When IBS starts running your life: can hypnotherapy help?

For many people with irritable bowel syndrome, the difficulty is not confined to what happens in the digestive system. It is also the worry about what might happen before any symptoms even begin.

You are invited out for dinner and immediately wonder what you will be able to eat. You are planning a journey and start thinking about toilets. You wake on the morning of an important meeting and check how your stomach feels.

There is a perfectly understandable reason for this. If your digestive system has behaved unpredictably in the past, you learn to anticipate problems. Unfortunately, anticipation can sometimes become part of the problem.

IBS is a genuine disorder of gut–brain interaction. It is not imaginary, and it is not simply caused by stress. However, the brain and digestive system communicate continuously, so anxiety, attention, expectation, and physiological arousal can interact with digestive symptoms.

This is one reason gut-directed hypnotherapy has become an established psychological approach to helping some people with IBS.

When you stop trusting your digestive system

Imagine experiencing several episodes of bowel urgency while away from home – it would be entirely understandable to become more cautious. Before the next journey, you might use the toilet several times. You might avoid breakfast. You check where the service stations are.

Then, while travelling, you notice a movement in your abdomen. Immediately you find yourself asking, "Is it starting?" Attention moves towards your stomach. You notice another sensation. Anxiety rises.

And because the gut and nervous system influence one another, increased arousal may itself affect digestive sensations. The result can be a vicious circle in which symptoms create anxiety and anxiety amplifies the experience of symptoms.

The person is not imagining anything. Their symptoms are real. What may have developed alongside those symptoms is a nervous system that has become extremely good at watching for them.

So what does hypnotherapy actually do?

People sometimes assume that hypnotherapy for IBS simply means being hypnotised and told to relax. Gut-directed hypnotherapy is more specific than that.

Hypnosis involves a state of focused attention and absorption. During therapeutic hypnosis, imagery and suggestion can be directed towards experiences of digestive comfort, regulation and reduced sensitivity.

For example, imagery might represent the digestive system becoming calmer or functioning more comfortably. Someone might imagine warmth soothing the abdomen, or picture the digestive process moving with an appropriate rhythm.

The imagery itself can vary considerably. What matters is that hypnosis provides a focused setting in which different responses to digestive sensations can be repeatedly rehearsed.

Hypnotherapy may also address some of the anxiety and hypervigilance that can develop around IBS. The intention is not to persuade somebody that symptoms are not happening. It is to reduce the unnecessary alarm that may have become attached to them.

From “What if?” to “I can cope”

IBS can generate an extraordinary number of "What if?" questions:

• What if I need the toilet while I'm driving?
• What if I have diarrhoea at work?
• What if my stomach starts making noises in the meeting?
• What if there isn't a toilet nearby?
• What if eating this causes a flare-up?

Once the brain starts looking for possible problems, it can become remarkably inventive. Hypnotherapy can be used to rehearse situations that have become associated with this anticipatory anxiety.

Instead of mentally practising the disaster, somebody can practise coping. They might imagine travelling while feeling increasingly comfortable. They could rehearse eating away from home without constantly checking their abdomen. They might picture noticing a familiar sensation and responding: “I know what this is. I don't need to panic about it.”

The therapeutic goal does not have to be: “My digestive system must behave perfectly.” It can become: “I don't have to be frightened every time I notice my digestive system.”

Turning down the volume

People living with IBS can become highly sensitive to abdominal sensations. That makes sense. If a sensation has previously predicted something unpleasant, the brain has good reason to pay attention. But attention can behave rather like a volume control.

Imagine sitting in a room with a ticking clock. Initially you notice every tick. Become absorbed in a conversation, and the clock effectively disappears from awareness, despite continuing to make exactly the same sound. Our attention influences what reaches the foreground.

For somebody who repeatedly checks their abdomen, ordinary digestive sensations can become extremely prominent. Hypnotherapy can help practise shifting attention away from constant internal monitoring and changing the meaning attached to sensations when they do appear. A gurgle can become a gurgle rather than evidence that the afternoon is about to be ruined.

IBS can gradually make your world smaller

One of the less discussed consequences of IBS is avoidance. Someone may stop eating in restaurants. They choose seats close to exits. They avoid public transport. Long walks become difficult because there may not be a toilet. They turn down social invitations.

Eventually, the person may be organising substantial parts of their life around their bowel. Again, these behaviours are understandable. If avoiding something prevents an embarrassing or frightening experience, avoidance feels successful. The problem is that it can also reinforce the expectation: “I was safe because I avoided it.”

Hypnotherapy can form part of helping somebody regain confidence in situations that have become difficult. Imagery and mental rehearsal can be used before taking manageable real-world steps, allowing the person to practise the response they want rather than repeatedly rehearsing what they fear.

What about stress?

People with IBS are sometimes understandably irritated when somebody tells them their symptoms are caused by stress. That is far too simplistic. IBS is not simply stress with a digestive symptom attached. However, many people do notice that their symptoms become more troublesome during periods of pressure, anxiety or emotional strain.

Hypnotherapy may therefore also help by teaching methods of reducing excessive arousal. This can include relaxation, focused breathing, imagery and self-hypnosis. The intention is not to spend life permanently relaxed. Stress is a normal human response. It is to become better able to move out of prolonged states of tension when they are no longer useful.

Self-hypnosis can be part of the treatment

An important part of gut-directed hypnotherapy can happen outside the therapy room. Clients may learn self-hypnosis or use therapeutic recordings between sessions.

Regular practice matters because the objective is not simply to experience an hour of relaxation with a therapist. It is to practise a different pattern repeatedly enough for it to become increasingly familiar.

Someone might use self-hypnosis to rehearse digestive comfort, reduce excessive bodily monitoring or settle themselves before a situation that previously triggered anticipatory anxiety. Over time, the person develops something they can use independently rather than becoming reliant upon the therapist.

Hypnotherapy is not about controlling every bowel movement

There is a potential trap here. Someone who has spent years monitoring and attempting to control their digestive system does not necessarily need another elaborate method of monitoring and controlling it.

The therapeutic aim can be almost the opposite. Rather than: “I must make my stomach behave,” the person can begin moving towards: “I can allow my digestive system to do its job without supervising it every minute.”

That can involve developing greater tolerance of ordinary bodily sensations and reducing the expectation that every sensation requires action. For some people, regaining trust in their body may be as important as relaxation itself.

Could other therapeutic approaches be useful alongside hypnosis?

Sometimes IBS has become associated with very specific emotional triggers. A previous episode of urgency or loss of bowel control may have been frightening or embarrassing. Travelling, eating in public or being somewhere without immediate toilet access may subsequently produce an almost instantaneous anxiety response.

Where appropriate, another approach is BWRT, which may be considered for particular rapid emotional responses or learned associations of this kind. However, the primary approach to the IBS itself is hypnotherapeutic, with additional therapeutic techniques used according to the person's individual needs. Not everybody requires the same combination of approaches.

IBS still needs appropriate medical assessment

Hypnotherapy should not be used to diagnose IBS. Digestive symptoms can have many causes, and somebody experiencing new, unexplained, persistent or changing bowel symptoms should seek appropriate medical advice.

Where IBS has already been appropriately assessed, hypnotherapy can be considered as part of its management rather than as an alternative to medical care. A responsible hypnotherapist should also be willing to work alongside other healthcare professionals where appropriate.

What would improvement look like?

Naturally, somebody seeking hypnotherapy for IBS is likely to want fewer or less troublesome symptoms, but there can be another important measure of progress: How much of your life does IBS control? 

Perhaps you stop checking for toilets before every journey. Perhaps you begin eating out again. Perhaps you notice a sensation in your abdomen without immediately becoming frightened. Perhaps you accept an invitation without first wondering whether your bowel will allow you to go. Perhaps your digestive system simply occupies less of your attention.

Gut-directed hypnotherapy may help some people reduce IBS symptoms. But therapeutic progress can also mean changing the relationship with those symptoms – reducing fear, hypervigilance and anticipatory anxiety and rebuilding confidence in situations that have gradually become difficult.

IBS may begin in the gut, but its effects can spread into many areas of life. Effective therapy therefore need not be concerned only with what the bowel is doing. Sometimes an equally important question is: “What could I start doing again if I wasn't spending so much time worrying about what my bowel might do next?”