Our brain and gastrointestinal (GI) tract, or gut, are linked by a vast network of cells and neurochemical pathways. Thanks to a growing field of evidence, we know this connection has a strong influence on our health and happiness. But when it comes to common GI problems, such as irritable bowel syndrome, the brain is largely left out of the treatment plan.
Enter Helen Burton Murray, PhD, director of the GI Behavioral Health Program, a division of Massachusetts General Hospital’s Center for Neurointestinal Health. A trained psychologist who works closely with the Division of Gastroenterology and the Eating Disorders Clinical and Research Program, Dr. Burton Murray is helping deepen our understanding of how non-pharmacologic interventions can help patients with common GI problems and eating-related disorders. We asked Dr. Burton Murray about her approach, how cognitive behavioral therapy (CBT) is helping GI patients and what the future holds for this integrated approach to care.
How would you describe your work?
My work straddles the intersection of eating-related disorders and gastrointestinal conditions. Specifically, I’m focused on gastrointestinal conditions where there’s no organic or structural cause — that is, there is no ulcer, cancer, mechanical problem, etc. Instead, these issues usually involve a signaling problem between the gut and the brain and are in a class of conditions referred to as disorders of gut-brain interaction.
How do the problems you’re describing differ from other eating-related disorders?
With disorders such as bulimia and anorexia, there’s usually a body image disturbance. However, the individuals I treat are limiting their diet because of gut-brain signaling problems. They are experiencing sensations they don’t need to be experiencing and relating those feelings with food intake. Many of the patients I see meet the criteria for avoidant/restrictive food intake disorder (ARFID) — that’s when a person limits the type or amount of food they consume leading to problems like weight loss or difficulty eating with others.
How do these issues develop?
While we still need more research to understand this, our initial research suggests that patients may develop ARFID because of attempting to use exclusion diets like gluten-free or low-FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols — carbohydrates poorly absorbed by the small intestine) diets to manage their GI symptoms. While exclusion diets can be safe and effective for many patients, some people may follow exclusion diets for longer periods of time than they need to. Others may become overly restrictive, following diet after diet to no avail.
What role can non-pharmacologic approaches play in treatment?
If we look at functional dyspepsia — which is a kind of recurring indigestion often characterized by feeling uncomfortably full right after eating — medication alone shows minimal benefit. But my GI colleagues — Kyle Staller, MD, MPH, Brad Kuo, MD, and Christopher Vélez, MD — and I believe that combining medication with behavioral treatments like CBT can provide a huge benefit to these patients.
We’re now piloting an eight-session telehealth program that uses CBT to help patients with functional dyspepsia gain weight and better tolerate their GI symptoms. We’ve already seen evidence that this approach can have substantial benefits.
One patient I saw earlier this year had developed functional dyspepsia after surgery to remove a cancerous section of his esophagus. Afterward, he developed difficulty eating and was fearful of eating socially. He was skeptical of the CBT approach at first, but over the course of three months, he got back to eating three meals a day and was able to start eating with family and friends again. Best of all, he surpassed his weight gain goal.
What does the future hold for your approach?
While there’s a growing awareness of the brain-gut connection and the utility of behavioral treatment, the field is still small. When it comes to treating adults, there are only a handful of other psychologists who are vetted in GI services in the nation, and there are no other psychologists that I know of who have this dual kind of role.
Looking ahead, we’re focused on growing the program. I currently train advanced practice providers like nurse practitioners to deliver CBT to patients with these GI signaling issues, and I’m hoping to formalize a program for psychology trainees as well. We have a tremendous opportunity to offer a variety of shared services that integrate psychology and adult and pediatric GI, and I believe the impact could be significant.
- To make a gift or learn more about supporting Dr. Burton Murray’s work at the Center for Neurointestinal Health, please contact us.
- To contact the Center for Neurointestinal Health directly, please call 617.726.0270.