In Your Pants with Dr. Susie G - Mind, Gut, and Pelvic Floor Connection

Episode Date: July 20, 2021

Your bladder, bowel, digestive system, and genitals all hang together; and just like the muscles and organs down there aren't in isolation, neither is your brain. The digestive system changes in how it functions when under stress and anxiety, and these psychological challenges come in all shapes and sizes. . I chatted with Dr. Alyse Bedell a GI Health Psychologist and Assistant Professor at the University of Chicago. She received her Ph.D. in Clinical Psychology from Northwestern University Feinberg School of Medicine where she pursued a research and clinical specialization in psychogastroenterology. . If you love the science behind the gut-brain axis, get jazzed to discover the intersection of psychology and gastroenterology  . Connect with Dr. Bedell on Twitter @DrAlyseBedell or via email at [e-mail] . ️ Grab a digital coffee with me in a 15-minute call and have your questions answered: https://drsusieg.com/pelvic-pain-specialist-15-minute-call Dive in and get started with a 6-week DIY Pelvic Pain Relief Program. Learn about your body and concerns in the comfort and privacy of your own home. With video demonstrations of hands-on treatment techniques, lessons on the science behind why you hurt, and exercises that will help you navigate out of pelvic pain: https://drsusieg.com/pelvic-pain-in-men-online-program

You're listening to In Your Pants with Dr. Suzy G, the physiotherapist for your private, helping you get in the know down below. Hey friends, it's Dr. Suzy G here and welcome to another In Your Pants podcast. So glad that you can join us today. In today's episode, I have guest Dr. Elise Bedell. She is a GI health psychologist and an assistant professor at the University of Chicago. She received her PhD in clinical psychology from Northwestern University Feinberg School of Medicine, where she pursued a research and clinical specialization in psychogastroenterology.

I had no idea that this specialty in psychology even existed until I was blessed to meet Dr. Elise in our University of Michigan sexual health program and I was so fascinated with not only her energy and passion for her work but also just the whole field of psychogastroenterology and I wanted to learn more and so here we are discussing the ins and outs of what psychogastroenterology is and why someone would see a psychologist for GI-specific medical disorders. We chat about some of the common signs and symptoms and diagnoses that Dr. Elise sees in her office. Some of those are irritable bowel syndrome, chronic constipation, pelvic pain, inflammatory bowel disease like Crohn's. And then we also talk about the experiences that are common among people with

chronic GI issues. So we chat about mental health concerns, sexual dysfunction, chronic pain issues, undisordered eating, and also other life events that might contribute to the experiences in addition to GI issues. And then we chat a lot about the components of holistic and integrative treatment. You know, what does it look like to have a team, a wellness team to help support some of the difficulties and challenges that encompass, you know, chronic illness such as GI issues and pain. And then Dr. Elise takes us through her evaluation and what a typical treatment session would look like for her and her client. So this is a wonderful episode. You don't want to miss this. And she also provides a really wonderful resource that I'm going to link in the

show notes as well for just a starting point to see if this could be something that is helpful in your life and to help with your concerns. So without further ado, I welcome Dr. Elise Bedell. Enjoy. Hi, Elise. Thank you so much for being on the show with me. Thank you so much for having me. And to all the listeners and viewers, I just want to introduce Elise, not introduced, but we met at least, I met Elise at the sexual health certificate program at the University of Michigan. And I found out that Elise has a very unique specialty. She is a GI health psychologist. And I was like, yes, we need to have you on the show because I had no idea this specialty existed. And it is such, from what I can gather and what

you've described to me off the air, it's such an important need in medical care. So let's just dive into it as far as what is this mysterious field of psychogastroenterology? Yeah, well, you pronounced it right. So kudos to you already off to a great start. I've been practicing. So yeah, so psychogastroenterology is a field that really references both the research and clinical space that is the intersection of psychology and gastroenterology. So gastroenterology being all the stuff related to your digestion. And so, you know, as I guess a little bit of background, some folks may know there is a really strong relationship between your brain and your GI tract. And so I think even over and above some of the other relationships between the brain and

other body systems, there is just a really huge component of what's going on in your brain and how that impacts your gut and then definitely vice versa as well. So again, like folks might know that there are psychologists that work in all kinds of medical specialties. So, you know, sometimes they are in urology, sometimes they're in gynecology or oncology, all these different things. And so in gastroenterology psychologists in the last, like really the last kind of 10 to 15 years, it's really taken off. So it's kind of a small, but growing specialty, psychogastroenterology. say that 10 times fast. I'm interested. I'm interested in what, or what inspired you to get into this specific field of gastro, psychogastroenterology. Yeah. Well, I, um, I had

a, an experience, um, as a teen where I have a family member that's very close to me that was diagnosed with Crohn's disease. And so watching that family members experience in the medical field and, you know, in many ways, uh, you know, got really great treatment, but it was very clear to me that there was kind of a component of that that was just missing. And also very clear to me that, that there's just a lot of stigma and can be a lot of embarrassment associated with GI issues. And so it wasn't actually until later, I have, I have a sister that became a gastroenterologist. Interestingly, I knew that I wanted to become a psychologist, but I wasn't exactly sure what type specialty I would have. And for folks going into PhD clinical psychology programs, you really do

have to kind of decide on a research focus before you're even applying. And I discovered Dr. Lori Kiefer's psychogastroenterology program at Northwestern. And that was like, whoa, it was a specialty I didn't know existed. And when I saw it, it was like, that's, that's where I need to go. And I was lucky enough that I was able to, um, get into my dream program. And so that's kind of, that's where that went. Well, that's amazing. We're so glad that you're doing the work that you do because there are a lot of common, uh, diagnoses and symptoms that you work with. Could you explain to us those diagnoses and symptoms and how your work, um, is integrated into that. Yeah, absolutely. So, um, so as a GI psychologist, we, um, really are trained to work

with any type of gastrointestinal disorder and the work might vary somewhat, uh, disorder to disorder, but a lot of it actually can be, um, pretty similar. It's grounded. And a lot of times the cognitive behavioral theory, definitely the biopsychosocial model, which I'm sure that your listeners and viewers have heard about in the past. Um, and so, you know, some of the most common conditions that I treat are irritable bowel syndrome, for short IBS, for people that's oftentimes a disorder that we hear a lot about, but many times people don't know exactly what it refers to. It's an abdominal pain syndrome with associated abnormalities in the consistency frequency of the stool. And then I work with a lot of folks who have inflammatory bowel diseases

like ulcerative colitis or Crohn's disease. Patients with different esophageal disorders could be difficulty swallowing, could be disorders where there's inflammation that requires different types of treatments of the esophagus. So it really does run the gamut. I also work with patients who have fears around eating, could be due to a diagnosis like celiac, for example. So really kind of anywhere you can imagine your GI tract, which is really your mouth all the way to your anus, it can work really well, or there can be problems. And if there are problems, then a GI psychologist can, can work with those conditions. That is amazing. So everyone knows that I'm a pelvic health therapist. Um, and we both are now, you know, in the realm of sexual health

counseling and education and chronic pain, pelvic pain and GI issues. I feel like go hand, almost like hang together because they're so close in proximity to one another, as far as the nervous system involvement, and even just from a mechanical standpoint of like neuromuscular motor cord control and coordination, as far as just being able to perform functionally those muscles to be able to poop. And so I'm curious as to your experience with, if you've had experience working with other pelvic therapists and, you know, how do you all collaborate together as far as a team and helping someone who has like pelvic pain in addition to GI related issues and symptoms. So yeah, so I, I consider pelvic floor physical therapists kind of like a major

cornerstone of a lot of my patients treatment. And so, you know, oftentimes my work with, with my patients can be, I consider it a little bit of kind of a consultant where I know that I'm not the person to treat every aspect of their presenting problem, right? There's biological components, which could include, at least in my mind, I can kind of consider some of the muscular components kind of to fall into that category. There could be dietary components. There can be definitely medications required. There can be psychosocial factors. Some of those, when they're really psychosocial or what we sometimes call cognitive and affective factors, those are the things that are definitely in my wheelhouse. But sometimes it just takes being able to have an

hour long conversation and to have a couple of hour long conversations with someone that really knows this stuff to also be able to identify what are some of the other factors that haven't haven't been seen. So sometimes I am the first person to pick up on the fact that this person has not had a pelvic floor evaluation. And if certain, certainly someone's referred to me that has chronic constipation or pelvic pain, or oftentimes both, that's going to be a recommendation I'm going to make to their gastroenterologist is that, yeah, I'm happy to work with this patient, but we really also need to make sure that they are getting worked up and treated for any kind of muscular components to this. So then it does definitely become more of a co-treatment where

I'm working more on the psychosocial aspects. And then the physical therapist is working on Sometimes also addressing some of those, actually, some of the really great ones that we know are talking about it as well. But definitely working at it kind of from the way I think about it is the more muscular or physical kind of perspective. So as you said, definitely these things hang together. My GI patients, when I ask them about their sexual functioning and about other types of pain in those areas are sometimes a little surprised by that.

And I kind of have to explain that these muscles are not in isolation. um and as i've heard you say before too men also help help pelvic floors um and it sometimes sometimes even are like even the most fantastic medical providers sometimes can forget that as well yes this is true not to not to point you know not to call anyone out but this is true yeah yeah there's just a connotation that we have about pelvic right it just seems kind of like it relates to women and so some of that education i can help with as well um but just to kind of circle back a little bit about our, you know, mutual, our connection and the sexual health work that we're that we're doing was actually I did a rotation during my clinical psychology internship

year that was in oncology, and doing a sexual health sex therapy focused training there. And that's when I mean, I really I had no experience in sex therapy and in that field before. And it was really having you know six months of working in that but I was just like our GI patients need this like this stuff hangs together and I realized that you know partly I I didn't know how big the scope of the problem was because these were questions I wasn't asking right I think there's oftentimes this fear among any type of provider including mental health providers that if you know if we ask about it we might need to be able to do something about it and so that kind of you know, I sort of felt like that was my calling. Like, I think there's a lot of stigma and

misinformation in GI. There's a lot of stigma and misinformation in sexual health. And, you know, I kind of want to be part of that solution. So. Well, again, we thank you for doing the work that you do because it's so important. Speaking of stigmas. So there's, there's two things rolling around my head right now is one, what are those stigmas related to GI? And second, the stigmas around just mental health and psychology, because I feel like, and I could be completely wrong, but for the patient population that I work with, you know, bringing up the, even just bringing up saying, Hey, you know, maybe we should have another person on our team to help with the psychosocial aspects or your mental health and wellbeing. You know, how do you navigate

the buy-in right because then you don't want to you don't you don't really want to say well it's all in your head because that's typically the patient population that i work with you know men who have chronic pelvic pain syndrome they've been told that many times so there's this huge mistrust in the medical community and so i feel like there there has to be a bit of a skill to kind of start to to have this conversation and to perhaps zoom out and as you've already mentioned Elise, the, you know, okay, here's the physical aspects that, you know, we're dealing with in this, in this realm. And then we've got, you know, what else is going on? Like, what is going on with your mood and your thoughts and your relationships and, you know, your belief systems? Like, how is

that all playing into, you know, the mix? So I'm curious to kind of chat with you about your experience. Yeah. It is, it is sometimes so messy, even in like, even in the best cases, it's like these concepts are tricky because I think on one hand, like I do very much focus on the fact that I treat medical disorders from a psychological perspective. And I think that that's really important for many of the people that I'd be working with because of that, whether they actually have experienced someone saying to them, this is in your head, which in some cases, I believe them that they have. But what's more common is just, I think, oftentimes well-intentioned folks in medicine or in other fields, or even among their own friends and family that are

actually trying to acknowledge the psychosocial aspects of pain and of chronic illness, but just maybe are missing a little bit of that nuance there, right? And it can come across as very invalidating. So I think for that buy-in piece, I do think it's really important. And so it's oftentimes a way that I introduce the work I do is that I am a psychologist, but I work with patients primarily on their medical disorder. And so to just kind of get on the same page that, no, I'm not actually here to treat you for depression or anxiety, though that might be something that's going on, not in every case, but sometimes it is. But really in the scope of our work, I am here to really treat you for the medical disorder using things that we know from

psychology can impact the way that our medical disorder actually presents. The other piece of that and where I kind of say that it gets messy is because I also want to be careful then to not stigmatize people who are experiencing depression, anxiety, or other mental health conditions, right? So it's not that we want to say that there's a dichotomy that one is better than the other, but I think sometimes just clarifying and giving each of these things their own space and respect. And, you know, similarly, I'm very, you know, happy and can train, you know, certainly trained to work with some depression and anxiety, particularly as it relates to a GI disorder. But there are also psychologists and other mental health professionals who are very highly skilled

in working with patients who have depression and anxiety. And so sometimes that's also about understanding my skill set and being able to really work with a patient to determine if the scope of any mental health symptoms that are present are really best addressed in this type of a model, this kind of health psychology model, or really whether we think they're better addressed either concurrently with a mental health treatment or that they'd really benefit from a mental health treatment first, and then they may be in a position that they're going to be a little bit in a better place to respond to this more health psychology approach. So it is messy. Like I said, you kind of want to be able to hold both of those, these things. And, and certainly there's

a lot of, I think a lot of it just comes down to stigma about mental health. Right. But then I think we just, again, we want to sort of be respectful that sometimes people who have these physical conditions have been really invalidated. And, and there is actually in most cases, a lot more physiologically that's going on than sometimes their test shows or their, you know, providers even can kind of communicate. So that's kind of where, it's kind of where my head is on that. Yeah, no, absolutely. I totally hear you. And how would someone know then like, who would be the, who would be, I guess, how would someone discern whether they should see a GI psychologist versus another provider, like you're saying, another mental health provider who may, who

might be more skilled at anxiety or working with depression or, um, some other, um, mental health, um, concern. Yeah. I think, um, maybe the, the easiest answer is in, in some cases, like just go and meet with a provider and kind of tell them and help them guide your decision. Cause I oftentimes, oftentimes, I mean, I meet with a patient, have an evaluation. We can have a very clear discussion on, um, on what it seems like could be a good fit because it's usually not one or the other, right? Oftentimes I might be able to meet with a person for an evaluation and we see like, ah, you know what, there's actually, we really would benefit from you being in a more weekly therapy with someone who specializes in depression. Um, but I think there's actually

something that we could do within even three sessions together to get you kind of on the right path with your physical symptoms as you do that work, then maybe let's stay in touch and you come back to me once the depression is better under control, right? So there can be oftentimes there is a more tailored approach to it that really depends patient to patient. But I would say if a person does feel like they have, you know, pretty good insight into what's going on, then my metric would be if, you know, a lot of the distress that you're experiencing on a daily basis is about your symptoms, your physical symptoms. And that's where a lot of your, like the healthcare, your time in healthcare is being spent and your stress and anxiety is less about other things

going on in your life. And it's really more centered on your physical illness than seeing a psychologist like myself, you know, if the issue is in GI, if you have access to a GI psychologist, great. If the issue is in pain and you have access to a pain psychologist, great. And if the issues are more about what we would consider to be a more kind of clinical depression or anxiety, and it's maybe grounded in other types of things going on in your life, that might be better suited to at least start that conversation with a general mental health provider, like someone that specializes in depression or anxiety. Then there's the piece too about access, and I'll just put that out there, right? Not everybody lives in kind of these major metropolitan areas

that have access to all of these different providers. And so I would also consider, you know, I think, you know, talk to your medical team. They may have some referrals. They may have some ideas already of therapists that have some training in this type of work. But if that, some, I mean, that might be a no-go as well. They might, they might not have any better ideas. What I would say is to look for in a therapist is someone who has some training in cognitive behavioral therapy is usually, usually a good sign. Someone that lists that they have experience working with patients with chronic health conditions. Also another good sign. And very likely, even if you're not working with someone that's highly specialized, that in a particular

area you will oftentimes have very very good mental health providers that if they have some experience in working with patients with medical conditions they can consult they can get get up on their reading right um and so so there are all kinds of ways that we that we kind of can fill in the gaps but of course you know my my inclination is just that we need to get more people trained we need to get more providers right that's right it's like sexual health right it's like we need meeting everyone talking about it way more and having some accurate sexual health literacy out there. Yes. Yes. A hundred percent. A hundred percent. So at least, so can you walk us through kind of what a typical session would look like for you? So like, say for example, someone has,

you know, pelvic pain and constipation, perhaps IBS irritable bowel syndrome, which is not uncommon. And I know in the research, there's a lot of correlations, right? IBS correlations with pelvic pain and vice versa. So what, what would that, what would a typical session look like? I mean, what kind of strategies would you, would you two be working on and yeah, just take us into your office. Yeah. So, um, so the first thing we do, like I said, is to have an evaluation and that's going to be a very jam packed hour where we are going to get a lot of information about the, the physical symptoms. We're going to talk about things that maybe a person has noticed that worsen their symptoms things that they've noticed seem to make it better whether they have

or haven't noticed a connection between stress and their symptoms we're going to get a little bit of an overview of what types of medical treatments they've tried what workup they've had so there's there's going to be a lot of conversation that's really catching up on on their actual physical symptoms but we also are going to have to get a picture a snapshot of lots of other areas so expect to talk about any mental health history kind of like how your mood is? What's your stress level like lately? We'll talk about social, just get a sense of the person, right? Get an understanding of what kind of social support they have in their life. So there's going to be a snapshot of a lot of different areas in that first evaluation, which will help, you know,

someone like myself make a decision about treatment recommendations and some preliminary ideas of where we could go from there. Follow-up sessions, at least I can speak to my approach, are very highly individualized. So while I do see pretty much all the work that I do from a cognitive behavioral model, that's just my training background. I think there's kind of a misconception that that can be kind of a cookie cutter approach for folks that maybe are familiar with the idea of CBT. And it really is very much a therapeutic orientation that is centered on the concept that a person's thoughts impact how they feel and how they feel can impact all kinds of other things in their lives, but we can't really change feelings, right? We don't have a

magic wand to like wave away feeling sad. Um, but we actually can with effort make changes to our thoughts, which can then indirectly change our emotional state. Um, importantly to them, the work that I do in both physical symptoms and on the GI tract in particular is that emotions are really key to whether your sympathetic nervous system or your parasympathetic nervous system is engaged, right? And so if we can change our thoughts, then we can help patients to get out of that sympathetic nervous, that sympathetic arousal state, which we know worsens all kinds of GI or all kinds of physical symptoms, including the GI tract, which is intended to change in its functioning when it's in a state of fight, flight, or freeze, right? So that's a, you know, a pathway

way that we can use is actually working on the cognitive work, right? Behaviorally, sometimes that is just looking at how is a person coping? I work with some folks that are really great problem solvers, and that might serve them really well in many areas of their life. But when it comes to having physical symptoms that do not have an easy solution, they can kind of come up against a wall over and over. That's distressing. I see that a lot as well. Yeah, absolutely. So that's where we work on a concept called adaptive coping. And that's really the idea that some types of problems are really best suited for these very action-oriented coping strategies. Things like making a to-do list, Googling things, making a list, right? Like problem solving. And if a problem

has a solution, definitely use those strategies. But a lot of times when it comes to chronic pain conditions, when it, you know, that there is not an easy solution, right? It's at least certainly not a short-term one. And so when we try to use those same very action-oriented or problem-focused turning your attention toward the problem, we're kind of hitting a wall, right? And so it's in situations like that where folks actually need to kind of work on using these more passive coping strategies, things like distraction, things like actually turning your attention away, taking away a little bit of power from the chronic pain, let's say. Those are things that, you know, some people are over-reliant on the passive, and they're under-utilizing some of the action that they can

take, and some folks are kind of in the opposite scenario. So again, that's where it's kind of individualized is where we look at what behaviors can we really optimize here. You know, one piece that I want to highlight for people is to just give a little bit of clarity too, on when I'm talking about things in our thoughts or psychological constructs that we might work on these. And I talk about it, not being just about depression and anxiety, because that's a lot of times what we think about, right. When we think about psychological factors or mental health issues, but there are all kinds of things that are not depression and anxiety that can still be little bit tricky and a little bit unhelpful. So two of the most common, or I'll say three of the

most common things that, that I work on are GI specific anxiety. So anxiety, but not anxiety about other stuff going on in your life, anxiety about the symptoms themselves. Right. So you may say like, well, I don't, I don't have a lot of stress in my life. So I don't think that stress is playing a role. Well, actually like your symptoms are a source of stress, right? They're a source of stress and anxiety. Do you have worries? Do you worry about what your symptoms mean? Do you worry that they might get worse? Sometimes these aren't unrealistic worries actually, right? But they might be unhelpful or they might be maybe a little bit in the catastrophic nature, right? There might be some work we can do to soften those. Other two things

are hypervigilance. So symptom hypervigilance, where people's brains are scanning, scanning, scanning. Again, that comes from a good place. It's adaptive, right? It's your brain trying to absolutely protective. But at a certain point, that can then become like a primary mode. And that can cause more harm. And then hypersensitivity. And when I work with that, I'm calling it visceral hypersensitivity, right? So it's like, it's really, we kind of think about that, I talk to my patients that it's kind of like a nerve issue. Your nerves are firing way too much. So things in your body experiences that you might have that might be totally normal and benign. And to some person, some other person might not experience it as painful to a person

with IBS or a person with chronic pelvic pain, that same experience is painful, right? Yeah. I look at it as like a, tell people the window of tolerance, like before all this started your window of tolerance, like your wiggle room, lots of wiggle room, lots of wiggle room before things just started, the alarm bells started going off right now, after all of this and your journey and the struggles and everything evolving, the wiggle room is like the window of tolerance is tiny. So anything can literally like set the alarm bells going off, but that doesn't necessarily mean that it's dangerous or harmful or that you're regressing it's it's really that sensitivity dial just ramped up you know and that that education alone right there is an example of how we can use

something like cognitive restructuring like changing somebody's thoughts right so it's it's still validating that person's experience that this is it's it's painful it's real we can even call it serious. These are things that can absolutely worsen a quality of a person's quality of life. Right. But the dangerous, dangerousness piece, if we can educate a patient to realize that, no, this is like, this is an overfiring and then an overpaying attention that has really kind of screwed up at what is otherwise a normal kind of interaction. At least it helps a person understand that they don't need to be then afraid about what their symptoms mean therefore boom if we can get there we have we have interrupted that stress response

yes and you can get back to life i think the most important thing that i'm hearing from our conversation right now is that a lot of our well i guess i'm speaking for my patients and i'm only assuming that that's what's going on i think we know that yes i think that there's a lot of share we just yeah right where it's like what have you stopped in your life what have you put on hold because of the fear because of the anticipation because of the symptoms and yes they are unpleasant and and they feel terrible but doesn't necessarily mean that they're bad it's and and we don't need to like put life on hold when that is when this is over then only right and and our work and that's what i'm gathering is that we're giving that power back to the individual to say

he listened and know you're struggling and, and life is very narrow right now. And it's myopic at this moment. And it seems like it's impossible to get back to doing the things you love, but here's, here's a little like here, let's do a little tool. Let's do a little strategy. Let's kind of soften, as you said, at least soften these thoughts and the worries around or your GI symptoms or your pelvic pain or what have you, you know, how can we soften and kind of ease into these experiences and also put back a sense of self, like, who are you now? And can we put you back into the equation? I think about that as like a values conversation, right? And then it's kind of like, how do we, how do we start taking the power back from these symptoms? Because the more

we sort of allow our life to get smaller and smaller and smaller, the more I talk, like the more powerful they get, right? And so at a certain point, it becomes a little bit more about start kind of like starving that monster. And that's hard, right? It means that at times you're accepting suffering, you're, you're, you're accepting physical suffering, but doing it with this kind of long game in mind that, you know, part of getting back engaged with things that you love to do helps to starve that monster, right? Because then the isolation, the depression, the loneliness, those, that, that feeds it, right? And again, even just the attention, turning it towards those symptoms kind of feeds the monster. So different, you know,

different presentations, some folks need more of one thing versus the other. But, you know, these are the kinds of things we pick up a little bit of it in the evaluation. And then in those sessions, a lot of it's, you know, tracking, it's kind of really exploring what's happening when you're experiencing symptoms, so that we can tailor the approach so that it really can target the things that, you know, are relevant for that particular person. I love it. And it definitely sounds reflective and interceptive, like having that person really be able to take themselves out of their own situation and be an observer almost to see what is hooking them in, what behaviors and actions are a result of those triggers

at when they get activated and then recognizing, well, is it what I'm doing to help mitigate that or modulate that? Is it really helping me to move forward or move towards something that's more important in my life? Or is it really kind of hindering me and really making life smaller and smaller and smaller? And that's what I'm, that's what I'm gathering with the beautiful work that you're doing with your, with your clients, with your patients of recognizing that and, and putting hope back on the table and a sense of agency and independence and empowerment. Yeah. Yeah. There were definitely, our sessions are oftentimes very, they're interactive, they're engaging. Sometimes it feels like we're doing little like science experiments as we look

over our data together and trying to, you know, we oftentimes have a lot of fun, like, you know, it can give a little bit of, you know, kind of power and control back to a person. And when people have been suffering with these symptoms for so long, it can feel very much like you have little control or sometimes you're controlling the wrong things, you know? And so sometimes I think just having, and I think that that's what therapists, whether it's a physical therapist or it's a mental health therapist or it's a GI, whatever it is. I mean, sometimes just having a partner, you know, having somebody that's kind of like on your team and is taking that time with you that you can have that outside perspective. I mean, I very much sometimes just see myself as

that person's coach. You know, I mean, I have, I have these, like these skills, right. And I can, and can teach them to you. But a lot of times too, I'm here to like cheer you on. I want you to learn this stuff for yourself. Right. And again, that's part of just respecting that each person comes in with their own particular experiences. And so the same thing that may be really problematic for one person is honestly not necessarily that problematic for the next person. Right. Right. So I think really taking that individualized approach and, you know, I think having that really good relationship with your patients is, is helpful. So very lucky. I love what I do like the day in day out. And I think my patients usually know that I have to like, it totally, you can, I can

see it. I can see it. You light up when you're talking about it and you love it. You're so passionate. And that's why I resonated with your energy in the program with the university of Michigan. I'm like, I need to have her on the show because she's totally awesome. And the work that she's doing is awesome. And she's transforming people's lives. So that totally, I mean, your passion and energy for what you do much respect, honestly. And before, and I'm cognizant of time. Uh, there was one thing that you had mentioned about gut hypnotherapy or gut directed hypnotherapy. If you can talk just briefly about that, like the experience of that, because I know hypnosis, um, there's some good research around it for chronic pain. And so I think there's a lot

of overlap. Yeah, absolutely. I think there's just a ton of unfortunate misconceptions about hypnosis. And so a lot of what I have to do when I tell patients about this is corrective and other colleagues too. I think folks in health psychology and other types of fields, like oftentimes are a little more familiar that it has therapeutic benefit, but sometimes it doesn't extend out of that in terms of knowledge. But yeah, it's a lot, I could say like in practice, it looks a lot like doing a guided meditation, which is something I also do a lot of with patients, but it's kind of getting patients in, you know, a trance state, which I define and others define as a state where you're very highly relaxed while also highly attentive. And this is something that you can

get into on your own through yoga, through exercise, through prayer, through other types of meditation, right? But we are doing it in a clinical setting because it can help a person be more creative. They can imagine things more easily and these kind of normal everyday defenses or strong held beliefs that they have are like a little bit lower, a little bit more receptive in that state. And then what really takes it from more of a meditation to a hypnotherapy session is that we're actually giving suggestions. So we're saying things about your specific symptoms that we want to see changes with. So usually about symptom reduction, right? And so we, you know, this is actually, these have been, these are considered evidence-based treatments. They have

been well-researched in GI and other types of conditions. And they can be very effective in reducing pain, especially as you said. But especially when we're thinking about someone who may be hypersensitivity seems to be a key piece of that. It seems that, and we don't understand exactly how it works, but it seems that that brain gut relationship, that kind of dysregulation of the brain gut axis, we're able to kind of better train people to have a little bit more lightness in the way that they're thinking about their GI tract. And it seems to also help their GI tract to not respond quite as extremely to sensations that they're perceiving internally or stress that they're experiencing externally. So it's another, another component of the work

that I do. And for patients with hypersensitivity, where we seem to think that that's playing a pretty big, big role, then that's oftentimes a really integral part of the treatment approach we'll use. That's fascinating. I love it. I love it. What's one of your favorite resources that you like to give your patients? Like if you have to pick one thing to share with the audience, I know there are probably, you probably have a million. I'm sorry to put you on the spot. Okay. I'm going to reach up to my bookshelf. Um, at least I think it's a great starting place and it's a really interesting read the mind gut connection by Emory and mayor. Um, really, really great one, all kinds of really great research in there, but it's, it's meant for

anyone to read. Um, so I would say it's just a really nice introduction and not only, I mean, it really emphasizes the relationship between the brain and the gut, but I think it kind of can extend to just the mind body period. Right. Um, and so really having a better understanding of some of the science that is, is behind this kind of work that we do and integrated care and rationale for the biopsychosocial model. So people love this book. I love it. Thank you so much. Thank you so much. And so if listeners wanted to connect with you, Elise, where can they connect with you? They can find me on Twitter at Dr. Elise Bedell. I'm always happy to receive an email with questions. You can email me at abedell1 at uchicago.edu.

And I'd love to hear from folks. And hey, if you're interested in pursuing a career in psychogastroenterology, get in touch. Let's talk about pathways to get you there. Thank you so much. Thank you again, Elise. Thank you so much for having me. Oh, it was a fabulous conversation. I appreciate your time and really you're a gift to the world. So thank you again for being on the show and to all of our listeners and viewers there. Thank you so much for your support and your patronage and as always in loving wellness for your pelvis until next time, my friend. Thanks for listening to today's episode. Be sure to head on over to drcg.com where you can get more information, show notes and related articles on today's topic.

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