ABSTRACT
This chapter details five different (hypothetical) patient protocols showcasing the range of problems that cognitive behavioral therapy (CBT) can be helpful for in patients with inflammatory bowel disease (IBD). One of the patients has no psychiatric comorbidity and just needs help transitioning to adulthood and thinking through what role Crohn’s will play in his identity. Another patient has relatively mild ulcerative colitis and meets criteria for an adjustment disorder with mixed anxious and depressed mood. A third patient with ulcerative proctitis developed somewhat disabling panic and agoraphobia after suffering from a hospital acquired infection secondary to a routine colonoscopy. A fourth patient had long standing depression and social anxiety in the context of family system issues, and started therapy with poorly managed diet and nutritional deficiencies. A fifth patient suffers from severe, poorly managed Crohn’s and has a lifetime of complex trauma and loss that needed to be addressed. Several of the patients have racialized identities, and one is also an immigrant. Both have experienced systemic racism and racial microaggressions, and bring that lived experience to every encounter in the world, including with new doctors, police, and the therapist. The fifth patient is from a rural area, smokes, and is overweight, and has experienced significant medical bias and poor treatment as a result. In every case, the therapist does their best to address the underlying issues, to be self-aware, and mindful of the patient’s intersectional identities, and to be culturally responsive in the care they give. Together, these protocols illustrate the flexibility and power of modularized, evidence based, IBD informed CBT in addressing the myriad of issues that patients with IBD may need help with.
