The Mind-Body Connection in IBS and IBD Featuring Ali Navidi, PsyD – About IBD Podcast Episode 178

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Amber interviews Dr. Ali Navidi, a gastropsychologist specializing in mental health for people with gastrointestinal disorders. They discuss the importance of addressing mental health alongside conditions like IBD and IBS, highlighting the stigma surrounding these issues. Dr. Navidi explains cognitive behavioral therapy (CBT) and clinical hypnosis, emphasizing their effectiveness in managing symptoms. He also shares insights on the challenges of accessing mental health care and introduces a new therapeutic group program for IBD patients developed in collaboration with the Crohn’s and Colitis Foundation, aimed at making treatment more accessible and affordable.

NEW! Watch this episode on YouTube: https://youtu.be/k9TAupEcRtk

  • Mental health challenges associated with inflammatory bowel disease (IBD)
  • Stigma surrounding mental health in gastrointestinal disorders
  • The connection between mental and physical health in digestive disorders
  • Disorders of gut-brain interaction and their implications
  • Importance of seeking support and building a network for mental health
  • Role of cognitive behavioral therapy (CBT) in treating GI disorders
  • Use of clinical hypnosis for managing pain and anxiety
  • Access to specialized mental health care for patients with GI disorders
  • Development of therapeutic groups for IBD patients
  • Need for specialized training for mental health professionals in GI disorders

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Transcript

[Music: IBD Dance Party]

Amber Tresca 00:00:05  I’m Amber Tresca, and this is about IBD, the podcast that knows that you can have IBD and IBS at the same time.

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 and ulcerative colitis about their disease, and to bring awareness to the patient journey.

Welcome to episode 178.

We know that people with IBD tend to have more challenges with their mental health. Yet it is still not common to be referred to a mental health professional. On top of just getting started with finding a therapist, there’s the cost to consider. Whether or not therapy is covered by insurance is all over the map, which puts it into the nice to have bucket when it should be one of the essentials for managing IBD. My guest is Doctor Ali Navidi. Doctor Navidi is a gastro psychologist, which means he specializes in helping people with digestive disorders with their mental health. Doctor Navidi sets the record straight on cognitive behavioral therapy and clinical hypnosis.

Amber Tresca 00:01:07  In particular, he explains why you may have tried CBT in the past and found it didn’t work, and how clinical hypnosis has a bad reputation when it is actually a useful tool for people living with chronic illness. Doctor Navidi is a licensed clinical psychologist and the co-founder and CEO of GI Psychology, a national telehealth practice that treats patients with gastrointestinal disorders. He understands a broad range of GI conditions and is trained in clinical hypnosis and cognitive behavioral therapy. Doctor Navidi, welcome to About IBD.

Dr Ali Navidi 00:01:47  Amber, thank you for having me. I’m happy to be here and happy to have this conversation.

Amber Tresca 00:01:53  Me too. I have really been looking forward to this. My first question though, I just want to know a little bit more about you. Would you tell us what brought you to psychology, and then what inspired you to specialize in GI health?

Dr Ali Navidi 00:02:09  Yeah. Psychology, that was an interesting road. And it and it basically was driven by hypnosis, as, like, I think it was maybe in my 20s. I found this book on hypnosis.

Dr Ali Navidi 00:02:30  It was like this old school little black book and, and in a very old style, like. And if you don’t know anything about hypnosis, it’s really the style of using it has changed a lot over the years, but that’s a whole different conversation. so anyway, I found this book and it was a family vacation. And just for fun, I went and used the book to hypnotize my sisters and cousins and stop it. And it worked on some of them. It didn’t. My aunt was great. Like she was awesome with it. but that’s how it kind of started. And I just kind of had an interest in hypnosis and psychology since then. And, I wasn’t very good at choosing professions, so I actually got a degree in microbiology, and, and, started working in biotech, and was about to get my degree in, about to start a degree in, doctorate in, like, biochemistry. And then I finally, like, saw the light and, shifted gears.

Amber Tresca 00:03:42  You know, sometimes I’m a little on the fence about asking people why they got into their profession because sometimes the answer is really not terribly interesting.

Amber Tresca 00:03:53  I am super glad that I asked you that question. Yes, Yes. So this is a little bit of an aside, but I can’t let this go by. So, how did you talk people into letting you hypnotize them? That seems like a really high level of trust that you must have had with with your siblings and and your family.

Dr Ali Navidi 00:04:16  Yeah. This is this is all siblings. This is all family. And and it’s fun. Like, people are fascinated by hypnosis. There’s this love hate relationship that we have as a culture have towards hypnosis. You know, on the one hand, we think of it as this, like the devil’s tool. And it’s like mind control and evil magic and and on the other hand, it’s this amazing thing that can magically let you know more about yourself. And so we have all these cultural beliefs about hypnosis that I think for, for, for kids and teenagers at the time is almost it’s almost irresistible, right? Yeah.

Amber Tresca 00:05:02  That makes sense. It was like candy.

Amber Tresca 00:05:03  Let’s see what we can do here. You know. Yeah.

Dr Ali Navidi 00:05:07  Yeah. And I’d love. Maybe later I can speak about what it actually is versus, you know, everything that the movies and, you know, stage magic have have shown us, right?

Amber Tresca 00:05:24  Yes, 100%. We absolutely need to get to that topic. My first topic, though, is, is to talk about stigma. much less entertaining than the story of how you came to be interested in hypnosis. But, you know, we hear a lot in the chronic illness community that we’re we’re told that our symptoms are all in our head. and it’s uncomfortable to talk about digestive problems in the first place. So these two things together, people might wind up just keeping their feelings about having IBS or having IBD to themselves. so I’m wondering if you have any thoughts and I’m sure that you do. About how we can help people overcome these ideas and to, to better address their, their mental health when it comes to GI disorders.

Dr Ali Navidi 00:06:17  Yeah.

Dr Ali Navidi 00:06:17  So so my view of stigma is that it’s always best to start within and then kind of move outwards. Right. So, you know, obviously it’s hard to fix everyone else’s opinions, especially until you fix your own. Right. So if, if the person and by the way, it’s all in your head is like this huge pet peeve of mine. because if you just think about the statement, it doesn’t make any sense. How could it be all in your head if it’s also in your gut? If it’s also in your nervous system, if it’s. You know what I mean? Yeah, it’s it can’t be all in your head because the symptoms are real, right? Like things are happening in the body. So regardless of whether you’re talking about IBD, which, which is a disorder of the immune system, or you’re talking about IBS, which is a disorder of the nervous system, right. it can’t be all in somebody’s head or we wouldn’t even be talking. It wouldn’t be a problem.

Dr Ali Navidi 00:07:31  The fact that it’s in our body and our body is connected to our head. Now, that’s a different story, because of course, the body is connected to the head. So, of course, what happens in our head affects our body. And what happens in our body affects our head. That’s obvious because we have a neck.

Dr Ali Navidi 00:07:50  You know.

Amber Tresca 00:07:52  Most of us.

Dr Ali Navidi 00:07:53  Most of us have necks. So of course there’s mind body interaction. It would be very weird if there wasn’t. Yeah. Yeah. So I think that’s the first step is like, let’s throw out this. It’s all in your head kind of talk. Because it obscures, a lot of the subtleties and nuances about these different disorders. yeah. I think that’s the first step is like, realize, okay, that is a ridiculous statement and that these are, profoundly difficult disorders to live with. no matter the severity. Just as difficult as any. Not in your head disorder. I can’t even say that phrase without getting worked up.

Dr Ali Navidi 00:08:43  but, yeah, these are very difficult disorders to deal with, and that should be appreciated right off the bat. And, once you understand that, it takes a lot of courage and a lot of, hard work to deal with either of these problems. Then you need to realize that, you know, we aren’t. We don’t live in isolation. And that however you can do it, it’s best to have a group, a society. you know, your friends, your family, as many allies, as many, supporters as you can get. And maybe the first few. Getting them is going to be a little anxiety provoking, but it’s definitely worth it. It’s definitely worth it.

Amber Tresca 00:09:26  So as far as internalized stigma is concerned, I haven’t really thought about it in that way, but that does make sense that you kind of have to get over your internalized stigma first. Is there I don’t know, is there a roadmap for that? How do people how can people start?

Dr Ali Navidi 00:09:47  Well, I think the start it should it should come with working with somebody.

Dr Ali Navidi 00:09:54  Whether you’re you’re talking to someone else who has the disorder, whether you’re in a support group, whether you’re talking to a therapist or a GI psychologist. it’s hard to see your own blind spots. It’s hard to see where you might be too hard on yourself, or you might be looking at yourself from a distorted view. Because when it when it comes to things that are very personal and very painful, that’s where we tend to not see things so clearly. So when we’re working on our own internalized stigma, it’s good to have help, right? Because it’s just hard to be objective when it’s so, so such an internal, difficult, painful thing that we’re talking about.

Amber Tresca 00:10:45  Right. That makes a lot of sense. And in the past, IBS and some other conditions too, were, I don’t know, they were called all sorts of different things. You know, diagnosis of exclusion, this type of thing. But now we’re referring to them as disorders of gut-brain interaction. I think that’s a new one on some folks.

Amber Tresca 00:11:07  So I wonder if you would explain a little bit more about what that means.

Dr Ali Navidi 00:11:12  Yeah. So in 2017, the Rome Foundation changed their designation. And these disorders used to be called functional disorders. Functional disorders is, in my opinion, kind of a lame name for a disorder because it just doesn’t tell us anything. All it means is that your function is messed up in some way. It doesn’t talk about why, it doesn’t talk about any like the roots of it. It just says, oh, the functions messed up. And other than that, we don’t really know much. It’s kind of like they’re giving up when you call something a functional disorder. Whereas DGBI, disorders of gut brain interaction. It’s actually starting to give us something. Right? It’s pointing us in a direction and it’s saying, okay, we’re not like just throwing up our hands and saying we don’t know. We’re saying, okay, the the evidence is is beginning to point to, that this is an interaction between the gut, the enteric nervous system and the central nervous system.

Dr Ali Navidi 00:12:25  And the way they’re interacting is creating these negative feedback loops that are causing all kinds of problems for the gut. Okay. So now we have like a lot more information. So I actually like the title a lot because it starts to point us in the right direction and how we might improve things.

Amber Tresca 00:12:45  And people might not realize that you can have IBD and that you can also have IBS, which might explain to some people why they tend to get the IBD under control and their labs look good and all of that, but they’re still having symptoms. Can you talk a little bit about how this this crossover can impact people?

Dr Ali Navidi 00:13:07  Yeah, you I think you explained it really well. It can be very frustrating because you work hard to get your labs under control. You know, you’re you’re trying to live a good lifestyle. You’re taking your meds, you’re doing everything right. And then the labs are good. You should be feeling good and yet you don’t. Yeah, right. and so there’s actually two problems occurring here, right? There’s there’s IBD, the immune system is under control.

Dr Ali Navidi 00:13:37  That’s good. And then there’s IBS or another one of the disorders of gut brain interaction because there’s many different these disorders. And so that solved differently. The same medications that are helping your IBD aren’t going to touch IBS, right? Because it’s a whole different, issue. It’s a problem with the nervous system needs a whole different kind of treatment. Right. There was a patient I worked with, Zach, and he came to me when he was a teenager, and he had that exact situation. Except it wasn’t IBS. It was kind of a vomiting disorder. So whenever he wasn’t on, like, high dose steroids, he was vomiting multiple times a day, even when his IBD was under control. Right. And they were considering doing various types of surgery and, luckily came in and we treated the disorder of gut brain interaction, the vomiting problem. he responded really quickly. Hypnosis worked well for him, and it actually ended up being a story that was covered because Zach wanted to let his, you know, let people know about it.

Dr Ali Navidi 00:14:50  So he ended up talking to a reporter with The Atlantic. And so there’s a story that got published a few years ago, which, I was really glad that it did, because it talks about that issue and it got the word out to more people. so the the answer is there are two different things need two different types of treatment, but it’s very, very treatable. Oh, and I didn’t mention but the treatments out there for these jeebies like IBS and other disorders, like they’re very effective. Like 80% like I actually know I think I mentioned that, but 80% will meet their treatment goals. So there’s no need to just live with these problems because they’re very treatable.

Amber Tresca 00:15:34  So when somebody comes to see you and say that they already know that they have IBD, and then they also have, let’s say IBS.

Dr Ali Navidi 00:15:44  Yeah.

Amber Tresca 00:15:45  Would the treatment focus on the two together? The two separately, like you know. Is there a distinction there?

Dr Ali Navidi 00:15:53  Yeah. So you would do kind of a comprehensive intake. You’d want to understand what’s happening.

Dr Ali Navidi 00:15:59  So maybe there’d be pain and discomfort from IBS. Maybe there’s medical trauma from from IBD. Maybe there’s a history of anxiety or depression. You know, you want to understand the bigger picture. And then you’d work with the person collaboratively, collaboratively to figure out, okay, like where do we want to start? What’s going to give you the biggest bang for your buck? Is it if we go after the IBS first? Is it we deal with the anxiety or maybe we want to deal with the trauma. Like we make a plan together after we’ve kind of gotten the big picture.

Amber Tresca 00:16:35  That makes sense. I am coming to believe that I think that everybody who has IBD has some kind of medical trauma that you almost just can’t get away from it.

Dr Ali Navidi 00:16:44  Yeah, yeah, it’s hard not to. Especially if you combine like, trauma with stigma.

Amber Tresca 00:16:52  Yes.

Dr Ali Navidi 00:16:54  And we know stigma is going to make the traumatic reaction worse. And so, you know it’s hard to get away from it. You’re right.

Amber Tresca 00:17:04  They’re feeding off each other.

Dr Ali Navidi 00:17:06  Yeah.

Amber Tresca 00:17:12  Up next, Doctor Navidi tells us why we have the wrong idea about clinical hypnosis. Doctor DVT, let’s talk more about clinical hypnosis. You already went through a couple of the misconceptions that people might have about it. So can you tell us how hypnosis is actually used in people with GI disorders.

Dr Ali Navidi 00:17:44  Yeah. So it’s a tremendously powerful tool. It’s got a lot of a lot of uses. So that’s why I kind of get a little overwhelmed because there’s a lot of different things you can use it for. we can start with a very straightforward use, which is working with pain. Right. So whether you’re talking about IBD or you’re talking about IBS, you know, pain is often a component of these of these problems. And what I think most people don’t realize is, and this maybe comes from the it’s all in your head kind of thing. All pain is in your head. And what does that mean? That means that if we did not have a head, if we did not have a brain, nobody would have any pain because the signals from our body are processed by our brain.

Dr Ali Navidi 00:18:38  There’s no pain until the brain processes things, right. And what that means is that treatments that can affect the brain can affect pain. And so there’s a lot of different techniques using hypnosis that people can use to change the way they experience pain, to reduce pain, to change the way that they’re emotionally reacting to the pain. There’s this great researcher called Mark Jensen. His name’s Mark Jensen, and he, does a lot of interesting neuroscience and clinical hypnosis research. And he can show you the different parts of the brain where these different hypnotic suggestions are influencing. Right. Like it gets that specific like, okay, this suggestion to reduce the pain, this is showing up in this area. Whereas the suggestion that the pain won’t bother you as much. That’s showing up in a different part of the brain, right? So all that to say that one of the great uses for clinical hypnosis is in helping people manage pain.

Amber Tresca 00:19:53  Interesting. Now, you said earlier that your first foray into, hypnosis, you had some subjects who were more susceptible.

Amber Tresca 00:20:05  Is that how you phrase it? And then others that maybe were were less. How does that work? Would someone know before they came to see you that this was going to be something that would work for them?

Dr Ali Navidi 00:20:17  That’s a great question because a lot of people have that as a concern. now and the term is susceptibility and I don’t like that term. Yeah. The term I prefer is hypnotic talent. Nice. Right. Because I think if you’re good at hypnosis that’s an amazing talent. That’s something that, you know, you owe it to yourself to develop Because you can do a lot with it. You know, you can use it to to manage your anxiety. You can manage pain. You could help to change bad habits. Like it’s a it’s a nice tool to have. So I see it as a real talent. So when they’ve studied this they found that it’s normally distributed in the population. So it’s like you know the bell curve right. And so there are certain people who are just like phenoms.

Dr Ali Navidi 00:21:05  They’re amazing. There’s videos I could show you of them getting surgery with their eyes open, talking to their surgeon while they’re cutting out. You know, it’s just amazing. Yeah. and then there’s the other end, right? And there’s. So there’s the small group who’s amazing. Small group who’s just, like, talking to a brick wall. They just cannot, wrap their brain around the skills involved for using hypnosis. And so you have these extremes, but then most people are in the middle. And unless we’re prepping you for surgery, you don’t need to be amazing. You just need you to not be terrible. Right?

Amber Tresca 00:21:48  Yeah.

Dr Ali Navidi 00:21:49  And most people are going to be average. And average is just fine. To to benefit, you know, to reduce your pain, to use it for anxiety or something like that, like average is going to be just fine.

Amber Tresca 00:22:02  So it sounds to me as though, because you’re talking about it as a skill, that it is something that people can improve over time if they practice it.

Amber Tresca 00:22:14  Does that sound right?

Dr Ali Navidi 00:22:16  Yeah, absolutely. I can give you just a, a really simple example. Everybody’s kind of heard of Pavlov, right? Like, ring the bell and the dogs are drooling. Yeah. Well, there’s similar concepts. We use that in psychology. And so when we use hypnosis, we create something called an anchor. So let’s say I just did this today. Actually, I it was a really anxious, young man. And, I taught him how to use hypnosis to calm himself down. Right. And it took about ten, 15 minutes, something like that. And he was feeling really relaxed at the end of it. But I don’t want him to have to, you know, come and find me every time he needs to come himself down. I need him to learn to do it. So we created an anchor, and that’s that’s, we picked, like, the left fist. So he makes a fist. And then it just automatically relaxes very deeply. So we created this conditioned response.

Dr Ali Navidi 00:23:21  And the more he uses it, the more automatic it’s going to be, the more powerful it’s going to be. Because, one of the things they say in neuroscience is, I don’t know, I’m going to forget it. Neurons that fire together. Wire together.

Amber Tresca 00:23:38  Okay.

Dr Ali Navidi 00:23:39  Right. That’s pretty common. And so the idea is that we’re pairing these two things over and over again. Left fist relaxation. Left fist relaxation. The more he does it, the better he gets at it. The more he can relax himself when he needs it.

Amber Tresca 00:23:56  It’s so interesting. So it took 10 or 15 minutes. Is that common? Can it take longer? Is it, you know? Do people need to see you for a series to to learn how to do that for themselves?

Dr Ali Navidi 00:24:06  Yeah. That’s, that’s another good question because, to go to learn, to go into trance for the first time, it could be as short as ten minutes. Wow. you can take much longer and and do a much more thorough.

Dr Ali Navidi 00:24:21  Kind of, like, very relaxing, type of trance. And that’s in the session. But what the research has shown, like, let’s say if we’re working with someone with stomach issues, they might start to get relief after, you know, let’s say three sessions. So maybe three weeks later, they’re already starting to feel better. But what the research shows is that it’s better for them to do the full like eight sessions.

Amber Tresca 00:24:51  Okay.

Dr Ali Navidi 00:24:53  because there’s something about completing all those other sessions that just really burns it into the brain. That makes it like a lasting change. And there’s something about, you know, 8 to 10 sessions. It’s like this magic number that they’ve kind of gotten it. So if it’s going to help them, often it’s you’re just you’re going to know it. So. So that’s the other nice thing. It’s a relatively short term treatment too right. Yeah.

Amber Tresca 00:25:22  Yeah I think from a lot of the research that I’ve read, it always does seem to be somewhere between 6 and 10 sessions that are tried for these before they look at outcomes.

Amber Tresca 00:25:31  So that’s so interesting. But it makes sense. You’re building a new habit, you’re not going to get it just from a 15 minute session. It’s going to take a little longer. So that does make sense.

Dr Ali Navidi 00:25:41  Right? It’s like that three month mark something around there you know.

Amber Tresca 00:25:45  Yeah. To build that habit and then to make it to make it stick. Gosh this is so interesting. You’ve already just told me what like so many things that I did not know. It’s fantastic. but I also want to talk about cognitive behavioral therapy because I think that’s another thing which, you know, the research shows over and over again that it works. But, you know, it doesn’t seem like very many people have access to it or understand what it is. So I’m wondering if you can explain a little bit about CBT and how it works for GI disorders.

Dr Ali Navidi 00:26:20  Yeah. So, the first thing I think to understand is there’s general CBT and you can pretty much find that anywhere most therapists are going to be trained in, in some version of it.

Dr Ali Navidi 00:26:36  The problem comes is that for GI disorders, there’s specific protocols that have been developed and most therapists are not going to be trained in those. And that’s where the difficulty comes because a lot of doctors will, you know, read the research and be doing a really good job and say, oh, this is helpful for IBS, and then they see their patient and they say, oh, you should go out and get some CBT. And the patients like can do and they go in the community and they get their CBT and it doesn’t really help their, their GI issue. and the reason is it’s because that person is probably not trained to specifically like work with those protocols.

Amber Tresca 00:27:18  Right?

Dr Ali Navidi 00:27:19  So that’s one thing to understand now, in general, how does CBT work? Well, a key component for a lot of these problems is something called hypervigilance, and that’s usually paired with catastrophizing. So in practice, the person is always scanning in an anxious way, scanning their body, looking for issues, and then when they feel something that feels a little off, their brain goes, what the.

Dr Ali Navidi 00:27:49  And just freaks out and thinks of all the worst case things that could happen. Now, if that was the end of it, that would be really uncomfortable and difficult. But a lot of these patients are wired in such a way that stress and anxiety, you don’t just feel it up here. It travels down to your gut. Yeah. And starts causing more symptoms. So then you get all these symptoms happening like an increase in symptoms. And that hypervigilant brain is noticing all of them and catastrophizing even more. So what CBT does is that it brings that process to people’s awareness and then gives them tools for changing those mental habits. That habit of hypervigilance. That habit of catastrophizing. CBT is, well, a big part of CBT is about helping people change the way they think. And those are two examples of habits of mind.

Amber Tresca 00:28:52  It sounds like CBT would be the technique to go to, for instance, something that a lot of us who live with IBD and IBS recognize is the the looking for the next bathroom and then worried you’re not going to be able to find it.

Amber Tresca 00:29:08  And then of course, then you need to use the bathroom because you’re looking for a bathroom.

Dr Ali Navidi 00:29:13  Yes, yes. Well said. and and looking for the looking for the bathroom phenomena is an example of that hypervigilance. Right. And then it’s and as you know, it’s probably often paired with that catastrophizing. If I can’t find a bathroom. Then I just can’t go there. And why can’t I go there? Because this catastrophic, terrible thing is going to happen. And. And the other thing people should understand is that when we think catastrophically, our brain doesn’t know the difference between our imagination and reality. So when we imagine having, you know, a terrible accident in public, the brain processes this as if it’s real. So it gives you the same level of fear, anxiety, you know, sadness, shame, you know, all those different emotions as if it were actually happening. which obviously for the person is just terrible. but the good news is again, CBT is about teaching people how to think in new ways that that aren’t going to work against them, that’s going to support what they want in life.

Amber Tresca 00:30:36  Right. So but people do need to be aware that there’s a specific way to go about it for a GI disorder, that that’s maybe a specialized form of training.

Dr Ali Navidi 00:30:49  Yeah. Yeah. So I think over the years, a lot of patients have come to me and, and I start talking about treatment and what it’s going to look like. And I talk about CBT and oh, no, I already did CBT. Yeah. It didn’t help. And I’m like, well what exactly did you do. Right.

Amber Tresca 00:31:10  Yeah.

Dr Ali Navidi 00:31:11  Because the CBT you might have been doing would have been maybe was great for anxiety. but the specific types of anxiety and the specific types of problems that people, let’s say, with IBS face are, are not the same as somebody with an anxiety disorder.

Amber Tresca 00:31:31  Right. So when you’re looking for a practitioner that’s something that you need to specifically look for. Or maybe ask if they’ve been trained. Yeah exactly. Interesting. Okay. That is very good to know because I did not know it.

Amber Tresca 00:31:46  so even with all of the, you know, the work that I do and in speaking to, you know, other healthcare professionals and lots of patients, that distinction has never come up before. So it’s so interesting.

Dr Ali Navidi 00:31:59  Well, that that is why I’m here, because, the gap between the research.

Dr Ali Navidi 00:32:05  Yeah.

Dr Ali Navidi 00:32:06  And what people, the information people actually have is massive. And I figure somebody’s got to get out there and start chipping away at it.

Amber Tresca 00:32:17  Absolutely. And that that’s something that I see in a lot of different areas all of the time. You know, we have all these amazing guidelines. I’m so glad that they’re there, that how ulcerative colitis should be treated. And then yet I hear from patients all the time that that is not. You know, no one is going through the guidelines with them and and doing things in that way.

Dr Ali Navidi 00:32:42  Right, right. Yeah. I mean, just as an example of that, like it’s built into the guidelines for IBS by the American College of Gastroenterology that these types of treatments be used.

Dr Ali Navidi 00:32:56  Right. Got focused CBT, clinical hypnosis. How many people know that.

Amber Tresca 00:33:04  Or are being referred or are being referred to the proper professionals for it?

Dr Ali Navidi 00:33:08  So yeah.

Amber Tresca 00:33:11  Oh, again, that’s why we’re here. but to that end, to be referred first. You need to be referred to somebody and hopefully it’s the right person. But so that’s access. And then there’s also Cost. And I’m thinking in particular of my community, people with IBD. We have a lot of other medical bills. We have a lot of other medical appointments. It’s tricky. So do you have any suggestions about ways that people can get mental health care that’s more accessible?

Dr Ali Navidi 00:33:45  Yeah. So so stepping back, it’s like, okay, there’s such a lack of providers. I think at last count there were like 5 or 600in the world who were trained in gut brain therapy. which which is why myself and another psychologist, we started GI psychology. because there just weren’t there providers out there. And so I’ve been in charge of training.

Dr Ali Navidi 00:34:12  And we’ve got 14 well-trained clinicians at this point. And we can do telehealth all over the country. which is not an easy thing to figure out how to do. Yes. We’re trying to build that pool of providers up. But what about the costs? Because we’re out of network. Well, there’s two things I think that can help with that. One is something that I think most people haven’t heard of, which is a single case agreement or in other terms, it’s called a GAAP exception.

Amber Tresca 00:34:50  Okay.

Dr Ali Navidi 00:34:51  But long story short, it’s basically you ask your insurance, hey, do you have gut brain therapists in network for me? And the answer is always no, I do not. And and if they don’t, then you apply for this gap exception. And if it’s granted, then they reimburse you as if we’re in network. And our admin help the patients actually apply for that. And a very high percentage. Get it? Who have private insurance? They get it. The other thing. So that reduces costs a lot.

Dr Ali Navidi 00:35:32  And a lot of our patients get those. The other thing is something that’s kind of exciting that we talked about right before we started, which is the work we’ve been doing with the Crohn’s and Colitis Foundation. And I know it’s been at least over a year we’ve been working on this maybe longer. but in conjunction with them we’ve created an, a therapeutic group for IBD patients. So it’s a therapeutic group. It’s an eight week program. It integrates cognitive behavioral therapy specifically for GI disorders and then clinical hypnosis. also for for IBD. And it’s all tailored specifically for IBD patients. And we even, have one session dealing with the issue of stigma and changing internal stigma. So there you go. And and the group format, of course, is a lot less expensive than seeing somebody individually.

Amber Tresca 00:36:32  Right. Do you imagine patients might think about self-pay for that type of thing, or do you think insurance would cover it?

Dr Ali Navidi 00:36:40  It does cover it because it is. So there’s like kind of two different groups we offer.

Dr Ali Navidi 00:36:44  There’s one that’s more of a workshop. And that’s like a four week skills workshop and that’s not covered. But therapeutic groups are covered because it’s kind of like a, you know, it’s a therapy. And so insurance will cover it. So that’s nice. So it’s already cheaper and it gets reimbursement by insurance. And oh go ahead. Sorry.

Amber Tresca 00:37:11  Well I was just going to say how is licensing handled. Because I know for myself if I’m traveling my therapist is in Connecticut. But if I’m in Florida, we can’t have a session. So how does that work?

Dr Ali Navidi 00:37:25  Right, right. So, like I said, it, it takes a lot of administrative, hoops to jump through. but so psychologists have something called psypact. Okay, psypact is an interstate license reciprocity agreement.

Amber Tresca 00:37:43  Okay.

Dr Ali Navidi 00:37:44  So what that means is, like Maryland honors your the license you have from like, Illinois, let’s say. Right. And so there’s 40 something states for psychologists that have agreed to this. So basically one psychologist could see patients in like 40 something states.

Dr Ali Navidi 00:38:05  So we use that to kind of get broad coverage. And then the states that aren’t included, we’ve gone and gotten individual licenses in those states. So we can say that we’re covering all 50 states, which we are.

Amber Tresca 00:38:20  Wow. That’s amazing. So do you have a timeline yet when this is going to be available to people?

Dr Ali Navidi 00:38:27  Yeah, so we’ve already started it enrolling like at GI psychology. We’ve already started enrolling the very first group. We’re already, you know, inviting people to join. And doctors are starting to send their patients and then on on Crohn’s and Colitis Foundation and I think that should be announced within a month or so. And once they announce it, they’ve got a hotline, that they have for patients that if they’re calling for financial stuff or they’re calling for questions for medications or any number of stuff, they’ve got this hotline and then the and we’re training the hotline, personnel, about who’s a good fit for the group. So they can also start recommending it to.

Amber Tresca 00:39:13  Oh, perfect.

Amber Tresca 00:39:15  Oh, wow. That’s amazing. This is going to be so helpful to so many patients. I just I can’t get over it. It’s just. It’s just an amazing thing that you’re doing, so.

Dr Ali Navidi 00:39:25  Oh, well. Thank you. Yeah. We have, one of our clinicians actually also has IBD. and she was generous enough to be our first test subject. once we, you know, myself and another clinician who developed it, and, she, she loved it. She actually had, not after like it was. She was about halfway through, and she had a medical procedure she needed to go through. And she told us about how she used the skills that she got from the class to, like, help her with the pain and discomfort for the procedure. I was like, this is perfect.

Amber Tresca 00:40:02  Yeah. Wow. What a great, test subject she was.

Dr Ali Navidi 00:40:07  Yeah, absolutely.

Amber Tresca 00:40:09  I’m always amazed when people have IBD, and then they also are a healthcare professional in some aspect of IBD because I mean it well kind of ends up taking over your whole life, I guess, but also to to to live with one of these diseases that is so challenging at times.

Amber Tresca 00:40:31  And but then be able to help others is is just really amazing. I’m always in awe of people that can do that.

Dr Ali Navidi 00:40:38  Yeah, and she’s incredibly passionate. Her and another person who works for us, they recently did the, take steps, the one in DC and one in DC recently. I’m sure there’s they have them all over the place. but there was one in DC, and, and she just loved doing it because, you know, she could connect with all these people that, you know, they they all share kind of similar challenges.

Amber Tresca 00:41:10  Yeah. We almost never meet other people like us out in the wild. So going to those events is really very helpful.

Dr Ali Navidi 00:41:18  Yeah. Yeah.

Amber Tresca 00:41:20  Okay. Doctor Navidi, let’s finish up by letting everybody know where they can find you. Where they can find GI psychology. and I guess if you have any thoughts about how they can get connected with one of your upcoming groups.

Dr Ali Navidi 00:41:34  The main website is GI psychology, and we offer a free phone consult.

Dr Ali Navidi 00:41:41  And so just sign up for one of those and they’ll tell you about the group and they’ll sign you up for it or and they’ll they’ll even answer all your questions. We have someone who’s clinically trained who will, you know, do those phone calls. Usually it’s, a graduate student who we’ve, like, given them a lot of training so they can answer all your questions about treatment and things like that. So that’s a that’s a really easy, free place to start, you know, getting all your questions answered. in terms of social media, I have to look this up special because, you know, I’m not good with the social media. Instagram. I think we’re on, GI psych USA. So Gypsy, C-H, USA and then Facebook. It’s just GI psychology, right?

Amber Tresca 00:42:38  Perfect. yeah. I will put all that information also in the show notes and on my website at about as well so that people can find it. And Doctor David, thank you so much for speaking with me. This is really incredible.

Amber Tresca 00:42:54  This. I think what you’re doing here is really going to revolutionize the way people see mental health care as it intersects with IBD, and is going to make it available to so many more patients. So thank you so much for what you’re doing.

Dr Ali Navidi 00:43:08  Well thank you. That means a lot coming from you. And, I appreciate it. And glad to hear that we’re on the right track and we’re going to keep trying to make these services available to people. So thank you.

Amber Tresca 00:43:26  Hey super listener, thanks to Doctor Navidi for taking the time to talk to me about the different types of therapy and how they work for IBD and IBS. You can get links to his practice, GI psychology, and the small group therapy sessions he developed in the show notes. And on my episode 178 page on about IBD.

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

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. 

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