The World of GI Behavioral Health, with Megan Riehl

| Episode 40

We often chat about the gut-brain connection here on the podcast and how your mental health can influence your gut health. Many people are aware of gastroenterologists and therapists, but did you know that there is a position that marries these two worlds?

This week we’re chatting with Dr. Megan Riehl, a GI Psychologist and Clinical Director of the GI Behavioral Health Program at the University of Michigan who specializes in the treatment of GI problems and anxiety-related disorders. Tune in for a fascinating look into a different approach to managing gut health.

Click the play button above to listen to our conversation with Megan Riehl.

Highlights from Today’s Episode

  • When someone should see a GI Behavioral Practitioner and how to find one 
  • How a GI Behavioral Health Treatment plan is created
  •  Tips for establishing a healthy gut-brain connection

Colon Health Podcast with Dr. Dac and Ariel Bridges

About the Colon Health Podcast

Co-hosted by Dr. Dac Teoli and Ariel Bridges, the Colon Health Podcast features guest interviews with expert physicians, leading researchers, nutritional scientists, integrative health specialists, and other foremost experts in colon health.

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Episode Transcript

Ariel: Hello, and welcome back to another episode of the “Colon Health Podcast.” I’m your host, Ariel bridges. And today, I have Dr. Megan Riehl with us. Hey, Megan, how’s it going?

Dr. Riehl: Good. How are you?

Ariel: I’m great. Thank you so much. And thank you for being here. I’m so excited to chat with you. Can we just start off by you sharing exactly what it is that you do with our audience?

Dr. Riehl: Yes. Thank you for having me today. I am a clinical health psychologist, but I specialize in working with patients with gastrointestinal conditions. So, I see everyone from those with irritable bowel syndromes to patients with inflammatory bowel disease, and I help them manage aspects of their disease and navigating the medical system.

Ariel: That is amazing. And I always love to start off with chatting with our listeners and having them share their journey that brought them to doing what it is that they’re doing. So, do you mind sharing a little bit more about that?

Dr. Riehl: I would love to, and I hope maybe even inspire other professionals in the mental health world to consider becoming a GI psychologist or somebody that can help patients with GI conditions. Because part of why I’m doing what I’m doing and have been doing it for so long is because patients really benefit from working with a multidisciplinary team. So, I studied as a clinical psychologist. So I saw people with, you know, anxiety and depression and the whole gamut of mental health conditions.

I did my training in the Chicago area. And later, you know, I was nearing the end of my doctoral training and I started to dabble in health, and how our mental health impacts our physical health and vice versa. And I took a fellowship at Northwestern University in a behavioral health program that was fully integrated into the gastroenterology division at Northwestern. And I really fell in love with it. I got to use some of my general mental health skills and hone those skills further into helping people manage really difficult-to-treat gastrointestinal conditions.

And when we used these behavioral interventions and aspects of what I do as a psychologist, patients were getting better. And so not only was it rewarding for me as a clinician because we want to help people, but also it was rewarding to the patient as well, to learn some tools and strategies that really helped mitigate their troublesome GI symptoms.

Ariel: So, I was so excited to chat with you today because I had no idea that this was something that existed. And back when I was in my own healthcare journey, I study neuroscience and behavior, which I chat about sometimes on the podcast. And I was planning on going to PA school, but at one point, and then another point, I was like, “Oh, maybe I’ll go and think about clinical psychology and all these things.”

So I was grappling back and forth, but this really is kind of the perfect marriage of these two things that, like you said, this multidisciplinary approach to health is something that I believe is so important. And I wanna know for all of the people out there, are there other programs like yours in other parts of the country or the world even, how do people go about finding a GI behavioral health program?

Dr. Riehl: Yeah. So, from Northwestern, I came to the University of Michigan, and that’s where we have our program here. And we are very fortunate. A couple of years ago, I started a fellowship training program for clinical psychology graduates that wanted to become GI psychologists because at the University of Michigan, we’re a really large tertiary care program. And so we have a lot of patients and a lot of referring provider,s and my waitlist would run six months to get in to start treatment.

So over the last couple of years, I’ve hired two additional GI psychologists. So, we have what’s considered a pretty large, robust GI behavioral health program, but there are others in the country. There is a psychogastroenterology as really what we call our field. It’s a mouthful, but there is about 400, a few more than 400 GI psychology specialists in the world.

So, when you take into consideration that, for example, just IBS, there are 40 million Americans that are suffering with IBS. Four hundred isn’t quite enough to help with everyone, but yeah, you can still find people. So there’s a GI behavioral health provider directory that you can search like, which can be used to locate a general mental health provider. The Rome GastroPsych website has a GI psychologist directory. So, I always direct people there first. But I’m also the director of the GI behavioral health services and support for an online platform called GI OnDEMAND, which is a partnership of Gastro Girl and the American College of Gastroenterology.

And so, even if you can’t locate a GI psychologist near you, we have a lot of really wonderful patient-focused resources that are delivered in really nicely done webinar formats by GI psychologists from around the country. So, there’s lots of different ways that you can start to get some information to learn about whether right now is the right time to seek out that general or that GI-specific mental healthcare, or whether you may benefit from first addressing more of the general mental health needs that can impact your GI symptoms.

Ariel: And that is the perfect segue for my next question because maybe even the majority of people have this understanding, but previously, I only thought about the intersection of maybe psychology and GI health when it comes to surgery. I know there are certain bariatric surgeries where it’s required part of pre-op to have these kinds of consultations, but for the more general population, I guess, for someone who’s dealing with IBS or any other sort of, maybe IBD even, how do they know when to come see you or another psychogastroenterologist?

Dr. Riehl: Yeah. It’s such a good question because our treatments… So I use GI-specific interventions that we have paled such as cognitive behavioral therapy or gut-directed hypnosis. Our treatment as GI psychologists is really focused on helping with the management of the GI symptoms. So, if your symptoms are brought on by stress or your symptoms cause you stress, and even mild levels of anxiety or depression, then working with a GI psychologist to help mitigate your GI symptoms and decrease that GI-specific anxiety is probably the right fit for you if you are having more severe symptoms of anxiety or depression about other more general issues in your life.

So we think about that as, like, the psychosocial stressors, finances, relationships, navigating the major stressors of the pandemic, which has presented a whole other kind of slew of issues for people. Then maybe it’s best to first work with a general mental health provider to stabilize those mood symptoms. Because we are really honing on the management of your GI health as GI psychologists. If you have more severe mood symptoms, our interventions are not going to be as effective. So, we really wanna make sure that we’re getting you the right care because we don’t wanna waste anybody’s time, and we also don’t wanna waste time that you could be focusing on the most appropriate treatment plan for you at any given time.

Ariel: So then, can you share a little bit about how you determine what type of treatment someone needs? Because I know you mentioned a couple of gut hypnosis, gut CBT, which both sound very fascinating to me, but what’s that process of determining what’s the best treatment option for someone?

Dr. Riehl: So our patients are referred by their gastroenterologist in my program. So, our gastroenterologists are really thinking about patients in terms of maybe they certainly will benefit from medical management, but maybe they’re at a stuck point. And they’re really describing that stress is really prevalent and their symptoms cause them a lot of stress. And we know that stress can worsen GI symptoms pretty significantly because of the brain-gut connection.

So when the referral is made, I then schedule the patient for an initial consultation. And in that first consult with the patient, we’re gonna talk about all aspects of their GI health history, other medical comorbidities. I’ll ask about their psychological history and any mental health conditions or concurrent symptoms. But I’m also asking about their nutrition, other health behaviors, their sleep, and social demographics, relationships. All of that information helps to guide how I come up with a treatment plan with the patient.

So we work really collaboratively to assess, is this a patient that recognizes that their body is very, very tense and they have a very difficult time relaxing? In those instances, then I might recommend some relaxation training and stress management, as well as maybe some gut-directed hypnotherapy. When a patient is identifying really catastrophic thoughts about their symptoms, and they recognize that how they think can have a huge impact on how they feel and the behaviors that they engage in, and so that patient, we may use more cognitive behavioral therapy strategies.

But part of the expertise as a psychologist is that I can also intertwine the various interventions to meet the patient’s needs. So, oftentimes, I’m working under this umbrella of cognitive-behavioral therapy and infusing different self-management strategies, and relaxation, and stress management based on what the patient really needs that we identify during that initial consult.

Ariel: I love that you mentioned it being more of a collaborative process. I feel like a lot of times when it comes to figuring out what’s going on with your gut health, if you’re not feeling well, it can make you feel frustrated first of all when you’re not finding solutions and trying all these different things, but it gives you back some of the power that you feel is maybe stripped by not having the answers and not knowing what steps to take. So I love that. I love having a collaborative health approach. I think that’s really beneficial for a lot of patients.

Dr. Riehl: And that’s what patients with GI conditions are looking for is they do, they feel helpless. They at times have lost hope because they’ve tried a lot of different things with their gastroenterologist. And I think our field of gastroenterology is really moving to this integrative multidisciplinary, one provider can’t do it all type of mindset.

So when I get the opportunity to work with a patient, I wanna know, what have you tried? How are you doing? Certainly, symptoms can be unpredictable and uncontrollable, and so let’s try to identify some ways that we can give you some hope back, give you some strategies that you can employ in the moment, such as the relaxation interventions that I teach patients, and all of that makes people feel validated, and heard, and hopeful. And that’s what start treatment from the get-go.

Ariel: Ooh, you took the words right out of my mouth. I was going to say those things are so validating. And so often patients are just wanting to be heard. I feel like it’s so often, unfortunately, that patients, everything they have tried is glossed over, or they feel like it’s not taken seriously in some manner. So I love that. And I know that patients definitely appreciate it.

You started touching on some of these things, but I wanted to ask you more explicitly, I guess, for some tips, for things that people can do at home to make sure they’re maintaining a healthy gut-brain connection. We talk often on the podcast about that connection, but I don’t know that we’ve given some solid, clear steps that people can take at home to make sure that they’re doing what they can.

Dr. Riehl: When we think about our brain and our gut, we have to recognize that it’s a bidirectional pathway. So, the gut is sending signals up to the brain and the brain is sending signals down to the gut and paying attention. And so, just knowing that and knowing that our environment can impact that can be empowering as well. So some of the things that you can do at home are just being conscious of asking yourself, how am I feeling? How am I feeling today in terms of my stress level? Am I at 10 out of 10? And if that’s the case, if you really had a really long week, you’ve had a really busy day, then I would encourage you to engage in some kinds of self-care that can help to regulate the effects of stress on the brain and the gut. And that might be a spectrum of things.

I like people to have a spectrum of activities that include maybe exercise, going for a walk, maybe doing yoga, and then more passive strategies that are more calming. So things like deep breathing, meditation, guided imagery exercises, talking with a friend or a loved one, all the way up to having fun and engaging in thoughtful conversation and laughter, all of which can stir up good endorphins and serotonin, and help again with the regulation of our stress, which impacts our brain and our gut.

So having an insight, having insight into your level of stress, and there are some things you can do about it at home. And it’s really something more chronic where you’re feeling more anxious, you’re feeling more depressed. You’re feeling like you’re having a difficult time managing stress. Then you might need to go outside of the house and seek out maybe some working with a professional.

And that’s certainly something that I encourage people to not wait until the dire depths of despair that working with a mental health provider can be really short-term and can teach you a whole bunch of things that you can do at home and how to incorporate them at home. So therapy doesn’t have to be only for people that are experiencing severe depression or severe mental health problems. It certainly can be a proactive thing that you do that can be short-term and can really make it so that you’re able to live a healthy, well-rounded life, doing the activities that you enjoy at home and with loved ones.

Ariel: I love that you shared an entire spectrum of different things that people can have in their toolkits, whether it’s something that’s more active, something that’s a little more passive, and I could not agree with you more. That’s the thing that I tell people so often and, like, we do regular checkups for our physical health, even if we are not feeling poorly. So we should do the same thing for our mental health, making sure that we’re checking in and on the right track to have happy healthy lives like you just shared.

Dr. Riehl: Yeah. And you’re absolutely right. Your emotional health is just as important as your physical health, and knowing that, and validating that, and giving yourself the permission to…even on those days where you might be feeling great, giving yourself the permission to engage in those activities that are gonna make you feel healthy and also doing that with regularity. So, again, if you’re struggling with finding those things, working with a GI psychologist or a general mental health provider, we can help you build that toolbox. And that really is something that I think can be done at any stage of life.

So I love working with college students because we’ll talk about we’re building this toolbox that you’ll be able to utilize over the course of your work life and your family life. And then I’ve also worked with people where they’ve reached the age of retirement and they’ll say, “Gosh, I wish I would’ve done this kind of work four years ago, but I’m glad I have it now so that I can really enjoy my retirement”. So, it doesn’t matter what the life stage is, a lot of this stuff can be really helpful and meaningful.

Ariel: And I feel like it’s so encouraging to know that you can meet people where they’re at. We chat about that also a lot on the podcast. But like you said, for those older people that feel like it’s too late or the young people that feel like they don’t need to worry about it yet, there’s different tactics and things that everybody can use based on where you’re at that can help you on your current path and what you’re facing.

Dr. Riehl: Exactly.

Ariel: So, we are already almost out of time, but I wanted to ask you if there were any more parting thoughts or things that you wanted to share with our listeners.

Dr. Riehl: I would say to think outside of the box when it comes to your GI health. So, whether it be working with a GI psychologist like myself, or maybe working with a registered dietician who is expert in gastrointestinal issues, we want to work collaboratively with your primary care doctor or your gastroenterologist. So, if you’re still experiencing symptoms related to your GI health, think about what other areas of expertise might be of benefit for you.

Ariel: Thank you so, so much, Dr. Riehl for being here. I have learned so much today. Everybody that’s listening, like I mentioned, I will always put these helpful resources in the show notes. So, be sure to scroll on down, check out the different resources that we discuss on this podcast. And like I always say, we all have colons, so ask your questions, do your research and have a conversation. All right, we’ll see you next time on the “Colon Health Podcast.” Bye.