Should You Try Gut-Directed Hypnotherapy for IBS?

After settling into a deeply relaxed state, you may hear, “Imagine the sun shining down on your stomach, warming your intestines and providing them with a great deal of relaxation.” You read that right! Such calming suggestions are the basis of gut-directed hypnotherapy, a highly effective treatment for irritable bowel syndrome (IBS) that’s proving to offer long-lasting relief.

A study published in July 2020 in the Lancet Gastroenterology and Hepatology compared patients with IBS who received either standard care or a multidisciplinary approach that included gut-directed hypnotherapy. Researchers found that 83 percent of the patients in the multidisciplinary group had symptom relief, compared with 63 percent of the standard care group. Patients in the multidisciplinary group were also far more likely to have a significant improvement in symptoms and quality of life than the group that received standard care from a gastroenterologist only.

The growing body of evidence showing just how effective gut-directed hypnotherapy is in relieving IBS symptoms and improving gut function spurred the American College of Gastroenterologists to recommend its practice in its 2021 clinical guidelines. And a review published in January 2022 in Gastroenterology noted that hypnotherapy is not only effective in helping IBS, but it's flexible — it can be done individually or in a group setting, and it can be done in person, virtually, or via an app.

Simone Peters, PhD, a leading gut-directed hypnotherapy researcher in Australia, recently created an app called Nerva that guides patients through a six-week hypnotherapy program.

With IBS, the brain misfires, interpreting normal gut sensations as pain. But through the power of hypnotic suggestion and the brain-gut connection, gut-directed hypnotherapy acts on the central nervous system to reduce the sensitivity of nerves in the gut.

“Patients who have completed treatment often find that the intervention has helped them learn how to relax not only their gut, but their mind,” says Megan Riehl, PsyD, an assistant professor of medicine at Michigan Medicine Gastroenterology Clinic in Ann Arbor, who has been providing gut-hypnotherapy services for people with IBS since 2012.

“This is helpful for managing stress, which significantly impacts IBS. Patients are also thrilled to report that as their stress and IBS gets better, so do other areas of health — such as their mood, sleep or muscle tension,” she adds.

For example, people with IBS might get stressed thinking about potential flare-ups while they’re trying to perform everyday functions, like driving a car to work or school. The stressful thought itself could rev up the digestive tract. But with gut-directed hypnotherapy, you may be taught to envision that your stomach is strong, smooth, calm, and protected while you’re driving.

“It teaches the gut to be less reactive to strong emotions, and changes the way the brain processes information sent from the gut,” says Kathyrn N. Tomasino, PhD, a specialist in gastrointestinal behavioral health psychology at Northwestern Medicine in Chicago. In other words, gut-directed hypnotherapy keeps people with IBS from reacting negatively to symptoms and stressors, she says.

“Patients with IBS experience miscommunication between the brain and the gut,” says Dr. Riehl. “Gut-directed hypnotherapy specifically targets the gut-brain pathway in a way that other treatments do not. We see patients who have suffered with their symptoms for decades achieve life-changing results.”

“People who often describe themselves as having a difficult time with relaxation find that the intervention changes that. They are able to learn skills to relax their body and their mind, which transforms their experience with IBS. It is empowering to patients when they feel better and gain confidence in their ability to manage something that once controlled so many aspects of their life,” she adds.

Standardized Mindset Makeover

During a 30- to 45-minute gut-directed hypnotherapy session, you’ll be induced into a hypnotic trance, which you start by closing your eyes. A trained hypnotherapist like Riehl will then guide you through a deep body relaxation exercise to relax your hands, shoulders, stomach, and legs. Once you’re deeply relaxed, the therapist will follow a technique like the North Carolina protocol, which is a standardized seven session treatment script tested by Olafur Palsson, PsyD, a professor of medicine and an internationally recognized expert in the use of hypnosis for gastrointestinal disorders at the UNC School of Medicine in Chapel Hill, North Carolina.

Using the protocol, the therapist will introduce suggestions with specific imagery — often metaphors from nature — which differ for each session. One week, for example, you may be asked to imagine yourself on the beach with the sound of crashing waves. Your therapist might say, for example, “Just like the sounds of the waves in the background of a relaxing day at the beach, you pay no more attention to uncomfortable sensations in your digestive tract.” In another session, while you’re deeply relaxed, you might be asked to imagine yourself protected in a cabin in the woods, while envisioning the smooth muscles of your digestive tract.

Tailored Treatments and Homework

Hypnotherapy sessions can be tailored to your specific symptoms and concerns. If you have problems with the way your stomach muscles contract and relax, known as gut motility, the hypnotherapist may add more suggestions that focus on the rhythm of your digestion. “If you’re experiencing pain, the suggestions might emphasize the perception of pain and the sensitivity of the nerves in the gut,” Dr. Tomasino says.

Between gut-directed therapy sessions, you may be asked to practice self-hypnosis at home four to five times per week. In these sessions, you'll listen to a recorded version of your guided hypnotherapy and a short audio track to reinforce techniques for inducing a hypnotic state on your own.

What if You’re Not Hypnotizable?

Research has shown that 85 percent of people can get into at least a light trance, Tomasino says, and that’s enough to see a benefit from hypnosis for IBS. Don’t be scared. There’s nothing mystical about being in a gut-directed hypnotherapy trance. It’s simply a state of inner absorption, concentration, and focused attention. “The trance is a focused state that feels like you’re immersed in a good book,” Tomasino says. When you’re in the zone, the rest of the world is tuned out, but you still can hear someone call your name and you can choose to respond or not. “Trance is an everyday phenomenon. We all go in and out of it every day,” she says.

Still, gut-directed hypnotherapy isn’t for everybody. “When you’re in this deeply relaxed state of hypnotherapy, people sometimes have the experience of giving up control,” Tomasino says. “For people with a history of trauma that hasn’t been resolved, the trance can be triggering.” Those patients with IBS are better off starting with cognitive behavioral therapy (CBT) to help manage their symptoms; CBT teaches you how to modify your thoughts, improve your emotional state, and thus reduce IBS symptoms. According to a January 2022 review article in Gastroenterology, cognitive behavioral therapies “seek to build and broaden psychological flexibility and a repertoire of new behaviors that are consistent with a patient’s values.”

Overall, gut-directed hypnotherapy is worth a shot. Results don’t usually happen overnight, but they might. Riehl and Tomasino say that most of their patients with IBS have noticed a benefit by session four. “I’ve had patients decrease or get completely off their IBS medication,” Riehl says. After seven sessions, positive results may last up to three years before you may need a booster gut-directed hypnotherapy session.

To find a gut-directed hypnotherapist near you, visit the IBShypnosis website.

Additional reporting by Jordan M. Davidson.