Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York.
University of North Carolina Chapel Hill, North Carolina.
Gastroenterology. 2018 Apr;154(5):1249-1257. doi: 10.1053/j.gastro.2018.01.045. Epub 2018 Feb 1.
Chronic digestive diseases, including irritable bowel syndrome, gastroesophageal reflux disease, and inflammatory bowel diseases, cannot be disentangled from their psychological context-the substantial burden of these diseases is co-determined by symptom and disease severity and the ability of patients to cope with their symptoms without significant interruption to daily life. The growing field of psychogastroenterology focuses on the application of scientifically based psychological principles and techniques to the alleviation of digestive symptoms. In this Clinical Practice Update, we describe the structure and efficacy of 2 major classes of psychotherapy-cognitive behavior therapy and gut-directed hypnotherapy. We focus on the impact of these brain-gut psychotherapies on gastrointestinal symptoms, as well as their ability to facilitate improved coping, resilience, and self-regulation. The importance of the gastroenterologist in the promotion of integrated psychological care cannot be overstated, and recommendations are provided on how to address psychological issues and make an effective referral for brain-gut psychotherapy in routine practice.
慢性消化疾病,包括肠易激综合征、胃食管反流病和炎症性肠病,都不能与其心理背景相分离——这些疾病的实质性负担不仅由症状和疾病严重程度决定,还取决于患者在日常生活中应对症状的能力,而不会出现显著中断。日益发展的心理胃肠病学领域专注于将基于科学的心理原则和技术应用于缓解消化症状。在本次临床实践更新中,我们描述了 2 种主要心理治疗方法——认知行为治疗和肠道导向催眠治疗的结构和疗效。我们重点关注这些脑-肠心理治疗对胃肠道症状的影响,以及它们促进改善应对、韧性和自我调节的能力。胃肠病学家在促进综合心理护理方面的重要性怎么强调都不为过,我们提供了如何解决心理问题并在常规实践中为脑-肠心理治疗进行有效转诊的建议。
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