Medically reviewed by Dr. Micol Artom
With or without inflammatory bowel disease (IBD), anxiety and stress can have powerful effects on our physical health. For people with IBD, however, these mental health conditions can mean a flare-up of physical symptoms, too. It’s not uncommon for people with a chronic disease to have anxiety as a constant companion, and about 40 percent of people with IBD have “abnormal levels” of anxiety. Because stress and anxiety are not the same thing, dealing with them effectively can require different tactics. Knowing what to do means knowing how to tell them apart, which can be tough because they have a lot in common. With either one, you can feel similar symptoms of trouble sleeping, muscle tension, increased heart rate, or stomach pain. So how can you tease out which is which and take the best approach to management?
How to Tell Anxiety From Stress
“Anxiety is more akin to fear, whereas stress is causal,” says Karen Conlon, LCSW, an IBD health therapist who specializes in treating anxiety and building resilience at the Susan and Leonard Feinstein IBD Clinical Center at Mount Sinai Hospital in New York City and in private practice. In other words, when you’re feeling stressed, you usually can trace that feeling to something specific. Even the process of pinning down the cause can help. “Thinking about stress in this context can help you to understand that most stressors are temporary or short-lived,” says Conlon. While you might be able to pin down exactly what’s stressing you—money problems, relationship tensions, work issues or illness—tracing the origins of anxiety is a trickier business. Anxiety’s the stress you still feel after the cause of stress is resolved, says Conlon. When dealing in anxiety in particular, people tend to worry about things that happened already or have yet to happen. Anxiety involves a lot of “what-if” thinking that takes the mind to the worst outcomes, creating more stress in our bodies through physical reactions in our nervous system, says Tiffany Taft, clinical health psychologist at Oak Park Behavioral Medicine and research assistant professor at Northwestern University Feinberg School of Medicine. A person may avoid certain situations to try and avoid anxiety, but instead they can create a recurring cycle of stress and anxiety, says Dr. Taft. So although anxiety and stress are not the same thing, anxiety itself can be a stressor.
How Stress and Anxiety Affect IBD
Through effects on the immune system, stress and anxiety can influence IBD. Concern about IBD-related factors is “quite normal,” says Taft. Worry about whether or not you’ll find a bathroom in time or that your medication’s effects will wane inopportunely is to be expected, she says.But when these worries are constantly tumbling around in your mind, they can trigger the very symptoms you’re trying to forestall. In that way, IBD-related anxiety becomes the stressor that in turn triggers an exacerbation of symptoms.
Do Ulcerative Colitis Vs. Crohn’s Patients Experience Stress- and Anxiety-Related Symptoms Differently?
The way the body responds to stressors, including anxiety as a stressor, does not necessarily vary with type of IBD. However, which IBD symptoms predominate can dictate which factors act as stressors or can snowball into a more general feeling of anxiety and catastrophic “what-iffing.”If you have pain and urgency that causes night-waking, for example, the resulting sleep problems can hit on every aspect of your life, creating a cascade of stressors that produce constant anxiety.
Ways to Take Control of Stress or Anxiety
In the short term, stress can trigger release of little bursts of cortisol, the “stress hormone.” These short-term responses can dampen inflammation associated with stress responses, keeping the body’s house in decent working order. You can navigate this transient stress by recognizing a stressor and resolving it or practicing relaxation approaches that work for you. Possible techniques including muscle-relaxation exercises, meditation, or yoga. Anxiety is a bit of a different beast and can produce longer-term cortisol and immunosuppression. This undesirable chronic suppression can make the body susceptible to disease. If your stressor is gone or your stress-relieving tactics aren’t working, it might be time to consult a professional. “A mental health professional can help you if you’re unable to learn relaxation or thought monitoring skills on your own,” says Taft. Because an IBD diagnosis itself is a likely stressor, mental health support can be important during any period of having IBD, says Conlon. “IBD can really make people feel as if they have lost control of their lives because in addition to the ‘regular’ life stressors, they are also learning how to create a ‘new normal,’” she says. “Therapy can help people get through the different stages and thought processes that they go through.”
Reviewer Dr. Micol Artom is a Research Associate at King’s College London. She is a psychologist by background and has a PhD looking at clinical and psychological predictors of fatigue in IBD. Her interests are focused on the links between psychology and health and the impact that disease can have on people’s quality of life. Her current research is focused on developing an online self-management programme for symptoms of pain, fatigue and urgency in IBD.
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