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How Salvo Health uses Brain-Gut Behavioral Therapies to improve Brain-Gut Dysfunction

Dr. Megan Oser supports Salvo Health's comprehensive approach to gut-mind interactions

Published:

November 11, 2022

Written by:

Dr. Megan Oser

Medically Reviewed by:

Published:

November 11, 2022

Mind-Gut Connection
Mind-Gut Connection
Research
Research
Microbiome
Microbiome
Clinical Advisory Board
Clinical Advisory Board

Although the gut-brain communication system is very complex, there have been radical advances in our understanding of how complex brain-gut connections really are, especially in those with disorders of gut-brain interactions (aka DGBIs). Those who have DGBIs, disorders like GERD or IBS, likely experience painful symptoms that thrive on stress, anxiety, depression, or even specific trauma.  

Decades of research has identified the key brain and behavioral factors affecting and disrupting the communication between the brain and the gut. These disruptions are ultimately what leads to the cycle of brain-gut dysfunction, the cause and effect of stress and  the painful symptoms to follow. Research strongly supports the use of brain-gut behavioral therapies or BGBTs, which are interventions that can break the cycle and help calm and streamline gut-brain communication for the benefit of the patient. 

What are Brain-Gut Behavioral Therapies or BGBTs? How do they improve communication between your gut and your brain?  

We know that DGBIs (or disorders of gut-brain interactions, as you may or may not already know!) are best treated with multiple therapeutic approaches, including brain-gut behavioral therapies. Your doctor may recommend a BGBT if you suffer from a chronic gut condition.

BGBTs include carefully chosen practices and techniques that address and treat gut-brain dysfunction. Dozens of research studies investigating the effectiveness of BGBTs show that these therapies distinctly target cognitive, behavioral, and emotional factors specific to gut-brain dysregulation, rather than stress, anxiety, and mood alone. 

Keep in mind, BGBTs are what a gastro doctor might call “short-term interventions” or treatments , which can help your pain and improve your GI symptoms when they flare-up. These therapies alter the communication between the brain and the gut, and how the brain processes signals from the gut specially.  In addition, BGBTs decrease the gut’s response to stress and improves overall stress management. However, keep in mind you will need to treat all the factors that may be contributing to your chronic gut condition, including nutrition, movement, sleep, and stress. BGBTs can be used in addition to other treatments such as supplements, medication, and other lifestyle changes.

What types of BGBTs are recommended by doctors for gastro conditions?

There are several types of BGBTs, but one thing is the same: How your doctor determines and works with you to identify the right BGBT for your condition. Your Care Team or GI Healthcare provider should ensure there is a strong relationship between you, the patient, and them, and provide education on how and why they’re recommending a BGBT, as well as describing how it reduces symptoms. 

BGBTs can include guided and non-guided activities like stress management training, relaxation training and diaphragmatic breathing. They can also include advanced techniques that are unique to treating a specific disorder or certain combination of disorders like-mindfulness, behavioral experiments, cognitive restructuring, promoting cognitive flexibility, and post-hypnotic calming suggestions.  You can think of these highly targeted BGBTs in a similar way we think of antidepressant medications. There are 3 general types of antidepressants (SSRIs, SNRIs, and NDRIs) that are all acting as re-uptake inhibitors but each one targets different neurotransmitters in a different way. 

The most rigorously studied of all BGBTs, with the strongest evidence, is a specific psychological treatment called GI-cognitive behavioral therapy (CBT). It has been studied most widely among people living with IBS and is one of the few treatments that’s effective for all types of IBS (IBS-D, IBS-C, IBS-M). CBT for IBS is based on our understanding of how IBS related thoughts, behaviors and emotional responses (such as avoidance of social situations, myths about constipation, gut-specific anxiety, and problematic toilet behaviors that develop over time) perpetuate IBS symptoms. CBT for IBS can normalize patients’ brain regions. In fact, a study conducted by Emeran Mayer and colleagues last year showed that CBT produced symptom changes in IBS patients by altering key components of the brain-gut-microbiome axis!

How does Salvo Health integrate BGBTs into their innovative virtual care delivery? What are some of the specific techniques Salvo delivers? Why are these well-suited to digital care delivery? 

Salvo Health integrates elements of BGBTs, targeting GI-related cognitions (thinking patterns), behaviors, and psychological factors, as part of a comprehensive care model to address common GI symptoms including visceral pain, distension, fullness, bloating, heartburn and acid reflux.

 This comprehensive care model is called Whole Self Science, and it simultaneously targets a member’s nutrition, movement, sleep, stress and other lifestyle factors, with a multidisciplinary Care Team. Comprehensive GI care is likely to have the best impact, and lead to the best outcomes for patients as we use current scientific advances to target the brain-gut system.  Salvo Health selects evidence-backed individual BGBT techniques based on their member’s condition or symptoms, and then includes these BGBTs in their optimal Care Plans. Diaphragmatic breathing is one such example of an individual BGBT technique, that might be recommended to a Salvo Health member who wants to treat bloating, abdominal distension, indigestion, and food regurgitation. 

But how does Salvo Health teach a BGBT technique like diaphragmatic breathing through a text-based app? Like most BGBTs, diaphragmatic breathing is highly structured with exact instructions on how to breathe, how long, and, in what position, making it easy to teach to digital healthcare patients. This makes BGBTs a great fit and a great opportunity for a text-based app within virtual care delivery.  Salvo Health’s virtual healthcare care platform has the potential to improve patient access to the most effective GI treatments and care across the nation. Interested in joining Salvo Health and addressing your chronic gut condition? 

Start the intake form right here. 

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Written by:

Dr. Megan Oser

Megan is a licensed clinical psychologist with 15 years of experience in behavioral medicine and treatment development. She is now the Director of Behavioral Medicine for Digestive Health at UCLA.

References:

Cognitive behavioral therapy for irritable bowel syndrome induces bidirectional alterations in the brain-gut-microbiome axis associated with gastrointestinal symptom improvement
Jonathan P. Jacobs, Arpana Gupta, Ravi R. Bhatt, Jacob Brawer, Kan Gao, Kirsten Tillisch, Venu Lagishetty, Rebecca Firth, Gregory D. Gudleski, Benjamin M. Ellingson, Jennifer S. Labus, Bruce D. Naliboff, Jeffrey M. Lackner, Emeran A. Mayer
Microbiome. 2021; 9: 236. Published online 2021 Nov 30. doi: 10.1186/s40168-021-01188-6