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Hypnosis for Gut Disorders: Addressing the Brain-gut Connection

Laurie A. Keefer, PhD
Laurie A. Keefer

Modern medicine has increasingly recognized the biochemical interaction of the central nervous system and the gastrointestinal tract, known as the “gut-brain axis.” Until recently, though, many practitioners considered functional gastrointestinal conditions such as irritable bowel syndrome to be psychosomatic.

However, brain imaging research by physicians like Emeran Mayer, MD, PhD, established the existence of a bidirectional link between the brain and the gut, including the microbiome. This bidirectional signaling manifests not only as the influence of psychological stressors on the gut microbiota, but also the influence of changes in the gut microbiota on psychological and emotional states.

“Patients with these functional GI disorders feel something that would be considered “normal” by others, such as fullness after eating, as painful.” Laurie A. Keefer, PhD, director of psychobehavioral research within the division of gastroenterology at Mt. Sinai Health System, told Healio Gastroenterology and Liver Disease. “People with brain-gut dysregulation might experience something like a little bit of acid secretion, which is normal and necessary to break down your food, as heartburn. Being able to identify this abnormal process of interpreting symptoms led us to say, ‘maybe this isn’t a psychosomatic disease. Maybe this is a disorder of brain-gut dysregulation.’”

Some have used hypnosis for GI disorders throughout history for a variety of purposes. For irritable bowel syndrome, considered psychosomatic as recently as the 1990s, the aim of psychotherapy was to calm the patient and decrease stress levels. With the relatively recent paradigm shift toward a bidirectional link, however, the goal of hypnosis is brain-gut repair.

Keefer, who specializes in psychosocial care of patients with chronic digestive diseases and performs hypnosis regularly, spoke with Healio Gastroenterology and Liver Disease about the role of hypnosis in improving symptoms of patients with various GI disorders.

Question: How does hypnosis address the gut-brain connection?

Answer: With brain-gut dysregulation, your brain is overreacting to things that are normal in your body. You’re experiencing these normal occurrences as problematic due to these messages from the brain.

Enter hypnosis, which can dampen these messages, and can turn off the different parts of the brain that would normally get lit up under these circumstances. Hypnosis can turn that off, so that patients really do begin to see that repair of the brain-gut access. We’ve been applying hypnosis in this way, and I think more recently it’s gotten a lot of attention, partly because you can do it via telemedicine. In the past, there’s been limited access to providers, but telemedicine significantly increases that access.

Also, we’re applying hypnosis to more diseases recently; we’re now able to say these therapies work for GERD, they work for irritable bowel syndrome, they work for chronic abdominal pain, even inflammatory bowel disease, which is more my area of research. We’ve been able to apply it because we know the influence of hypnosis on this brain-gut connection.

Q: What kind of hypnosis is done for this? Is it like the old-fashioned hypnosis a lot of people might envision?

A: This is definitely not like the early days of Mesmer, where he’s swinging a pendulum and telling you you’re getting sleepy, or like Las Vegas where a hypnotist is instructing you to cluck like a chicken.

Brain-gut hypnotherapy is very directed. I often tell my patients to think of hypnosis like an IV going into their veins. We’re creating a state of relaxation, a state of suggestibility. The suggestion that we make under hypnosis is like the dose of the medication we’re pushing through that IV. The suggestion itself is where the power of the therapy lies. I could say, “You’re smart and pretty and everyone likes you,” and it would not make any difference in your GI symptoms. You might walk around feeling better about yourself, but your GI tract is not going to benefit.

What will actually influence your symptoms is if I say, ‘In situations where you have previously experienced abdominal discomfort, you now experience warmth and pleasant sensations.” That’s the difference, I think. It’s really gut-specific therapy.

Q: How conscious is the patient during the hypnosis?

A: Hypnotizability is definitely a characteristic that ranges across the population. About 20% of people are probably not at all hypnotizable. They’re just never going to enter into that trancelike state. The rest of the people do get into a trancelike state to some extent. Some people get deeper than others. For some, it’s faster than for others. Some patients will say, “I heard every word you said, but I still was really relaxed.” Other people might say, “As soon as I closed my eyes, I was out until you counted back.”

The good news here is that hypnotizability doesn’t need to affect the efficacy of the therapy. Patients do not need to feel pressured about whether they are hypnotizable, whether they can do it. Most of the time they can. They just have to be open to the experience.

Q: Do you find that some patients benefit more from hypnosis than others?

A: Yes. There are other brain-gut therapies that we use, cognitive behavioral therapy being one. When I see a patient, I assess them and decide whether [cognitive behavioral therapy] or hypnosis would be the best approach. Obviously, patient preference is a major factor. If they really want to try hypnosis and think it would be cool, then obviously we can do that.

I also find that patients who are very physically symptomatic do particularly well with hypnosis. It’s like the patient who needs the IV infusion instead of a pill.
These patients need something more subconscious; they’re so focused and so uncomfortable, we need to go a little deeper into the subconscious. I definitely recommend that for those patients.

However, if a patient is super anxious about losing control, or they don’t really buy into the idea of the brain-gut connection, I’m more likely to try something like cognitive behavioral therapy, where we can focus more broadly on coping and the impact of symptoms. I also wouldn’t do hypnosis on people with trauma histories or dissociative characteristics.

In most patients who are very physically symptomatic, though, I tend to prefer hypnosis.

Q: How widely adopted is this therapy?

A: I think the biggest problem we face right now is a lack of providers. I think gastroenterologists are hooked on brain-gut psychotherapies now. People seem to really get it, and see it as almost a first or second line treatment for at least some of these GI conditions. The dilemma is, how do they find a provider? How many GI psychologists are out there in the world to see the plethora of patients with these conditions? That’s the rate limiting obstacle.

I am actually a scientific advisor to a group of people who are developing an online brain-gut psychotherapy platform; as long as a patient has a provider in their state, they can receive the treatment through telemedicine. For example, California is a huge state. If I get a request for hypnotherapy from a person in San Francisco, and San Francisco is four hours away, that won’t work.

We’re able to now say, “Okay, you can still get the treatment via telemedicine as long as there is a provider in your state.”

Q: Is hypnosis covered by insurance?

A: Psychologists can bill for hypnosis as typical psychotherapy, because it’s a form of psychotherapy. If you’re seeing a psychologist and the psychologist takes your insurance, it should be no problem. If you’re not a psychologist and you want to do hypnosis, it’s a little bit trickier We’re actually working on getting a CPT code for nurse practitioners and social workers. Right now, though, a patient’s best bet for being covered is to see a health psychologist who takes your insurance. – by Jennifer Byrne

For more information:

Laurie A. Keefer, MD, can be reached at 17 E. 102nd St., New York, NY 10029.

Disclosure: Keefer reports serving on the scientific advisory board of www.MetaMeConnect.com, a company that has developed an online brain-gut psychotherapy platform.

Laurie A. Keefer, PhD
Laurie A. Keefer

Modern medicine has increasingly recognized the biochemical interaction of the central nervous system and the gastrointestinal tract, known as the “gut-brain axis.” Until recently, though, many practitioners considered functional gastrointestinal conditions such as irritable bowel syndrome to be psychosomatic.

However, brain imaging research by physicians like Emeran Mayer, MD, PhD, established the existence of a bidirectional link between the brain and the gut, including the microbiome. This bidirectional signaling manifests not only as the influence of psychological stressors on the gut microbiota, but also the influence of changes in the gut microbiota on psychological and emotional states.

“Patients with these functional GI disorders feel something that would be considered “normal” by others, such as fullness after eating, as painful.” Laurie A. Keefer, PhD, director of psychobehavioral research within the division of gastroenterology at Mt. Sinai Health System, told Healio Gastroenterology and Liver Disease. “People with brain-gut dysregulation might experience something like a little bit of acid secretion, which is normal and necessary to break down your food, as heartburn. Being able to identify this abnormal process of interpreting symptoms led us to say, ‘maybe this isn’t a psychosomatic disease. Maybe this is a disorder of brain-gut dysregulation.’”

Some have used hypnosis for GI disorders throughout history for a variety of purposes. For irritable bowel syndrome, considered psychosomatic as recently as the 1990s, the aim of psychotherapy was to calm the patient and decrease stress levels. With the relatively recent paradigm shift toward a bidirectional link, however, the goal of hypnosis is brain-gut repair.

Keefer, who specializes in psychosocial care of patients with chronic digestive diseases and performs hypnosis regularly, spoke with Healio Gastroenterology and Liver Disease about the role of hypnosis in improving symptoms of patients with various GI disorders.

Question: How does hypnosis address the gut-brain connection?

Answer: With brain-gut dysregulation, your brain is overreacting to things that are normal in your body. You’re experiencing these normal occurrences as problematic due to these messages from the brain.

Enter hypnosis, which can dampen these messages, and can turn off the different parts of the brain that would normally get lit up under these circumstances. Hypnosis can turn that off, so that patients really do begin to see that repair of the brain-gut access. We’ve been applying hypnosis in this way, and I think more recently it’s gotten a lot of attention, partly because you can do it via telemedicine. In the past, there’s been limited access to providers, but telemedicine significantly increases that access.

Also, we’re applying hypnosis to more diseases recently; we’re now able to say these therapies work for GERD, they work for irritable bowel syndrome, they work for chronic abdominal pain, even inflammatory bowel disease, which is more my area of research. We’ve been able to apply it because we know the influence of hypnosis on this brain-gut connection.

PAGE BREAK

Q: What kind of hypnosis is done for this? Is it like the old-fashioned hypnosis a lot of people might envision?

A: This is definitely not like the early days of Mesmer, where he’s swinging a pendulum and telling you you’re getting sleepy, or like Las Vegas where a hypnotist is instructing you to cluck like a chicken.

Brain-gut hypnotherapy is very directed. I often tell my patients to think of hypnosis like an IV going into their veins. We’re creating a state of relaxation, a state of suggestibility. The suggestion that we make under hypnosis is like the dose of the medication we’re pushing through that IV. The suggestion itself is where the power of the therapy lies. I could say, “You’re smart and pretty and everyone likes you,” and it would not make any difference in your GI symptoms. You might walk around feeling better about yourself, but your GI tract is not going to benefit.

What will actually influence your symptoms is if I say, ‘In situations where you have previously experienced abdominal discomfort, you now experience warmth and pleasant sensations.” That’s the difference, I think. It’s really gut-specific therapy.

Q: How conscious is the patient during the hypnosis?

A: Hypnotizability is definitely a characteristic that ranges across the population. About 20% of people are probably not at all hypnotizable. They’re just never going to enter into that trancelike state. The rest of the people do get into a trancelike state to some extent. Some people get deeper than others. For some, it’s faster than for others. Some patients will say, “I heard every word you said, but I still was really relaxed.” Other people might say, “As soon as I closed my eyes, I was out until you counted back.”

The good news here is that hypnotizability doesn’t need to affect the efficacy of the therapy. Patients do not need to feel pressured about whether they are hypnotizable, whether they can do it. Most of the time they can. They just have to be open to the experience.

Q: Do you find that some patients benefit more from hypnosis than others?

A: Yes. There are other brain-gut therapies that we use, cognitive behavioral therapy being one. When I see a patient, I assess them and decide whether [cognitive behavioral therapy] or hypnosis would be the best approach. Obviously, patient preference is a major factor. If they really want to try hypnosis and think it would be cool, then obviously we can do that.

I also find that patients who are very physically symptomatic do particularly well with hypnosis. It’s like the patient who needs the IV infusion instead of a pill.
These patients need something more subconscious; they’re so focused and so uncomfortable, we need to go a little deeper into the subconscious. I definitely recommend that for those patients.

However, if a patient is super anxious about losing control, or they don’t really buy into the idea of the brain-gut connection, I’m more likely to try something like cognitive behavioral therapy, where we can focus more broadly on coping and the impact of symptoms. I also wouldn’t do hypnosis on people with trauma histories or dissociative characteristics.

In most patients who are very physically symptomatic, though, I tend to prefer hypnosis.

PAGE BREAK

Q: How widely adopted is this therapy?

A: I think the biggest problem we face right now is a lack of providers. I think gastroenterologists are hooked on brain-gut psychotherapies now. People seem to really get it, and see it as almost a first or second line treatment for at least some of these GI conditions. The dilemma is, how do they find a provider? How many GI psychologists are out there in the world to see the plethora of patients with these conditions? That’s the rate limiting obstacle.

I am actually a scientific advisor to a group of people who are developing an online brain-gut psychotherapy platform; as long as a patient has a provider in their state, they can receive the treatment through telemedicine. For example, California is a huge state. If I get a request for hypnotherapy from a person in San Francisco, and San Francisco is four hours away, that won’t work.

We’re able to now say, “Okay, you can still get the treatment via telemedicine as long as there is a provider in your state.”

Q: Is hypnosis covered by insurance?

A: Psychologists can bill for hypnosis as typical psychotherapy, because it’s a form of psychotherapy. If you’re seeing a psychologist and the psychologist takes your insurance, it should be no problem. If you’re not a psychologist and you want to do hypnosis, it’s a little bit trickier We’re actually working on getting a CPT code for nurse practitioners and social workers. Right now, though, a patient’s best bet for being covered is to see a health psychologist who takes your insurance. – by Jennifer Byrne

For more information:

Laurie A. Keefer, MD, can be reached at 17 E. 102nd St., New York, NY 10029.

Disclosure: Keefer reports serving on the scientific advisory board of www.MetaMeConnect.com, a company that has developed an online brain-gut psychotherapy platform.