About IBD Podcast Episode 145 - IBD and PTSD With Stephanie Brenner, LCWS, MSW

Post-Traumatic Stress Disorder and IBD With Stephanie Brenner, LCSW, MSW

My guest is Stephanie Brenner of Chronic Illness Psychotherapy. Stephanie is a Licensed Clinical Social Worker who has experience in working with clients with chronic illnesses. She has also taken on a variety of roles in GI space, including previously serving on both the advisory team for the Pediatric Crohn’s Guidebook and the recruitment committee for the Rome Foundation’s GastroPsych organization.

Stephanie lives with Crohn’s disease and a permanent ileostomy and is also a cancer survivor. I asked her to help us better understand PTSD and PTS as they relate to having a chronic illness like IBD. She defines PTSD and why it can happen with IBD, what some of the signs and symptoms might look like, and what patients can do to address their mental health


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Transcript

[Music: IBD Dance Party]

Amber Tresca  0:05 

I’m Amber Tresca and this is Sbout IBD.

Amber Tresca  0:08 

I’m a medical writer and patient educator who lives with a j-pouch due to ulcerative colitis. It’s my mission to educate people living with Crohn’s disease or ulcerative colitis about their disease and to bring awareness to the patient journey.

Amber Tresca  0:21 

Welcome to Episode 145.

Amber Tresca  0:24 

People who live with an inflammatory bowel disease are more likely to develop certain mental health conditions such as depression and anxiety. But it turns out that the experiences from living with these illnesses might also lead to post-traumatic stress or post-traumatic stress disorder.

Amber Tresca  0:41 

My guest is Stephanie Brenner of chronic illness psychotherapy. Stephanie is a licensed clinical social worker who has experience in working with clients with chronic illnesses. Stephanie lives with Crohn’s disease and a permanent ileostomy. She’s also a cancer survivor, I asked her to help us better understand PTSD and PTs as they relate to having a chronic illness like IBD.

Amber Tresca  1:03 

She defines post traumatic stress and why it can happen with IBD what some of the signs and symptoms might look like, and what patients can do to address their mental health. Plus, she recommends several comedians that she enjoys who are exploring the connection between health and comedy.

Amber Tresca  1:25 

Stephanie, thank you so much for coming on About IBD

Stephanie Brenner, LCWS, MSW  1:28 

Thank you so much for having me, Amber. I’m happy to be here. Excited to dig in today.

Amber Tresca  1:33 

Oh, me, too. I’m really excited about this conversation. It is one that we I don’t think I’ve really touched on before. So I’m excited to learn a lot more from you. But let’s let the listeners know who you are. I already know who you are, but I don’t matter. So let’s begin by you introducing yourself a little bit for the audience.

Stephanie Brenner, LCWS, MSW  1:55 

Sure. My name is Stephanie Brunner. I am a Crohn’s patient and permanent ostomates. I am also a licensed clinical social worker. She’s just a fancy way of saying therapist, a work in Evanston. So outside of Chicago. And I have a private practice called chronic illness psychotherapy.

Amber Tresca  2:20 

Awesome. Thank you so much for sharing all of that as a perfect introduction. So everybody knows where you’re coming from. So you have had a journey with Crohn’s disease as I like to call it a journey because every person’s is different. I’d like to know more about when you were diagnosed, what your symptoms look like, if you care to share any, and then what the process of diagnosis was like for you.

Stephanie Brenner, LCWS, MSW  2:49 

Great, let’s get let’s get into it.

Stephanie Brenner, LCWS, MSW  2:53 

Down and dirty as as most GI disorders are, I didn’t have a knowledge of any GI disorders, we didn’t have a strong family history. And I had a pretty sudden onset. So right after I graduated high school, right after senior year, it was very sudden that I noticed blood in my stool. So I was like, I need to tell my mom.

Stephanie Brenner, LCWS, MSW  3:18 

Luckily, I felt like secure and safe enough to tell her and she immediately took me to the doctor who referred us to a GI who I got a pretty quick diagnosis of UC. So at first they thought it was ulcerative colitis because it was just in my colon. Tried all the available meds for about the next year to lots of prednisone, everything that was on the market at the time. Nothing was working quality of life was going down pretty quick and got my three step j pouch got my colon removed.

Stephanie Brenner, LCWS, MSW  3:57 

So we rearranged it around my school schedule because I really wanted to be like my peers and go to college. And so I had this J pouch and and really was it was marketed to me as I was cured so that I was done. I know I was cured it was done and that whole weird gi illness world is behind me what a weird year I’ve had.

Stephanie Brenner, LCWS, MSW  4:21 

Soon after started getting recurrent pouchitis then years late, you know it was trying to treat that over and over. So that was kind of the first tip off that the pouch wasn’t that happy from the get go. And later got a rash of vaginal fistulas and abscesses. And so that was the tip off for Crohn’s diagnosis.

Stephanie Brenner, LCWS, MSW  4:43 

That was probably the roughest switch for me mentally tried all the medicines on the market at the time. I think it’s like in 2012 nothing was working. I got a temporary ileostomy because I knew what that quality of life was like and I was ready for some normalcy that bought me a little bit more time.

Stephanie Brenner, LCWS, MSW  5:05 

And then in 2018, I did the total APR Barbie but made my ostomy permanent and got the the J pouch excised. So that’s me and kind of in a nutshell, it was quite the journey.

Stephanie Brenner, LCWS, MSW  5:18 

To top it off in 2019, I also was diagnosed with breast cancer, so I double mastectomy that year. So I would describe this topic that we’re talking about today as one that’s dear to my heart, one that’s a work in progress.

Stephanie Brenner, LCWS, MSW  5:34 

One, my relationship with my body is a complicated one, as I would affirm to anyone with a chronic illness or who has had to deal with surgery or illness, but one that’s healing one that I see progress in, and I’m passionate about it because it’s it is so important to reconnect, even if we’ve had all these different traumatic experiences, surgeries, procedures that are really hard to integrate and make sense of.

Amber Tresca  6:05 

That’s a lot. So thank you for sharing all of that. With me, unfortunately for for you. And I’m so sorry that you’ve gone through all of that. But on the flip side of it, it means that you are probably the perfect person to dig into our topic today, which is post traumatic stress disorder. And people who live with IBD may also be coping with PTSD.

Amber Tresca  6:33 

But I don’t think people truly understand what it is sometimes because of what goes around in the in the in the swirl in the ether and what we hear about PTSD, could you give an overview to sort of dispel some of the misperceptions that people might have about what it is?

Stephanie Brenner, LCWS, MSW  6:52 

Sure. So today, I feel like I’m going to zoom in on medical PTSD. But in general, when you think about PTSD, when you’ve heard it, in the media, we often the examples that come to mind are a war veterans, someone in you know, a serious accident, victim of sexual assault. In reality, there are just so many more kinds of people who have PTSD.

Stephanie Brenner, LCWS, MSW  7:21 

So medical PTSD is kind of a subset one of those and I would consider it something called disenfranchised trauma. So it’s not commonly acknowledged, there’s something also called disenfranchised grief.

Stephanie Brenner, LCWS, MSW  7:34 

It’s, it’s a more complex form. It wasn’t a one time incident. It wasn’t someone outside your body that did something to you. It’s nuanced. It’s this special kind of trauma that we don’t necessarily acknowledge in our society, because our bodies are us. So how could we be our own perpetrators? The medical team, we are paying them to care for us, they’re saving our lives, how could they be the perpetrator? So it’s, it’s very confusing.

Stephanie Brenner, LCWS, MSW  8:09 

There’s not a lot of dialogue, there’s not a lot of books on it. And if you had to drill down to what is trauma, you ask a bunch of different trauma therapists, you’re gonna get just as many answers. It’s the one thing that we can’t all agree on exactly what the definition is. I would say it is being exposed to something that is extremely overwhelming. And then the reaction and the aftermath of that, that is trauma.

Stephanie Brenner, LCWS, MSW  8:40 

One person can be exposed to something that is overwhelming and bounce back, be resilient and not have PTSD. Another person so it’s really in the perception of that person’s brain and nervous system. That’s all that matters. We don’t argue was that trauma or was that not if that’s how you experienced it? It’s trauma. It counts.

Stephanie Brenner, LCWS, MSW  9:03 

So I just did a training with Dr. Sasha McBain she’s out of Little Rock, Arkansas. She loves and studies, medical trauma. I love her work. Follow her Google her. I’ll be quoting her work quite a bit because she’s phenomenal. And this is like one of her biggest focuses. So there’s something called PTSD, Post Traumatic Stress Disorder. There’s also something called PTS post traumatic stress. I don’t view it as that important either way, trauma is trauma. If we had to get nitty gritty as a therapist and figure out which diagnosis you qualify for, there are different instruments that we can use that are validated.

Stephanie Brenner, LCWS, MSW  9:49 

Basically, PTS is a little less severe. It doesn’t hit all of the eight criteria on in the DSM five which is kind of like our diagnostic guy. It’s basically the duration and intensity of the symptoms, how much are they interfering with your functioning? When a patient comes in, and we’re talking about medical trauma, I don’t feel like it is super necessary to get into. You don’t qualify for that one in Utah.

Stephanie Brenner, LCWS, MSW  10:17 

I more just give the overview of these are some of the things to look for which ones are you experiencing? I really liked Dr. Sacha McBain. Her definition. Again, everyone’s is different. For medical trauma, it’s an event a series of events, a set of circumstances that is experienced by an individual as physically or emotionally harmful, or life threatening. And that has lasting adverse effects on the individual’s functioning, mental, physical, social, emotional, spiritual well being. So pretty broad definition.

Stephanie Brenner, LCWS, MSW  10:57 

And it allows, I would say, for a much more generous, like, I have trauma here. It may be PTSD, it may be PTS, it may just be some symptoms. Either way, we want to welcome that into the therapy room and look at that and say, like, how are these symptoms affecting my life, and maybe I want to shift maybe I want to process through some of this so that it’s not holding me back.

Stephanie Brenner, LCWS, MSW  11:26 

The one piece of medical trauma that is a really great phrase that I love to stress is this enduring somatic threat. So the threat is inside our body. Often, we have as someone with IBD, I have an autoimmune disease, my body is attacking itself. So the source of the trauma is within.

Stephanie Brenner, LCWS, MSW  11:53 

I would also argue through all of the procedures and surgeries and things like that. The threat is also outside, it’s the medical system. It’s the knife of a surgeon, it’s the you know, the thread is outside but also the thread is within that is the most disconcerting in my opinion is feeling unsafe in my own body like that it is attack it is at war with me.

Stephanie Brenner, LCWS, MSW  12:21 

Some people will come in and feel like I want to do couples therapy like with my body because I’m ready to just give up and divorce I do not want to have a relationship with this thing. But realizing the thing is actually me. It’s whatever pronouns I use, she hurt like she is me and she and I need to come together repair, talk about what happened, calm ourselves.

Stephanie Brenner, LCWS, MSW  12:47 

So one other. One other quote that I just felt was so necessary that she had thrown out in her training. It is from a book, an old book, the psychology of the sick bed. The body is the healthy person’s faithful ally, the healthy person is allowed to be their body, and they make use of this regularly. They are their body illness disturbs this assimilation, our body becomes foreign to us.

Stephanie Brenner, LCWS, MSW  13:25 

So we’ll talk a lot about some of the symptoms but it’s just that feeling of I am separate from my body, my illness my this disconnect of how do I how do I don’t feel safe in my body.

Amber Tresca  13:40 

Right? I think that is all very validating for me personally. And so I think it will also be the same for other people who live with IBD because of the feeling that your body is failing you and then also you need to undergo procedures or surgeries or what have you that are not easy to undergo or are kind to your body

Stephanie Brenner, LCWS, MSW  14:07 

Yeah.

[Music: About IBD Transition]

Amber Tresca  14:28 

But I’m going to ask you a question that I already know the answer to. But I think it’s just important that we get to the root of this outright. And are people with IBD more likely or more prone to develop PTSD or PTS?

Stephanie Brenner, LCWS, MSW  14:45 

So glad you’re asking that. Yes. There have been three studies, and the most recent one in 2021 showed a quarter to a third of patients with IBD report significant symptoms of PTS from their directly from their disease experiences.

Stephanie Brenner, LCWS, MSW  15:05 

So there are some factors that make you more prone to this female being younger, less education, non white, Hispanic, more severe disease, that’s not a surprise more hospitalizations, any sort of ICU stays. Yeah, it is more common than you would think. And it’s just now coming into the conversation.

Stephanie Brenner, LCWS, MSW  15:35 

In terms of IBD mental health, we’ve been really looking at anxiety and depression for a long time, just like a lot of other chronic illnesses. And now realizing this particular I would argue that IBD, because of the stigma around poop, in our culture, there’s this internalized ableism for anyone with an illness, but then you have this extra layer of I’ve had clients describe it as this feels like an assault, I haven’t been this feels dirty and shameful. This is just a procedure. This is just an enema. This is just a suppository. But it’s that internalized feeling this is dirty, wrong, bad. Gross, I am on a track, it goes really deep.

Stephanie Brenner, LCWS, MSW  16:27 

So it doesn’t surprise me that quite a few people are showing up. And I think it will be a bigger topic in the years to come. Just because we’re going to want to be able to prevent tree in the acute setting. And then also treat kind of long term with the people who have it. It also has a relationship with patients, the more PTS you have similar to depression, anxiety, the more can affect your condition, it can affect your behaviors, your compliance, so just realizing we have to treat the whole person, because that’s going to actually help their disease markers.

Stephanie Brenner, LCWS, MSW  17:08 

It’s not all in their head, but it does affect their pain, interference, their fatigue, how much they utilize the healthcare system, when you have PTSD, you can be over utilizers because we’re hyper vigilant and under we avoid, so realizing like wow, these things can really be playing in the background, if we’re never assessing or talking about it, it’s a pretty big gap we need to this is this is something that we need to it needs to be in the forefront, especially with GIs and having conversations just to assess,

Amber Tresca  17:42 

Right 100%. Sometimes we are putting out all these fires, the physical ones, and our GI system, and then all of extra intestinal manifestations. And so mental health, for sure, sometimes takes a backseat.

Amber Tresca  17:56 

And now that we know this, we know that people with IBD are more prone and we know some of the most common risk factors. What are some of the ways that mental health care providers help people manage these symptoms of PTSD? You said that there were some tools? Can you give a sense of of what that might look like?

Stephanie Brenner, LCWS, MSW  18:17 

Sure. So the first place is just having that safe place to process the trauma in a very titrated way tight like a term from chemistry, where we just go slowly, little by little. We don’t want to overwhelm and flood the nervous system.

Stephanie Brenner, LCWS, MSW  18:35 

We do a lot of psychoeducation. What is trauma? Why does it feel this way? In my body? Why do I feel this disconnect? Where’s this fear? The biggest thing that comes up after trauma is avoidance. We do not want to go into that really overwhelmed state.

Stephanie Brenner, LCWS, MSW  18:53 

Again, we never want to experience it, it is a survival reflex. So that the work is to do slow small exposures, whether it’s through journaling, or writing over and over, like narrative therapy, whether it’s through something called Cognitive Processing Therapy, where we talk through it. And then also, in my opinion, it’s not it we’re not quite integrated in terms of the health psych medical model, and then the somatic model, but we need to help restore the trust that the patient has with their own body.

Stephanie Brenner, LCWS, MSW  19:32 

So it’s not just talking about it. There is a nervous system kind of repair that happens when you do find some sort of movement like I’ve done some trauma informed yoga, restorative yoga, it’s very gentle. It’s learning how to be in my body without just wanting to scream and run away. It’s hard work.

Stephanie Brenner, LCWS, MSW  19:59 

There’s other some adic interventions like called sensory motor and somatic experiencing, there’s something called EMDR, which is eye movement, desensitization is so hard to movement, desensitization and reprocessing, which doesn’t even go to the verbal level. It’s something that, you know, the therapist would need to be trained in where you are reprocessing some of the memories that are the most traumatic on a nonverbal level sounds a little out there.

Stephanie Brenner, LCWS, MSW  20:32 

But again, these are things that have been studied for years with veterans and other PTSD populations, I would view those as really good tools that could be of benefit for people who are noticing these symptoms. And so as for practical tools that you can kind of do on your own or start learning, if you don’t have a therapist, one of the biggest things I start with is diaphragmatic. Breathing, you might have heard about it, it’s used for anxiety and depression, also for trauma.

Stephanie Brenner, LCWS, MSW  21:08 

There are things if you Google grounding, exercises grounding, meaning, like I just want to feel planted on the ground, I want my feet on the ground 54321. So if you’re in a flooded state, trying to really be present in your environment, there’s kind of these like little exercises, help you figure out how to come back, come back to the room come back to your body.

Stephanie Brenner, LCWS, MSW  21:31 

 But again, I would say that that movement piece, somehow finding joyful movement, how can I move and be in my body without it feeling? So exhausted or so overstimulated, like, how can I find that window of tolerance to like, what brings me comfort and pleasure in my body?

Stephanie Brenner, LCWS, MSW  21:52 

That’s a very foreign concept, our bodies kind of become medicalized. Like, we get poked and prodded. And so what positive touch obviously, this is not in the therapy room. I’m not we don’t touch clients, but positive touch, like massage. Do you like to have a weighted blanket? What sensory things help your body calm down? What smells? What movements? Do you like to dance? Do you feel very restricted than like, what pushing exercises? Can you push against a wall? Can you stomp your feet? Or do I want to have like the yoga mat out with, you know, a weighted blanket and just lay and feel the earth underneath myself.

Stephanie Brenner, LCWS, MSW  22:39 

So trying to figure out ways to work with your body when it feels overwhelmed, underwhelmed, distant, those are some of the things that I like to kind of give patients is like, try this at home and see how it affects your relationship with your body, see if it shifts anything, or let’s try it in. Like I have a yoga mat in my office, I’m not a trained yoga therapist. But let’s try it and see what happens. As we’re talking about this. Let’s try notice your body language. So trying to think more about what is going on in real time in the body.

Amber Tresca  23:17 

Yeah, that makes a lot of sense. And as you were talking, I remembered to plant my own feet on the ground and not have them dangling, and you know, doing all sorts of things, you plant them on the ground, it is really a much better way to engage, especially in a in a conversation to have your feet on the ground in that way. S

Amber Tresca  23:39 

o it’s a good reminder, that’s like, every so often you go you go through social media, and somebody will post something that’s like, hey, lower your shoulders right now. And you go, Oh, my gosh, you know, I yeah, I need to be reminded of that every so often to, to be to be a little more aware of my, my body and what I’m what I’m doing with it.

Amber Tresca  23:56 

And so in that vein, I think that these things can sneak up on us in terms of IBD those symptoms in terms of mental health. So what are the things that people with IBD and then also their caregivers, maybe two should be looking for thinking about that would point them in the direction of saying, Okay, I need to maybe get some outside help in order to deal with all of the situations and the emotions that are coming upon me because of what’s going on with my IBD.

Stephanie Brenner, LCWS, MSW  24:32 

Yeah, things can really sneak up on us. So sometimes our loved ones are one of the best mirrors for us like they might notice it. Again, the things that have been studied a lot are anxiety and depression. And now PTS is kind of coming out as the thing to look for.

Stephanie Brenner, LCWS, MSW  24:49 

There is if you are curious about do I have this there’s the VA again, we’re veterans. There’s a great tool. It’s called the self report. tackless PTSD checklists for the DSM. So if you Google that it’s the top link, it’s from the VA the government. And that’s kind of nice. If you want to just do a self screen of like, I wonder if this is wonder if this is going on right now, in terms of other things to look out for, or to notice some of the symptoms is this re experiencing.

Stephanie Brenner, LCWS, MSW  25:24 

So it could be these traumatic memories that are popping into your head at really inconvenient times. It could be nightmares, flashbacks, some of the physical sensations that you would might feel around anxiety as well like sweating, nausea, heart racing, trembling, and then the avoidance.

Stephanie Brenner, LCWS, MSW  25:46 

So noticing that you really don’t want to connect with your body. It is just uncomfortable. I don’t want to think about that memory that thought that feeling, let’s not talk about it, and then a form of avoidance would be numbing. So how do everyone knows? Yeah, it’s a human instinct. We don’t like pain. So how am I numbing? And how much am I numbing? What am I using? Is that working? How much is it affecting my everyday life.

Stephanie Brenner, LCWS, MSW  26:19 

And something that’s very common with IBD patients is the hyper arousal so like I have had so much pain surgeries, uncomfortable experiences, that I have this overactive alarm system, and it goes to fight or flight and that kind of like the alarm just stays on, because I’ve had so many layers over the years of these terrible, invasive procedures.

Stephanie Brenner, LCWS, MSW  26:45 

And there’s also a hyper vigilance, which just means you’re constantly scanning for threats, again, survival mechanism, we do not judge ourselves for this. But we notice it with curiosity, or we say, am I avoiding going to the doctor or my emailing the doctor 10 times a day? Like, are we going to either of those extremes, and usually loved ones can No, you know, how much of a toll is this taking on your sleep on your enjoyment of life on your ability to function socially. So those are some of the things that I would look for. And it’s not just anxiety, depression, or trauma.

Stephanie Brenner, LCWS, MSW  27:25 

There’s also something within anxiety OCD, I’ve seen that come up anecdotally. So people who have some sort of routines around medical things because it gives them a sense of control. There’s something called BFR B’s body focused, repetitive behaviors I’ve seen anecdotally a lot of these, this is people who might, who are, who do some sort of repetitive behavior, like picking, picking up their cuticles at their scar at their scalp, knowing that a lot of the trauma is in the body.

Stephanie Brenner, LCWS, MSW  28:02 

Of course, that’s like a way to connect, but also it’s not in a way, it’s a way that there’s a lot of shame. There’s a lot of food related issues, because so I’m always assessing not only for kind of the big three of like anxiety, depression and trauma, but like, how else are you relating to your body? How do you nourish it? How restricted were the fear of food and our fit? Like, there’s so many things, self confidence, what’s your self concept like, it’s, it’s all there with IBD, we really get a grab bag of nuts.

Stephanie Brenner, LCWS, MSW  28:39 

So that doesn’t mean we’re destined to struggle with all of these. But as a clinician, I would say there’s not one IBD patient that’s like, oh, it’s normally it’s just this, it’s really trying to explain all the different things that we may be prone to from the literature and also say, okay, which ones do you feel like you’re struggling with? Let’s start there.

Stephanie Brenner, LCWS, MSW  29:02 

Even if it’s not at a DSM level of you’ve met all these criteria, and it’s been for this long and you’re you can’t leave the house. But let’s try and we all just want to move towards healing towards a better quality of life towards a more integrated nervous system. So those are the things that I kind of go broad, even though you know, in the literature, I don’t feel like we’re, it’s a little more pointed.

Amber Tresca  29:27 

Yeah. Grab Bag. That’s such a great way to describe it. It’s like the mystery box that nobody wants to know. But unfortunately, we for sure have to open up this grab bag and see what’s see what’s in it, and look at it and bring it out into the light.

Amber Tresca  29:46 

And so when somebody feels as though that they do need to start looking for a professional in order to help them figure out what’s in this grab bag that they don’t want to open. Do you have any advice on how people can start that that process.

Stephanie Brenner, LCWS, MSW  30:01 

Yeah. So glad you’re asking this is the good stuff. Because there’s hope there are people out there providers. You don’t have to suffer alone. Oftentimes I like to speak at support groups or conferences, because I feel like it’s, it’s hitting more people. And it’s decreasing the stigma, but what one on one is golden, because this is your space to go into whatever this is kind of your, your protected time to just organize how has IBD affected me, and my mental and emotional health, but not everyone has access to that.

Stephanie Brenner, LCWS, MSW  30:35 

So if you are in a place where you feel like I really think I might be ready for some support, I usually tell people, depending on where they live, ask your GI, they usually have great connections with people in the community, you’re not the only you’re not the first IBD patient to ask them. I’m struggling, who should I see I need a therapist. Ask your chronic illness friends.

Amber Tresca  31:00 

Yeah.

Stephanie Brenner, LCWS, MSW  31:01 

And if you need someone, if you want to find someone specifically, who deals with a lot of Gi, there’s a organization called Rome, as in Italy, so Rome, Rome, gi psych, like psychology.org. So it’s all of us gi mental health providers, you can search by your zip code, we’re growing over the last, it’s a newer organization, there’s not enough of us to go around, we’re working with partnerships and things like that. So knowing it might be a long wait to get someone who’s just gi focused and trained through their own foundation.

Stephanie Brenner, LCWS, MSW  31:44 

here’s also Psychology Today, which is like the yellow pages, and I don’t know if you’re older like online dating of for the younger generation, where you can type in what you want your insurance, your zip code and see these profiles and see if it matches. And you can check off chronic illness or chronic pain if you’re a provider. So you can also search that way.

Stephanie Brenner, LCWS, MSW  32:13 

Again, that’s not going to be as gi focused, I would argue any help is better than none, right? So I would love for everyone to have access to an integrated care team with their GI with a GI mental health person. And a dietary like that is the model we’re moving towards. But if you are not getting anywhere going to the Rome gi psych org, and there’s no one that’s taking new patients or there’s no one in your state.

Stephanie Brenner, LCWS, MSW  32:38 

I would also say Psychology Today, you can also reach out to me I’m going to give my email at the end. Just I’ll try and kind of makeshift ask the network of people that I know. It is quite a undertaking. So don’t wait until it’s an emergency if you can mentally you know, just knowing that there can be a shortage just because there is there’s such a demand post COVID of having a provider with an opening. But yeah, there’s it’s worth it. It will help.

Stephanie Brenner, LCWS, MSW  33:12 

There’s also a lot of other resources. So the International Society for traumatic stress studies. That’s what Dr. McBain does. So she has some like fact sheets for medical trauma survivors. There’s books so there’s things if you’re not quite ready, or you’re waiting to get into a therapist, there are other resources. But I would argue having a one on one support that can really thoroughly assess and kind of help you titrate through it. trauma can be really overwhelming. So just know that if you’re trying to do it on your own, and you’re getting stuck, there’s a reason for that. It’s not because you’re not trying hard enough, you might just need a professional. So no shame don’t need to be the hero.

Amber Tresca  33:59 

I love that. Seriously. One of my doctors said that to me. Not long after I was diagnosed, he was like, don’t try to be a hero if you need pain management if you need you know, to the more appointments with a social worker, he was like this is what we’re going to do for you. So I think I think he knew he knew me better than I knew myself at that time.

Stephanie Brenner, LCWS, MSW  34:25 

Yeah.

[Music: About IBD Transition]

Amber Tresca  34:46 

So this is what you do all day, but you’re also living with it in your own body. That’s a lot. How do you cope with these ideas of compassion fatigue or or burnout as you’re, as you’re going through your life managing these, your career and also your, your personal journey with IBD.

Stephanie Brenner, LCWS, MSW  35:08 

Yeah, my conditions, I mean, I had to post cancer, I decided to, I needed to have a firm stop of this is the amount that I can do every day. And then I’ve played with it each year of like, I can have a max of x people a week or a day, I need to have gaps in between it used to be back to back to back to back Nope, because you can jam it in and just really maximize your client load, you don’t do a good work. It’s not also good modeling for my patients who I’m trying to teach the self care tech, right.

Stephanie Brenner, LCWS, MSW  35:44 

Similar to self care, it’s setting boundaries. So having breaks, prioritizing time, meals, snacks in between clients, hydration, I love massage, it’s like the one really safe, calming touch. So prioritizing those, doing the restorative yoga, trying to titrate myself, you know, like just being in my body stretching,

Stephanie Brenner, LCWS, MSW  36:11 

I love comedy. I feel like it’s like the antidote to suffering. So I’m a huge, I love going to comedy shows, and I did improv for the last couple of years and profit therapist, for my continuing ed credits. It was amazing. Wow. So anything that will get you feeling more like yourself, have a great consultation group. So having other people who get it, and who are in it, going through my own therapy, all the best therapists do their own work. You can only take someone as far as you’ve gone.

Stephanie Brenner, LCWS, MSW  36:42 

So knowing if your therapist isn’t seeing someone that might do they believe in their profession? I don’t know, I would ask I, I think it’s an amazing profession. But we’re never done growing. We’re all human. And so realizing like you want someone who’s in that place of I don’t know it all. But I’m here journeying with you. And maybe I’m a little bit ahead, and I can just provide a safe container. But I definitely feel like my own therapy has been a huge getting to go through it as a client, that gives me really valuable input towards how it might feel for the people that I’m talking with. So those are some of the things that help.

Amber Tresca  37:25 

Those are great. I want to lean into the idea of comedy for a minute, because, for instance, earlier in the week, I myself was kind of having a little bit of a down day, you know, it’s like you do something big on a Sunday, then on Monday, you kind of need to keep it a little more quiet. And that was kind of the experience this week.

Amber Tresca  37:48 

So I was actually just went to the Google machine and was asking it for comedy shows and movies. And literally, it was just picking some things off the list. It’s not my normal genre. So I really did I don’t have a go to.

Amber Tresca  38:05 

Do you have any go tos? What are some of the things even I’ve read some really funny books too, you know, so So what do you think like movies, TV shows? Is there anything that you that you love for yourself or even anything that you have recommended to clients or friends or anybody else who’s dealing with a hard time?

Stephanie Brenner, LCWS, MSW  38:25 

Sure. I love Samantha Irby who has IBD I don’t know if you know her. She’s a local. She’s from Evanston, which is where my practices, we’re not friends. She’s a big famous person.

Amber Tresca  38:38 

Oh, do you have a parasocial relationship with her?

Stephanie Brenner, LCWS, MSW  38:42 

Sure, I love her stuff. And I love the amount of poop talk that she does in the most irreverent way. So I would say it’s not a PG, or what would say a clean. Beware, but it’s so refreshing and hilarious. I just saw her when she came to Chicago and talked about her latest book.

Stephanie Brenner, LCWS, MSW  39:04 

And then one of my other favorites, because I’m a breast cancer survivor, Tig Notoro. Both of these are queer comedians, but yeah, just the amount of illness jokes really gets me going. That she talks about having C Diff having being in the ICU, or double mastectomy, but she makes it in such a you’re laughing and you’re crying at the same time because you can so relate, going through PT and like with her little Walker, you’re just picturing these things. And you’re you’re also relating on like a cellular level, like I remember so any those words, I would say those are like my two favorites, but there’s so many more. I feel like it’s becoming the trend to talk about mental illness in comedy, but physical illness who are …

Stephanie Brenner, LCWS, MSW  39:59 

Who else did I see? Um, Hannah Gatsby? Do you know her? She’s from New Zealand, Australia, she does a lot of around illness. So I just love any comedy that can talk about the bizarre world and the experiences that we go through and translate it to the rest of the public who don’t have to deal with this. It’s it really is amusing, in some ways, and it does, it does bring some levity to like some of the heavier topics, you know.

Amber Tresca  40:35 

Yeah, I imagine that that helps a lot. Especially if you’re dealing with your own particular hard time at the moment seeing somebody take it out and expose it to the light and poke a little fun at it. Those are some great suggestions. You almost made like a whole listicle of comedians.

Stephanie Brenner, LCWS, MSW  40:55 

Top I know, there’s so many more, there’s so many more.

Amber Tresca  40:59 

Yeah, well, we will dig those up and put everything in the show notes as long as well as all of the other resources that you came up with, some of which I was aware of, but some of which I wasn’t. So I love that you’re teaching me as well. And so in that vein, please let everyone know how they can find you and how they can get in touch.

Stephanie Brenner, LCWS, MSW  41:23 

So my practice name is kind of lengthy. That’s my email, chronic illness psychotherapy at Gmail. It was probably a rookie move is way too long. And people don’t know how to chronic sometimes in psychotherapy, that’s the name of the website, chronicillnesspsychotherapy.com. Type that in and there’s a forum that you can get in contact if you don’t want to just email.

Stephanie Brenner, LCWS, MSW  41:49 

I’m on Facebook, but I rarely post busy. I don’t Yeah. So I feel like I do sometimes I’ll go through spurts of posting different illness related content, but not not in a way that I’m going to win any awards to sit like, so don’t follow me. Just reach out if you need anything. Because it’s probably underwhelming to be like, Oh, she posted five things in 2018.

Stephanie Brenner, LCWS, MSW  42:17 

Follows Dr. Sasha McBain, she’s on Twitter, or x or just now, but she has great lengths as I was doing her training, I was looking at all and if you are into medical trauma, I just am all the links, all the conversations, all the books and resources so that she’s a much better resource, but I am a great connector. So if you have needs and need to be connected to someone that can help you. I’m there.

Amber Tresca  42:46 

That’s amazing. I’m still going to tell people to follow you on the book face or wherever else because even if the things that you were posting, were not consistent or whatever, when I go to follow you on that page, I’m still gonna get access to everything that you posted in the past. And if there’s something there that’s that’s relevant, and that speaks to me, then then I can find it. And maybe we’ll prod you to do a little bit more, I don’t know.

Amber Tresca  43:13 

But in any case, thank you so much you have taught me as I knew that you would. And then hopefully our listeners are coming away with a better understanding of PTSD PTS that they may be at risk, what to look for, and that there is a whole group of psychologists that focus on this that are doing research, there is help and hope available for us.

[Music: IBD Dance Party]

Amber Tresca  43:38 

We don’t want anyone to feel helpless because we do have resources for them. So thank you so much, Stephanie. It has been really lovely to connect with you. And I appreciate all you’re doing for the IBD community. So thank you.

Stephanie Brenner, LCWS, MSW  43:50 

You’re welcome. Thanks for having me. This is really fun.

Amber Tresca  43:59 

Hey, super listener.

Amber Tresca  44:01 

Thanks to Stephanie Brenner of chronic illness psychotherapy for taking the time to explain the connection between IBD and post traumatic stress. Stephanie is also an accomplished speaker for support groups and conferences. You can find her at chronic illness psychotherapy.com.

Amber Tresca  44:18 

As always, links to a written transcript, everyone’s social media handles and more information on the topics we discussed is in the show notes and on my episode 145 page on about ibd.com

Amber Tresca  44:31 

Thanks for listening and remember until next time, I want you to know more about IBD.

Amber Tresca  44:39 

About IBD is a production of Mal and Tal Enterprises.

It is written, produced, and directed by me, Amber Tresca.

Mix and sound design is by Mac Cooney.

Theme music is from Cooney Studio

Stephanie Brenner, LCWS, MSW  44:55 

My air pod just fell into my slipper. That was amazing.

Amber Tresca  44:56

It ejected. Your air your air pod is experiencing PTSD.

Stephanie Brenner, LCWS, MSW  45:07 

Right? It does not want to be used for any of these purposes

Amber Tresca  45:09 

It doesn’t wanna be there.

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