Gut-directed hypnotherapy for IBS management

In this episode of PodMD, Claire Hall, Research Lead at Mindset Health, will be discussing gut-directed hypnotherapy for IBS management.

To determine if digital hypnotherapy is the right approach to IBS management in your clinic, contact Nerva to receive 3 complimentary 12-month program subscriptions for your patients to see how referring gut-directed hypnotherapy transforms IBS care.

Claim free Nerva access

• Transcript
  Please note this is a machine generated transcription and may contain some errors.
  *As always, all in this PodMD podcast is intended for health professionals and the comments are of a general nature. Information given is not intended as specific medical advice pertaining to any given patient. If you have a clinical issue with one of your patients please seek appropriate advice from a colleague with expertise in the area.

  ---

  Today I’d like to welcome to the PodMd studio Claire Hall, the Research Lead of the Nerva program for IBS.

  Claire is the Research Lead at Mindset Health, a digital therapeutic company that uses hypnotherapy-based protocols to help people manage their health. Claire was on the founding team at Mindset Health and has helped grow the company into a model for how health tech companies should prioritise strong clinical research in the digital therapeutic world.

  Claire has a B.S. from Tufts University in Psychology and Nutrition and previously worked in chronic pain research studying the trans-generational effects of opioid use. She now leads the research strategy at Mindset Health and has facilitated research that has been presented at conferences worldwide.

  Claire has been involved in the development and research strategy for the Nerva app for irritable bowel syndrome, the Evia app for menopausal hot flashes, the Finito app for smoking cessation, the Claria app for mental health, and Relio for chronic low-back pain.

  Today, we’ll be discussing the topic of gut-directed hypnotherapy for IBS management.

  We do hope you enjoy this podcast but please remember that the advice here is of a general nature and is not intended as specific advice about a given patient. The views and opinions expressed in this podcast are those of Research Lead Claire, not PodMD. If you do have a patient on whom you require specific advice then please seek advice from a colleague with appropriate expertise in that area.

  Claire, thanks for talking with us on Pod MD today.

  Claire: Thank you for having me.

  Question 1
  The topic of today’s discussion is gut-directed hypnotherapy for IBS management. Claire, Can you describe for our listeners how gut-directed hypnotherapy supports IBS?

  Claire: IBS is a disorder of brain-gut interventions (DGBI). Symptoms are a felt because the communication between the brain and the gut is dysfunctional. Gut-directed hypnotherapy is a brain-gut behavioral therapy (BGBT) that addresses the gut-brain connection. The gut and brain are in constant communication via the autonomic nervous system, and in IBS, this communication can become dysfunctional, leading to symptoms like pain, bloating, and changes in bowel habits. Gut-directed hypnotherapy helps by prompting patients into a deeply relaxed state, where suggestions are aimed at calming the digestive system and reducing the sensitivity of the gut are offered. These suggestions include visualizations of the gut functioning smoothly, for example, like a beautiful river that you can control the flow of, or dialing back pain like the controls of a train. Over time, these mental exercises help reframe how the brain interprets signals from the gut, helping patients manage their IBS symptoms.

  Question 2
  How would a patient with IBS typically present?

  Claire: A patient with IBS is diagnosed using the Rome IV criteria, which are a set of diagnostic guidelines used to identify irritable bowel syndrome (IBS). The patient meets the diagnostic criteria for IBS if he or she has: Recurrent abdominal pain, on average, at least 1 day per week in the last 3 months, and associated with two or more of the following: Related to defecation, Associated with a change in frequency of stool and Associated with a change in form (appearance) of stool.
  IBS subtype is determined using the Bristol stool chart which classifies patients into either IBS-C (constipation predominant), IBS-D (diarrhea predominant), or IBS-M (mixed).

  Question 3
  What are the risks of IBS?

   

  Claire: IBS isn’t life-threatening, but it can significantly affect a patient’s quality of life, making it a common issue GPs encounter. Patients often report chronic abdominal pain, bloating, and changes in bowel habits, which can disrupt daily routines and increase anxiety or depression. The psychological impact is substantial, as stress often exacerbates symptoms, creating a cycle that’s hard to break. Nutritional deficiencies can also arise, especially if patients are following restrictive diets like low FODMAP without proper guidance. Overuse of medications like laxatives or antidiarrheals can lead to dependency or side effects, so careful management is key. As GPs, it’s important to look at both the physical and psychological aspects of IBS, helping patients find the right balance of dietary, medical, and stress management strategies to improve their quality of life.

  Question 4
  What are the treatment options?

  Claire: IBS does not have a known “cure,” however, there are three main management options considered evidence based. They can be used as stand-alone management options, but the gold standard is offering patients a individualised combination approach. The three modalities are:
  Dietary Modifications: This includes strategies like the low FODMAP diet, which reduces fermentable carbohydrates to help alleviate symptoms like bloating, gas, and abdominal discomfort. Patients should be referred to a dietitian for dietary intervention.

  Psychological Therapies: Brain-gut behavioral therapies like gut-directed hypnotherapy or CBT can help by addressing the mind-gut connection, which plays a significant role in IBS symptoms.

  Medications: Depending on the subtype of IBS (constipation or diarrhea predominant), treatments may include antispasmodics for pain, laxatives for constipation, antidiarrheals for diarrhea, and sometimes low-dose antidepressants to manage the gut-brain interaction and pain perception.

  Question 5
  Have there been any developments in treatment in the last years or are there any in trials or development now?

  Claire: I can speak to recent developments in the brain-gut behavioral space, as that is my speciality. The research around GDH for IBS is robust and until recently the major barrier to access for patients have been 1) access to high quality GDH (400 GI psychs in the world), and 2) cost of care.

  The major breakthrough in research this year has been a randomized controlled trial looking at the efficacy of app-delivered GDH using the Nerva app. The landmark clinical trial published a few months ago and presented at both DDW and AGW this year showed that app-delivered GDH showed similar levels of efficacy to previous in-person studies, and demonstrated that Nerva is a great solution that improves access and hugely lowers cost for patients and providers wanting to access high quality GDH.

  Question 6
  Are there any warning signs a GP or their patient can look out for?

  Claire: The red flags to look out for when making an IBS diagnosis (that would indicate further evaluation is necessary) are:

  Unintended weight loss
  Diarrhea present at night that wakes the patient up
  Blood in stool
  Age, onset over the age of 50
  Family history of IBD
  Persistent daily diarrhea
  Progressive worsening of symptoms
  Recurrent vomiting
  Fever
  Anemia

  Question 7
  What is the likelihood of recurrence of the condition?

  Claire: IBS is a chronic condition with no known cure, and while symptoms can be managed effectively, the likelihood of recurrence or flare is high. IBS tends to follow a fluctuating course, with periods of symptom flare-ups.

  In the long term research into the efficacy of GDH, many patients experience long term symptom improvement – however, flare-ups can happen especially during periods of particular stress.

  Question 8
  When should a GP refer?

  Claire: A GP can refer to Nerva GDH for any diagnosed IBS patient, regardless of subtype. If can be referred as a standalone management tool or in combination with dietary and/or medication interventions. It is important to get patient buy-in for any course of care, but for a brain-gut-behavioral therapy like Nerva, it is especially important because if patients don’t listen to the sessions, it won’t work.

  The only contraindications are patients with psychosis (active or a history of) and severe psychological co-morbidities who are a better fir for in-person care with a mental health provider.

  Question 9
  What role does the GP play in the treatment of IBS?

  Claire: GPs are often the first point of contact for patients with IBS, and the role is critical in both diagnosis and long-term management. Initially, you’ll work with patients to make a diagnosis rule out any other conditions. From there, your focus will be on managing symptoms with practical approaches—like recommending dietary changes, psychological interventions and/or medication.

  You also play a key role in recognising the psychological component of IBS, which is important because stress and anxiety often exacerbate symptoms.

  If first-line treatments don’t work, you’ll coordinate with specialists—like gastroenterologists or psychologists—while continuing to monitor and support your patients over the long term. Ultimately, your role is to guide patients through the management of this chronic condition, making adjustments to treatment plans and ensuring they have the tools to improve their quality of life.

  It’s about balancing medical, dietary, and psychological support to offer comprehensive care.

  Concluding Question
  Thank you for your time here today in the PodMD studio. To sum up for us, could you please identify the three key take home messages from today’s podcast.

  Claire: Diagnosis and Education: As a GP, your role is crucial in accurately diagnosing IBS and ensuring that other conditions are ruled out. After diagnosis, patients should understand that IBS is a disorder go gut-brain interaction and management should be personalized to the patient but include dietary, psychological and/or medical aspects.
  Gut directed-hypnotherapy: GDH is highly efficacious in the management of IBS symptoms and should be considered for all patients with IBS because it is low-risk and can be used stand alone or combined with other management options.
  Ongoing support: Given the chronic nature of IBS, GPs should provide long-term support by following up with patients to monitor progress and coordinating with specialists when necessary.

  Great. Thanks for your time, Claire. And the insights you’ve provided.

  Claire: Thankyou.