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Imagine you’re in cozy room, your whole body cocooned in a comfy chair. As you count from 1 to 20, feel yourself getting more and more relaxed. Now, in your mind’s eye, imagine this deep sense of calm moving all the way down your body into your gut. Imagine that there’s no pain, no cramps, no diarrhea…imagine all your UC symptoms have just floated away…
Sounds pretty dreamy, right? Well, what if we told you that working with a hypnotherapist along with your gastroenterologist might help you achieve a new level of relief for your ulcerative colitis? This isn’t some woo-woo treatment: “Gut-directed” hypnotherapy been around for more than 40 years. It was first used for IBS at the University Hospital of South Manchester in England in 1984 by an innovative gastroenterologist named Peter Whorwell, M.D., Ph.D. Since then, more than 30 studies have been published, mostly on IBS. However, when researchers have looked at UC specifically, the results have been consistently promising.
One British study found that patients with UC who completed a gut-directed hypnotherapy program remained flare-free 78 days longer than those who didn’t undergo the treatment. What’s more, 68% of them maintained remission at one year vs. 40% of the other group. Plus, other research suggests the therapy can help reduce inflammation and improve quality of life. And depending on your insurance, it might even be covered!
“Gut-directed hypnotherapy is certainly not a replacement for medication,” says Megan Riehl, Psy.D., a gastrointestinal health psychologist and assistant professor at the University of Michigan in Ann Arbor, MI. But in the seven years she’s been using gut-directed hypnotherapy with patients, she’ seen high success rates, from 50% to 70%, and long-term improvement in GI functioning. “Most patients I see with UC receive a combination of cognitive-behavioral therapy to improve coping strategies and identify faulty thinking, and then we also incorporate gut-directed hypnotherapy as part of the treatment plan.”
Ready to learn more about how it works? We’ve got the answers.
How Are the Brain and Gut Connected?
Those “gut feelings” people talk about aren’t just about instincts. Scientists now know that there’s a complex communication system connecting the brain and the gut (they call it the “brain-gut axis”). They “talk” via nerves, immune cells, and the microbiota that happen to make their home in your digestive tract, according to a study in the journal Cells.
In the case of IBD, there’s increasing evidence, for instance, that stress can trigger changes in the microbiome that then spur your immune cells to churn out more inflammatory cells. The result? More relapses and severe disease. What’s more, the brain-gut axis is a two-way street. Changes in the gut can lead to changes in the brain, upping patients’ risk of anxiety and depression. It’s because of this innate connection that psychologically based therapies for UC and other forms bowel disorders can be such powerful complements to traditional medicine.
How Does Hypnosis Even Work?
Let’s start with what it’s not first: Hypnotherapy has zero in common with what you’re probably imagining…there’s no pendulum, no loss of consciousness, no loss of control (and definitely no clucking like a chicken). All these misconceptions have contributed to a stigma around the therapy.
“Some patients really need more education on what hypnosis is,” says Sarah Kinsinger, Ph.D., a GI psychologist and director of Behavioral Medicine for Digestive Health at Loyola University Medical Center in Maywood, IL. “There can be unrealistic expectations about what it feels like to be in a hypnotic state, with some individuals thinking it’s a dramatic experience, with no conscious awareness and loss of control,” she says. “That’s just not how it is in practice.”
Dr. Riehl says when those tired but still-common misconceptions come up, she’s able to work through them with patients more times than not.
“This is not staged hypnosis, but a medically based intervention to better manage one’s health,” she says. If a patient is skeptical, she provides additional education—including evidence from the medical literature—to explain that it targets and treats the dysregulation between brain and gut.
Ok, so what is hypnosis then? It’s a deep form of relaxation that allows you to be open to suggestion. And in the case of gut-directed hypnosis for UC, all the suggestions have to do with reducing your symptoms and healing your colon. For instance, your therapist may ask you to place you head on your belly and imagine a pleasant feeling of warmth. She may then ask you to think of the movement in your gut like a slowly flowing river. There are no crampy rapids here. You get the idea.
How conscious you are through all of this depends on how hypnotizable you are. Some people say they hear every word (while very relaxed); others hear nothing after their eyes close. But ultimately, how deep you’re able to go into the trance doesn’t impact the outcome that much.
“We do have research that shows one’s hypnotizability doesn’t really matter when it comes to utilizing this as an intervention," Dr. Riehl says. "The most important thing is openness to implement it as part of the greater treatment plan.” (There are a couple situations in which the treatment may not be recommended, including anyone who has a history of untreated trauma and those living with active symptoms of post-traumatic stress disorder.)
What Does a Hypnotherapy Treatment Plan Look Like?
Usually, the process starts with a discussion about how this therapy might be helpful, says Dr. Riehl. “Maybe the patient is in clinical remission but still having bowel problems—lots of diarrhea or abdominal pain. Hypnosis can be an excellent strategy to calm down those more functional bowel symptoms. A person with UC can be controlled but still have those symptoms, which are similar to those with IBS. Hypnosis can address the visceral hypersensitivity they experience with that overlap.”
Typical treatment protocol for hypnotherapy calls for seven sessions, two weeks apart for four months, Dr. Riehl says. Patients do sometimes return for refresher sessions. In between appointments, they listen to a 20-minute audio recording once a day.
“That helps them refine their skills and find time to relax and observe their body as they listen to the intervention,” she says. “They can then begin to incorporate that practice into their daily routine.”
And “practice” is the key word here. It’s not like you instantly know what to do to get the most out of the treatment. Dr. Kinsinger says. “When patients start, they may not feel something dramatic happen, but I encourage them to give it a few sessions, just like they would with any new skill they’re learning.”
She knows it’s easy to be impatient. “I work with patients on letting go of any critical or judgmental thoughts about the process as we work to develop this skill,” Dr. Kinsinger says. “That’s why it is important to work with a licensed mental health professional, someone who understands the nuances of this treatment, so that you can fully benefit.”
Also key: Don’t view it all as so black and white, she says—like you can or can’t be hypnotized or that this happens quickly, or not. “With the right guidance, you can learn to do this, and can benefit even if you’re not one of those ‘most hypnotizable’ people,” she says. “If you’re moderately hypnotizable, committed to doing this and using your skills, you can benefit greatly from it.”