Case study: Helping a High-Stress Patient

Case Study Overview

• Invest the time in educating patients in-depth about the mind-gut connection to help them fully comprehend how gut-directed hypnotherapy can alleviate symptoms.
• Before the first consult, Dr. Shamistra Barathan sends relevant patients a video to watch about stress, which successfully primes them to be open to discussing this in their appointments and helps her set expectations from the start.
• Shamistra uses follow-up appointments as opportunities to remind patients about adhering to the program for the full six weeks to secure the best possible outcome, even if they have already experienced a symptom reduction.

Patient history

While Caroline* knew she led a stressful lifestyle, it still took considerable convincing from integrative health GP Dr. Shamistra Barathan that her mind and gut health issues were deeply connected.

“Caroline, who’s in her 30s, holds down a high-powered job and I could see how stressed she was when she first presented to me,” said Shamistra.

“Apart from IBS, she was experiencing reflux, couldn’t properly digest protein, and described feeling very uncomfortable. Her eating habits were really erratic because of her digestion issues, and she was losing weight. 

“She’d tried the low FODMAP diet in the past and had begun taking a closer look at what she was eating. She knew she had to eat more, but she just couldn’t digest her food. She was also aware her anxiety was high and had been thinking about how to create more of a work/life balance and what needed to change in her career.

“I also sent Caroline a video about stress to watch before we met for the first time. In my experience, this helps patients become primed to have a discussion about stress and their body in their appointments.”

While Caroline had already received an IBS diagnosis, Shamistra still recommended a series of tests after their initial consultation.

“Even though I could see stress was her biggest trigger, it was important to screen for other red flags. We investigated whether she had any obvious deficiencies in iron or B12, screened for blood in her stool, and determined if she had any inflammatory markers.”

Emphasizing education

Shamistra believes it’s critical that her IBS patients understand their own bodies and stress reactions, and she devotes considerable time to educating patients about their condition.

“Right from the start, I told Caroline, stress is a big player when it comes to gut health. Then, I explained what that means, how it connects to her enteric nervous system, and why she needs to begin implementing stress strategies, like better sleep, breathing, exercise, meditation, and mindfulness.”

Shamistra has long been a proponent of gut-directed hypnotherapy and is a firm believer in its transformative capabilities for her gut health patients with anxiety, and she encouraged Caroline to give Nerva a try early on. 

“While I’ve been aware of gut-directed hypnotherapy for many years, I was happy to stumble across the Nerva app as it’s so hard for patients to receive in-person therapy like this because it’s expensive, waiting lists are long, and often patients like Caroline need help much quicker.”

Shamistra gave Caroline a simple outline about the program to get her started.

“When it comes to talking about gut-directed hypnotherapy, I told her, ‘It’s just 15 minutes and you can start today.’ I acknowledged that yes, there is a cost, but I encourage all of my patients to look at the big picture and discuss the benefits of trying it on an app.

“I’ve found it’s very easy to get them started on Nerva if I’ve taken the time to educate them in detail about the mind-gut connection.”

Setting expectations

To help her patients avoid setbacks, Shamistra is firm in setting expectations for following the Nerva program.  

“I tell all of my patients trying Nerva that they have to be committed, and they have to be motivated to make the time to listen every day. I usually receive positive feedback from the ones who see changes very quickly, but by weeks three or four, they tend to lapse. 

“It can be challenging to keep them on track, but the majority of my patients make it through the full six-week program as I use our follow-up appointments to reiterate the importance of their mind-gut connection. I’m very encouraging to keep them going. 

“It can, of course, take longer to rewire a person’s stress response. I let everyone know it may take you longer than six weeks; maybe you need to keep listening for three months and follow Nerva’s maintenance plan. 

“Overall, I’ve seen phenomenal results, which I love, especially with patients who’ve been dealing with painful symptoms for years and years.” 

From doubt to belief

While Shamistra knew Caroline would benefit from gut-directed hypnotherapy, she had to work hard to shift Caroline’s doubts about how an invisible connection between her mind and gut was central to her symptoms.

“She knew something was wrong, but she just didn’t quite believe her stress was connected to her gut health.

“I took her through all the steps and focused heavily on education with her—it really took some time to convince her that her brain and gut symptoms were interconnected. I worked hard to shift her belief system. 

“Finally, I got her to try Nerva, and within days her reflux was gone, she could eat and digest protein, and her bowel habits changed. She said to me, ‘Oh my God, you’ve been telling me about the mind-gut connection for ages! And I didn’t believe you—now I know it’s there.’ 

“It was hard for someone like Caroline to understand this invisible connection as it wasn’t tangible to her as she couldn’t see it. And most patients simply don’t hear much about it, so they don’t know if such a thing is believable. 

“Often patients like Caroline will visit a conventional GP, who might offer them Endep and an SSRI for depression, admitting there isn’t much else they can do. But I see so many relapses because they haven’t dealt with the brain-gut connection and they haven’t developed a deeper understanding about why it all starts in the first place.”

‍Dr. Shamistra Barathan has over 20 years of experience as a general practitioner and has specialized in nutritional, lifestyle, and environmental medicine for the past 10 years. She founded and runs a private integrative medical clinic in Melbourne, Australia.

‍*Name changed. As we share real stories from real people, stock images have been used to ensure we protect the privacy of our users.

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