David Godot, Psy.D.

Psychotherapy & Hypnotherapy for Irritable Bowel Syndrome

December 29, 2012 • Mental Health

Most people come to therapy for irritable bowel syndrome reluctantly.

They feel confused by their symptoms, and upset that their doctors don’t seem to have any real solutions. They feel skeptical about whether psychological treatment can help them… because no one has explained why it should.

On this page I’m going to go into some detail about how and why psychotherapy and hypnotherapy can be used to alleviate IBS more effectively than medical treatments. I’ll explain some of the causes of IBS — how it relates to diet, lifestyle, stress, and even relationships. And then I’ll explain some of the techniques that I use to help my clients achieve lasting relief from the pain, bloating, diarrhea, and constipation that disrupt their lives.

There are so many neural connections in your gut, researchers are calling it the “second brain.”

There are literally about a trillion neural connections in there. And each one of them responds to all the same sorts of things that the ones in your brain do. You probably already know that neurotransmitters like serotonin, dopamine, and GABA affect your brain in ways that control your thoughts and feelings… but did you know they do exactly the same thing inside your intestines?

Emotional experiences have a direct effect on our guts, and this is something we recognize intuitively:

  • When we describe a troubling experience as “gut-wrenching”
  • When excitement causes that feeling of “butterflies in the stomach”
  • When nervousness makes us feel queasy
  • When stress triggers heart-burn

The connection between the gut and the brain, which scientists refer to as the gut-brain axis, works in both directions.

Just thinking about food causes your digestive system to start producing and releasing the acids and enzymes needed to digest that imaginary food. This starts in your mouth. Just imagine sliding your tongue across a big, bright yellow, juicy slice of lemon… feeling the sting of the acid as that strong sour flavor fills your mouth — and it’s likely you can feel the saliva starting to well up in your mouth to neutralize the acid of your imaginary lemon. This is happening all the way down your digestive tract, all the time.

And the gut sends strong signals to the brain as well. All the way back to the Ancient Greeks, the stomach has been thought to be the seat of emotion, and new studies are showing that gut health plays a profound role in psychological well-being. A number of studies have shown that the natural balance of bacteria in your intestines plays a large role in this, with probiotic supplements used to alter that balance causing changes in both brain neurotransmitter activity, and in behaviors related to anxiety and depression.

This two-way communication means that gastrointestinal disruptions like those seen in IBS bring about a lot of emotional problems. It also means that we can use psychological treatments to improve not only the emotional correlates, but also the actual disorder of the gut.

The standard of medical care for IBS is to attempt to simply address the symptoms without discovering or correcting the root causes. I find this completely unacceptable.

There are four main strategies that I use in the treatment of irritable bowel syndrome

1. Behavioral

Most people who suffer from IBS will have to make some serious behavioral changes in order to get better.

Most of this is stuff that your doctor should have told you about… but probably didn’t. For some reason gastroenterologists seem to be more comfortable prescribing painful, invasive, and dangerous tests — that are usually inconclusive — than talking to patients about the real gold standard test for food intolerance:

The elimination diet

A huge number of IBS cases are caused by food intolerances, especially undiagnosed gluten intolerance. A growing number of physicians are at least aware of celiac disease — a dangerous form of gluten intolerance that causes damage to the intestinal lining. But most doctors, even GIs, are simply not aware that non-celiac, non-allergic gluten sensitivity exists… and its primary symptoms are the symptoms of IBS. Other symptoms include headache, fatigue, unexplained pains, and rashes.

So in order to find out whether the symptoms are being caused by intolerance to gluten or some other food component (some of the most common are soy, dairy, grains, legumes, fructose, sugar alcohols, caffeine), you have to eliminate all common irritants for at least a month, and then add them back into your diet at a rate of one new food component every 2 weeks. These time frames are necessary because many people continue to have symptoms for up to 3 months after eliminating the food that is giving them trouble. And often the symptoms don’t reappear immediately after reintroducing them into your diet.

So this process takes a lot of patience, and diligent record-keeping. Even though it’s easy to recognize that a few months’ of sacrifices are well worth a lifetime of health and vitality, it can still be difficult to maintain your motivation… especially when the rewards don’t always come immediately.

So I help my patients keep track of what’s been eliminated, what’s been added back in, and what the results have been. I use my scientific training to help patients conduct a hugely important personal experiment, and I use my clinical skills to help them remember why they’re motivated to follow through on these changes.

There are a variety of other behavioral interventions that I use to help improve the symptoms of IBS as well — things like relaxation training, stress management, assertiveness training, dietary enhancement, and meditation that help balance physical, emotional, and social functioning.

2. Cognitive

The way that you think about your symptoms affects the way that you perceive them. Most people think that the amount of pain or discomfort that a person feels is proportional to the amount of tissue damage or inflammation. But that’s not actually the case — every person has their own level of tolerance for pain and discomfort. And by restructuring your mental approach to discomfort, you can actually increase your level of tolerance. That means you’ll perceive less discomfort, and won’t be as bothered by the discomfort you do feel.

This component of treatment, combined with the behavioral elements described above, comprise cognitive-behavioral therapy, which a number of clinical studies have shown to be effective for relieving the symptoms of IBS.

3. Psychodynamic

I’ve also found that certain kinds of people are more prone to this type of condition. They generally fall into one of two groups: people who have difficulty controlling their emotions, and people who control their emotions too tightly.

In either case, it is necessary to understand the origins of that predisposition, in order to reshape the dynamic way a person processes emotions. This type of therapy has a way of not only improving symptoms — but producing positive changes across many, often unexpected areas of life.

4. Hypnotic

Hypnosis is a highly undervalued psychological technique that makes it possible to achieve big changes quickly. It is renowned for its ability to bridge the mind-body gap, allowing for direct control of involuntary physiological functions. It’s also the single best, most empirically supported treatment for IBS.

The type of hypnosis used for IBS is called gut-directed hypnotherapy, which means the types of imagery and suggestions employed are focused very intentionally on influencing the inner workings of the gut. I generally adapt the University of North Carolina model of hypnosis for IBS, developed by Dr. Olafur Palsson, which has a very high level of scientific support for its effectiveness.