Young woman suffering from abdominal pain feeling stomachache, symptom of pms on white background

Psychotherapy may help ease persistent gastrointestinal distress.

Functional gastrointestinal disorders affect 35% to 70% of people at some point in life, women more often than men. These disorders have no apparent physical cause — such as infection or cancer — yet result in pain, bloating, and other discomfort.

Multiple factors — biological, psychological, and social — contribute to the development of a functional gastrointestinal disorder. Numerous studies have suggested that stress may be particularly important, however. The relationship between environmental or psychological stress and gastrointestinal distress is complex and bidirectional: stress can trigger and worsen gastrointestinal pain and other symptoms, and vice versa. This is why psychological therapies are often used in combination with other treatments — or even on their own — to treat functional gastrointestinal disorders.

The enteric nervous system as a second brain

Life-sustaining functions, such as breathing, heartbeat, blood pressure, and body temperature, are regulated through the autonomic nervous system. This complex network of nerves extends from the brain to all the major organs of the body and has two major divisions. The sympathetic nervous system triggers the “fight or flight” response. The parasympathetic nervous system calms the body down after the danger has passed. Both the sympathetic and parasympathetic nervous systems interact with another, less well-known component of the autonomic nervous system — the enteric nervous system, which helps regulate digestion.

The enteric nervous system is sometimes referred to as a “second brain” because it relies on the same types of neurons and neurotransmitters that are found in the central nervous system (brain and spinal cord). After sensing that food has entered the gut, neurons lining the digestive tract signal muscle cells to initiate a series of intestinal contractions that propel the food farther along, breaking it down into nutrients and waste. At the same time, the enteric nervous system uses neurotransmitters such as serotonin to communicate and interact with the central nervous system.

This “brain-gut axis” helps explain why researchers are interested in understanding how psychological or social stress might cause digestive problems. When a person becomes stressed enough to trigger the fight-or-flight response, for example, digestion slows or even stops so that the body can divert all its internal energy to facing a perceived threat. In response to less severe stress, such as public speaking, the digestive process may slow or be temporarily disrupted, causing abdominal pain and other symptoms of functional gastrointestinal disorders. Of course, it can work the other way as well: persistent gastrointestinal problems can heighten anxiety and stress.

Psychotherapy options for gastrointestinal distress

Reviews suggest that several types of psychotherapies may help ease persistent gastrointestinal distress — or at least help people learn to cope with such symptoms. Although this research has limitations — in particular, many studies have been criticized for using a waiting-list control, which does not allow investigators to account for the therapeutic effects of receiving medical attention — the evidence suggests that the following psychotherapies may provide some relief for many people with severe functional gastrointestinal disorders.

Cognitive behavioral therapy (CBT). This standby of psychotherapy helps patients to change counterproductive thoughts and behavior and learn coping skills to better manage stress and anxiety. CBT may be most useful in helping patients to cope with persistent gastrointestinal distress, rather than reducing pain.

Relaxation therapy. This encompasses a number of techniques designed to help people relax and reduce reactivity to stress. Techniques include progressive muscle relaxation, visualization, and restful music. It is effective for gastrointestinal disorders when it is combined with CBT.

Hypnosis. Gut-directed hypnotherapy — which combines deep relaxation with positive suggestions focused on gastrointestinal function — may be helpful for people whose symptoms occur even without obvious stress.


Angel Kissi says she has struggled with loneliness since she was a child

Do we inherit loneliness from our parents in the same way we inherit our hair and eye colour? Two women explain how loneliness has played a part in their lives – and how it relates to their parents and children.

“Loneliness for me is constant. No matter where I am, it just doesn’t go away. It’s almost like you can feel it in your bones, this deep feeling of wanting to fit in and wanting to be around people you know and love, but you can’t.

“I do think I have inherited it. It’s kind of been passed on to me.”

Angel Kissi and her mum Hayley, both struggle with anxiety, depression and loneliness. For her mum, the latter was sparked by severe post-natal depression. For Angel, it started when she was a child.

“My family stood out in Peterborough. Everyone knew who we were because we looked different. I’m really tall and mixed race and I stood out,” says the 20-year-old. “When I went to university, things were good but I still felt like I didn’t fit in. I thought moving to London would change that and it didn’t.

“I still felt like I was quiet and awkward. I really struggled to connect with people and make friends straight away. Everyone was going out for drinks after class and I was never invited. I felt like I was doing something wrong.

“Eventually I stopped going to my lectures. I would get up, get ready to go and then go back to bed. I would avoid going to shared areas of my flat, I shut myself away and isolated myself. I went into the loneliness and let it take over.”

Angel and Hayley
Image captionHayley’s struggle with anxiety, depression and loneliness started after Angel was born

Unable to cope, Angel left university before the first year was over. Although she felt a strong desire to go home and be close to her mum, she rented a room close-by.

“It’s good we don’t live together because we would be bringing each other up and down all the time. She has definitely helped me with some aspects [of my mental health] but other times I didn’t want to speak to her because I didn’t want to make her worse.

“If she was different, then maybe I’d be different. I don’t blame her at all, she didn’t choose to be like this, it’s not her fault. It’s probably something that I have got from her. Personality traits or attitudes that I’ve learnt from her without meaning to.”

Media captionAngel Kissi struggled with loneliness from a young age

According to Age UK, loneliness is defined as feeling a lack of affection, closeness or social interaction with others.

The charity Mind says it is not a mental health issue but research suggests it is associated with an increased risk of depression, anxiety, low self-esteem and stress, and can be triggered by major life events such as bereavement, relationship break-ups, retirement, changing jobs and moving.

Dr Rebecca Nowland, who has researched the subject of loneliness, says it can be passed down in families.

“I don’t think we’re going to find a gene for loneliness but it’s about how we respond to an experience of loneliness that might be genetic,” she said.

“There has been a number of studies that have indicated that loneliness is certainly hereditary, that it might run in families and there might be associations between a parent’s loneliness and a child’s loneliness.

“Being parented by someone who has been in a lonely state for some time means we might transmit some of those negative feelings. It’s the transmission of negativity that might be happening rather than the experience of loneliness itself.”

Kirsty and son
Image captionKirsty McGrath fears passing on her feelings of loneliness to her children

Kirsty McGrath thinks loneliness became a problem for her after her son was born five years ago. She tried going to a number of mother and baby groups to make new friends but struggled to organise play dates and found herself increasingly isolated.

Although her husband supports her in the evenings, she finds daytimes difficult because she is often alone and has no-one to talk to. The 33-year-old teacher, who lives in Eltham, south London, says she is worried that not being able to socialise her children will have an effect on them and she might pass on her own feelings of loneliness, which she describes as a “grey cloud”.

“I am paranoid of passing it on to the kids, I wouldn’t be surprised if I did. It’s something I am very aware of. I just want them to feel comfortable around others and not feel like they don’t fit in.

“My son has come home from school and said to me that he doesn’t have any friends and that he hasn’t played with anyone. I’m worried he is like this because of me, that I haven’t put him in enough social situations to know how to mix with others.”

Loneliness is a common experience among new parents and finding groups with shared interests, as opposed to those just focused on parenting, is one way to cope, says Dr Nowland.

Dr Faruq Fazal, a GP who has worked in mental health services, says loneliness comes about when people don’t have a support network and believes teaching coping skills in school could help.

“Nobody really teaches you how to cope through life’s challenges. For those suffering from loneliness, it’s not just about physically having people around you, it’s when you feel you’re not able to talk to people and you don’t have any emotional support,” he says.

“I see people who don’t have a support network and their coping strategy has gone.”

Child and parent holding hands
Image captionExperts say parents might transmit their feelings to their children

Mind suggests a number of ways to manage loneliness, including peer support and talking therapies.

Dr Nowland says seeking professional advice can also help those stuck in a cycle of behaviour brought about by loneliness.

“Loneliness leaves you with this emotional feeling that is quite painful and distressing. If someone is lonely and they have felt it for a long time, it’s realising that it’s ok and that you might have developed negative thought patterns.

“You might need some help with cognitive behaviour therapy to help you think and reframe things.”

Angel has had counselling but says although it has helped with her anxiety, it hasn’t helped with her feelings of loneliness.

She returned to university briefly but has since decided to focus on her mental health, work, and learning to drive.

“Loneliness is really different from anxiety and it’s different from not being able to make friends,” she says.

“Anxiety can isolate you, but the loneliness that I felt at university was separate from that – it’s about being around people, but being in your own little world.

“I’m in a relationship and I’m close to my family but that loneliness is still there. Overall, things have improved a lot, but I don’t know if it’s ever going to go.”


  • Scientists are hoping a new cowpox-style virus could kill every type of cancer 
  • Professor Yuman Fong, from the US, is engineering the treatment called CF33 
  • The treatment is being developed by Australia biotech company Imugene 

Scientists have created a new cowpox-style virus in a bid to cure cancer.

The treatment, called CF33, can kill every type of cancer in a petrie dish and has shrunk tumours in mice, The Daily Telegraph reported.

US cancer expert Professor Yuman Fong is engineering the treatment, which is being developed by Australia biotech company Imugene.  

They are hoping the treatment will be tested on breast cancer patients, among other cancer sufferers, next year.   

Scientists have created a new cowpox-style virus in a bid to cure cancer (stock image)

Scientists have created a new cowpox-style virus in a bid to cure cancer (stock image)

Professor Fong is currently in Australia to organise the clinical trials, which will also be run overseas. 

Patients with triple negative breast cancer, melanoma, lung cancer, bladder, gastric and bowel cancer would be tested in the ‘basket study’.  

Success with mice does not ensure the virus will be able to treat humans, but  Professor Fong remains positive, as other specific viruses have been effective in fighting cancer in humans.  

The virus, which causes the common cold, was turned into a treatment for brain cancer by scientists in the US.

The cancer in some patients disappeared for years before it came back, while others saw tumours shrink considerably.

Similarly, a form of the cold sore virus called Imlygic or T-Vec was found to be able to treat melanoma, as it helped the body’s immune system recognise and destroy tumours and melanoma cells in the body. 

US cancer expert Professor Yuman Fong (pictured) is engineering the treatment, which is being developed by Australia biotech company Imugene

US cancer expert Professor Yuman Fong (pictured) is engineering the treatment, which is being developed by Australia biotech company Imugene

‘There was evidence that viruses could kill cancer from the early 1900s when people vaccinated against rabies had their cancer disappear, they went into remission,’ Professor Fong said.

But there were concerns viruses could be too toxic for humans and turn fatal.   

‘The problem was if you made the virus toxic enough to kill cancer you were worried it would also kill man,’ he said.

Professor Fong said cowpox – which proved to successfully protect people from smallpox 200 years ago – is known to be harmless in humans. 

By mixing cowpox with other viruses, testing found it could kill cancer. 

Cancer patients would have the engineered virus injected directly into their tumours for the breakthrough treatment. 

It’s hoped the virus would infect the cancer calls and make them explode. The immune system is then expected to be alerted about other cancer cells in the body, prompting the diseased cells to be killed. 

Cancer patients would have the engineered virus injected directly into their tumours for the breakthrough treatment (stock image)

Cancer patients would have the engineered virus injected directly into their tumours for the breakthrough treatment (stock image)


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