Stress and Anxiety

Stress and Anxiety in IBD

The GI Stress Cycle

Breaking the cycle

Medications that can help

Anxiety, Stress, and Sleep

When to get help

What to expect at your visit

Living with inflammatory bowel disease (IBD) is stressful and the presence of anxiety and/or stress can impact symptoms.  For example, people may experience a flare-up during times of stress, and a flare-up may cause stress or feelings of anxiety.  Therefore, how well a person can manage and cope with stress may influence their disease experience.  As a result, anxiety and stress management is an important part of any comprehensive care plan for IBD and will have a direct impact on disease.

What is Stress?

Stress is the body’s response to any situation that poses demands, constraints, or opportunity. In the event of a stressful situation, the body reacts by releasing hormones, which help to prepare it to take action.  This is known as the Fight or Flight response and is responsible for the physical reactions experienced during stressful situations, such as increased heart rate, perspiration, and the tightening of muscles.

Stress is initiated by the presence of stressors, which can be anything that triggers a physical response.  Stressors can be anything from common experiences (such as running late for a meeting or giving a presentation) to major life events (such as a job change or the death of a family member).

Good Stress vs. Bad Stress

Everyone experiences some level of stress trying to meet the demands of their day-to-day lives.  This common type of stress, known as acute stress, is easily managed and short-lived.  Small doses of acute stress can oftentimes be considered “Good Stress,” in that it can motivate us to be productive, create feelings of excitement in certain situations, and even help us avoid danger.

However, after prolonged exposure to stressors, usually as a result of a traumatic event or major negative lifestyle change, stress can be harmful.  This is identified as “Bad Stress,” and can be harmful to both our mental and physical health.  It is important to know the difference between these two types of stress, and be aware of the implications associated with “Bad Stress.”

What is Anxiety?

Anxiety is an emotion consisting of feelings of panic, worry, and nervousness.  Panic can be described as having overwhelming fears, which can be associated with physical symptoms.  Generally, the fear is irrational, but nevertheless it can be made worse by feelings of anxiety.  Excessive worrying is also associated with anxiety.  Anxiety is often experienced as a result of, or in association with, stress and stressful situations.  Similar to stress, anxiety is very common.  However, when it becomes persistent and excessive it can begin to interfere with mental and physical health.

How Anxious Are You?

Over the last two weeks, how often have you been bothered by the following problems:

  • Feeling nervous, anxious, or on edge
  • Not being able to stop or control worrying
  • Worrying too much about different things
  • Trouble relaxing
  • Being so restless that it is hard to sit still
  • Becoming easily annoyed or irritable
  • Feeling afraid as if something awful might happen
If you have been bothered by some of these things for several days within the last two weeks (and it has made it difficult for you to work, take care of things at home, or get along with other people), you may want to consider an anxiety management program.  If you have been bothered by several of these things for half the days (or nearly every day) within the last two weeks, you may want to consider following up with a mental health professional.

Stress Reduction Techniques

Stress reduction techniques can help you to stay calm and maintain perspective.  There are many stress-management techniques; however, each person is different.  Therefore, try an approach that appeals to you.  If one approach doesn’t work, try another.  Here are some techniques for managing stress:

  • Biofeedback
  • Practicing yoga or tai chi
  • Hypnotherapy
  • Cognitive behavioral therapy
  • Meditation
  • Books, recordings, guided imagery, etc.


Diaphragmatic Breathing

The ability to relax and clear your mind is a helpful coping skill for managing life’s stressors. However, if you have many stressors, such as those that can be associated with having a chronic disease, than you may have some difficulties with relaxation. You may even wonder, “Where would I begin?”  Your breath is a wonderful place to begin.  There are many advantages to learning how to diaphragmatic breathing (i.e. belly breathing, deep breathing). Here are just a few:

  • Lowers heart rate and blood pressure
  • Decreases muscle tension
  • Oxygenation of your blood
  • Brings warmth to the hands and feet
  •  Increases energy and motivation
  • Improves concentration
  • Strengthens the immune system
  • Reduces stress hormones
  • Activates the relaxation response of the body (reversal of the stress response)
  • Can be easily implemented, doesn’t require medication and won’t cost you a thing

The activation of the diaphragm through diaphragmatic breathing, also allows for a gentle massage of the internal organs (intestines and stomach).  This can aid with abdominal pain, urgency, bloating and constipation.


Learning to Diaphragmatic Breathe

  • Sit or lie in a comfortable place. Close your eyes.
  • Place one hand on your chest and one hand on your abdomen. Your bottom hand should do the moving. Top hand should remain still or only move as the bottom hand moves.
  •  Inhale through your nose for about 4 seconds, feeling your abdomen expand. You may feel slight tension during these initial inhalations.
  • Hold your breath for 2 seconds.
  •  Then exhale through your mouth very slowly for about 6 seconds. Mouth should be relaxed with a steady, slow exhalation.
  •  Repeat for 5-15 minutes.


When first learning diaphragmatic breathing, you may have some uneasiness or lightheadedness.  This is normal, allow yourself time to acclimate after your practice (i.e. don’t stand up quickly). Diaphragmatic breathing is a skill that requires practice. It will become easier with time and can become an excellent tool for relaxation.


Helpful Apps

  • Breathe2Relax
  • Belly Biofeedback


Progressive Muscle Relaxation

Progressive Muscle Relaxation (PMR) is an easy to learn stress reduction technique that involves tensing and relaxing of various muscle groups. While under stress, many people carry added tension in their body that can make stress and pain worse. The goal of PMR is that as a person works the various muscle groups they become more aware of the relaxation of the muscles when the tension is released. You can hold the tension in each muscle group for 7-10 seconds, and then relax the muscle for about 20 seconds. You do the same muscle group a second time. There are many examples that can be found for practicing PMR on your own. Here is one:

  • Begin by sitting or lying in a comfortable position. You may want to close your eyes. You can move until you find a comfortable position. You are now ready to begin. Start with the muscles in both hands. Make fists and hold them tightly for 7-10 seconds. Then let go. Notice how your hands feel as they release tension. You may begin to notice a warm sensation. Repeat this one more time.
  • Next, tense the muscles of your upper and lower arms by bending the arms at the elbow and tensing as you bend. Hold this for 7-10 seconds. Release the tension and allow the arms to relax comfortably. Enjoy that relaxation for about 20 seconds. Repeat once again.
  • Next, focus on the muscles in your shoulders and neck. Shrug your shoulders up toward your ears; hold for 7-10 seconds and then release and let go. Notice the warm, heaviness and relaxation coming into the muscles of your shoulders and neck. Enjoy that relaxation. Again, tense for 7-10 seconds, then let go and relax.
  • Now, push your head against whatever is supporting it. Gently tense the muscles of your neck for 7-10 seconds and then let go. Repeat.
  • Next, gently pull your chin toward your chest. Notice the feeling of tension. Hold for 7-10 seconds and then let go. Repeat.
  • Now you will focus on the muscles in your face. Wrinkle the muscles of your forehead and the area around your eyes. Hold for 7-10 seconds, noticing the feeling to tension in these muscles. Then let go. Enjoy the relaxation for about 20 seconds. Repeat a second time.
  •  Now, move down toward your chest. Arch your back slowly and easily as you inhale and tense the muscles around your ribcage. Hold the tension, and then let go. Let go completely. Notice the sensations of relaxation. Enjoy that relaxation for about 20 seconds. Then repeat.
  • Tense the muscles of your lower back and stomach by pressing your buttocks down into your chair, floor or bed. Pressing down and feeling the tension. Hold for 7-10 seconds noticing the tightness in the low back, stomach and buttocks. Then let go. Let go completely. Relax. After about 20 seconds, repeat.
  • Focus on the sensations of relaxation coming into your body. You may feel warmth and a sense of well-being and peace.
  • Now, lift the right leg and point the toes upward and slightly inward. Noticing the tension running from the top of your leg, down through the knee, calf and toes. Hold for 7-10 seconds. And then release. Let that leg relax. Enjoy the relaxation. Now repeat.
  • Finally, lift the left leg and point the toes upward and slightly inward. Feeling the tension run through the leg muscles all the way to the toes. Hold. And then relax. Notice the warmth that has flowed into these muscles. Repeat.
  • Now, scan your entire body from head to toes. Notice the relaxation that has come into your body. Which muscles have relaxed? Simply notice the difference between how your body feels now, and maybe how it felt 15 minutes ago. If you would like to re-visit certain areas of your body you can. Or, you can enjoy the relaxation that you currently feel and feel proud of yourself for doing something very good for your body and mind.


For further information, call Crohn's & Colitis Foundation's IBD Help Center: 888.MY.GUT.PAIN (888.694.8872).

The Crohn's & Colitis Foundation provides information for educational purposes only. We encourage you to review this educational material with your health care professional. The Foundation does not provide medical or other health care opinions or services. The inclusion of another organization's resources or referral to another organization does not represent an endorsement of a particular individual, group, company or product.

About this resource

Published: December 5, 2016

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