Integrative Therapies

A Few Thoughts on Cognitive Behavioral Therapy

I had the privilege of attending a seminar at the Beck Institute in Philadelphia, the birthplace of cognitive behavioral therapy, or CBT.
 
You might be wondering why I would choose to attend a seminar on mental health as a digestive health dietitian. You may remember my August 2015 tip on the brain gut connection, but just in case you missed it ... the brain gut connection is the near constant communication between two intricate systems of neurons known as the central and enteric nervous systems that connect the brain and the digestive tract. Stress signals can be transmitted from the brain to the gut and vice versa, leading to anxiety, depression, changes in mood, gas, bloating and altered bowel habits, such as seen in Irritable Bowel Syndrome (IBS). Stress is a part of being human, but when it leads to digestive distress, it needs to be investigated. This means that as a digestive health dietitian, I can't just focus on the gut! And several studies have shown that stress reduction therapies, such as mindfulness meditation, hypnosis and CBT can be an effective treatment tool for those with functional gut disorders such as IBS.
 
Here are some of the valuable lessons I learned:

• CBT is a solution based therapy tool - focus is on what is happening now that is leading to certain behaviors or thoughts that lead to actions leading to symptoms; no discussions needed about childhood or familial issues
• CBT is not long term - total number of sessions generally ranges between 10-22 and are meant to empower the patient to use skills acquired during sessions to be their own teacher/therapist out in the world
• CBT gets at core beliefs and automatic thoughts to help unlock how we think and behave. It is truly fascinating and very useful

If interested in learning more about CBT and whether or not it might be useful for managing your digestive symptoms, we can help.

New Year, More Compassionate You

New Year's Eve, a night of parties, staying up all night long and, most importantly, New Year's resolutions --- "I will start going to the gym 5 nights a week"; "I will not eat more than 1200 calories per day"; "I will lose those last pesky 5 pounds."

Resolutions by nature are demanding and commanding. "A firm decision to do or not to do something" says the dictionary when you look up the word. When we obligate ourselves to something, as with a firm resolution, the spirit and joy of the task is depleted. This can lead to feelings of worry, anxiety and, eventually, to giving up.

How about instead of making New Year's resolutions, we make New Year's intentions? The word intention means "an aim or plan; the healing process of a wound." When we create space for change there is an element of self-compassion, of believing in one's self that comes through.

Instead of "I will start going to the gym 5 nights a week," the compassionate intention version might be "May I start to work out this year in a way that is right for this body and that makes me feel strong." For "I will not eat more than 1200 calories per day," one could instead make the intention to "be mindful of the food I consume and listen to my body cues as to when I need food to quell hunger vs. when I am trying to fill an emotional need." And finally, instead of "I will lose those last pesky 5 pounds," "may I do activities and eat nourishing food that sustains my body without overindulging."

Once you have your New Year's intentions, creating a game plan for each task feels like a fun adventure instead of a chore or duty. Have fun with it! Sign up for a dance class you always wanted to try or purchase a cookbook that inspires you to make more dishes at home. Let your New Year's intentions create an opportunity for cultivating compassion.

The Gifts That Keep on Giving

It is easy to get wrapped up (pun intended) in gift giving and spending money this time of year. But what about the gifts of time, attention and listening? These are gifts that keep on giving, not only to the person receiving your time, attention and listening ear, but also for your health! Happiness, created by feeling connected to community and support systems, has been shown in research to significantly boost overall health and decrease stress, which can dramatically change digestive well-being towards the good.

Ever heard of the Blue Zones? These are five regions of the world with the highest populations of 100+ year olds; Ikaria, Greece; Okinawa, Japan; Ogliastra Region, Sardinia; Loma Linda, California; and Nicoya Peninsula, Costa Rica. These five regions of the world have different cultures and beliefs but share several attributes; 1) diets that center around plants (fruits, vegetables, grains, legumes, nuts, seeds) with moderate alcohol intake (mainly red wine), little to no red meat along with small portion sizes; 2) lots of moderate exercise - daily activities such as walking to the market or chopping wood; 3) strong sense of community - whether familial, religious or friendly; 4) feel a sense of purpose in life - usually relating to giving to others and back to their chosen community; 5) take time off to relax and spend time with family, friends and community.

The research is clear --- spending time with loved ones can lower the risk of heart disease, obesity, cancer, diabetes and encourage longevity. The decreased stress experienced by being an active part of loving and supportive communities can decrease all manner of digestive symptoms. So this time of year, the season of giving, instead of giving something purchased with money, consider giving the gifts of time, attention and listening.

Turkey, Pumpkin Pie and Gratitude

It is the time of year for gathering with friends and family, feasting and giving thanks. Gratitude is an affirmation that good things exist in the world. Even though life is imperfect and inherently contains burdens and hassles, gratitude asks us to recognize the sources of good in our lives and give thanks for their presence.

Believe it or not, practicing gratitude can positively affect digestive health. You may remember from the August 2015 Well-Being and Nutrition Tip, that the brain-gut connection plays a big role in functional digestive issues, such as irritable bowel syndrome (IBS), functional dyspepsia and functional abdominal pain syndrome. These two organ systems (central nervous system and gastrointestinal system) are talking to each other all the time, sending messages of stress, pain and fear or calm, relaxation and rest.

When experiencing gratitude, our hypothalamus becomes highly active. This part of the brain controls lots of body functions including defensive behaviors, stress responses, metabolism and sleep. When messages to decompress, de-stress and relax are being transmitted along the brain-gut connection, as they are when we practice gratitude, it can help decrease abdominal pain, bloating and changes in bowel habits, i.e. a decrease in functional digestive symptoms.

The next time you feel stressed out or anxious, consider making a list of things you are grateful for, that make you feel positive and supported. This practice will train the brain to recognize stress, but instead focus on all the things in life that deserve appreciation and gratitude.