Tag: Cognitive Behavioral Therapy

Inside IBD Pregnancy with a GI Psychologist: What Patients Need to Know

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Finding out you’re pregnant can be one of the most profound moments of one’s life; and, if you’re living with Crohn’s disease or ulcerative colitis, that moment is almost immediately followed by a flood of questions that others don’t have to think about. Will my IBD flare? Is my medication safe? What does this mean for my pregnancy? Can I even do this?

The answer to that last question is yes, absolutely, yes. But it takes a team, a plan, and attention to more than just your GI symptoms. As an IBD mom of three, I’ve been in your shoes and know how it feels to bring a life into this world with so many unknowns.

This week on Lights, Camera, Crohn’s we hear from Licensed Clinical Psychologist, Dr. Antonia Repollet, who specializes in gut-brain health at GI Psychology. Dr. Repollet is a fellow Crohnie and a mother. She works with people navigating exactly this intersection every day. She shares what she wants every person with Inflammatory Bowel Disease (IBD) to know about pregnancy: the medical side, the emotional side, and the parts that often get left out of the conversation entirely.

Your Gut Is Already Under Pressure

Pregnancy is a full-body experience. Hormonal shifts in progesterone, estrogen, and cortisol affect mood and energy, and they directly shape how the gut functions. Progesterone relaxes smooth muscle, slowing the movement of food through the digestive tract (Alqudah et al., 2022). Estrogen influences gut permeability and the composition of the gut microbiome (Chen et al., 2025). Cortisol, the body’s primary stress hormone, can heighten GI sensitivity and drive inflammation (Cherpak, 2019). Together, these hormonal changes can increase bloating, reflux, and constipation even in people without IBD. Add a growing uterus physically displacing digestive organs, and it’s no wonder the gut feels unsettled!

Whether you’re a first-time mom-to-be or someone who has had several children, we know how complicated it can feel to navigate these changes in your body on top of IBD. It’s not unusual to feel a bit overwhelmed.

“For someone with Crohn’s or ulcerative colitis, these changes land on an already-sensitive system, and the hormonal picture matters more than people often realize. Hormones are among the key messengers of the gut-brain axis, the two-way communication highway between the digestive tract and the nervous system,” explain Dr. Repollet. “During pregnancy, when hormone levels are shifting, this axis is working overtime, and stress often amplifies this further. For example, anxiety about your health, your pregnancy, your body, your medications: all of it feeds back into the gut through hormonal and neurological pathways, and the gut sends it right back to the brain. Thus, pregnancy can disrupt this loop.”

Why Remission Before Conception Matters

Here’s something important: research consistently shows that the best predictor of IBD staying stable during pregnancy is whether disease was well-controlled at the time of conception (Abhyankar, 2013). Studies have found that approximately 66% of IBD patients who conceive during active disease experience continuing or worsening symptoms throughout pregnancy (Hashash & Kane, 2015).

Dr. Repollet says, “Remission going in doesn’t guarantee smooth sailing, but it does dramatically improve the odds for both the pregnant person and the developing fetus.”

Looking back, I’m grateful for the timing of my bowel resection surgery when I was engaged, because it put me into surgical remission, and helped prep my body for pregnancy after I got married. Prior to surgery, I had never heard the word “remission” from my gastroenterologist. With IBD pregnancies, this is where the “rule of thirds” comes in. One third of women experience an improvement of IBD symptoms, one third stay the same, and one third see an uptick.

Active disease during pregnancy is associated with increased risks of miscarriage, preterm birth, low birth weight, and other complications (Boyd et al., 2015). This is why the conversation with your gastroenterologist needs to happen before you start trying to conceive, not after a positive pregnancy test.

The Medication Questions

Please don’t stop without talking to your doctors!

“One of the most common things I hear from IBD patients considering pregnancy is some version of: “I thought I should stop my medication just to be safe.” The instinct makes complete sense, because you want to protect your pregnancy. But stopping IBD medication without medical guidance can put you and your fetus at greater risk by triggering a flare,” Dr. Repollet advises.

Many IBD medications, including biologics like infliximab, adalimumab, and certolizumab, are considered safe during pregnancy and are recommended to maintain remission (Mahadevan et al., 2019; Peifer, 2024). Some, like methotrexate, do need to be stopped well before conception, and this applies regardless of which reproductive organs you have (Peifer, 2024). This is important for both partners, as medication safety around conception is a conversation for anyone planning to conceive, regardless of gender. Your GI and obstetrician (OB) should be making these decisions together, with your input.

Build Your Team Before You Need Them

A whole-person approach to pregnancy with IBD means your care team should include more than just your GI and OB. Depending on your history, you may also benefit from a maternal-fetal medicine specialist (an OB with advanced training in high-risk pregnancies), a dietitian who understands IBD and prenatal nutrition, a lactation consultant familiar with chronic illness, and a mental health provider who specializes in the gut-brain connection. According to findings from the Global Consensus on IBD and Pregnancy, all IBD pregnancies are deemed “high risk.”

Dr. Repollet tells me the last one matters more than people realize.

The Part That Doesn’t Get Talked About Enough: Your Mental Health

People with IBD are two to three times more likely to experience anxiety and depression than people without (Neuendorf et al., 2016). Rates of anxiety in IBD hover around 32%, and depression around 25% (Barberio et al., 2021). These numbers don’t go down during pregnancy. If anything, the uncertainty, the body changes, the fear of flares, and the weight of managing a chronic illness while growing a new life can make them go up.

“And here’s what’s easy to overlook: your emotional state is not separate from your physical symptoms. Stress releases hormones that increase inflammation. Anxiety heightens gut sensitivity. When you’re scared that every cramp might be a flare, that fear itself can worsen symptoms. The mind and the gut are in constant conversation,” says Dr. Repollet.

This is why mental health support isn’t a “nice to have” treatment during pregnancy with IBD and should be part of the medical plan.

Evidence-based approaches like Cognitive Behavioral Therapy (CBT) for GI conditions (CBT for GI) (Gracie et al., 2017) and gut-directed hypnotherapy (Keefer et al., 2013) have been shown to reduce GI symptoms, lower flare frequency, and improve quality of life in IBD patients. These approaches are safe during pregnancy, non-pharmacological, and can be genuinely life-changing for anyone who feels like they’re white-knuckling through their pregnancy.

A Story That Might Sound Familiar

“One of my patients (I’ll call her “Alex”) was 12 weeks pregnant and living with Crohn’s. Inflammation was well-controlled, but daily abdominal cramping and pain, diarrhea, and racing thoughts about whether symptoms were affecting the pregnancy had taken over. The response from providers (e.g., “It’s just pregnancy hormones.”) left Alex feeling dismissed and alone.”

With gut-brain therapy, Alex learned to track symptom patterns, practice diaphragmatic breathing, and use clinical hypnosis to interrupt the anticipatory anxiety that was amplifying physical symptoms.

Dr. Repollet says, “Over eight weeks, symptoms decreased, sleep improved, and (maybe most importantly) there was a renewed trust in the body’s signals. Feeling prepared going into delivery and postpartum was something Alex hadn’t expected to feel, but did. This is a reminder that emotional care is physical care. They are not separate things.”

What to Watch For and When to Reach Out

Consider seeking mental health support if you are:

  • Struggling to eat or sleep due to GI symptoms or anxiety
  • Experiencing GI symptoms that feel emotionally overwhelming, are hard to separate from anxiety, or seem to worsen with stress
  • Experiencing distress (whether related to your IBD, your pregnancy, or both) that is interfering with daily life
  • Having fears about flares, delivery, or being a high-risk patient that feel consuming
  • Dealing with resurfacing trauma from prior pregnancy loss, difficult medical experiences, or a complicated diagnosis journey
  • Simply wanting a space to process this enormous thing you are navigating

Please know that you don’t have to be in crisis to deserve support.

The Postpartum Chapter

Pregnancy often gets most of the attention, but postpartum is its own significant transition for people with IBD.

“Hormonal shifts after delivery, sleep disruption, feeding decisions in the context of your medication regimen, and the emotional adjustment to new parenthood can all influence disease activity. Having a plan for the postpartum period, including who on your care team you’ll check in with and how, should be part of a complete prenatal plan,” explains Dr. Repollet.

I remember during all my pregnancies how fearful I was about how I would feel after delivery. By staying on my medication (Humira), it helped keep symptoms at bay not only during my pregnancies, but also after my scheduled c-sections. I required a short burst of steroids after my second child was born, but luckily never experienced a full-blown flare.

It can be easy to place all your focus on your baby but be mindful of how your body is speaking to you through symptoms so you can communicate this directly to your care team, before you’re dealing with an acute flare. Trust that by sharing what you’re going through you’re doing what is not only best for yourself, but what’s best for your family.

You Deserve Coordinated, Whole-Person Care

Pregnancy with Crohn’s or ulcerative colitis is possible. Many people do it every year with the right support, effective communication between providers, and attention to both the physical and emotional layers of what they are carrying.

“At GI Psychology, we specialize in helping people with IBD and other GI conditions navigate exactly these kinds of life transitions. Our clinicians are trained in gut-brain therapies including CBT-GI and gut-directed hypnotherapy, and we work via telehealth across all 50 states + Washington D.C., so support is accessible wherever you are. We also offer an 8-week virtual IBD Psychotherapy Group for adults living with Crohn’s and ulcerative colitis, designed to provide evidence-based tools alongside community with people who truly get it,” says Dr. Repollet.

If you’re planning for pregnancy, currently pregnant, or navigating the postpartum period with IBD, you don’t have to figure it out alone.

Learn More About GI Psychology:

Participate in IBD Pregnancy Research

References

Abhyankar, A., Ham, M., & Moss, A. C. (2013). Meta-analysis: the impact of disease activity at conception on disease activity during pregnancy in patients with inflammatory bowel disease. Alimentary pharmacology & therapeutics, 38(5), 460–466.

Alqudah, M., Al-Shboul, O., Al Dwairi, A., Al-U´Datt, D. G., & Alqudah, A. (2022). Progesterone inhibitory role on gastrointestinal motility. Physiological research, 71(2), 193–198.

Barberio, B., Zamani, M., Black, C. J., Savarino, E. V., & Ford, A. C. (2021). Prevalence of symptoms of anxiety and depression in patients with inflammatory bowel disease: a systematic review and meta-analysis. The lancet. Gastroenterology & hepatology, 6(5), 359–370.

Boyd, H. A., Basit, S., Harpsøe, M. C., Wohlfahrt, J., & Jess, T. (2015). Inflammatory bowel disease and risk of adverse pregnancy outcomes. PloS One, 10(6), e0129567.

Chen, M., Wang, J., Yang, Y., He, Y., & Li, L. (2025). The interplay of estrogen, gut microbiome, and bone immunity in osteoporosis. Cell communication and signaling : CCS, 23(1), 516.

Cherpak C. E. (2019). Mindful Eating: A Review Of How The Stress-Digestion-Mindfulness Triad May Modulate And Improve Gastrointestinal And Digestive Function. Integrative medicine (Encinitas, Calif.), 18(4), 48–53.

Gracie, D. J., Irvine, A. J., Sood, R., Mikocka-Walus, A., Hamlin, P. J., & Ford, A. C. (2017). Effect of psychological therapy on disease activity, psychological comorbidity, and quality of life in inflammatory bowel disease: a systematic review and meta-analysis. The Lancet Gastroenterology & Hepatology, 2(3), 189–199.

Hashash, J. G., & Kane, S. (2015). Pregnancy and inflammatory bowel disease. Gastroenterology & Hepatology, 11(2), 96–102.

Keefer, L., Taft, T. H., Kiebles, J. L., Martinovich, Z., Barrett, T. A., & Palsson, O. S. (2013). Gut-directed hypnotherapy significantly augments clinical remission in quiescent ulcerative colitis. Alimentary Pharmacology & Therapeutics, 38(7), 761–771.

Mahadevan, U., Robinson, C., Bernasko, N., Boland, B., Chambers, C., Dubinsky, M., … & Kane, S. (2019). Inflammatory bowel disease in pregnancy clinical care pathway: A report from the American Gastroenterological Association IBD Parenthood Project Working Group. Gastroenterology, 156(5), 1508–1524.

Neuendorf, R., Harding, A., Stello, N., Hanes, D., & Wahbeh, H. (2016). Depression and anxiety in patients with Inflammatory Bowel Disease: A systematic review. Journal of Psychosomatic Research, 87, 70–80.

Peifer, R. (2024, January 26). IBD and pregnancy: What you need to know. Crohn’s & Colitis Foundation. https://www.crohnscolitisfoundation.org/blog/ibd-and-pregnancy-what-you-need-to-know

How an innovative prescription app looks to change the game for IBS and IBD patients

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This blog was sponsored by Mahana Therapeutics. All thoughts and opinions shared are my own.

Did you know that two thirds of people with inflammatory bowel disease (IBD) also meet the criteria for a functional GI disorder? Dr. Aline Charabaty, Dr. John Damianos, and Dr. Katie Dunleavy recently presented a paper at the 2022 Guild Conference addressing the substantial overlap between Crohn’s and ulcerative colitis and the gut-brain interaction. You may wonder what constitutes a functional GI disorder, irritable bowel syndrome (IBS) is the most common.

“What we know is that up to 30-40% of patients with IBD in remission (absence of gut inflammation) continue to have GI symptoms such as abdominal pain, bloating, diarrhea, constipation, and fecal urgency, due to disorders of gut-brain interaction (DGBIs, also known as functional gastrointestinal disorders),” explained Dr. Aline Charabaty, director of the IBD Center at Sibley Memorial Hospital.

As someone who was diagnosed with Crohn’s disease more than 17 years ago, I’ve been told by multiple gastroenterologists that I have IBS as well. At one point I was told, “you have a touch of IBS” …whatever that’s supposed to mean. I know I am not alone in believing I have both IBD and IBS, especially since having 18 inches of my small intestine removed for bowel resection surgery in 2015.

Dr. Charabaty says this is the case for many patients because of the following:

  • Structural damage to the gut caused by IBD. Crohn’s disease can lead to small bowel stricture, which can cause cramps and constipation (by blocking or slowing down the stool flow); Long standing UC can create a “lead pipe colon” (where the colon loses its normal twists and turns that typically slow the stool flow down and become like a straight tube which makes the stool “fall” straight down), which can cause diarrhea and urgency. Resection of part of the small bowel and colon decreases the surface of the bowel that can absorb the water and solidify stools, which leads to loose stool. Finally change in bowel anatomy from stricture or resection, abdominal adhesions from prior inflammation, abscess, or surgery, can lead to small bowel bacterial overgrowth (SIBO) which can cause bloating, pain, diarrhea, or constipation.
  • People living with IBD can become intolerant to certain foods or modify their diet. This can lead to change in gut flora that affect gut functioning and lead to GI symptoms.
  • Recurrent flares or previous severe inflammation can lead to change in the gut sensation. Visceral hypersensitivity, gut motility, gut microbiome, intestinal permeability, and how someone perceives and tolerates all the sensations (pain, discomfort) that come from the gut. 
  • IBD affects people’s emotional and mental health and is associated with a higher incidence of depression and anxiety. We know that depression and anxiety can affect the gut functioning and lead to IBS symptoms.

“All these changes are similar to what we see in people living with IBS and can cause IBS and IBS symptoms in people living with IBD. Sometimes the way I explain it to patients with IBD, is that IBS is like the PTSD of the gut. The gut has been inflamed, traumatized, manipulated, changed from prior flare and now it can’t go back to functioning properly, even if it’s healed and it looks normal,” said Dr. Charabaty.

This is where Mahana IBS comes in. The main mission? To empower people with chronic conditions to lead fuller lives through digital therapeutics. That’s why they debuted their new prescription digital therapeutic app, Mahana IBS, in the fall of 2021. Their wish is to destigmatize IBS and bring hope and meaningful solutions to patients like you and me.

Steven Basta is the CEO of Mahana Therapeutics. He says the app is safe, FDA-cleared, and has been clinically proven in the world’s largest trial of its kind to reduce IBS symptom severity.

“Cognitive Behavioral Therapy (CBT) has long been recommended in clinical guidelines as a safe and effective treatment for IBS. Access to traditional CBT with a therapist has been a huge challenge due to the limited number of IBS-trained therapists (less than 300 in the US). Now patients can access CBT and learn the skills it provides to help a patient manage their disease by using Mahana IBS on their smartphone, with great results: 3 out of 4 patients find relief and results for most patients are lasting. Mahana users can complete the program in 90 days or less at their own pace with daily lessons on their phone to create a healthy brain-gut connection and live life more fully.”

Both IBD and IBS negatively impact our quality of life. Our mental health, our psychosocial health, and our financial health (increased health care utilization, missing days of work, medications to treat symptoms).

“Beyond treating the inflammation of IBD, and preventing IBD-associated complications, it is important to recognize and treat IBS when it is present, so people can recover and optimize their quality of life. CBT is an effective therapy for IBS and reduces or eliminates symptoms of abdominal pain, diarrhea, constipation, and bloating,” said Dr. Charabaty.

Unfortunately, access to a therapist who can provide gut-directed CBT can be limited: lack of therapists trained in CBT in someone’s geographical area, limited time availability (many therapists are not taking new patients, or have long waits to see someone; or from an IBD patients’ standpoint—lack of “extra” health care time available, when we often juggle many health appointments), deal with lack of insurance coverage, additional costs related to taking time off work and the expenses related to travel and participate in CBT sessions. Which makes the app even more useful and beneficial for the patient community.

Bringing up digital therapy to your GI provider

Digital therapy is new, and Mahana Therapeutics is working hard to spread awareness in the clinical and patient community to ensure everyone who could benefit, has access, and knows about Mahana IBS. 

“It’s important for patients living with IBD to ask their doctor whether Mahana IBS is suitable for them and discuss how it can work with their treatment plan,” said Steve.

As a gastroenterologist who specializes in IBD, Dr. Charabaty says, “Having an FDA-cleared prescription app that provides CBT right at the patient’s fingertips is pure gold! Easy and effective access to CBT at a time that is convenient for the patient, in the privacy of their home, without the added extra time and cost burden of a visit to a clinician. I believe that with this technology/app, which removes many barriers to accessing therapy for IBS, that many more people living with IBS (whether they have IBD or not) will benefit from what CBT has to offer and will be able to improve their symptoms and regain their quality of life.”

Patients who are in IBD remission experiencing IBS Symptoms may want to ask:

“If my IBD is in remission and my symptoms are IBS related, could a digital therapy treatment such as Mahana IBS gut-directed CBT be suitable for me?”

GIs who want to understand more about the clinical evidence and indications for use for Mahana IBS can head this website to check out the medical provider welcome pack which contains all the clinical information they need to get started and to prescribe Mahana IBS.

While the app is a prescription, patients can also download the app on their own and show their gastroenterologist in clinic. But to gain access to the full program, patients need to get a prescription to unlock the benefits.

How the app is tailored to each patient

People experience IBS differently which is why Mahana IBS provides a personalized approach, regardless of type of IBS. In the early sessions of the app, patients create an IBS symptoms profile, take an IBS Symptom Severity Score assessment, and create their personalized model. 

“This means people get to identify and capture their own symptoms and associated thoughts, behaviors and actions that arise as a result of these. As patients progress through the app and unlock tools and content, exercises are provided that are tailored to people’s individual IBS symptoms. Progress is recorded through the IBS Symptoms Severity Score at the beginning, the middle, and at the end of the program to measure results,” explained Steven.

Reframing thought process to reduce IBS symptoms

We can all relate to how feeling anxious can leave our ‘stomach in knots’ but in IBS there is a disorder of the brain-gut communication which causes and perpetuates symptoms. For example, our guts can release hormones that change our mood, and the brain in turn sends a signal to our guts to change our bowel functions which then sends more signals to the brain.

“Patients may develop habits or use ‘coping’ techniques that perpetuate the vicious cycle of brain-gut miscommunication without knowing it. The Mahana IBS app uses a gut-directed CBT program that was researched and developed over several decades. It is designed so you can understand your personalized patterns and then learn skills to help support a healthier brain-gut interaction. The program delivers a combination of education and exercises so that patients identify and reframe thoughts, feelings, and actions related to IBS. Through the Mahana IBS program, patients can gain tools and habits for managing symptoms long-term,” said Steven.

Along with learning to reframe our thoughts, the app also features visceral relaxation exercises like diaphragmatic breathing or belly breathing, which can reduce visceral pain and improve GI function. Mahana IBS has easy to follow animations to help patients learn and practice these techniques.

While Mahana IBS is a treatment program designed to be completed in 90 days or less with lasting results, Steve tells me some patients may experience relief from their functional GI disorder within a matter of weeks.

“Patients go at their own pace, so they may complete the program more quickly. Once the 90 days have elapsed, patients can still access their personal data (for example goal setting, IBS-SSS score or their personal IBS Model). Patients can return to the app at any time to find support in any of the lessons, tools, and exercises they have completed.”

Accessing Mahana IBS 

Mahana is committed to affordable access. Some patients may be reimbursed by insurance. For those patients who are not covered by insurance, there is a subsidized program to ensure patients will pay no more than $90 out of pocket for prescription cost. That’s less than a single session with a therapist ($120/session) for the complete 10-session program.

Steven says it’s incredibly rewarding and a huge privilege to lead the Mahana team transforming access to treatments like this through digital therapy.

“As CEO of Mahana Therapeutics I am inspired by so many amazing patients with IBS.  One patient who had struggled for years with IBS symptoms that made her feel truly hopeless expressed that Mahana IBS changed her life.  With the lessons and skills she learned, she no longer avoids the food she loves, and the way she thinks about IBS has altered so completely, it no longer limits her life.  Our team’s mission is to make this story a reality for millions of IBS patients.”

Mahana IBS is available for download directly from the Apple App store and Google Play store—and the first session is free to try! To unlock all the specific features and benefits, you’ll want to get a prescription from your GI. Once you’ve been prescribed the app by your doctor, you will get a message from Blink Pharmacy with instructions to get started.