There is strong evidence for the gut brain connection as well as for the effectiveness of behavioral therapy in improving gut health concerns.
·October 7th, 2021
As Western society becomes increasingly conscious of the connection between the gut and the mind, behavioral therapy techniques are being investigated as a potential treatment route for some digestive health conditions
Stress and anxiety can take a toll on gut health, but gut health conditions are also likely to generate stress and anxiety – creating feedback loops that behavioral therapy may be able to break up
Several behavioral therapy options exist to address gut health conditions, including cognitive behavioral therapy (CBT), gut-directed hypnotherapy, and stress management therapy/breathwork
Western medicine tends to treat areas of the body as if they are separate. There’s a different MD specialist for every part you can think of, and often there isn’t a ton of discourse around how one part—say, the brain—interacts with another part—say, the gut.
Because of this, people who have grown up in a Western medical system often need help identifying the connections between the various parts of their body. For people with gastrointestinal conditions, making these connections clear can have a profound effect on the day-to-day experience of living with GI distress.
How can behavioral therapy work on the gut?
The gut is a complex part of the human body, performing many essential functions and interfacing directly with nutrition and elimination. Behavioral therapy, which includes talk therapies as well as mind-body modalities, can be effective on a number of physical conditions, from poor gut health, to anxiety disorders to cancer.
The vagus nerve, which connects the brain to the gut, sends signals in both directions. Certain inputs, like stress, can cause simultaneous reactions in the brain and the gut, so the idea that the gut is just for digesting food is an outmoded one that isn’t supported by science—rather, the gut and the brain are like motherboards, each working at their own complicated sequences of activities, and also communicating with each other.
One of the reasons behavioral therapy works is because of the way we respond, react, and make sense of physical sensations. We often create patterns out of these behavioral responses without being aware of them, and those patterns settle into what are known as feedback loops, in which a thought becomes automatic. Feedback loops can be positive or negative, but the ones we fall into unwittingly tend to decrease the quality of our experiences, bringing anticipation and anxiety into the fold.
Because gastrointestinal disorders are so unpredictable, and because flares can be devastating to quality of life and cause issues with work, relationships, and ability to function, it is very common for people with Crohn’s disease, IBS, ulcerative colitis, and other GI conditions to live with fear and anxiety around their symptoms.
When will it happen again, what will I do, will it be embarrassing, will it be painful, how will I manage, who will help me, what if it gets worse, what if it never gets better—these are the looping thoughts common to the rollercoaster ride of GI flares and remissions. If you’ve ever had an incident of public incontinence as part of your disease, the fear of social shame can also weigh heavy.
Unsurprisingly, stress and anxiety take a toll on gut health, whether you have a GI condition or not. Thus, the loop of fearful anxiety/GI distress/confirmation of anxious fears exacerbates itself infinitely until something intervenes—and that intervention is what behavioral health therapy seeks to do.
As part of your treatment, learning to unspool negative feedback loops and inaccurate thought patterns can do more than just improve your mental health (though it can certainly do that, too). It can actually have a positive impact on the health of your gut. The feedback loop can be replaced with old fearful anxiety/intervening behavioral health technique/new and improved experience, and that can be a game-changer, improving mental and physical health simultaneously.
Types of GI behavioral therapy
Let’s take a look at these types of therapy and some of the behavioral health modalities and techniques with proven track records of improving GI conditions.
Cognitive behavioral therapy(CBT)
Cognitive behavioral therapy, or CBT, is one of the most well-researched methods of behavioral therapy, with a proven track record of efficacy. It is a thought-based therapeutic modality that trains clients to assess, interrogate, and reframe their thought patterns, thereby replacing negative, ineffective, or inaccurate thought loops. Cognitive therapy is used to treat a wide range of mental health conditions, from panic attacks to depression, as well as to improve relationship dynamics and mental wellness in people who don’t suffer from mental illness.
In a cognitive behavior therapy session, the client and behavioral health practitioner (who may be a psychologist, therapist, or counselor) sit down together and examine, through a structured conversation, how the client’s thought patterns may or may not be serving them. CBT focuses on specific issues in the client’s current life—in this case, it would be issues around their GI condition.
The therapist or psychologist will then train the client to use different cognitive techniques, including identifying and challenging irrational thoughts, calming self-talk, thought stopping, and visualization. They may also employ physical techniques such as progressive muscle relaxation and breathwork.
For cognitive therapy that is targeting IBS, Crohn’s, ulcerative colitis, or another inflammatory bowel condition, therapy sessions may focus on anxious thought patterns around symptoms, strategies for calming the body, and desensitization to difficult situations and symptoms. Recognized by the American College of Gastroenterology for treatment of IBS, CBT can have real, physical effects on symptoms like abdominal pain, constipation, and diarrhea and can tremendously improve patient quality of life.
Hypnosis has been proven to be an effective form of psychotherapy for treating issues like insomnia, substance abuse disorders, and at managing the pain of childbirth, and hypnotherapy as a form of behavioral therapy for GI conditions shows great promise.
In a gut-directed hypnotherapy session, which is conducted by a practitioner called a gastrointestinal health psychologist, the client is guided through a hypnotherapy script to enter a state of deep suggestibility and relaxation—hypnosis.
Once in that state, the therapist will introduce ideas for the client to visualize and imagine, for example, imagining their intestines being free of pain and discomfort. Because the brain is more able to receive these ideas during the state of hypnosis, many patients report immediate relief of painful symptoms. Gut-directed hypnosis seeks to address the miscommunication between brain and gut that can be an element of many GI conditions.
Stress management therapy and breathwork
Traditional talk therapy with a counselor, therapist, or psychologist can improve the mental and emotional aspect of living with a GI condition. Having a safe, private space to talk through challenges, fears, and issues can help untangle the feelings of overwhelm, anger, frustration, fear, and shame that can come with diseases like Crohn’s, IBS, and UC.
Breathwork techniques, which can be taught by a mental health practitioner as well as by a wellness coach, yoga teacher, or breathwork specialist, can also have a positive effect on the body’s ability to manage chronic GI distress.
These techniques range from the simple, like deep breathing, to the intense, like holotropic breathing and the Wim Hof method. Finding a wellness coach in your area who is well versed in breathwork can help you connect the dots between mental and physical health.
Using the mind to treat the body
Living with an inflammatory bowel condition can take a tremendous toll on mental health and wellbeing. It’s tempting to think of the mind and the body as separate issues, but the more we can tap into holistic treatments that acknowledge the interwoven natures of our physical and mental health, the more options we have for treatment.
If you have GI disease, working with a nutritionist or dietitian, a psychologist, a naturopathic doctor, and a wellness coach in addition to your gastroenterologist has the potential to level up your treatment plans, and to bring you better results.
If you think you may benefit from this form of therapy, the right provider can help you build a personalized plan to support your wellbeing. Connect with credentialed behavioral therapists who serve your area here.