GUTTED OVER COELIAC

GUTTED OVER COELIAC

WELCOME TO THE   GUTTED OVER COELIAC   PROGRAMME!

  • 1 - Arriving on time

    Please be sure any technical issues have been resolved so you can engage in the session fully as soon as it starts.

    2 - Cam/Mic

    Having your camera on if you feel comfortable to do so (this may help the group feel a sense of community), and your microphone off unless you are speaking to the group.

    3 - Active Listening

    Showing you are giving your attention and not speaking over others.

    4 - Respect

    We all come from various walks of life and may have different views, however, should you disagree, please still treat others how you would hope to be treated yourself.

    5 - Confidentiality

    There may be times when attendees may share their experiences. Please do not video/audio record the sessions and do not take any identifiable information about this person outside of the group. Equally, there is no pressure to share if you do not wish to.

    6 - Between group tasks and questionnaires

    Please ensure you complete both the between session tasks and questionnaires within the time frame given. This is to understand how and if the intervention is effective and valuable. We understand it may feel like a lot but we really hope you can engage with all the material! There are suggestions in how to pace this out if helpful.

    7 - Questions and Time Keeping

    There will be allocated times in the sessions for your questions so please write these down throughout so you do not forget these!

  • If you have thought about any rules not listed here that you feel are essential or helpful, feel free to note these down ready to discuss in the first group.

Understanding Coeliac Disease 

so we start our sessions with the same baseline knowledge.

Coeliac disease (CD) is a lifelong autoimmune condition which means the immune system is triggered when any amount of gluten (wheat, barley, rye) is consumed. The immune system works to protect the body, but for all individuals with coeliac disease, the immune system mistakes gluten as an invading pathogen (e.g. bacteria/virus). This (auto-immune) response leads to damage to the lining of the small intestine, the villi. See images. This response causes inflammation and may cause many gut related symptoms. Being asymptomatic does not mean the damage is not occurring. 

The villi cover the small intestine and their function is to absorb nutrients from food, a particularly important role for digestion. Therefore, when gluten is consumed and this is damaged causing the surface area to decrease, the amount of nutrients that the small intestine is able to absorb is significantly hindered. The good news is that with sticking to a strict gluten free diet, this lining can recover, but this is not an overnight recovery and the time this takes varies.

SAD VILLI

HAPPY VILLI

  • Gastrointestinal pain and discomfort

  • Constipation and/or Diarrhoea

  • Nausea or feelings of Fatigue

  • Brittle hair and/or hair loss

  • Headaches / Migraines and/or brain fog

  • Skin rashes and blisters

  • Tingling or numbness in hands and feet, damage to nervous system

Symptoms of CD are (but not limited to):

  • Changes in mood i.e. increase in anxiety, low mood or irritability

  • Irregular periods or fertility issues including recurrent miscarriage

  • Weight loss or painful bloating

  • Acid reflux and heartburn

  • Anaemia and other vitamin deficiencies 

  • Brittle bones, osteoporosis, aches in joints

Treatment

The only current treatment for coeliac disease is to adhere to a strict gluten free diet. This is to allow your gut to heal, reduce risk of complications such as anaemia and osteoporosis, encourage growth and development in children, and alleviate symptoms.

It is important to consider the risk of cross-contamination of gluten too as even a crumb of gluten can trigger a response

Tips to reduce cross contamination:

  • Separate gluten free only equipment – i.e. toaster not previously used for gluten, clean chopping board.

  • Different preserves/butters etc. - i.e. that have not had crumbs from gluten in.

  • Cleaning– washing hands and cleaning surfaces and utensils before preparing gluten free food. 

  • Keep gluten free food separate - i.e. in tupperware boxes in cupboards, on different trays when in the oven, cooked in separate oil. 

  • Know that gluten free doesn’t always mean coeliac safe! Don’t be afraid to ask about cross contamination and fryers out at restaurants etc.

Understanding CBT

and how Coeliac Disease and mental health are connected.

What is CBT?

CBT stands for Cognitive Behavioural Therapy and considers the individual’s cognitions (thoughts) and behaviour to be connected, in addition to emotions, physical, situation and at times, history. See the hot cross bun model image. An aim of CBT is to help individuals develop insight and your awareness into this. Secondly, it focuses on the lens in which we view or think about ourselves, the world, others and the future as well as our style of thinking or beliefs and so allows reflection on how this impacts how we experience life. 

CBT & CD

This model of therapy has a vast amount of evidence to suggest it is effective in reducing anxiety and depressive symptoms, improving confidence, wellbeing and supporting individuals with the management of long term health conditions such as diabetes, chronic fatigue syndrome and gastrointestinal conditions such as IBS. This study you are a part of is learning if the same or similar benefits are felt by the coeliac disease (CD) community!

Research has suggested that individuals with CD have higher levels of anxiety and depression when compared to those without CD. This may be for a variety of reasons. Those who have consumed gluten may be experiencing symptoms of malnutrition which causes i.e., stress on the body, fatigue and irritability. Those following a strict gluten free diet may feel overwhelmed with the lifestyle change, feel misunderstood or to be a burden to others catering for them, struggle with socialising that involves eating out due to lack of restaurant knowledge, risk of cross contamination or not being catered for.

This is not an extensive list and all of the above and others not listed make sense.

Research has also shown that anxiety and depression may impact an individual's ability to follow a gluten free diet (GFD) which is the only treatment for CD. It is here you can start to understand the cycle (HOT CROSS BUN MODEL) below. The group sessions will therefore look at quality of life and psychological wellbeing to support living with CD as well as GFD adherence ability.

Before the group, spend approximately 10 minutes writing or drawing out this diagram thinking about what the Hot Cross Bun Cycle looks like for you. Some ideas that may help are listed below:

  • - Your own adherence to a gluten free diet (i.e., difficulty level, barriers, beliefs) as a Behaviour and how it impacts the rest of the cycle.

  • - The connection between having Coeliac Disease and your mental health (the good and the less good).

You will not need to share this but it may support you in applying session material to yourself during the group.

Thought Patterns

Negative Automatic Thoughts (NATs)

These thoughts are commonly experienced whether you have consumed gluten or not and can feel like an inner critical voice. They can impact your mood and your self-esteem. They are what they say on the tin – they are negative, they are automatic and they are thoughts! An example could be “I’m rubbish at this” or "I always feel ill".

Using the hot cross bun model, spend a few minutes to think about a NAT relating to CD that you have noticed in the last few days, and consider how this impacted your feelings, behaviour and physical sensations. Noticing our thoughts can feel tricky at first if you are not used to this.

THINKING TRAPS

You may have noticed that different people react in different ways to situations. One reason of many, may be because one person may experience a thinking trap, and the other may not, leading to different interpretations of situations. It is important to recognise thoughts that lead you to feel more stressed or low and to recognise that you are not your thoughts. Some types of thinking traps include:

  • This is also known as ‘Black and White Thinking’. This means the individual does not see ‘grey’ instead they think ‘in extremes’.

  • This means an individual would ‘home in’ on the one negative thing and filter out everything else.

  • This means an individual would jump to conclusions and believe they know exactly what someone else is thinking.

  • This is when an individual takes everything personally. They will assume they are the reason.

  • This refers to the tendency to add ‘should’ and ‘must’ to statements. An individual adds unnecessary pressure to themselves or to others and sets too high expectations that are likely to be unmet.

  • This is when an individual picks one occasion and largely generalises this.

  • This means an individual acknowledges the positive but declines to accept it.

  • This is when an individual wholly believes their emotions as fact. “I feel therefore it is true”.

  • Think about binoculars. Wear them one way, it magnifies your view, wear them the opposite way it minimises your view. This is the same for thinking – imagine your view is ‘importance’.

In the group session, we will think about how to manage thinking traps and NATs some more. However, what will be useful before then is to record a few of your own, relating to living with Coeliac Disease! Please use the thinking diary below to help with this. Again, you do not need to share this if you do not wish to.

Worry Chains

Worry can be a normal response and with CD can serve a helpful purpose; worrying may lead to checking ahead you can eat at a location or ensuring the ingredients on a label do not include gluten. However, worry can come in varying levels of severity and can be placed on a continuum from ‘normal manageable worry’ to ‘excessive worry’. It may be helpful to notice when you are worrying and consider where you would place this on the arrow:

<——————————————————--——————————————————————->

Normal, manageable or appropriate level of worry

Excessive or disproportionate level of worry

Worry may also be placed into categories such as ‘real events happening in the present’ or ‘hypothetical events’ (made up or in the future where you have no control over yet). It may also be helpful to consider what type of worry you are having here. 

It is helpful to notice that worries can also lead onto other worries and turn into ‘worry chains’. Stopping to think about each link  (often with ‘What if’ ‘Maybe it’) in the chain and noticing when it is happening is the first step to stopping the chain from spiralling.

See below a short example of someone who has been invited to a BBQ. These thoughts make sense, however, this person has not yet even checked their diary and these thoughts have taken a lot of head space and energy and are likely impacting their Hot Cross Bun cycle, taking away from their present moment.

RUMINATIng

  • Unhelpful – not coming to any solution

  • Negative – not making you feel better

  • Time consuming – going round in circles or in chains for a long time and can impact functioning

Worry chains are a bit like ruminating. Rumination is thinking a lot about something that is:

 

This is common for people with depressive symptoms and although it could say you care about an issue such as your physical health which is great, it may not be the best way to manage or direct that care. We will discuss techniques on how to manage rumination more in our group. However, until then, spend no more than 5 minutes to write down your own worry chain, relating to Coeliac Disease that you may have noticed/experienced recently. Again, you do not need to share this but it may be helpful for you to have as a personal reference.

GUTTED OVER COELIAC

GUTTED OVER COELIAC