Welcome to 2016, blog readers! Since its been a busy season for both myself and Tiffany, we are starting by reposting a wonderful interview that we did exactly three years ago back when we were new at this whole business thing. We've come a long way, but a lot of the things we talk about in this interview with our friend Rebecca at Caring for Crohn's still hold true. Thanks again for your support and spreading the word to all your chronic illness pals!
Caring for Crohn’s Interviews Oak Park Behavioral Medicine (reposted from 1/7/13)
Oak Park Behavioral Medicine, located in Oak Park, Illinois, specializes in working with adults and children living with chronic medical illnesses. Dr. Taft and Stephanie are experts in the psychology of digestive illnesses, including IBS, Crohn’s Disease, Ulcerative Colitis, and Eosinophilic GI diseases, but also treat patients with other chronic illnesses.
What’s even more unique about this practice aside from the focus on treating patients with chronic illness is that both Dr. Taft and Stephanie are fellow Crohnies!
Read on to hear about their practice and how they help improve the psychological health of IBDers.
Caring for Crohn’s: How long have you been in practice?
Tiffany Taft: We’ve been together in private practice since August 2012, so we’re quite new but not new to working with people with chronic illness. Steph worked for the past three years at a hospital in the Chicago suburbs in the oncology department helping people living with cancer. She continues to work there doing part-time clinical work and part-time research. I spent eight years at Northwestern University in the gastroenterology department working with people with chronic GI illness and doing research on the psychological aspects of these conditions.
C4C: Why did you decide to focus your practice on people with chronic illnesses?
TT: There are a couple of reasons we did this. First, both Steph and I have been personally affected by chronic illness, so we felt this was a natural area for us to give back to those who live every day with an illness. Second, we understand that there’s a gap here in that there aren’t many therapists who specialize in working with people with chronic illness or who have undergone specialized training while in graduate school for this. There’s more to it than saying “Oh, I can help people with medical illness.” We wanted to let people know there are therapists who understand both the psychology and the medicine of a chronic illness, and who are experienced working side-by-side with physicians so everyone is on the same page.
Stephanie Horgan: We have both worked in a hospital setting and been patients in a hospital setting and have seen the lack of support first-hand. We feel that having the option of a therapist is a crucial component of treatment when someone is diagnosed with a chronic illness.
C4C: Do either of you or anyone in your family have IBD or other GI ailments? If not, what drew you to wanting to help patients with these ailments?
TT: Both Steph and I have been diagnosed with Crohn’s disease for roughly the same amount of time – 10 years. So we understand what it’s like to live day-to-day with IBD, but we also understand that each person’s experience is unique and what we’ve been through may not be the same as what our IBD clients have been through. We do our best not to blur our experience with our clients’ and only use our own experience if it’s helpful for our clients to know about. Some people want to know more, some less.
SH: I have had Crohn’s for 13 years now, and actually just finished a three week stay in the hospital for another surgery. I don’t have a family history of IBD but my own experience is what inspired me to help others with similar conditions. When I was first diagnosed, I saw a therapist that specialized in GI ailments and found it tremendously helpful. She worked alongside my gastroenterologist and surgeon and I didn’t need to educate her on everything. Having someone like this made my experience better, but not everyone is open to that kind of support. If a therapist sounds uninteresting to you, I encourage you to at least reach out to CCFA(Crohns and Colitis Foundation of America) as they have lots of helpful resources for those newly diagnosed. Something that keeps me going is my network of other people I know who are diagnosed, as they inspire me to keep going and give back.
C4C: How does a behavioral medicine therapist help patients with chronic illnesses? How does it differ from a traditional therapist?
TT: A behavioral medicine therapist will focus on how the chronic illness fits into the person’s life story, and where it may be causing problems. It all depends on what the person wants to work on in therapy. Some people are newly diagnosed and are just trying to wrap their brains around the whole thing, so we can help with that through education and just giving the person a safe place to talk about their illness. Some people are anxious about their symptoms, so we help treat this anxiety by evaluating what’s triggering it and teaching relaxation techniques. Or a person may be depressed and feeling isolated, so we help them cope and increase their social interactions.
The main difference between a behavioral medicine therapist and a traditional one is the central focus with us is the medical diagnosis.
Behavioral medicine therapists can be psychologists or social workers. I’m a licensed clinical psychologist, which means I havea doctorate in clinical psychology. I specialized in health psychology so I have expertise in working with those with chronic medical illnesses. We even bill insurance differently than a traditional therapist, using the person’s medical diagnosis rather than a mental health diagnosis with special treatment codes.
SH: Technically, I am a Licensed Clinical Social Worker, which means that I have completed 2 years of graduate school as well as 2 years of clinical supervision. During my training, I focused on clinical work/therapy, as it was something I knew I wanted to do in the future. I also took many courses on mental health and health, which is something I was interested in looking at the intersection of. Both Tiffany and I do very similar things, but we have different training and different letters after our name.
C4C: What techniques are used in your practice?
TT: Steph and I use a lot of Cognitive-Behavioral Therapy (CBT) techniques in our practice. The basic idea of CBT is how we think affects how we feel emotionally and physically, and that affects how we behave. I like CBT because it empowers people. We ultimately only have control over ourselves and how we think and react to what life brings us. So one of the first things we have clients do is start paying attention to their self-talk, especially as it relates to their illness.
For example, I had a client with Ulcerative Colitis who was very anxious about having an accident, and her anxiety was causing her to have urgency and a lot of close calls. She was stuck in a vicious cycle. I had her think of the places that she was most likely to feel urgency, and then pay attention to her self-talk even before she was in that place but knew she would be soon. Once she was more aware of what she was saying to herself, we then worked on changing these thoughts to ones that were more productive and less likely to lead to worry and urgency.
At the same time we evaluated and changed her thinking, I also taught her some relaxation techniques. The basic skill is deep breathing, which sounds really easy – but if it’s not something you do regularly (like in yoga, for example) it’s actually pretty difficult for most people when they start. We also added some guided imagery exercises so she could picture herself in a relaxed place – for her it was a beach in Puerto Rico that she’d visited. She was able to reduce her anticipation of having an accident, her anxiety went down, and she had fewer close calls. This all took about 8 weeks.
SH: Each patient is different. Some may need long-term support, some may just need a few sessions. Our goal as therapists is to give the client tools and help them become independent of us so that they can live their life fully. When I work with kids, I use play therapy and mindfullness so that the child can start to explore what living with IBD will look like and get to know their body’s cues.
C4C: Are any techniques more successful than others in treating IBD patients?
TT: I wouldn’t say there are techniques that work specifically for IBD. We know that the most important predictor of therapy being helpful for someone is the relationship they have with their therapist. So finding someone who is a good fit is key. There are many approaches to therapy, and your experience will be different depending on the approach your therapist uses. CBT tends to be an active discussion with problem solving and home practice, where in other types the therapist may do more listening and not ask you to do things in between sessions. It all depends on what style works best for you. We have some questions on our blog to ask a potential therapist.
C4C: What sort of benefits do patients with IBD typically see after seeking therapy?
TT: The most common benefits we see are a greater acceptance of the IBD diagnosis with less impact on day-to-day life. People who feel socially isolated because they’ve withdrawn for fear of having symptoms in public find the courage to go out again. Worry about a flare or symptoms goes down. People feel more empowered to self-manage their condition and more in control.
SH: People find that their stress goes down and it helps with overall life enjoyment.
I also see people move past the stigma of having a chronic illness and begin to feel less awkward talking about it. The best part of it for me is when I see a client who starts to give back to others who are in the same boat.
C4C: Do many of the patients you see with IBD come to you with depression as a result of the disease?
TT: We do see some depression in people with IBD.
The statistics tell us about 25 percent of people with IBD will experience depression even when in remission, and that number goes up to 60 percent during a flare.
Usually depression is related to social withdrawal and isolation, or feeling like they have very little control over their illness.
C4C: How does medical hypnotherapy work? Is it successful in treating IBD?
TT: Medical hypnotherapy is a special type of relaxation that should only be done by people who are trained in the technique. The way I describe it to clients is you go to that place where you’re about to fall asleep but you’re not quite there, so if there were a loud noise or something you’d be wake right up. You’re never not in control, we don’t make you do or say things like you may have seen on TV or stage hypnotists. When a person is in a state of hypnotic relaxation, the thinking part of the brain is pretty quiet and the theory is that the more primitive parts of the brain are better able to receive information. If the person was coming in for abdominal pain, I would talk about their pain decreasing using various “suggestions.” Hypnotherapy usually takes eight visits, and I give people a home practice CD to use in between visits. Medical hypnotherapy is very helpful in treating various medical conditions, and I’ve used it with irritable bowel
syndrome (IBS), ulcerative colitis, migraine, and chronic pain to name a few. Generally we see improvement in about four weeks.
syndrome (IBS), ulcerative colitis, migraine, and chronic pain to name a few. Generally we see improvement in about four weeks.
Medical hypnotherapy is successful in maintaining remission in people with IBD. We did a cool research study when I was at Northwestern where we had people with Ulcerative Colitis undergo hypnotherapy, regular supportive talk therapy (not CBT), or treatment as usual. We followed them for a year after they finished treatment, and found that people who underwent hypnotherapy maintained remission for about six months longer, on average, than people in the talk therapy or treatment as usual groups. We still don’t know if hypnotherapy would actually treat active IBD, but we do know that relaxation strategies like hypnotherapy have an effect on the immune system. So it’s possible but more studies are needed.
C4C: What would you say to an IBD patient who is resistant to therapy but is very angry/depressed about their diagnosis? How can a loved one help them through it?
TT: I guess first I would say that we know there’s a very real stigma in our society toward mental health treatment, so it’s understandable to be resistant to coming in to see “the shrink.” However it is not a sign of weakness to need help adjusting to a chronic illness diagnosis like IBD. It doesn’t negate the severity or imply that your symptoms are “in your head.” So we would encourage people who are very angry or depressed to give therapy a try for a few weeks. If that’s not an option, then we’d say find someone to talk to about how you’re feeling. There are online support communities for pretty much every illness out there. For IBD, there are many Facebook groups, blogs, and support groups including those through The Great Bowel Movement and the CCFA. For loved ones, I’d recommend offering yourself up to be there to listen without giving advice. Many people say to us that family and friends mean well, but often they railroad a conversation with unsolicited advice (“have you tried…”), comments that feel judgmental (“what did you eat?”), or failed sympathy (“I had the stomach flu really bad so I get it.”). So try to keep that in check.Let the person come to you, but also check in periodically to see how they’re doing since people who are depressed tend to withdraw from others. Don’t only ask “how are you feeling?” but keep it more general since IBD isn’t the only aspect of the person’s identity and life. Finally, if you’re struggling with your emotions related to a loved one living with IBD, you may want to consider seeing a therapist. Steph and I not only see patients but their family members, and our peers would say the same.
C4C: Are there many behavioral medicine therapists across the nation? How would someone go about finding a therapist who focuses on treating people with chronic illnesses?
TT: There are many, although I’m not sure how many specialize in GI illness. That number seems to be pretty small. There are websites out there that you can search for a therapist and check off certain criteria. I’m listed on Psychology Today andGoodtherapy.org, which both have the option to filter your search by “medical illness” or “chronic illness.” Patient organizations like the Crohn’s & Colitis Foundation of America have professional directories that include mental health professionals, so this is another place to look. You can also call your local chapter’s office and see if they have a directory for your area. You can also ask your physician if they know anyone in the area that they recommend. Some therapists are more web-savvy and may be on Twitter or Facebook.
SH: We know how much people use the Internet now to address their health issues, so we decided to start a blog, Facebook page, and Twitter account. Feel free to check us out as we post about all kinds of chronic illness issues.