Jack Harley, Therapeutic Neuroscience at Oxford University
reviewed by Dr Michael Yapko
Friday, November 26, 2021
Jack Harley, Therapeutic Neuroscience at Oxford University
Friday, November 26, 2021

CBT vs Hypnosis for IBS

Contents

Managing your Irritable Bowel Syndrome (IBS) symptoms may be as simple as mind over matter⸺or at least mind over gut.

While eliminating certain foods from your diet may help to improve your IBS symptoms, restrictive diets can be hard to navigate and come with their own unique set of stressors.

Another approach to IBS management is to take medication, but that too has its drawbacks— medication has been shown to be effective in fewer than 50% of patients and performs only 7-14% better than placebo effect for IBS. It’s not surprising that up to half of people with IBS are dissatisfied with the results of their clinical management.

An alternative approach to treating IBS symptoms is to target the mind, using management tools such as hypnotherapy, cognitive  behavioral  therapy (CBT) or even acceptance and commitment, or mindfulness-based commitment therapy.

The gut-brain axis

Under normal circumstances, the brain and the gut constantly communicate in both directions. Information such as appetite, digestive patterns, and emotions are transmitted back and forth through  hormonal and nerve signals. It’s this communication that can make you feel ‘sick with worry’ or ‘have nervous butterflies’.

In IBS, there is miscommunication, or disrupted communication between the gut and the brain, which can lead to pain and changes to your bowel habits.

Are IBS symptoms ‘all in your head’?

While there is a connection between your gut and your brain, that doesn’t mean IBS is ‘all in your head’. What you are experiencing in your gut is very real, as are management methods that involve the mind and the body.

What is hypnotherapy?

Hypnotherapy is a form of hypnosis that aims to therapeutically address a health or wellbeing concern, such as quitting smoking, anxiety, or IBS. Patients meet the therapist in person or alternatively, they can listen to pre-recorded hypnotherapy sessions through an app such as Nerva.

During a hypnotherapy session for IBS, you will be guided into a hypnotic state. This simply means you’ll be deeply relaxed but with a heightened state of focus. You will be completely in control and aware of what is happening, but also comfortable, calm, and able to ignore outside distractions while you listen to the therapist.

In this state, the therapist will take you through visualizations and suggestions designed to help your mind gain control of your digestive processes.

For example, you may be asked to visualize your gut as a series of lubricated passages, or as a fast-flowing river without any obstructions.

After the session, you may be given self-hypnosis exercises to complete at home and use when you feel like you need some extra help with your IBS.

How does hypnotherapy work for IBS?

Hypnotherapy aims to address the miscommunication between the gut and the brain.

In IBS, stress and anxiety play a role in making the smooth muscle of the intestines become overly sensitive. This leads to pain and discomfort from otherwise normal gut function.

When your gut experiences this oversensitivity, it sends signals of distress to the brain, even during normal digestive functions  (ie.when your gut creates  gas after  breaking down sugars). Because the gut and the brain are in constant communication, a little miscommunication can lead to debilitating IBS symptoms.

Hypnotherapy is thought to help restore normal patterns of gut-brain communication, although exactly how this works is not fully understood.

One thing we do know is that stress can have a big impact on your IBS symptoms, and hypnotherapy has been shown to be an effective form of stress relief⸺possibly acting as a circuit breaker for your symptoms.

The stress and IBS loop

Is hypnotherapy effective for IBS?

Hypnotherapy has been demonstrated to be effective for treating symptoms of IBS. One study from Melbourne, Australia, showed that a six-week course of hypnotherapy reduced symptoms of IBS, such as abdominal pain, bloating, and nausea, in 72% of patients.

This improvement was maintained for six months after treatment, suggesting a long-term benefit of hypnotherapy.

Research has also shown that hypnotherapy can be as effective as strict elimination diets, such as low FODMAP, for reducing IBS symptoms, and more effective than medications such as laxatives and antispasmodics.

Hypnotherapy has been endorsed by the American College of Gastroenterology for treating IBS.

What is CBT?

CBT is a form of talk therapy that focuses on replacing negative thought patterns with more positive and realistic ones. It is an evidence-based treatment option for a range of psychological conditions such as depression and anxiety, as well as helping people cope with physical conditions, such as IBS.  

While hypnotherapy aims to address the altered connection between the brain and the gut in IBS, CBT focuses on coping strategies and tools to manage symptoms. CBT helps people  set goals and build skills to cope with the challenges of life, including painful sensations in the gut.

CBT is administered by a qualified therapist, who may teach you a variety of cognitive and behavioural techniques, such as:

  • Positive self-talk
  • Exposure to fear-evoking situations
  • Removing negative thoughts
  • Challenging irrational thoughts
  • Deep breathing

During a session for IBS, you will work with the therapist on any distorted thoughts, feelings, and emotions caused by painful sensations. This may help you better cope and reduce any anxiety and stress you have related to IBS.

CBT also focuses on education. For IBS, the therapist may teach you about how stress and anxiety may impact your gastrointestinal tract. Then, they may take you through some stress management techniques to help you manage stressful experiences.

The therapist may also assign tasks for you to practice and complete at home. For example, you may be asked to record your emotions during the week which can be reflected upon in the next session.

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How does CBT work for IBS?

Over time, CBT may help you to better control your mind’s response to the sensations of pain and discomfort with IBS.

CBT works by addressing psychological factors, such as anxiety, that play a role in symptoms of IBS. For example, you will learn how to avoid catastrophizing symptoms and have the tools to manage feeling overwhelmed by your IBS symptoms.

Is CBT effective for IBS?

Research has demonstrated that CBT is effective in helping to reduce the severity of IBS symptoms. One large review of over 40 clinical trials of psychological interventions for IBS showed a benefit in approximately one-third of patients receiving CBT.

This statistic is higher than results seen by people using several medications to treat their IBS.

Hypnotherapy or CBT, which is better for IBS?

Between CBT and hypnotherapy, there is no clearly superior treatment option for IBS. Both approaches have been demonstrated as effective for reducing symptoms of IBS. Both CBT and hypnotherapy are psychological approaches, meaning you will not have to restrict your diet in order to reduce IBS symptoms.

The difference between them is that CBT is designed to build healthy coping strategies and thought patterns whereas hypnotherapy helps the brain modulate pain signals from the root cause of IBS pain, oversensitive nerves in the gut.  

Both CBT and hypnotherapy are designed to work with a range of patients. However, no treatment for IBS works in all cases, so it is worth consulting a healthcare professional for advice on which treatment option is better for you.

The Wrap Up

IBS can be a debilitating condition that can severely impact a person’s quality of life. Although many treatment options are available, finding an effective management tool can be challenging.

Cognitive behavioral therapy (CBT) and hypnotherapy are becoming more commonly prescribed to manage IBS symptoms. Hypnotherapy involves progressive relaxation, followed by suggestions and soothing imagery tailored to a person’s symptoms. CBT involves retraining a person’s thought patterns to cope with the symptoms of IBS. Both approaches have been shown to reduce individual and overall symptoms of IBS. If you are considering CBT or hypnotherapy, it is important to work with a well-trained, qualified therapist and consult your doctor before starting a program.

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Our Sources

Mindset Health only uses high-quality sources, including peer-reviewed research, to support our articles. We work with experts to ensure our content is helpful, accurate and trustworthy.

  1. Hammond, D.C., 2010. Hypnosis in the treatment of anxiety-and stress-related disorders. Expert review of neurotherapeutics, 10(2), pp.263-273. https://www.tandfonline.com/doi/abs/10.1586/ern.09.140
  2. IFFGD. 2021. Hypnosis Treatment of Irritable Bowel Syndrome - IFFGD. [online] Available at: <https://iffgd.org/resources/publication-library/hypnosis-treatment-of-irritable-bowel-syndrome/> [Accessed 17 September 2021]. https://iffgd.org/resources/publication-library/hypnosis-treatment-of-irritable-bowel-syndrome/
  3. Ford, Alexander C. MB ChB, MD, FRCP1; Moayyedi, Paul BSc, MB ChB, PhD, MPH, FACG, FRCP, FRCPC, AGAF2; Chey, William D. MD, FACG, AGAF, FACP3; Harris, Lucinda A. MD, FACG4; Lacy, Brian E. MD, PhD, FACG5; Saito, Yuri A. MD, MPH, FACG6; Quigley, Eamonn M. M. MD, MACG, FRCP, FACP, FRCPI7 for the ACG Task Force on Management of Irritable Bowel Syndrome American College of Gastroenterology Monograph on Management of Irritable Bowel Syndrome, American Journal of Gastroenterology: June 2018 - Volume 113 - Issue - p 1-18 doi: 10.1038/s41395-018-0084-x
  4. Ballou, S. and Keefer, L., 2017. Psychological interventions for irritable bowel syndrome and inflammatory bowel diseases. Clinical and translational gastroenterology, 8(1), p.e214. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5288603/
  5. Breit S, Kupferberg A, Rogler G, Hasler G. Vagus Nerve as Modulator of the Brain-Gut Axis in Psychiatric and Inflammatory Disorders. Front Psychiatry. 2018;9:44. Published 2018 Mar 13. doi:10.3389/fpsyt.2018.00044
  6. Canavan, C., West, J. and Card, T., 2014. The epidemiology of irritable bowel syndrome. Clinical epidemiology, 6, p.71. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3921083/
  7. Szałwińska, P., Włodarczyk, J., Spinelli, A., Fichna, J. and Włodarczyk, M., 2021. IBS-Symptoms in IBD Patients—Manifestation of Concomitant or Different Entities. Journal of Clinical Medicine, 10(1), p.31. https://www.mdpi.com/935900
  8. Fond, G., Loundou, A., Hamdani, N., Boukouaci, W., Dargel, A., Oliveira, J., Roger, M., Tamouza, R., Leboyer, M. and Boyer, L., 2014. Anxiety and depression comorbidities in irritable bowel syndrome (IBS): a systematic review and meta-analysis. European archives of psychiatry and clinical neuroscience, 264(8), pp.651-660. https://link.springer.com/article/10.1007/s00406-014-0502-z
  9. Walter, S., Bodemar, G., Hallböök, O. and Thorell, L.H., 2008. Sympathetic (electrodermal) activity during repeated maximal rectal distensions in patients with irritable bowel syndrome and constipation. Neurogastroenterology & Motility, 20(1), pp.43-52. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2982.2007.00998.x
  10. Quigley, E.M., 2018. The gut-brain axis and the microbiome: clues to pathophysiology and opportunities for novel management strategies in irritable bowel syndrome (IBS). Journal of clinical medicine, 7(1), p.6. https://www.mdpi.com/2077-0383/7/1/6
  11. Poynard, T., Regimbeau, C. and Benhamou, Y., 2001. Meta‐analysis of smooth muscle relaxants in the treatment of irritable bowel syndrome. Alimentary pharmacology & therapeutics, 15(3), pp.355-361. https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1365-2036.2001.00937.x
  12. Vasant, D.H. and Whorwell, P.J., 2019. Gut‐focused hypnotherapy for Functional Gastrointestinal Disorders: Evidence‐base, practical aspects, and the Manchester Protocol. Neurogastroenterology & Motility, 31(8), p.e13573. https://onlinelibrary.wiley.com/doi/abs/10.1111/nmo.13573
  13. Tan, G., Hammond, D.C. and Gurrala, J., 2005. Hypnosis and irritable bowel syndrome: a review of efficacy and mechanism of action. American Journal of Clinical Hypnosis, 47(3), pp.161-178. https://www.tandfonline.com/doi/abs/10.1080/00029157.2005.10401481
  14. Peters, S.L., Yao, C.K., Philpott, H., Yelland, G.W., Muir, J.G. and Gibson, P.R., 2016. gut‐directed hypnotherapy or low FODMAP diet for the treatment of irritable bowel syndrome? Authors' reply. https://pubmed.ncbi.nlm.nih.gov/27634231/
  15. Gonsalkorale, W.M., Miller, V., Afzal, A. and Whorwell, P.J., 2003. Long term benefits of hypnotherapy for irritable bowel syndrome. Gut, 52(11), pp.1623-1629. https://gut.bmj.com/content/52/11/1623.short
  16. Peters, S.L., Yao, C.K., Philpott, H., Yelland, G.W., Muir, J.G. and Gibson, P.R., 2016. Randomised clinical trial: the efficacy of gut‐directed hypnotherapy is similar to that of the low FODMAP diet for the treatment of irritable bowel syndrome. Alimentary pharmacology & therapeutics, 44(5), pp.447-459. https://onlinelibrary.wiley.com/doi/abs/10.1111/apt.13706
  17. Kingdon, D. and Dimech, A., 2008. Cognitive and behavioural therapies: the state of the art. Psychiatry, 7(5), pp.217-220. https://www.sciencedirect.com/science/article/pii/S1476179308000517
  18. Garland, E.L., Gaylord, S.A., Palsson, O., Faurot, K., Mann, J.D. and Whitehead, W.E., 2012. Therapeutic mechanisms of a mindfulness-based treatment for IBS: effects on visceral sensitivity, catastrophizing, and affective processing of pain sensations. Journal of behavioral medicine, 35(6), pp.591-602. https://link.springer.com/article/10.1007/s10865-011-9391-z
  19. Craske, M.G., Wolitzky-Taylor, K.B., Labus, J., Wu, S., Frese, M., Mayer, E.A. and Naliboff, B.D., 2011. A cognitive-behavioral treatment for irritable bowel syndrome using interoceptive exposure to visceral sensations. Behaviour research and therapy, 49(6-7), pp.413-421. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3100429/
  20. Black, C.J., Thakur, E.R., Houghton, L.A., Quigley, E.M., Moayyedi, P. and Ford, A.C., 2020. Efficacy of psychological therapies for irritable bowel syndrome: systematic review and network meta-analysis. Gut, 69(8), pp.1441-1451. https://pubmed.ncbi.nlm.nih.gov/32276950/
  21. Lacy, B.E., Pimentel, M., Brenner, D.M., Chey, W.D., Keefer, L.A., Long, M.D. and Moshiree, B., 2021. ACG clinical guideline: management of irritable bowel syndrome. Official journal of the American College of Gastroenterology| ACG, 116(1), pp.17-44. https://journals.lww.com/ajg/Fulltext/2021/01000/ACG_Clinical_Guideline__Management_of_Irritable.11.aspx

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