I attended a webinar recently (June 2023) entitled 'Autism & GI Disorders' (GI meaning Gastrointestinal), as I work a lot with people who are on the spectrum and I want to understand more about the link between the two. The webinar was led by Dr. Ali Navidi or gipsychology.com, an organisation in the US that treats people with gastrointestinal issues.
I'm going to share here what I learned in case it may be useful for people on the spectrum.
Disorders of gut - brain interaction (DGBIs) are disorders where there is no known cause (unlike issues where there is a cause such as an ulcer or visible inflammation).
It's called 'interaction' because DGBIs develop as a result of the break-down in interaction between two nervous systems - the central nervous system and the enteric nervous system.
Relative to comparison groups, children on the autistic spectrum have significantly more GI symptoms (abdominal pain, diarrhea, constipation etc) (McElhanon et al 2014), and autistic children are four times more likely than non autistic children to develop GI problems.
In the webinar, Dr. Navidi described how stress and anxiety feeds down into the gut, causing sensations. The signals that then go back up to the brain are dialled up (as if someone has turned up the volume too high) and this is called 'visceral hypersensitivity'. It's like a feedback loop that gets amplified:
The person anxiously scans their stomach for signals which leads to catastrophising and stress, which leads to more pain etc. The visceral hypersensitivity can mean that even normal processes such as digestion can be then be perceived as pain.
Additionally, ASD people may miss cues internally if they are under-responders to neuroception or are caught in a hyper-focus tunnel.
So what's the way to address it?
The aim is to break the cycle as seen in the picture above. The webinar suggestions for addressing this were :
- CBT specifically tailored to DGBI issues
- Clinical hypnotherapy, also tailored to breaking the cycle.
It was stressed in the webinar that not all CBT is created equal so it is essential to find a CBT that fits with a neurodivergent person. The aims of these treatments are:
- relaxation training to reduce anxiety and build emotional regulation skills
- reframing unhelpful thoughts which decreases helplessness and builds emotional resilience
- behavioural exposure
- interoceptive exposure
It was highlighted that clinical hypnotherapy can be very helpful in supporting a person to address breaking the cycle, and that it is very easy to learn. The only caveat mentioned was that it would not be suitable for people who have strong concrete thinking (a lower access to imagination).
My final thoughts: I would highly recommend seeking out tailored CBT or hypnotherapy if it feels appropriate. I do offer focusing-oriented therapy which can help with developing the skill of interoception.
My notes from the webinar are available if you would like to view them as a different way of absorbing the information here!