Johnston Sasha, Fraser Aileen, Biddle Carrie, Wild Jennifer
Department of Experimental Psychology, University of Oxford, Oxford, UK.
National Health Service England, Workforce Training & Education Directorate, Plymouth,, UK.
Crohns Colitis 360. 2024 Oct 17;6(4):otae050. doi: 10.1093/crocol/otae050. eCollection 2024 Oct.
Ulcerative colitis (UC), a chronic inflammatory bowel disease, causes stomach pain, diarrhea, and rectal bleeding. The exact cause is unknown, but it is thought to involve genetic, environmental, and psychological factors. Some people experience annual flare-ups without obvious reason. This article adopts a theory-driven approach to consider how and why past traumatic events may contribute to annual flare-ups.
We applied learning theory, which explains the development of re-experiencing phenomena in post-traumatic stress disorder (PTSD), to better understand the occurrence of annual flares in patients living with UC.
Two possibilities emerged in which associative learning may contribute to annual UC flares. First, flare-ups could be a physical response to sensory cues in the present that overlap with trauma experienced at the first onset of UC. Annual episodes may strengthen the UC flare as a learned physiological response to trauma reminders. Second, flare-ups may result from elevated stress due to trauma re-experiencing at anniversaries. Sensory features of the initial UC trauma may be associated with strong reactions, which generalize to similar stimuli, triggering re-experiencing symptoms and increasing psychological stress. Elevated stress raises glucocorticoid levels, promoting UC-specific inflammation. Stimulus discrimination from cognitive therapy for PTSD may help to over-ride the associations that have formed between sensory features of past trauma, linked reactions, and similar cues in the present.
Research is needed to understand how traumatic events influence the onset and recurrence of ulcerative colitis, as well as the potential benefits of stimulus discrimination for reducing the frequency of annual flares.
溃疡性结肠炎（UC）是一种慢性炎症性肠病，会导致胃痛、腹泻和直肠出血。确切病因尚不清楚，但认为涉及遗传、环境和心理因素。有些人会无缘无故地每年发作一次。本文采用理论驱动的方法来探讨过去的创伤性事件如何以及为何可能导致每年发作。
我们应用学习理论来解释创伤后应激障碍（PTSD）中重新体验现象的发展，以更好地理解UC患者每年发作的情况。
出现了两种可能性，即联想学习可能导致UC每年发作。首先，发作可能是对当前与UC首次发作时经历的创伤重叠的感官线索的生理反应。每年的发作可能会强化UC发作，使其成为对创伤提示的一种习得性生理反应。其次，发作可能是由于周年纪念日时创伤重新体验导致的压力升高所致。初始UC创伤的感官特征可能与强烈反应相关，这些反应会泛化到类似刺激，引发重新体验症状并增加心理压力。压力升高会提高糖皮质激素水平，促进UC特异性炎症。针对PTSD的认知疗法中的刺激辨别可能有助于打破过去创伤的感官特征、相关反应和当前类似线索之间形成的关联。
需要进行研究以了解创伤性事件如何影响溃疡性结肠炎的发作和复发，以及刺激辨别在降低每年发作频率方面的潜在益处。
