronic GI conditions as well as further understanding the role placebo and nocebo effects in the experience of GI symptoms.

It is important to understand the basic distinction between health psychology and general mental health, Dr Ballou said. Treatment to health psychology is short-term and skills-based whereas treatment for mental health is often ongoing. Health psychology would require a collaborative care model, but a treatment of mental health is separate from medical treatment. “It is a separate branch in itself,” Dr Ballou explained.

Modified behavioral, cognitive, and environmental variables that affect illness are the desired outcomes of treatment in health psychology. Therefore, a patient may undergo cognitive, behavioral, or physiological approaches to therapy. Often, more than one form of therapy would be combined to achieve superior results.

While health psychology would affect patients with rheumatoid arthritis (RA), inflammatory bowel disease (IBD), type 1 diabetes and psoriasis, for the purposes of the presentation, Dr Ballou decided to focus on only IBD and RA.

Dr Ballou listed common psychosocial concerns in IMIDs as “mental health comorbidities, stigma, reduced quality of life, reduced productivity, sleep disturbance and fatigue, and stress-related changes in symptoms.”

Then, Dr Ballou delved into the various behavioral therapies for IMIDs that are evidence-based.

Speaking of cognitive behavioral therapy (CBT), Dr Ballou said this method has been applied to a range of mental health and chronic medical conditions. “The goal of CBT for IMIDs is to help patients manage their symptoms confidently and to decrease the interference of symptoms on daily functioning,” she said.

Speaking of medical hypnosis, the desired outcomes include prolonged remission, reduction in inflammation, and management of comorbid functional symptoms among others.

She then helped the audience participate in relaxation training—a common component of behavioral therapy—with guided diaphragmatic breathing.

Some of the common psychosocial treatment targets include treating comorbid mental health concerns such as anxiety and depression seeping into other areas of life such as productivity, fatigue, risk of surgery or medication non-adherence. Treating disease-specific concerns would include coping with a new diagnosis, pain, medication adherence, relationship dynamics, disease stigma, work productivity and self-esteem. “Not every patient experience all of these issues,” Dr Ballou cautioned. “Individual reactions to each of these disease-specific concerns vary widely.”

Yet another target in treatment is comorbid functional condition. “Up to a quarter of patients with RA or IBD have comorbid functional conditions such as fibromyalgia or irritable bowel syndrome,” she said. “The presence of functional overlap is associated with increased healthcare use, increased psychological comorbidity, and decreased quality of life.” Identify with somebody within the community and establish a relationship with them to achieve remission, she added.

What can a physician do? She presented pointers and conversations starters such as routinely asking about quality of life, anxiety about symptoms, and ability to engage in daily activities; introducing the role of behavioral therapy early on as an important component of multidisciplinary treatment; and finally, have a psychologist integrated into the clinic whenever possible.

Finally, Dr Ballou parted with specific ways to find a good psychologist for your needs by looking up on the Rome GastroPsych directory or the Psychology Today directory.

—Priyam Vora

Reference:
Ballou S. The psychological impact of IMIDs. Interdisciplinary Autoimmune Summit. April 26-28, 2023. Virtual.