This story was originally published in our Sept/Oct 2023 issue as "Hypnotizing the Gut?" Click here to subscribe to read more stories like this one.
Ashley had just begun to dig into the cream-sauce pasta when it occurred — that familiar, urgent need to find the bathroom. She was dining at a friend’s house, with many other guests. “I need to get out of here,” the teenager thought as she started to sweat.
To avoid unwanted questions, Ashley devised an excuse to leave and rushed out of the gathering. She stopped at two gas station bathrooms as she sped toward her house. “I was in so much pain I was crying by the time I got home,” she says.
Similar episodes plagued her well into adulthood. The culprit: irritable bowel syndrome (IBS). “When I was having an IBS attack, it was an immediate fight-or-flight response,” Ashley recalls. “I just wanted to get myself out of there.”
She craved more outdoor time with her family, particularly her two young daughters. But even the idea of taking them hiking made her nervous. “[I’m] out in the middle of nowhere; there’s no bathroom,” she would fret. “What would I do?” About five years ago, she even said no to a friend’s bachelorette getaway because of stomach issues.
Ashley tried diet modifications and antidepressants, which treat IBS symptoms in some people. Neither remedy helped. The over-the-counter drug Imodium limited symptoms, but the episodes didn’t diminish. Defeated, she landed in a psychologist’s office, hoping therapy would help her bowel movements.
Ashley’s struggle is hardly unique. She is among more than 25 million people in the U.S. living with IBS; in the U.K., at least 13 million deal with the condition. Increasingly, they are pursuing nonpharmaceutical treatments such as cognitive behavioral therapy and gut hypnosis to heal.
Brain and Gut
Each case of IBS carries a unique combination of issues. Along with stomachache, people can experience frequent episodes of either diarrhea or constipation — sometimes both.
The condition generally relates to gut nerves and muscles functioning improperly. Factors like food allergies, stress and hormonal changes can all contribute, disrupting communication between the gut and brain. With no known cure, doctors prescribe medications and change patients’ diets to alleviate symptoms. But not everyone improves.
Researchers now know that the gut and the brain need to work in tandem to maintain a healthy digestive system — and this synchronization falters in people with IBS. That reality leads some patients to gut-directed hypnotherapy, which clinicians have used in conjunction with medical interventions for nearly four decades.
In application, a hypnotherapist tries to put their client in a state of peaceful wakefulness by asking them to relax different muscle groups and practice other techniques. This can help a person receive “suggestions” — affirming statements that focus on improving different aspects of digestion. In a protocol developed by Olafur Palsson, a clinical psychologist at the University of North Carolina, a suggestion may sound like this: “No matter what is going on in your life, no matter what happens in your GI tract, your intestines will just maintain their normal rhythmic activity.”
While therapists supply suggestions, they encourage patients to conjure up inspiring mental imagery. Peter Whorwell, a professor of medicine and gastroenterology with the U.K. National Health Service, often uses a river metaphor for patients with diarrhea-predominant IBS: Imagine the gut as a turbulent mountain river, then change this visualization to a river moving gently along plains.
“You’re converting the flow in your gut from that raging stream at the top of the mountain to this lovely, smooth-running river, and it can be under your control,” says Whorwell. “That’s the key word all the time: You’re controlling your gut rather than your gut controlling you.”
Similarly, gut-focused variations of cognitive behavioral therapy (CBT) can address elements that wreak havoc on the gut, such as stress. Traditionally, CBT involves tweaking the way someone thinks or behaves in order to improve their emotional well-being. “The goal is then to teach individuals who have IBS a more constructive way of processing information that dampens the kind of stress reactivity that disrupts how the brain and the gut communicate,” says Jeffrey Lackner, a clinical psychologist and chief of the behavioral medicine division at the University at Buffalo school of medicine.
When Ashley started seeing Lackner in mid-2018, she realized anxiety had played a role in her condition. Then she began to change her worry-inducing thought patterns. For example, when concerned about performing poorly in a job interview, she turned to a calming breathing technique as part of her CBT, then confronted her anxious thoughts: “What data do I have? I’ve never bombed a Zoom interview before.” She would instead focus on reviewing her notes.
Lackner also taught Ashley to identify uncontrollable problems and a more flexible way to address challenges. “You need to be able to resign yourself to problems and handle the emotional fallout of a problem,” he says. When Ashley found herself obsessing over situations out of her control, she would say, “Don’t abuse worry. There’s no solution I can get to,” and redirect her attention. Within a couple of months, she was worrying less often — and her gut episodes had dwindled by the start of 2019.
The American College of Gastroenterology’s clinical guidelines recommend using these cognitive therapies with other standard IBS treatment. And, indeed, studies show that these techniques can improve physical symptoms, with CBT approaches garnering the most research.
In a 2018 study by Lackner, 61 percent of participants who primarily accessed CBT therapy at home through learning materials reported that their IBS had significantly improved. The treatment involved only a few visits to a therapist. This was compared to only 43 percent of participants in the control group, who received education about IBS and support, but no CBT strategies.
Gut-directed hypnotherapy’s track record is solid, too. In a 2015 study by Whorwell, 76 percent of the 1,000 IBS sufferers who had not benefitted from medication or diet changes reported that their symptoms had ameliorated after three months of the treatment. A similar study published in Gut in 2003 showed that these types of improvements can last up to five years.
Giving a Hint
Researchers are just beginning to understand how these therapies are strengthening the connection between the brain and gut. Through suggestions in hypnotherapy, Palsson says, therapists are “giving the brain the hint” that it should stop overreacting to threats (stress or inflammation) to allow normal functioning of the gut.
Evidence suggests hypnotherapy can even change how people perceive pain. Some individuals with IBS experience bellyache when their digestive system is running fine. Studies show hypnotherapy can make these people less sensitive to these sensations.
Moreover, brain-imaging data suggests that hypnotherapy changes the interplay among the brain’s pain centers, which corresponds with the easing of bellyache. Similarly, one of Lackner’s brain-imaging studies showed that CBT treatment in IBS patients alters activity in brain areas, such as the limbic region, involved in emotion processing.
The brain-gut remedies can be life-changing for people who’ve suffered for years. “Until I started doing hypnosis, I’ve never seen people say to me, ‘You’ve changed my life,’ ” says Whorwell, who conducted the first clinical trial of gut-directed hypnotherapy in 1984 and continues to research and use the method with patients.
CBT has undoubtedly transformed Ashley’s life. The now-36-year-old, who works as an early-childhood speech pathologist, has started a side business photographing newborns — an ambition she couldn’t previously fulfill because of stomach issues. “It’s not perfect,” she says, “but there are never attacks anymore. I’m not in and out of the bathroom constantly.”
As for her social life, three years ago another friend invited her to a getaway in Siesta Key, Florida. This time she said yes without hesitation — and even participated in a boat cruise at sea, with a calm mind and stomach.
Apps to Help You Go
It’s not easy to find a psychologist trained to deliver brain-gut therapies. Tim Rudolphi, CEO of metaMe Health, a digital therapeutics company, estimates that only 100 to 150 psychologists are licensed to deliver gut-directed hypnotherapy in the U.S. And they typically have to place new patients on a six- to 12-month waitlist.
Instead of waiting, you can access these solutions through apps — no therapist required. Here are a few you could try alongside your regular IBS treatment:
Regulora: This prescription-only remedy by metaMe Health offers seven audio/video gut-directed hypnotherapy lessons. The FDA has cleared the app for treating abdominal pain caused by IBS, drawing on research conducted by Olafur Palsson, who is a scientific advisor for the company.
Mahana IBS: This FDA-cleared digital tool from Mahana Therapeutics also requires a prescription. Its sessions are based on a gut-focused CBT protocol developed at the University of Southampton and King’s College, London.
Nerva: Australian wellness company Mindset Health’s gut-hypnosis tool is rooted in research conducted by Simone Peters, a psychophysiologist at Monash University in Australia. In a 2021 study in the Journal of Gastroenterology and Hepatology, 64 percent of the users reported that the app considerably improved their IBS symptoms — no prescription required.