The Mind-Gut Connection Requires a Multidisciplinary Approach
Our minds and bodies are not only connected by spinal columns but also via a series of nerves that send signals to each other like information superhighways. This connection has led many health providers in the field of gastroenterology and psychology to start co-creating mind and gut protocols when treating patients with irritable bowel syndrome (IBS), inflammatory bowel disease (IBD) and other digestive disorders.
The gastroenterologist's perspective
"IBS is one of the most common of gut disorders," said Shapiro, who specializes in disorders of gut-brain interaction (including IBS and functional dyspepsia). "IBS can present in various ways: abdominal pain with constipation, diarrhea or both. About 10 to 12 percent of the adult population has this."
"IBS can be challenging both for doctors and patients because syndromes are not defined by a 'structural problem,'" he added. "Patients have had 'normal tests' and no clear diagnosis, which leads them to think, 'Oh, this is all in my head.' This is one of the first things I try to dispel, whether this was said to them directly or they were left to conclude this themselves."
The effect of living with chronic abdominal pain, bloating, diarrhea and/or constipation directly impacts a person's quality of life.
How nerves communicate between mind and gut
Just as the brain has a nerve center, the gut does, too, and "one of the ways they are connected is through what is called the vagus nerve," according to Shapiro.
"This cranial nerve begins at the base of the skull, impacting the heart and the lungs and the intestines and many different actions throughout the body as it wanders [away] from its origin," Shapiro explained. "This nerve sends signals both ways—brain to gut and gut to brain. And some [chronic] pain comes from abnormal signaling from the gut to the brain, almost like static from an old TV set."
These chronic pain signals to the brain may block other non-pain signals, which means patients will struggle to find relief from their symptoms.
Shapiro noted that "cognitive behavioral therapy (CBT) and gut-directed hypnosis are two of the most effective [treatments]" for IBS and other GI disorders. "We think that one of the ways these may work is by ramping up the inhibitory signals that block pain [signals] to the brain. Both [of these therapies are performed] by specially trained psychologists.
"The other benefit of psychological therapies is their treatment of [comorbidities]," Shapiro continued. "There is a significant mental and emotional toll of patients who suffer from the daily stress of living with IBS symptoms."
Studies have indicated a direct correlation between both the development of and the exacerbation of GI conditions and anxiety and depression. Along with these psychotherapy protocols, Shapiro additionally gives his patients dietary suggestions and education on FDA-approved medications.
The potential role of hypnotherapy
Fukui, a licensed professional counselor who integrates clinical hypnosis and biofeedback into her psychotherapy practice, is only one of only three licensed mental health providers in the Houston area specially trained in gut-directed hypnosis.
"[I] first require that a client with gastrointestinal distress be diagnosed by a physician," she said. "Some IBS clients improve with medication and/or diet; some do not, [and] these are the clients who seek additional solutions."
Fukui's additional solution, hypnotherapy, is not quite as mystical as it sounds.
"We go into hypnosis every day and people just don't know it," she said. "It's very similar to daydreaming. Or, if they're an athlete, they probably have experience going into 'the zone.' Say they were a basketball player. They want to get the ball in the hoop and they're just so focused they don't see the crowd. They don't hear the crowd."
Though the "communication highways" between brain and gut are continually updated, Fukui said their mechanism allows hypnotherapy to be successful.
"Most of the incoming information from the intestines...is kept outside of a patient's conscious awareness and that's where hypnosis can [help]," she said. "With hypnosis, you can access your unconscious and begin to calm strained emotions and negative thoughts."
'With hypnosis, you can access your unconscious and begin to calm strained emotions and negative thoughts.'
She added that her patients are under intense stress from the constant threat of intestinal movements or pain, feeding a vicious cycle.
"Psycho-gastroenterology not only works for gastrointestinal issues but for abdominal pain, anxiety and depression," she said. "The key is to learn how to take care of yourself better. Self-management is really important."
Fukui also said this "brain/gut axis" treatment approach has been part of treating IBS since the Lancet published Peter Whorwell's study on the topic in 1984. In the study, 30 patients with severe IBS were randomly assigned treatments that ranged from hypnotherapy, psychotherapy or placebo. Of the three, the hypnotherapy indicated a "dramatic improvement in all features, [with] the difference between the two groups being highly significant."
Gut-directed hypnotherapy can be done remotely as well. In 2019, a study compared Skype versus face-to-face hypnotherapy sessions. Using a 50-point or more reduction in the IBS Symptom Severity Score, 65 percent of the subjects responded to the Skype hypnotherapy with outcomes "significantly improving" compared to 75 percent of the subjects for face-to-face hypnotherapy.
It's also important to note, "70 percent of the people who participated in the Skype hypnotherapy would not have been able to get treatment otherwise, because they lived over an hour away [from a practitioner]."
Help for sufferers of GI issues
Both Shapiro and Fukui emphasized the need for a multidisciplinary approach when treating patients with IBS and other gastrointestinal disorders. Communication between providers is essential to meet the needs of each patient.
If you have GI symptoms and/or concerns, take the first step today and make an appointment with your primary care physician or a gastroenterologist in your area.