Kids Matter!

It's NOT Just All In Your Head: Gut-Brain Disorders with Dr. Ali Navidi

• Alisa Minkin

Share episode

Use Left/Right to seek, Home/End to jump to start or end. Hold shift to jump forward or backward.

0:00 | 51:34

Send us Fan Mail

In this episode, Dr. Ali Navidi of GI Psychology discusses the brain gut connection and ways to help children with disorders of brain gut interaction with specific therapies.
Dr. Navidi is a licensed clinical psychologist and one of the founders of GI Psychology, a national telehealth practice specializing in helping patients with GI disorders and chronic pain. Dr. Navidi oversees training and outreach at the practice. 
 Dr. Navidi has given talks about GI disorders and chronic pain to organizations around the country such as American College of Gastroenterology, UNC School of Medicine, George Mason University, Georgetown University Grand Rounds, INOVA, various podcasts, television and various State Academies of Nutrition and Dietetics.
https://www.gipsychology.com/our-clinicians/alinavidipsyd/

https://creators.spotify.com/pod/profile/jowma/episodes/Gut-Feelings-Disorders-of-Gut-Brain-Interactions-with-Dr--Beate-Beinvogl-e1gjku6

Cover art by Charlotte Feldman
Please note that while I am a pediatrician, I am not your child's pediatrician. This podcast is for informational purposes only and does not constitute medical advice. For any medical concerns or decisions, please reach out to your child’s health care professional.


Welcome to Kids Matter. I'm Dr. Elisa Minkin. As a pediatrician, mom and grandma, I understand how challenging it can be to help our kids grow into their best selves. We are so much more powerful together. Here I will be sharing the knowledge and wisdom of a wide range of people who understand and care deeply about children. I'm hoping for your input as well because kids really do matter. They are our future.

Alisa Minkin

Dr. NTI is a licensed clinical psychologist and one of the founders of GI psychology, a national telehealth practice specializing in helping patients with GI disorders and chronic pain. Dr. NTI oversees training and outreach the practice. Dr. Nati has given talks about GI disorders. And chronic pain to organizations around the country such as American College of Gastroenterology, UNC School of Medicine, George Mason University, University, grand Rounds in Nova, various podcasts, television, and various state academies of nutrition and dietetics. So thank you so much for doing this with me today.

Ali Navidi, Psy.D.

It's my pleasure. I'm glad to be here.

Alisa Minkin

It's a really important topic and I've been listening to you on other podcasts and I heard something great that you said on the Peds Doc Talk podcast. So I thought that was the best explanation I've ever heard of the, of the gut-brain connection. So I'd like you to start with that, please.

Ali Navidi, Psy.D.

Oh yeah. Yeah. So I mean, and I think this is basically an explanation that, that I've developed over the years for patients and for their parents. I feel like a lot of times people get way too excited about the science. You know, they, they go into neurotransmitters and hormones and vagal nerve and like, all this is great and, and we know the science is really solid. But I think what people really just need to understand is we have, we have a big brain, you know, our central nervous system and we have a little brain, and that's our enteric nervous system. And the two are talking to each other all the time. And what happens in one. Can affect the other and what's happening in the other can affect the one. So, so what happens in our gut, in our, our enteric nervous system can definitely affect our brain. And what's happening in our brain can really affect our gut. And once patients understand that, that this isn't. People just making stuff up or it's all in their head because it's literally not all in their head because the brain is connected to the body and has a very special connection with that little brain down there in our gut. And so once they can get that foundation. Then the rest of it comes easier. Then they begin to understand, okay, why has my kid been throwing up every day for the last. Weak, but they can't find anything wrong. Why? Why do they have intense stomach pain to the point they're taking'em to the er? But again, they're, they can't find anything wrong. It's not because it's all in their head, it's just because the head and the gut are intimately connected, and so they're always affecting each other.

Alisa Minkin

That's a great explanation and I wanna go from there into what we're now calling disorders of gut brain interaction. I love all this new information because I'm, I'm really tired of this misconception that, like you said, it's all in your head. That's the title. Now, it's not just all in your head

Ali Navidi, Psy.D.

I love that. Yeah.

Alisa Minkin

So I wanna talk about when it becomes a disorder.'cause obviously you could say, have an upset stomach when you're nervous about speaking. That's not a disorder.

Ali Navidi, Psy.D.

Right.

Alisa Minkin

an example of the gut brain interaction, right?

Ali Navidi, Psy.D.

Yeah. Yeah, it's a great example. It's not a disorder. There's, I think, 20 something different disorders classified under disorders of gut-brain interaction. In fact, the. That term is relatively new, at least from my perspective. You know, I was doing this, I've been doing this work for a while, and I remember when they changed it, I think it was 2017, something like that. And it used to just be functional GI disorders, which. It's fine. But it doesn't really give people much information like, okay, functional, the average person hearing that name doesn't know what to make of it. But disorders of gut-brain interaction, it literally has the key phrase in the title. So it saves a lot of time'cause people immediately begin thinking of the brain in the conversation. The biggest mistake, I think a lot of these these patients and parents can make is to try to leave the brain out of the conversation. Because when you do that, what you get is years of bouncing around the medical system, looking for answers, looking for another test, another scope, and. They just are, just reinforce, actually just reinforcing the problem.

Alisa Minkin

We have to get into that in more depth later. But as a pediatrician, we see so many, and it's not just, by the way, the gut brain disorders, it's a lot of other disorders that are called functional. And I think they keep changing the name to try to get rid of the stigma of it's, it's, it's not real, but still people and, and physicians often feel, it's not real unless I can measure it.

Ali Navidi, Psy.D.

Right, right, right. And the problem isn't measurement. It's the problem is our level of scientific sophistication. There's absolutely measurable things happening the way the nervous system is interacting that we just don't have the technology to directly measure. So, so all those people that are stuck on measurement, they're, they're kind of pushing forward this idea that again, it's not that it's all in your head, which you know, is kind of the theme of this episode, right?

Alisa Minkin

Absolutely. It's, it's, let's go into it. Let's go talk more about this because think that both, both healthcare professionals and parents and patients need to know so much more about this. so let's talk more about the most common disorders that we see in children that are gut-brain interaction disorders. I'm thinking just to give you.

Ali Navidi, Psy.D.

Yeah.

Alisa Minkin

I'm thinking functional abdominal

Ali Navidi, Psy.D.

Yes.

Alisa Minkin

and irritable bowel syndrome.

Ali Navidi, Psy.D.

Yeah. Yeah. In my experience, I think the most common I would see is, is functional abdominal pain. And then, you know, irritable bowel syndrome is up there too. The good news is from my perspective, it's very treatable. I remember when I started doing this kind of work and I was kind of the. The last call on, you know, the last station on the stop. Usually patients only saw me after they had been through everything and everyone else. And it, and that would be years and, and it didn't actually take that long to treat them. And with kids, the treatment is even shorter than adults. So often we'd be getting results in kind of like four to eight sessions. Adults, I'd say on average, yeah. Yeah. Adults maybe are more like eight to 12 or 13 sessions. But kids, they would generally respond pretty quickly. And, and these are very disabling conditions. You know, they'd have this chronic pain. It would be worse when they would be stressed, but it wouldn't only be caused by stress. Often they would worry that something had been missed and that there was some medical condition that the, that was dangerous to them and that would kind of perpetuate the problem. But again, these are very treatable problems with the right techniques.

Alisa Minkin

Right, and I'm going to bring up Dr. Beatty, Ben Vogel, who I interviewed for a different podcast. I'm gonna link it to the, to the show notes because she said something that really struck me. She said that it's really important to set the expectations right upfront. She compared it to the golden hour that you have in the emergency room where you have to get that diagnosis of stroke or whatever right away. So that I'm gonna, I'm gonna link that to the show notes, but the point is that it's not a diagnosis of exclusion, right.

Ali Navidi, Psy.D.

Yeah. Yeah, I think it used to be considered. But as I understand it among, let's say, pediatric gastroenterologists the movement has been that they can get these diagnoses from a good history and then. Depending on the situation, certain key tests, but often I think they're not needing to scope or do other things much more, that are much more invasive.

Alisa Minkin

Back to what you said about part of the pain can come from the anxiety that something is wrong,

Ali Navidi, Psy.D.

Yes. Yes. If, if you wanted to make a theme about these problems, I think the theme would be safety. So a lot of the work is, is reestablishing safety the brain, and this is conscious and unconscious level. This, what do I mean when the, when the brain feels something is unsafe. Like, imagine, you know, you are walking outside on a lovely evening, you're feeling good, you're walking with somebody, versus you are walking outside alone. There's been rumors that there's this madman running around the, you know what I mean? Like you're perspective about every sound, every movement out of the corner of your eye is gonna be completely different. You're gonna become hypervigilant. You are gonna be looking everywhere for threats. And these, and this is a very common situation for patients where for various reasons, they've begun to see their, whatever their problem area is. As threatening, as unsafe. And when that happens, the brain processes that stimuli differently in it. Instead of just kind of presenting it to us neutrally, it presents it to us in a way that like, you know, we're walking around we're, we think there's a murderer around the corner, and then we hear a noise right behind us. We're gonna react, right? And that's how the brain is responding to the stimuli from, from the GI system. And that's, and there's even a clinical name for it that's called visceral hypersensitivity. And that occurs fundamentally when the brain doesn't feel like an area is safe. So it's essentially. Amplifying the signals from that area and also sometimes distorting them. So you might get something like a full stomach being perceived as painful.

Alisa Minkin

Right, but it is actually painful. I wanna keep drilling it in

Ali Navidi, Psy.D.

Yeah.

Alisa Minkin

and over, that this is not just all in your head. That experienced pain is real pain. And I believe from Dr. Bain Vogel, she also talks about how they've done studies to show that different people experience gut sensation through their nervous, you know, enteric nervous system differently, correct.

Ali Navidi, Psy.D.

it's interesting'cause this concept, I think people get lost. Real pain, fake pain all pain. Is in the brain. If we didn't have a brain, we wouldn't have any pain, right? So all pain comes like the brain is there to decide if something is painful or not, and then how much importance to give it. And it's a complicated multi-stage process where the brain is sorting and sifting and categorizing all the stimuli that that comes from our body at all time. And it just doesn't happen in the gut. It also happens in other parts of the body too. So you talked a little bit about general, about functional disorders. You know, there's a relatively newer term out there called neuroplastic pain. The field is rife with all these different terms. Well, one of'em I really like is neuroplastic pain, and it's the idea that the pain isn't generated because there's damage to the body. It isn't de, it isn't generated because there's damage to the nerves. The pain is generated in the brain and, and remember, all pain is in the brain. So it's not fake pain. It's not any less real. It's just as real as structural pain, meaning I accidentally cut my arm. That structural pain. Whereas somebody who's got visceral hypersensitivity and eats some food and their, their visceral hypersensitivity is centered in their stomach, their, those sensations of fullness will go to their brain and then be processed in a way that they perceive it as painful, that pain. Is entirely real. No different than the pain of me cutting my arm.

Alisa Minkin

That's a great, that's a great explanation, but I'm still stuck with, well, how do you know how much to work the patient up? Because

Ali Navidi, Psy.D.

Yeah.

Alisa Minkin

tell just from looking at that patient whether there's something structural you might be missing.

Ali Navidi, Psy.D.

Right, right now. And now this is outside of my area of expertise because I rely on pediatricians, I rely on, you know, pediatric gastroenterologists. I just have a vague understanding of that, and that's why my, myself and then my practice, GI psychology, we always need some level of workout. Right. I, we don't want patients just coming directly to us, you know, and that's, that's been our philosophy since we started. We haven't advertised directly to patients or their parents. We've reached out to the medical professionals because we see our work as being done in partnership with them.

Alisa Minkin

This is so, so important, and I'm glad you said this so clearly, and that's why I'm gonna link to the Dr. Bain Vogel talk because she provides the medical piece that we're not going to be discussing here. I'm trying to say over and over the same basic thing that we can say a, the pain is real. And B, we're gonna look for structural things because you don't wanna be the situation where you're assuming it's functional disorders of gut brain interaction that you're, there is no structural thing, but there was, and you missed it. And so I think these things have to go on parallel tracks. The question is how much and the attitude, if the attitude is, say the parent is anxious. And no matter how many times you tell them, we've done a reasonable workup. And they're still anxious and want more done. That may be the tricky spot, you know, how much to do. Right. And also the attitude, which leads me, I really wanna talk a little bit about the, the attitude of the parents and how that can affect this

Ali Navidi, Psy.D.

I love and is it Dr. Vogel that you're referencing?

Alisa Minkin

Vogel.

Ali Navidi, Psy.D.

Vogel. I love what you're saying because again, that's what I saw in my career at first. You know, I was the last stop. But as the understanding of the science has evolved, as, you know, people in the area learned to trust, you know, my work and what I've, what I was seeing more is they were, they were bringing up gut brain therapy in the first visit. They're saying, look, you know, you've had this pain for X amount of time. We're gonna do a reasonable workup, we're gonna make sure it's none of the red flags. But the good news is it looks like it could be a disorder of gut brainin interaction. And if it is, that means it's very treatable. We've got just the person to send you to. Right? Like just putting that idea in at the beginning. Versus after you've exhausted all the testing, makes a huge, huge difference,

Alisa Minkin

It really does, and I, I want to get the message out to healthcare professionals as well, because I do think that there's a huge stigma of I'm gonna see this patient and I think it's functional, and I'll just do the workup and then I'll send them out.

Ali Navidi, Psy.D.

right?

Alisa Minkin

And I think the message they may unintentionally be conveying is, this is not as real.

Ali Navidi, Psy.D.

Right, right. Because they're saying, well, it isn't all these really serious things, so you're good. But the fact is that patient is absolutely not good. They are suffering just as much, maybe more. Then when they came in, they still need a lot of help. And by just saying, you know, Hey, you're good. They can feel really abandoned and, you know, there can be different reactions. The, there could be one reaction, okay, we just have to live with this. The reaction can be no, we're gonna find out what's really wrong. Right. And. We don't want them to do either. Right. We just want them to get the treatment that's gonna actually help them.

Alisa Minkin

Right. I think it could be really helpful as long as you make sure you're validating

Ali Navidi, Psy.D.

Yeah.

Alisa Minkin

That the pain is real and that it's really disabling and a problem, and you're gonna try to help them feel better,

Ali Navidi, Psy.D.

Yeah.

Alisa Minkin

going to, you're gonna look for structural things and then

Ali Navidi, Psy.D.

Mm-hmm.

Alisa Minkin

you're not medical gaslighting. Right. That I think, unfortunately, I see this a lot with the parents where they are so afraid that we're not taking it seriously.

Ali Navidi, Psy.D.

Right. Right. And I think there's an art to that, right? The providers, I think, who have the best. You know, essentially like patient skills. They're able to form those good relationships, build trust. They tend to be the ones who, who aren't just like, okay, we do these tests, we did the test. You're clear, we go on your merry way. Versus, you know, the ones who are, you know, validating, helping them know that they understand that there's hope. You know, I really encourage. Providers to frame this as good news because think about the other things they might have, right? It could be inflammatory bowel disease, it could be, you know, different kinds of cancer. It like the alternatives are not great and the fact that they don't have those things A, is good. And then B, the fact that based on 40 years of research. These disorders of gut brain interaction are very treatable to me, that's great news and I think that should be conveyed to the patient in some way to build that hope and motivation to go forward and get help.

Alisa Minkin

That's really, really true because the bottom line is everybody wants to feel better. The child wants to feel better, the parent wants the child to feel better. And you can speed up that process by not first waiting to send them to somebody like you. We're gonna get to more of what you do in just a few minutes. But I think that that's really important. And I think one of the problems is the. Interpretation that this must be psychological. And so I do wanna talk about the connection to psychological and, and the resistance to that too, by the way.

Ali Navidi, Psy.D.

Yeah. And I think, I think that's what makes this tricky, because I think just people in general, we don't do well with subtlety. We want something to be either this or this. And the problem with dg, and I'm gonna call'em DG bs, you know, because it's just shorter. The problem with D GBIs is. Just like we were talking about earlier, everything's connected. You know, we're not this isolated entity. Our brain is affecting our gut, but that, but that also means that all the different things going on in our brain is also affecting our gut. So I can give you an example. Let's say there's a kid who develops what's called post-infectious IBS. Right, so you're of course very familiar with it. They get some kind of infection, an infection you can measure. You could see they get over the infection, however they get over it, and then the problems continue. So the pain or the discomfort or the vomiting might continue. With IBS, it wouldn't be more likely pain and or constipation in diarrhea. So there's these symptom, there's symptoms that continue. And so now what has been established is this connection between the brain and the gut, where the, where this pattern of, of pain and, you know, altered bowel function has been established, and then it's being maintained by this dysfunctional interaction between the brain and the gut. So now you've got this. This pattern in the brain that's established, but guess what? It's not in isolation. So what does that mean? That means if the kid is extra stressed because of a test, it's gonna go from the brain they got and the symptoms are gonna get worse. Or if the kid is anxious about, you know, learning to drive or whatever, like they're gonna see more symptoms and people can confuse that. With, oh, this is all just anxiety disorder, or This is all stress. The problem is it's not just. All stress. It's not just an anxiety disorder, but stress and anxiety affect the brain. And this is an open system that's kind of feeding back on itself. So you're gonna see effects from stress, from anxiety, from mental health issues. And so that level of subtlety, I think, confuses people. They want like one or the other. Is, is it, is it mental health? Is it caused by, caused by anxiety? Yes. No, a little like it's, it's a variable, but it's not caused by it. And it's more than anxiety. It's more than stress. Right.

Alisa Minkin

I'm guessing that you can have an anxiety disorder and have these, but also have these disorders without having an anxiety

Ali Navidi, Psy.D.

said. Well said. Exactly, exactly. More people with anxiety have these disorders,

Alisa Minkin

Right.

Ali Navidi, Psy.D.

but plenty of people who don't have anxiety disorders have these disorders of gut brain interaction.

Alisa Minkin

I think that's really important to stress.'cause I think that again, the physician or other healthcare professional are, are more likely to say, okay, I've ruled out the medical stuff. Go to psychiatry, go to psychology. This is an anxiety issue and I think that the resistance is, is rational because sometimes it is, but it's not all that it is

Ali Navidi, Psy.D.

Yeah.

Alisa Minkin

it isn't.

Ali Navidi, Psy.D.

And I've seen very, very frequently, especially when they're. There weren't resources you know, like myself or the bigger organization available. You know, what doctors would do is, you know, they didn't have very many options. So they'd see the patient and they'd say, okay, go, go see a therapist in your community. And that's fine. That's not, well, it's not fine, really.'Cause what would often happen is inadvertently the message gets sent, Hey, this is. This is because you have a mental health condition. This is because you have anxiety and that well-intentioned therapist in the community. They don't know the specific techniques, the methods used to train a, to, to treat a gut brain disorder. They're just gonna do what they know, which is treat anxiety, treat depression, you know, and, and that might help a little, but it's really not gonna help the core problem.

Alisa Minkin

Very well said. And I, I think that that's something that we have to get into our heads that anxiety is a problem that can be treated as anxiety, but gut brainin interactions are not going to be solved by treating the anxiety alone.

Ali Navidi, Psy.D.

Yeah, exactly.

Alisa Minkin

And that's a great segue is, well, how do you treat these?

Ali Navidi, Psy.D.

Well there's two modalities of treatment that are well established, well researched, like I mentioned before, 40 years of research. The one is. Cognitive behavioral therapy and, and I say that and every time I need to make the caveat,'cause this is where people get confused. Well-intentioned providers get confused because when they look at the research, they see CBT, cognitive behavioral therapy and they're like, oh, we've got plenty of people out there in the community who can give this patient CBT. The problem is there are different. Protocols, different specialties within CBT and what you're sending them to most likely is someone who knows kind of generic bread and butter CBT, and they don't know how to translate that into working with something like IBS because there's specific GI focused protocols for treating dgs. So, you know, again, a lot of patients will come to me after seeing other providers and say, oh, you're gonna do CBT. Well, that doesn't help. That doesn't work for me. And I say, okay, well it's likely that you weren't given the type of CBT that you needed. So CBT is one. GI focused CBT. And then the other is clinical hypnosis. And clinical hypnosis is another one where a lot of explanation is needed'cause there's a tremendous amount of misunderstanding.

Alisa Minkin

Talk more about that, please, I'm interested.

Ali Navidi, Psy.D.

yeah, absolutely.

Alisa Minkin

for it.

Ali Navidi, Psy.D.

So I think the main question to answer, so again, the same thing I said about CBT applies to clinical hypnosis. There's tons of good research showing it works, it works, it works. But what the heck is it? Right? So. You'll have heard this in my other podcast, right? And I don't think I can ever say this enough. Take everything you know about clinical hypnosis and it's probably gonna fit into the category of entertainment hypnosis. Entertainment Hypnosis is fun. It's a great plot twist in a movie or a show. It makes for a good stage show. You know, it's like magic and witchcraft and weird things are happening. Mind control, but that's entertainment, hypnosis. So if we say, okay, then what is clinical hypnosis? Clinical hypnosis is probably one of the most studied techniques in all of psychology. If anyone wants to just check it out, they're listening right now. You know, go onto your browser, type in PubMed. PubMed will take you to the national database for basically scholarly publications and then just type hypnosis. You're gonna get thousands of studies that have been done looking at this technique. It's been studied for a very long time. It's, it's well understood and all it is is. Is that as a human, we all go in and out of states of consciousness. One of those states of consciousness is called trance. Trance is occurring all the time throughout our days. More, even more so in kids than adults. There's zoning out, they're, they're losing themselves in their games and their play and their imagination. When we drive somewhere, we've been a long, a lot of times we go into trance. If we're watching a movie, if we're watching a game, we're really into it. Trance is happening all the time. All we're doing in hypnosis is we're teaching someone how to go into that state, eight deliberately instead of accidentally. And the reason we care about trance is because in trance, it turns out we have more access to that mind body connection. We're more internally focused and, and through the power of suggestion and imagination, we're able to influence that mind body connection in ways that we aren't able to in our normal states of consciousness. As an example, we talked earlier about visceral hypersensitivity in trance with someone who's got good hypnotic talent, we can literally turn down that visceral hypersensitivity in the moment. What does that mean? That means that many, many, many times. I've had patients come into a session, seven outta 10 pain, eight out of 10 pain. 15 minutes later they're at a three, a two, a one, a zero level of pain. It's not magic, it's not witchcraft. It's just utilizing the brain, gut connection, understanding how hypnosis works, how the brain works, and people are capable of more than they realize.

Alisa Minkin

Once you do the hypnosis, is this something they can do on their own later?

Ali Navidi, Psy.D.

Yeah. So part of that process, first, it's kind of like. It's kinda like if you're learning a sport, you first you have your coach show you what to do, then you get feedback as you practice it with the coach. Eventually you get confident enough that you can do it in the game without the coach saying anything.

Alisa Minkin

Wow.

Ali Navidi, Psy.D.

Yeah, and so we specifically teach self-hypnosis. Why? Because we have to, because often the problem isn't happening when they're in the office with us. It's happening at school. It's happening in the morning. It's happening at home. So we need to teach them the techniques that they can use when they're not with us. Yeah.

Alisa Minkin

That is absolutely amazing. I'm gonna get a little technical here. I, I'm guessing that that is what we call a bottom up approach as opposed to CBT, which is top down. Am I correct there?

Ali Navidi, Psy.D.

Yeah. If you're thinking of the brain as like kind of the bottom parts of the brain, the limbic system, the emotional parts of the brain, and then the top is like the cortex, the higher functioning. Absolutely. So you could consider hypnosis and experiential therapy. We're getting the emotions involved, we're getting feelings into it. Whereas CBT is more thoughtful. It's more intellectual. It's more logical.

Alisa Minkin

That's a great explanation. I wanna go back to the GI CBT'cause you, you mentioned that it's different from regular CBT, but I,

Ali Navidi, Psy.D.

Yeah.

Alisa Minkin

you to get a little more into depth on how it is different because I think this is such an important understanding.

Ali Navidi, Psy.D.

Yeah. So. First off, the, the, the practitioner needs to have an understanding, and this is a larger topic, right? So I have to be a little vague, but like the practitioner has to have a good model for. For how hypervigilance, catastrophizing, visceral hypersensitivity all are working and the gut-brain connection are all working together to create these self-reinforcing cycles. They have to understand the common cognitive distortions that these patients have. They have to understand. How did, how to look for the, the normal types of avoidance behavior that these patients exhibit? Because avoidance is one of the this is a kind of a different topic, but avoidance is what feeds anxiety. So you have to find that avoidance and you have to slowly help the patient face it. And with these patients, there's certain particular types of avoidance they should look for. There's, there's avoidance of places and activities, there's avoidance of foods, and there's even avoidance of their own body sensations where they've developed fear of those body sensations. And we do something called interceptive exposures. We're teaching people to feel safe with their body feelings.

Alisa Minkin

That's, that's really incredible and I, I can see how that could be so important. Do you train other clinical people to do this? Because I don't think there's enough of you out there.

Ali Navidi, Psy.D.

Well, you kind of got to what was my frustration as well? So, you know, I've been in private practice in the Northern Virginia area for 14 years and, and they were very well, when you take all the different. Key parts. There was literally no one on an outpatient basis who could do this work. So what do I mean? I mean, who could work with kids and adolescents who was trained in hypnosis, trained in GI CBT and that were familiar with gut brainin issues. So you have to have these four things and there's literally nobody who, who put them all together. And so about five years ago, just out of frustration, like I would, I was full, you know I didn't have anybody to refer to. And as you know, there's thousands of kids like with these problems. So myself and another psychologist, we created GI psychology and the mission and we're very mission focused. And our mission was we wanted to create access. To this specialized gut brain therapy, these gut, gut brainin therapies, one, to help patients with these GI disorders. And we wanna do that in two ways. One, by training more clinicians and two by educating medical professionals like yourself and hopefully the people who are listening to this podcast. And so I've been in charge of you know. Training those clinicians and over the years we've developed something. I'm really proud of this really extensive gi, gi psych university that. That can take a therapist with maybe some health psych experience, but no, no GI experience. And then in a structured, supervised way, it's very intensive. Over about six to nine months, turn them into a high level competent GI psychologist.

Alisa Minkin

That is phenomenal. And we're gonna link to, to your website course. So I also want to talk about, a couple of things. First, I just wanna underscore, I, I mean, I, I feel like I have to keep saying this over and over. The, the difference between GI CBT and hypnosis and regular therapy

Ali Navidi, Psy.D.

Yeah.

Alisa Minkin

on helping with the pain, not with the potential underlying or coexisting psychiatric or psychological issues. Is very basic, but I'm presuming that anybody who is a GI psychologist also deals with those other things, that this is a tool in their toolbox, but not their only tool.

Ali Navidi, Psy.D.

Absolutely. Yeah. We also treat comorbid conditions, so it's kind of like if they've already got a therapist. That's awesome. We'll go in, we'll do very targeted work. We'll work on the GI condition and the, the other therapist can keep doing their job. But if the patient doesn't have another therapist, often what ends up happening is you treat their GI disorder and then they, they freaking love you. And they're like, yes. And there's tremendous therapeutic momentum. And what that means is then you can treat their social anxiety or their history of trauma or their depression or whatever it is you've got. It's so much easier to treat it after you've already helped them with this other problem. Yeah.

Alisa Minkin

Hmm. And, and the Dr. Ab Bain Vogel works at A-D-G-B-I clinic, and it is one of those comprehensive multidisciplinary clinics that I

Ali Navidi, Psy.D.

Nice.

Alisa Minkin

every patient.

Ali Navidi, Psy.D.

Yeah.

Alisa Minkin

It's not a thing in most places.

Ali Navidi, Psy.D.

And that's, that's kind of what we tried to do in the sense of, you know,'cause GI psychology is telehealth in all 50 states. So the idea is that for all those clinics that aren't lucky enough to have that great wraparound treatment, which we know is, you know, is what we're, we should all be aiming for, right? What we've been able to do is slot in to these different clinics and be their GI psychology resource. So, for example, I told you that we, we haven't advertised a patients, we've, we've tried to create partnerships with organizations. So one of the first, partnerships that we had was with PSV, so pediatric, I think, associates of Virginia. I always get their name wrong, but basically they're all the pediatric gastroenterologists in Northern Virginia. Then it was with Georgetown and their GI clinic, and then UCLA and then Mayo Clinic, and then Cleveland Clinic. And then we've. Form these bigger partnerships with the Crohn's and Colitis Foundation for all those patients with IBD and, and also the American College of Gastroenterology. So the big overarching organization that works with all the gastroenterologists. So our goal has always been to be that resource that can slot in and be that, be that GI psychology, support wherever we are in the country.

Alisa Minkin

It's really amazing and you said something very interesting. You mentioned IBD. So again, back to the real versus not real.

Ali Navidi, Psy.D.

Yeah. Yeah,

Alisa Minkin

False dichotomy here, right? That people with IBD have pain and that pain can be helped too. It's not a matter of this is only

Ali Navidi, Psy.D.

Yeah.

Alisa Minkin

functional pain,

Ali Navidi, Psy.D.

Exactly, so, so IBD is an interesting one because there's a tremendous need for GI psychology with patients with IBD on a, on numerous levels. So, as an example, patients with IBD have an increased risk of depression and anxiety. And there's very, and just at a baseline, there's very few clinicians who even kind of know what IBD is frequently, they're mistaking it for IBS. Right? And so we're talking about Crohn's and colitis. So we've got increased depression and anxiety. We've also got increased increased rates of medical trauma. You know, if there's different surgeries, they go through a tremendous amount. When there's a flare, they're often in the emergency room being treated when their, when their symptoms are flaring. And then there's also an increased risk of DG bs. Because of what they go through with their GI system they're more likely to develop a disorder of gut brain interaction on top of all these physical structural symptoms that they're having. So even when, often, even when they manage to get their immune system under control they're still having symptoms. And why are they having symptoms? Because they also have. On top of the IBD, they're having disorders of gut brain interaction as well,

Alisa Minkin

I mean, in my mind, I'm not even thinking about having to call it A-D-G-B-I, I'm saying you have pain

Ali Navidi, Psy.D.

right.

Alisa Minkin

learning how to deal with it and help you with that pain is an important component in your treatment.

Ali Navidi, Psy.D.

Yeah. And that's really something we do a lot of work with. Really wherever the pain is coming from, whether it's structural or if it's nervous system based or if it's nerve based. There are many different techniques and and methods for helping people reduce and manage their pain better.

Alisa Minkin

That's really very, very helpful. But I wanna go back a little bit. Something I'm trying to get you to talk about and it's hard to talk about, but I'm gonna push anyway and that is the role of the parents. And the reason it's It sounds like if we say the parents can make it worse than we're blaming the parents and we are not gonna do that here.

Ali Navidi, Psy.D.

yeah.

Alisa Minkin

But, but we need to talk about the role of the parents. Do you, by the way, work with families as a whole or just with the individual?

Ali Navidi, Psy.D.

I would say that if I'm working with kids, especially the younger, the kid it's rare that I wouldn't be meeting with the parents also. And this is a distinction that's kind of subtle, which is the difference between family. So there's like, let's say family therapy. Which is a thing. And then, you know, parent training, you might work with a parent just to help them on their parenting skills or you're working with the patient and then you're bringing in the parent to help with that patient's treatment. So there's a lot of kind of subtleties and different things along that continuum, but especially the younger, the kid. The more, I think just it's a general rule, the more you need to be working also with the parents.

Alisa Minkin

Why I am pushing you,

Ali Navidi, Psy.D.

Yeah.

Alisa Minkin

I'm

Ali Navidi, Psy.D.

So,

Alisa Minkin

hard'cause this is important. As a pediatrician, I what I see all the time is parents are the worst pain in the world is experiencing your child's pain.

Ali Navidi, Psy.D.

right, right.

Alisa Minkin

so the parents' experience of it and how they can regulate with their child to use that psychological term of

Ali Navidi, Psy.D.

Yeah.

Alisa Minkin

is so important and, and I want you to talk more

Ali Navidi, Psy.D.

So, I'll give you an example. There's some research looking at parenting style in terms of patients with D GBIs, and they found that the best outcomes were for parents that did not have an empathetic style. And this is again, not blaming the parents. Because there's plenty of situations where an empathetic style is helpful, is useful, it's good, but when patients have A-D-G-B-I. It's not, in fact, it can, it can make things worse versus parents that have kind of a more matter of fact style, like, yeah, oh, I'm sorry to hear your stomach's hurting today. And we still need to go to school, so, you know, let's go pick out some clothes and get ready. Right? It's, versus like, oh my gosh, my poor baby. And you know, like. That actually tends to make it make it worse. And so what I, what I say to parents often is, you know. What you've been doing has been good. But now you have a child that has different needs. So we need to learn different ways to interact and different ways to work with that child. Just like any good parent, if their child suddenly has different needs, you're gonna adapt to what that, what that child needs, and that's what we're doing here. You have to sometimes learn a different way of parenting. When your child has, has needs that are different than the average kid.

Alisa Minkin

That's really a great explanation, but I wanna make it clear that we're not talking about. Dismissing your child's pain. I think there's studies

Ali Navidi, Psy.D.

Right,

Alisa Minkin

as well that those

Ali Navidi, Psy.D.

right.

Alisa Minkin

aren't helping either. When they're say, go snap out of it again, it's a problem if the doctor says, oh, everything's normal. It must all be in their head,

Ali Navidi, Psy.D.

Yeah.

Alisa Minkin

to school because they're just trying to avoid school, which is a whole separate podcast.

Ali Navidi, Psy.D.

Yeah. School avoidance is. Is something that I worked with a lot, you know, throughout the years because these kinds of problems often lead to school avoidance. It's, it's really natural, you know, because what happens is your kid's stomach starts hurting chronically, so they're missing a lot of school. But the problem is the more school they miss, the more they develop anxiety. About school. So then you develop that as a secondary problem, and then if they miss even more school, they start developing social problems. You know the kids, you aren't seeing the kids very much. You're not, the kid isn't socializing enough, and so you start developing all these secondary problems, and so it's really, really imperative to get them back to school if they're not, if they're not there, or to prevent them from missing a lot of school if they're just developing one of these problems.

Alisa Minkin

And that's why again, the GI psychology therapies are so important because you can't just say, get to school. You have to go to school. You have to have them have tools to cope with the pain.

Ali Navidi, Psy.D.

You have to, you have to give them tools to cope with the pain, the fears, the stress, the anxiety, the unique situation that they find themselves in. We've got the tools because we've seen it over and over and over again. But just a parent saying ah, this is all in your head. Get your butt to school. It's gonna end badly, right?

Alisa Minkin

right,

Ali Navidi, Psy.D.

Yeah,

Alisa Minkin

you, you need that middle ground. You need the, a certain amount of empathy, but a matter of fact, you, you need to go to school and this is how we're gonna help you cope. And I think it's important to underscore that avoidance underlies making things worse here.

Ali Navidi, Psy.D.

yeah, absolutely.

Alisa Minkin

to school.

Ali Navidi, Psy.D.

and psych. And in the world of psychology, we have this term called scaffolding. Right. It's, it's the idea of figuring out where the kid is and then giving just enough support to, to get them to the next level and then give them just enough support to get them to that next level. And it's not just like, oh, go from A to Z, just like that. It's more like, okay, knowing exactly what they need and how much they need and how to give that to them so they can kind of move up that ladder.

Alisa Minkin

That's also a really good explanation. I really wanna thank you so much for your time today. I just wanna give you a chance to say how we can find you, how we can access your programs.

Ali Navidi, Psy.D.

Yeah. Our mission is to, to get the word out there to the, to the, you know, the doctors, the nurses that are seeing these patients. And we can be reached at GI psychology. Com and there, what you'll find is you can, you can like look at all the different research. You can watch videos, you can learn all about this stuff. And then if this is something that could be helpful. We've got a free phone consultation and you can talk to someone who's trained to answer all your questions, answer any questions about the cost, the admin, all that stuff. And if it's something for you, you can sign up and get started. If not, that's fine too. But the key part is just building just. More and more awareness over time so that people do not have to go years and years suffering needlessly when there's, when there are good treatments out there.

Alisa Minkin

This is amazing, and I hope more and more professionals take your course so it becomes more widely available because I think it's, it's so incredibly needed.

Ali Navidi, Psy.D.

Thank you. I appreciate it and it was really great talking with you.

Alisa Minkin

You too. Thank you so much.

Thank you for listening to Kids Matter, raising Healthy, happy Children Takes a Village, and I'm grateful you're part of ours. If today's conversation resonated with you, please share this episode with another parent, grandparent, teacher, or anyone who cares about kids. Together we can build the supportive community our children deserve. I'd love to hear from you. Share your thoughts, questions, or suggestions for future topics at Kids Matter podcast@gmail.com. With no exclamation point, your voice truly matters. Until next time, keep advocating for the children in your life because kids really do matter. They are our future. I'm Dr. Elisa Minkin and this has been Kids Matter. Please note that while I am a pediatrician, I am not your child. Pediatrician, this podcast is for informational purposes only and does not constitute medical advice. For any medical concerns or decisions. Please reach out to your child's healthcare professional.