Patients with various gastrointestinal symptoms without meaningful organic findings, which already account for 50-60% of gastroenterology outpatient visits, are known as gastrointestinal disorders. Although this group of diseases is not life-threatening, it seriously affects the work and quality of life of patients. Recent studies have found that the role of psychosocial factors in the development and treatment of FGIDs is becoming more and more obvious. The current treatment is basically limited to biomedical treatment, which has little effect.
This not only causes a great waste of medical resources, but also brings a great economic and mental burden to patients. For many reasons, psychotherapy is not yet well developed in China, especially in many general hospitals. After fully excluding the organic disease, selective psychotherapy can be very effective for this kind of disease. Combined with the study abroad and recent treatment practice,
The results of research in the field of digestion and psychiatry have shown that it is not ideal to treat functional gastrointestinal diseases by treating the stomach and intestines from the stomach and intestines from the brain or “heart”.
Psychological therapies currently considered effective for gastrointestinal dysfunction include.
1) General psychological support therapy
2) Cognitive therapy
3) Relaxation therapy
4) Psychodynamic therapy
5)Morita therapy
6) Psychoanalysis and hypnotherapy. Among them, general psychological support therapy, cognitive therapy, psychodynamic therapy and Morita therapy are the most effective for patients with Eastern cultural background. Relaxation therapy and psychoanalysis and hypnotherapy, which are popular in the West, are not as effective as the previous ones for our patients. Morita therapy already includes psychodynamic therapy, so general psychological support therapy, cognitive therapy and Morita therapy are mainly introduced.
(1) General psychological support therapy
Establishing a good therapeutic relationship is the basis for all other treatments, and psychological support therapy is the first step in building a trusting relationship. The key skill of this therapy is empathy. Empathy was first proposed by Rogers, the founder of humanism, who believed that good counseling was inherently therapeutic. At its core, it is about making the patient feel understood and accepted.
Expressing empathy has to be patient-centered and meet individualized needs. To achieve accurate empathy, there are three elements that
First, there must be an awareness of empathy.
Second, empathic skills, i.e., knowing how to implement empathy effectively.
Third, one must have a keen sense of judgment and an accurate understanding of the effects of empathy at all times. Steps of empathy.
First, the physician should put aside his or her own frame of reference, keep an open attitude, put himself or herself in the patient’s shoes to understand the patient’s discomfort and pain, rather than making too many subjective assumptions, and achieve empathy with the patient. Secondly, express an understanding of the patient’s inner experience, so that the patient understands that you have accurately understood the content of his or her illness. Finally, it is important to make the patient feel empathy while doing further reflection on their own feelings. Several issues should be noted.
(1) Listen carefully and avoid rushed responses. A hasty response will often interrupt the patient’s thoughts and affect the effectiveness of the confession, while also leaving yourself with insufficient time to think about the patient’s words.
(2) Avoid not saying anything or simply judging.
(3) The doctor should avoid clichés and some crowning terms or reassurances, and also avoid his or her own inappropriate body language so that the patient does not feel put off.
(2) Cognitive therapy
It is also called cognitive-behavior therapy, which is very operational, simple in principle but very difficult to operate well. In particular, it requires doctors to have strong language skills. Through some easy-to-understand metaphors to make patients understand their condition, help them correct their original prejudices and change some of their original thinking and behaviors, including fear of tumors, excessive caution in diet, demanding on the time and frequency of bowel movements, self-examination and self-diagnosis behaviors, as well as misinterpretation of many physiological phenomena of human body.
It is important to note that the patient’s thinking or understanding is wrong but often not absurd. Therefore, it is often not easy to correct. It is important to avoid simple criticism and forceful correction of the patient and to look for opportunities to correct his or her errors during the communication process, otherwise it will lead to the inability to continue the treatment.
(3) Morita therapy
In the 1920s of this world, Freud created psychoanalytic therapy in Europe, but this psychotherapy was based on a Western cultural background. Dr. Morita Masa, a Japanese doctor of the same generation, created a psychotherapy with an Eastern cultural background, which his disciples called Morita therapy after the death of Mr. Morita. This therapy works best with patients with gastrointestinal disorders, especially those with gastrointestinal functional disorders with suspicious qualities.
Anatomy of the psychology of these patients is characterized by the following aspects
(1) hypochondriacal fear.
(2) excessive concern for the gastrointestinal tract.
(3) misinterpretation of physiological phenomena of the gastrointestinal tract
(4) the lingering expectation of complete eradication of gastrointestinal symptoms. These features are interconnected and form a vicious circle. Morita believes that the quality of suspicion is the basis for the formation of symptoms and the mental interaction is the cause of the formation. Therefore the core of Morita therapy is
(1) Teaching the patient to go with nature, helping the patient to recognize the nature of his or her pain and discomfort, and overcoming the quality of doubt.
(2) To do what is right, interrupt the mental interaction, and get rid of the gastrointestinal problem once and for all.