The role of gut-brain therapies in IBS treatment
Has your doctor recommended you try therapy or relaxation for your symptoms?
Or have you been hearing about the gut-brain connection in irritable bowel syndrome (IBS)?
The gut and brain are connected and communicate with each other. This is why you get butterflies in your stomach when you are excited or you feel the pit in your stomach when you’re nervous or scared.
This not only connects the brain and gut together, meaning what happens on one end can impact the other, but it also plays a role in IBS symptoms. This is why the definition of IBS has shifted to “a functional disorder of the gut-brain interaction.”
Listen to The Gut Show episode on this topic on iTunes or Spotify, watch the video below, or keep reading to learn more how the gut and brain are connected, the role in IBS, and how gut-brain therapies can be used to target this.
The gut brain connection
The reason why the gut and brain are connected starts with an understanding of the nervous system and gut-brain axis.
The nervous system is made up of:
the central nervous system which includes the brain and spinal cord
the peripheral nervous system which controls sensory and motor information across the body
The gut is called the “second brain” because of the enteric nervous system (ENS). The enteric nervous system mimics the central nervous system, and it regulates gut motility and digestive secretions. It can run independently of the brain and can be directly influenced by the messages it receives from the brain.
The gut and the brain are in constant communication with one another, primarily through the vagus nerve and the HPA axis
The vagus nerve is the longest cranial nerve in the body that runs from the brain to the colon. The vagus nerve is influenced by the way our brain perceives stress via the sympathetic and parasympathetic nervous systems.
The HPA axis is the neuroendocrine link between perceived stress and physiological reactions to stress. This means it involves nerves and hormones to transmit information and reactions.
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What does this have to do with IBS?
With IBS, we know that there is an altered gut-brain connection. Some refer to this as “over communication” between the two, as if they are yelling at each other versus working together in harmony. The exact mechanism for this disruption is not known and is an area of interest by researchers to better understand the development of IBS.
Hypersensitivity for those with IBS starts in the brain. The disruption of communication between the gut and brain causes the brain to be more responsive to pain signals from the gastrointestinal (GI) tract that may be due to gas, constipation, or diarrhea.
This means the body notices the sensations in the body, communicates those to the brain, then the brain perceives the pain to be worse than it actually is, which manifests as pain in the GI tract. The pain is very real, but the signal from the brain causes the pain to be worse than someone without IBS may be experiencing.
The gut-brain connection in IBS also explains the stress-symptom cycle many experience. Even for those without IBS, the gut tends to mimic what is happening in the brain.
When the body is in a stressed state, no matter what that stressor may be, this can lead to a stressed gut. For those with IBS, this will include symptoms. IBS symptoms, including the fear and uncertainty around them, can also be a stressor, causing the body to be stuck in a stressed state. This is the stress-symptom cycle.
What can we do about this?
Gut-brain therapies support and target the gut-brain connection. The exact mechanisms for their treatment response are not known, but beneficial outcomes have been in well-developed studies for the main two therapies available:
gut-directed cognitive behavioral therapy (CBT)
gut-directed hypnotherapy
What is gut-directed cognitive behavioral therapy (CBT)?
CBT targets thoughts and behaviors associated with symptoms, meaning how you think about your condition and how you respond to it. The goals with treatment are to reframe beliefs about IBS, identify patterns of thinking and action working against them, and build more effective coping strategies to improve quality of life.
In studies, CBT has been shown to improve IBS symptoms, including pain and quality of life for IBS patients, both when provided in person or online. Results have been shown to last for at least 12 months after treatment, making this a safe and effective treatment option to consider.
Gut-directed CBT is a unique form of CBT, so it must be provided through a trained provider or platform that has been studied. You can receive therapy through a GI psychologist or through an FDA-cleared app called Mahana IBS.
What is gut-directed hypnotherapy?
Gut-directed hypnotherapy is a form of hypnotherapy that does not put you in a state of hypnosis, but does induce a deep state of relaxation to guide you through a visualization that teaches your body to control gut function. This is thought to target the pain responsive brain regions.
Studies show this can help reduce pain and bloating, and improve quality of life. This is provided through weekly sessions for 6-12 weeks, with 12 weeks is the most used in programs. This can be done from a trained provider, ideally a GI psychologist, or through proven online programs including Nerva (direct to patient access) or Regulora (prescription option that is FDA approved).
GI psychology
The research so far has been focused more on isolated therapies, but another option that is effective for treatment is a personalized GI psychology approach. This may combine CBT, hypnotherapy, relaxation therapy, and dynamic psychotherapy to personalize treatment for you.
GI psychology is provided by a GI psychologist, a subspecialty within psychology. You can find a provider through your current healthcare team, or online through this directory.
Gut-brain therapies may not be the end-all treatment for IBS, but they can be highly effective for many and are worth considering with your full healthcare team in case they could offer support.
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