“Though I had times when life was tough and I was sad, frustrated, or angry, I didn’t actually struggle with anxiety and my mental health until after surgery,” says Cleasby, founder of the blog SoBadAss, who says she also suffers from post-traumatic stress disorder (PTSD). “It wasn’t the surgeries themselves but the loss of control that was the source of my panic attacks and anxiety,” explains Cleasby. Around 30 percent of people with IBD suffer from either anxiety or depression, nearly double that of the general adult population in the United States, according to the Anxiety and Depression Association of America. According to Megan Petrik, PhD, a clinical health psychologist at the University of Minnesota in Minneapolis, symptoms of anxiety and depression often increase when IBD is active. A study published in May 2018 in the journal Inflammatory Bowel Diseases also found that people who underwent surgeries related to their IBD, as Cleasby has, were more likely to suffer from anxiety and depression. In addition to coping with their illness, people with UC have to manage doctors appointments, medication, and changes to their lifestyle and eating habits, says Mira Zein, MD, a psychiatrist with Stanford Health Care in California. Flare-ups can also put a damper on socializing. According to the Mayo Clinic, signs and symptoms of anxiety include:
Difficulty controlling worried thoughtsFeeling weak or tiredIncreased heart rateRapid breathing (hyperventilation)Having difficulty sleepingFeeling nervous, restless, or tenseHaving a sense of impending danger, panic, or doom
“People think a panic attack is all in your head, but it’s such a powerful physical thing. My hands would cramp until I couldn’t move them, my chest felt like it was being crushed, I couldn’t breathe, my vision would blur. It’s terrifying,” says Cleasby. There is no evidence that IBD is caused by stress, anxiety, or depression, says Dr. Petrik. However, the symptoms of IBD, along with many other diseases, often worsen in times of stress, according to a study published in October 2019 in the journal Frontiers in Pediatrics. For example, stress may be related to a flare-up of symptoms like abdominal pain or diarrhea, says Petrik. “When the body’s stress response is activated, it can result in physiological changes in the functioning of the digestive system,” explains Petrik. According to the American Psychological Association, chronic stress can also weaken the immune system. To help you manage anxiety while living with UC, follow these tips:
Talk to a Professional
Lawrence S. Gaines, PhD, a clinical psychologist at the Vanderbilt Inflammatory Bowel Disease Clinic in Nashville, Tennessee, says that working with a therapist or other mental health provider is an important part of managing ulcerative colitis. Cleasby agrees. “I think the most important way to deal with anxiety and depression is to speak out about it. It’s easy to feel so alone and that no one will understand you, but actually just voicing your fears takes away some of their power.” Petrik recommends cognitive behavioral therapy (CBT), a type of talk therapy that helps patients develop skills to cope with emotional challenges, like those associated with UC. Acceptance and commitment therapy (ACT) is a type of CBT that helps people who suffer from a chronic illness manage their symptom-related anxiety. One study, published online in March 2019 in the journal Gastroenterology, found that two months of ACT reduced stress and anxiety levels in people who suffer from IBD by 45 percent after 20 weeks. Petrik says to ask your doctor if there is a mental health provider on staff, or if your doctor can recommend a therapist that specializes in chronic illness or IBD. Psychology Today also maintains a searchable database of verified mental health providers across the United States. A therapist can help determine whether or not anxiety medication is a good fit for you.
Identify Stress Triggers and Explore Relaxation Techniques
According to Dr. Gaines, keeping baseline stress levels low through meditation, yoga, or other exercise can help keep a particularly stressful event from triggering anxiety. “One thing I want is for people to be more relaxed, so if an adverse event happens, they will react to it but they won’t go through the roof,” explains Gaines, who also recommends keeping a journal of thoughts so you can recognize what triggers anxiety for you specifically (it’s different for everyone). “Recognizing the initial symptoms and heading them off with deep breathing and meditation works for me. But it’s about finding what works for you,” says Cleasby. “Speak to your doctor about how you are feeling and to your loved ones. There is no shame in needing support." Dr. Zein also recommends eliminating everyday stressors that could trigger anxiety with a few simple rules of thumb:
Set realistic goals for yourself each day and break big tasks into smaller ones.Prepare the night before for the day ahead — such as packing a lunch or laying out your clothes — to decrease stress the following day.Build structure into your days, whether in a flare or a remission. Zein suggests using a calendar or daily planner to keep track of your daily activities and appointments.
Zein suggests using relaxation techniques to reduce anxiety after it’s set in. These include breathing exercises, muscle relaxation, and meditation. “Oftentimes, using apps like Calm or Headspace can be really useful to guide people through these techniques when they’re feeling more anxious,” says Zein. “One technique is to combine slow, deep breathing with muscle tensing and relaxing,” Zein explains. “Try balling your fists while inhaling, holding, and then releasing them slowly while exhaling is enough to relieve anxiety.” Another technique is to inhale slowly while raising your arms overhead and exhale slowly while lowering them back to your sides.
Cultivate a Support System
To help you learn more about your disease and to form a network of people who are living through a shared experience, you can join online support groups or groups in your local area. According to a study published in 2016 in the Canadian Journal of Gastroenterology and Hepatology, peer support can help people who were recently diagnosed with IBD to not feel alone. “Having good support is an important part of managing physical and mental health in IBD. Asking for and accepting help from family and friends is important,” says Zein. And whatever your ritual, “It’s really important for people to develop coping skills that work for you,” says Zein.
