Kathleen (not her real name) came to counseling because of anxiety. After an intake, we identified several areas in her life that sounded like they were contributing to her difficulties. We started working with Cognitive Behavioral Therapy, a system that looks at the thought sequence you use, and where a distorted belief can be corrected and thereby relieve suffering.
After teaching her a series of formulas, she was able to apply the principles herself when not in the office with me. This is a very effective psychotherapy intervention, that is so useful that many insurance companies paying for counseling expect to see it as part of a treatment plan. But, it did not seem to offer Kathleen the relief I was expecting. So, we continued looking elsewhere in her life for the source and solution of her anxiety. If it wasn’t her thinking causing it, perhaps it was situational.
We identified that her work setting wasn’t a good match for her. After having her take the Myers-Briggs Type Indicator, a measure of personality preferences, which looks at how someone’s energy moves, how they take in information, how they make decisions, and how much structure they like in their outside world, we confirmed her natural tendencies. Looking through this lens, we could see that a certain work flow, and pressures, just weren’t going to work well with her personality type. Through a lot of focused work, she figured out what would be a better work environment for her, found a job that fit her better, and made the move.
After a short time of relief, the anxiety returned. More exploration followed. More areas in her life seemed to point to sources of her distress. But, I had a growing suspicion forming in my mind. She decided she wanted to try medication, and her insurance company wanted her to too. I arranged for a medication evaluation with a psychiatrist, but I also arranged to confer with a clinical nutritionist. As Kathleen was meeting with the doctor, I was floating some of my thoughts with this trusted nutritionist colleague of mine.
I wondered aloud with her. What sort of nutritional deficiencies might contribute to anxiety? How would those nutritional deficiencies happen? How could we test her for them? The nutritionist was accustomed to hearing lists of digestive symptoms associated with a celiac disease discussion, but not mental/emotional symptoms.
I had a read a series of articles in a variety of publications about celiac disease. Being a mental health counselor, I always gravitate to all possible explanations for mental health symptoms and disorders. I had been noticing for quite a while references to celiac disease including symptoms like depression, anxiety, inability to focus, schizophrenia, attention deficit problems. One article led me to a book called Gut and Psychology Syndrome (GAPS), by Dr. Natasha Campbell-McBride.
GAPS, an acronym Campbell-McBride coined, is a book dedicated to how the digestive track impacts mental and emotional functioning. I found trying to skim through the book pointless, as it was one of those books where you had to start from page one, and move sequentially through the chapters to have a productive read. So, one afternoon, I forced myself to sit down and read the book, cover to cover. I learned much more about digestion, and how it works, than I ever wanted to know. But by the end, I felt certain that not only were some solutions for Kathleen contained in the book, but for other clients of mine as well.
When Kathleen didn’t get the comprehensive relief from the medication she was hoping for, I approached the discussion of celiac disease. It didn’t ring true to her, as she said she had no trouble after eating wheat. Not being a nutritionist, or doctor, I told her I couldn’t fairly represent how it all worked, but that this disease was often not like having a peanut allergy. A peanut allergy is more straightforward. Eat a peanut, throat closes, someone knows clearly they have a problem with peanuts. But, I explained, for many, a delayed, adult-onset case of celiac disease will present itself in a much less cause and immediate effect way.
Kathleen was willing to trust me on this one, and went for an evaluation with the nutritionist. Her blood panel came back negative for celiac disease. She wanted to stop there, but the nutritionist told her that all that a negative blood test meant was that the immune reaction could be being contained in the digestive track. The nutritionist told her that it was good news, because once it hits the blood, “you’re really in trouble,” with things like osteoporosis, and other big problems.
The nutritionist wanted to order a test for Kathleen from EnteroLab.com. Kathleen and I looked at it together, as she was having difficulty deciding if she wanted to commit to the test. It was expensive, for her, and her insurance wouldn’t pay for it. They wanted to stop with the blood test. Why keep testing when the first test came back normal?
We read through the description of the test online at their website. The nutritionist wanted her to have the comprehensive gene and stool analysis test. We let some weeks pass by, and as my client continued to feel new anxieties emerge, she decided to go forward with the testing.
The nutritionist sent the results of the test, and arranged for a meeting with my client to go over what it meant. It turned out that she had a genetic predisposition for celiac disease, and an active immunological reaction going on in her GI track. Kathleen and I met for our weekly session, and she was still stunned by the results. How could this not have been identified earlier in her life? What about her kids? Did they have it too? What is involved with going gluten free?
With a new course set, we started down this new treatment plan road. First I found some simple books about celiac disease for her, with recipes included as part of the book. In our sessions, she processed how massive a change this would be in her life. “Do you know how much gluten is in prepared foods?” she burst out with at the start of one of her sessions. “I threw out nearly everything in my cupboards! This is outrageous!” Even though I heard indignation in her complaints, I also heard hope. For a psychotherapist, hope is the pivot point that often signals the beginning of success. I was eager to see where this would lead.
Her journey took work, but it was so worth it. As quickly as within 2 days of being on a gluten free (GF) diet, she began seeing changes in her symptoms. Conditions she just figured she’d have for a lifetime began to change. Joint pain began to ease. Sleeping became less problematic. Nasal blockage she was accustomed to began going away. Months later other symptoms changed too. Bloating she didn’t even know she had went away. Chronic skin conditions went away. And, yes, her mood began to change.
Some chronic jealousy she would feel regarding her husband just disappeared. Her whole perspective about herself, and her life became broader. Her baseline mood rose up, and she operated from a place of more buoyancy. I say this from my perspective, as I’m not sure that she would identify these issues. To her, it was all happening so naturally, that she could hardly keep up with all the shifts. But, as her therapist, I had witnessed some chronic, stubborn mental and emotional symptoms that were easing and changing finally.
For Kathleen, this process of identifying celiac disease was life changing. For more of my clients, it was also life changing. I put celiac disease on my filters, as diagnostic possibilities for new clients. Now, I spend time talking to colleagues, and forwarding articles about celiac disease and psychology, to spread the word about the interaction between the gut and the brain. I’ll admit, celiac disease education in the psychological community is slow going.
There appears to be quite a resistance in professionals to integrate interdisciplinary thinking. The psychological models we learned in graduate school originally, then reinforced by continuing education classes after graduate school, guarantee that a change in the culture will take time. But, I’m hopeful, and as I said, hope is the pivot point that signals the beginning of success.
Author Information: Claire Houston, MS, LCMHC
Claire Houston, MS, LCMHC, is a licensed psychotherapist in NH and NY, with offices in Exeter, NH. She integrates holistic and spiritual philosophies into her empowering counseling approach. Visit her at www.wswcenter.com or call 603-772-0799.