Crohn’s disease (CD) is an inflammatory bowel disease (IBD) that affects an estimated three million Americans, according to the Crohn’s and Colitis Foundation. People with Crohn’s disease have bouts of inflammation in their digestive tract, which can lead to diarrhea, cramping, pain, and significant weight loss. All these symptoms, combined with the inability to know when a flare will strike, can be stressful. According to Melissa Hunt, PhD, the associate director of clinical training at the University of Pennsylvania in Philadelphia, stress, anxiety, and depression can make it harder to live with Crohn’s. “Stress does not cause Crohn’s in any way, and no one gives themselves Crohn’s by worrying too much,” explains Dr. Hunt, who says emotional distress can also change how we perceive our health. The disease itself can cause the very stress that makes its symptoms worse, which is important for those who suffer from it to recognize and address. “I often say to patients, there’s no way to rid one’s life of stress — it is part of life. It’s more about managing stress,” says Jessica Gerson, PhD, a clinical psychologist at New York University Langone Health in New York City.
Minimize Everyday Stress
As a way to manage sources of stress such as worry about flares, possible complications, or whether you’ll respond to or tolerate medication, Hunt suggests general stress management techniques. These techniques include deep diaphragmatic breathing and mindfulness meditation. When done correctly, deep breathing activates the parasympathetic nervous system (“rest and digest”), helping to move food through the digestive tract. Mindfulness meditation can keep you grounded in the present moment, with your attention focused where it is helpful. She also suggests maintaining a trusting and collaborative relationship with your gastroenterologist. “This will go a long way toward helping you feel confident that your IBD is being well-managed medically, and will give you the best chance of achieving remission,” says Hunt.
Stay Active, Even if It’s Just Stretching
The key is to find activities you like and give yourself time to do them three to four times a week, Hunt says. “Exercise should never be painful. ‘No pain no gain’ is an absolutely terrible mantra that leads to injuries and quitting,” she says. “Anything that moves your body counts as exercise, and you will feel better having done it than you will feel if you sit on the couch and binge the latest Netflix series.” She suggests going for a walk, taking a hike, biking, and if you feel up for it, taking a yoga class — just find something you like to do that keeps you active. Hunt recommends avoiding intense weightlifting or contact sports like football and rugby if you currently have an ostomy.
Learn to Relax
Mindfulness techniques like meditation and focused breathing can yield great results, especially when Crohn’s symptoms interfere with your day. According to the Crohn’s and Colitis Foundation, mindfulness-based therapy has also been shown to help with anxiety and depression. In a small study published in the journal Scientific Reports in April 2020, 37 patients ages 18 to 25 with Crohn’s disease and ulcerative colitis were examined to test the effectiveness of mindfulness-based therapy compared with standard medical therapy. Patients received a mix of face-to-face therapy sessions and virtual therapy sessions. Lower levels of inflammation were found among patients with mindfulness-based interventions than among those who received standard medical therapy. Progressive muscle relaxation (PMR), in which a person tenses and then relaxes different muscle groups to relieve them of tension, is another way to train your body to relax. The Crohn’s and Colitis Foundation recommends starting by clenching your hands into fists for 7 to 10 seconds, then relaxing for about 20 seconds. Repeat this rhythm of tensing and relaxing through the arms, shoulder muscles, and neck. Pull your chin to your chest, then relax. Repeat with the muscles in your face, back, abdomen, legs, and feet. In a small study published July 2, 2021, in the journal Evidence-Based Complementary and Alternative Medicine, 60 undergraduate students were randomized to complete 20 minutes of PMR, deep breathing, and guided imagery training. They found that PMR and guided imagery improved bodily relaxation in some participants, compared with others who received no relaxation training. The research team noted that stress relaxation training can be effective in improving relaxation states at both the mental and physical levels.
Seek Therapy or Mental Health Support
A chronic disease is stressful in itself. It can be isolating to feel sick, and anxiety-inducing to constantly have to worry about when a flare will strike. “It’s great talking to a therapist — we’re professionals, we’re trained — but I actually find sometimes just patient to patient is the most helpful and empowering, to have other patients to connect to and talk to who kind of get it,” says Dr. Gerson, who recommends patients join support groups in addition to talking to a professional. Another option to consider is acceptance and commitment therapy (ACT), a type of cognitive behavioral therapy (CBT) that focuses on helping people who suffer from consistent pain manage their symptom-related stress and anxiety. Studies have shown this type of therapy is particularly effective in helping patients who suffer from IBD. A study published in May 2022 in the Journal of Clinical Medicine examined IBD patients who suffered from moderate to extreme stress. Researchers found that among seven participants, half experienced reduced stress, increased function, and stronger engagement after an ACT intervention session targeting stress and a brief telehealth intervention targeting stress and increased psychological flexibility (which means being open to whatever thoughts and feelings show up). Gut-directed hypnotherapy is another research-backed form of therapy that has been shown to help people with other gut disorders alleviate stress and even improve symptoms. A therapist trained in hypnosis will first help the patient relax their body, then describe soothing imagery and sensations — such as warm sunlight or a calm meadow — meant to alleviate the patient’s symptoms. While research on hypnotherapy for IBD is limited, in one study published in Alimentary Pharmacology & Therapeutics, researchers looked at the impact of hypnotherapy on patients with ulcerative colitis. They randomized 54 patients to receive either seven sessions of gut-directed hypnotherapy or control therapy and followed them for one year. Hypnotherapy prolonged clinical remission by 78 days, with 68 percent of patients receiving hypnotherapy and 40 percent of patients receiving control therapy, maintaining remission for one year. According to Megan Riehl, PsyD, a clinical assistant professor at University of Michigan Health in Ann Arbor, a wide range of coping strategies to manage physical and emotional discomforts is important when you have IBD. “While gut-directed hypnotherapy is not a cure for Crohn’s disease and does not replace medical management, it is a helpful intervention that can aid with calming the stomach, improving brain-gut dysregulation, and can be used in the comfort of home.” She says it is also helpful if you have an overlapping functional GI condition, like irritable bowel syndrome (IBS). “There is some evidence that gut-directed hypnotherapy can improve quality of life and may help people with an IBD sustain clinical remission,” says Hunt, citing a study published in Expert Review of Gastroenterology and Hepatology. The study found that perceived distress contributes to IBD symptom flares, and that anxiety and depression are often found in patients with IBD. Researchers note that gut-directed hypnotherapy has been used successfully in functional gastrointestinal disorders. It is also a useful treatment for any secondary irritable bowel syndrome that has developed, Hunt says. Seeking therapy can be daunting, but mental health professionals are an important resource for patients dealing with a chronic disease. “Quality of life is determined largely by how we feel about our circumstances, so achieving and maintaining good mental health is a crucial part of living successfully with an IBD,” says Hunt. “Learning how to cope effectively with Crohn’s (or colitis) can go a long way towards improving quality of life.” Additional reporting by Ali McPherson.
