Introduction to the Special Issue: Advances in Psychogastroenterology
Digestive disease experts have long understood that psychological stress and emotional responses influence gut function (Almy & Tulin, 1947; Grace, Wolf, & Wolff, 1950). More recently, the relationship between brain and gut is understood to be bidirectional and mediated not only by neural substrates but also by the microbes hosted in the gut (Osadchiy, Martin, & Mayer, 2019). Psychological treatment of digestive diseases has evolved alongside knowledge of the brain-gut axis itself. The formal application of behavioral and psychophysiological principles to the management of digestive disorders dates to the development of biofeedback for irritable bowel syndrome (IBS) in the 1970s and the adaptation of several psychotherapy modalities during the 1980s. Despite these early advances, the integration of clinical psychologists in gastroenterology settings has not progressed at the pace seen in primary care or even in other medical specialties such as oncology and bariatrics. There are signals of a new level of cohesion within the field, however, including recent adoption of the term psychogastroenterology to describe “the application of psychological science and practice to gastrointestinal health and illness” (Knowles, Keefer, & Mikocka-Walus, 2020). In 2018, Drs. Laurie Keefer and Sarah Kinsinger founded a new psychology-focused section of the Rome Foundation, a professional society devoted to disorders of gut-brain interaction (formerly termed functional gastrointestinal disorders). As of this writing, 175 psychologists and other mental health professionals are listed as members of the Rome Foundation’s GastroPsych group (Rome Foundation, 2020). The recent publication of Psychogastroenterology for Adults: A Handbook for Mental Health Professionals (Knowles et al.) is a landmark for the field, with coverage spanning multiple diseases and treatment paradigms. Although psychologists are not new to gastroenterology settings, these recent initiatives suggest that they are finding one another and collaborating on a scale not previously seen. This special issue of the Journal of Clinical Psychology in Medical Settings represents another effort to bring together the collective expertise of professionals working at the interface of gastroenterology and clinical psychology. When I solicited submissions for this issue, I was unsure what to expect. My hope was to present a range of work in research and practice settings to demonstrate the adaptability of psychological science to new problems and unmet needs. Mindful of the silos that tend to spring up around new subfields, I also hoped that the call for papers would attract submissions from people whose research is not exclusive to this area. Although the resulting articles do not show the full breadth of research and practice in psychogastroenterology, they do show how the full complement of clinical psychologists’ competencies—consultation, assessment, intervention, and evaluation—can inform and enhance the care of people with digestive diseases. The first two articles in this special issue address celiac disease, an autoimmune disorder that can cause damage to the small intestine, leading to malnutrition and other complications including neurocognitive and mood symptoms. Despite the fact that behavior change (lifelong adherence to a gluten-free diet) is essential to management of celiac disease, there is relatively little literature on psychological interventions in this population. Coburn et al. (2020) describe their experience in a celiac disease clinic for children and adolescents, working as part of a team of professionals including physicians, a dietician, and a health educator. Their model included a routine psychological consultation for each newly diagnosed patient; notably, the authors found evidence of unmet mental health needs in a significant proportion of patients at the time of this consultation. Also working within a multidisciplinary team model, Cassisi, Ross, Vivier, James, and Su (2020) describe the use of the National Institutes of Health’s patient-reported outcome measures to assess changes in gastrointestinal symptoms, cognitive function, and quality of life in response to * Andrea Bradford andrea.bradford@bcm.edu