The mind and the gut often work together, says Stephen E. Lupe, PsyD, a gastrointestinal psychologist and director of behavioral medicine in the department of gastroenterology, hepatology, and nutrition at Cleveland Clinic. “If someone’s experiencing a lot of symptoms…[it] causes a stress reaction, which then makes the symptoms worse,” he explains. The gut sends out messages that the brain interprets — but sometimes, the nervous system starts to overinterpret those signals, according to Lupe. “You’ll see patients become more and more sensitive to the symptoms in their gut,” he says. Indeed, a study published in May 2020 in the journal PLOS ONE found that about 75 percent of people with IBD thought their stress exacerbated their symptoms. “It’s hard to go to work, it’s hard to be in relationships,” says Lupe. “The more demand we put on the body, the more dysfunction we see.” Although a busy schedule can put self-care activities on the back burner, prioritizing your well-being is especially important if you have UC, says Lupe. Self-care engages the calming parasympathetic — or “rest and digest” — part of the central nervous system (CNS). “This generally helps with GI functioning and how our CNS interprets the sensations that come up from the gut,” he says. “We see a decreased pain response, a decrease in inflammatory hormones being released, and decreased dysfunction in the body.” Here are a few natural ways to manage UC-related stress that are worth considering for your wellness routine.
Hypnotherapy
Gut-directed hypnotherapy has received a lot of attention recently for treating IBD — and for some people, it seems to work. In gut-directed hypnotherapy, a trained practitioner helps you get into a state of highly focused concentration and relaxation. They then use guided imagery, muscle relaxation, and other techniques to teach you how to manage IBD symptoms that are otherwise out of your control. Research on hypnotherapy for IBD is limited, but one report published in Expert Review of Gastroenterology & Hepatology suggested that the practice could be helpful for people with ulcerative colitis. “The brain gets better at figuring out where to place its attention,” says Lupe. “It seems to be activating parts of the brain involved in filtering out some of the noise and decreasing some of the sensitivity in the central nervous system, so that the signals may still be there but not as loud. And it results in deep relaxation, which can help the body function better.”
Journaling
You may already be tracking your symptoms and diet with a journal. But writing down your emotions and thoughts — i.e., journaling, in the more traditional sense — may also help boost your mental health. Journaling, especially if you’re working with a mental health professional, can help you identify negative thoughts and behaviors, recognize your triggers, and prioritize your concerns to find solutions. “When we journal, [there’s an acceptance piece of your emotions],” says Lupe. “You don’t react to them like they’re happening, but instead as thoughts.” For people with UC who are constantly anticipating pain, journaling may help slow down the fight-or-flight response that’s partially responsible for triggering symptoms, he says.
Acupuncture
A form of traditional Chinese medicine, acupuncture is the practice of inserting tiny needles into specific points of the body to balance your “vital energy.” A number of high-quality studies have found that acupuncture seems effective at treating chronic pain. Western medicine researchers believe the technique may reduce inflammation and possibly lead to the release of natural pain-relieving hormones. While the National Institutes of Health (NIH) notes that there’s little evidence that acupuncture is effective at treating conditions beyond chronic pain, the technique has been studied for many other purposes including to relieve depression, anxiety, and stress. Acupuncture might also help relieve the symptoms of IBD, which could, in turn, help ease your stress levels and boost your mental health. A study published in August 2020 in the journal Mayo Clinic Proceedings that enrolled 531 people with IBD found that acupuncture was more effective than some prescription medications at controlling IBD symptoms; another review published in the World Journal of Gastroenterology found that acupuncture helped relieve IBD symptoms such as pain, bloating, and frequency. For now, there’s not enough evidence to show that acupuncture can help treat these symptoms. However, it’s a low-risk option as long as it’s practiced by a trained practitioner, so it could be worth trying to see if it helps you.
Meditation
Mindfulness-based meditation helps you to focus on what’s happening in the present moment and accept your feelings and sensations without judgement. If you’re struggling to cope with stress, you may want to try mindfulness-based stress reduction (MSBR), including group sessions and at-home exercises that teach you to increase mindfulness and relieve stress through yoga and meditation. You can also practice mindfulness alongside cognitive behavioral therapy (CBT) with a licensed mental health practitioner. Meditation isn’t about “turning off” your mind, says Lupe. “With meditation, you’re seeing your thoughts and sensations and emotions and not reacting to them,” he explains. That can help put some distance between you and anxiety about UC symptoms, so that they may have less of an effect on you. The NIH notes that there’s some evidence suggesting that mindfulness meditation may help ease symptoms of UC and UC flares, as well as relieve anxiety and depression symptoms. A review of more than 200 studies found that mindfulness meditation was helpful for relieving anxiety, depression, and stress.
Exercise
You probably already know that regular physical activity can help relieve stress, improve mood, and reduce anxiety and depression symptoms, in part because exercise supports your overall health and releases feel-good endorphins. Despite this, “exercise is probably the least utilized medication we have for anxiety, depression, and stress,” says Lupe. Exercise produces a cascade of benefits for the body, Lupe explains, including anti-inflammatory effects and increased circulation. It can also help maintain a healthy weight and support a healthy immune system. These effects are especially important for people with UC, since the immune system and intestinal inflammation are thought to play a central role in promoting UC symptoms and flares. Lupe notes that people with UC who are able to exercise tend to have fewer flares and stay in remission longer. A review published in 2018 in Clinical and Experimental Gastroenterology found that moderate-intensity exercise could benefit people with IBD by easing their disease, improving their sleep, and boosting their quality of life. While finding the motivation to work out can seem overwhelming, particularly if you’re having a flare, simply walking a bit can help.
Deep breathing
Taking deep belly breaths is a surprisingly simple and effective way to ease your stress and lower your blood pressure levels. A review published in 2018 in Frontiers in Human Neuroscience found that slow breathing techniques lead to real physiological changes in the body, which are in turn responsible for increased relaxation and decreased anxiety and depression symptoms. For people with UC, deep breathing massages the gastrointestinal tract. This can help with symptoms such as pain, urgency, and constipation. Taking a deep breath during moments of UC-related stress can also help calm the body and body’s fight-or-flight response. “Deep breathing activates the parasympathetic or rest-and-digest part of the nervous system,” says Lupe. “It’s taking us out of that threat mode, which can decrease the perception of sensations.” Focusing your attentions on your breathing also tends to help you relax and cope with pain and nausea, he says.
Grounding techniques
If you have UC, you may naturally spend a lot of time worrying about the future — for example, getting stuck without a restroom at the concert you’re going to next weekend. But worrying can arouse the sympathetic nervous system and put you into fight-or-flight mode, exacerbating symptoms, says Lupe. If you find your emotions are taking over, Lupe says it’s important to ground yourself in the present moment. He suggests looking around at your surroundings and noticing you’re in a safe place by noting five things you see, five things you hear, five things you feel, and five things you smell. “That can get us out of reacting to our thoughts,” says Lupe. Finally, if your UC symptoms are so overwhelming that they’re getting in the way of your daily activities, find someone to speak with — whether that’s a therapist or a member of your treatment team. “A lot of times we won’t talk to people, including even the people who love us. But just talking about what’s going on and being able to feel supported helps,” says Lupe.
