Snapshot of an integrated psychosocial gastroenterology service

Table 1 Guidelines for appropriate referrals for health psychology services

Appropriate referrals

Patients with moderate to severe functional symptoms who have not responded to medical management (Palsson and Whitehead, 2013)

Stress or emotional factors are exacerbating gastrointestinal (GI) symptoms

Any patient interested in non-pharmacological treatment of functional GI symptoms

Patients newly diagnosed with chronic GI illness (e.g., crohn’s disease; ulcerative colitis)

Any patient needing assistance coping with chronic, uncomfortable GI symptoms

Inappropriate referrals

Patients with significant psychological symptoms that are independent of the GI condition

Current severe psychiatric symptoms (suicidal ideation, psychotic disorder, obsessive-compulsive disorder)

Active eating disorder

Low insight into the role of stress on his/her GI condition

Poor motivation to engage in psychological treatment

Table 2 Demographics based on response to referral

	Patients seen for an initial intake (n = 118)	Patients not seen for an intake (n = 141)
Demographics
Average age	40	38
Gender (% female)	71	79
Disease type
IBD	22	29
Functional bowel	49	59
Dyspepsia	23	30
Esophageal	15	11
Other	9	12

Patients seen for an initial intake: Includes all patients evaluated by a psychologist, including both functional GI disorders as well as other disease groups; Patients not seen for an intake: Includes all patients that were referred for psychological services by their gastroenterologist, but did not meet with a psychologist; "Other" disease group: Chronic pancreatitis, celiac disease, non-cardiac chest pain, rumination syndrome, functional vomiting, gastroparesis, eosinophilic disease, and aerophagia. Diagnosis Type refers to the patients diagnosed with each disease type. IBD: Inflammatory bowel diseases; GI: Gastrointestinal.

Table 3 Myths and misconceptions of psychological treatments for gastrointestinal conditions

Myth	Fact
Only patients with significant psychological distress will benefit from working with a health psychologist	The majority of patients seen in our clinic do not suffer from a psychological disorder and yet benefit significantly from treatment
Only patients with functional GI conditions are appropriate for referral to psychologist	Patients with a wide-range of GI conditions can benefit (crohn’s, ulcerative colitis, chronic pancreatitis, GERD); 20% of patients in this study had IBD
Psychological treatments are expensive	Psychological treatments are often covered by insurance and are associated with reduced long-term health-care costs.
Psychological treatment requires significant time commitment	Many patients can benefit in as few as 4 sessions

GI: Gastrointestinal; IBD: Inflammatory bowel diseases; GERD: Gastroesophageal reflux disease.