Applying What We Know: Conceptualization and Intervention of Visceral Pain Through a Cognitive-Behavioral Lens

Psychological processes can influence symptom experience in gastrointestinal (GI) disorders, where visceral pain is a predominant symptom. Attempts to protect oneself from pain can trigger maladaptive cognitive-affective and behavioral processes, such as hypervigilance, visceral anxiety, and avoidance behaviors. These responses are reinforced when symptoms decrease in the short-term, resulting in long-term adverse consequences. Given the role of gut-brain dysregulation in symptom etiology, research has historically focused on disorders of gut-brain interaction (irritable bowel syndrome, functional heartburn). However, principles of classical conditioning and fear-learning are increasingly implicated as mechanisms of visceral pain perception and modulation across the GI spectrum, including organic disease. Given the modifiable nature of these processes, behavioral intervention has proven effective in decoupling learned associations and teaching effective skills. Consistent with a cognitive-behavioral framework, treatment focuses on psychoeducation about the gut-brain axis, skills-training in relaxation and adaptive coping, restructuring unhelpful thinking patterns, and behavioral exposure. This talk will review the translational aspects of visceral pain perception and modulation, specifically focusing on conceptualizing a patient’s symptom experience through a biopsychosocial lens and applying brain-gut behavioral therapy to the GI patient population.