Digestive problems—whether it’s an upset stomach, diarrhea, constipation or abdominal pain—can make life miserable. 

Until recently, doctors have treated these problems by focusing on the gut—approximately 30 feet of tubes and organs through which food is ingested, digested and excreted. Now an increasing body of scientific evidence shows that a new target—the brain—is a missing link in finding relief.

What most people don’t realize: Your gut contains more than 100 million nerves, more than what’s found in your spinal cord. This “enteric nervous system,” connecting the gut and brain, is in constant two-way communication. 

For example, signals from the brain play a key role in the day-to-day, ­moment-to-moment function of digestion. By the same token, feelings like fear, anger and depression are now being increasingly recognized for their effect on digestive functions. 

Given the strength of the brain-gut connection, it should be no surprise that top-down treatment with a psychologist (or “brain-gut therapy,” as it’s come to be called) can help—and in some cases is more effective than conventional medical care, including many medications. What you need to know…

The Brain-Gut Axis in Action

While many details of this “upstairs-­downstairs” interaction have yet to be worked out, we know that signals from the brain—via neurotransmitters and nerve signals—control the muscular contractions that move digested food through the digestive tract, regulate secretions such as stomach acid and enzymes that break down food and influence pain sensitivity in the gut.

Because your brain and gut are in such close and constant communication, stress and troubling emotions that alter brain function readily disrupt the smooth workings of your digestive system. These effects are most clearly seen in disorders of brain-gut interaction, where there is no evidence of physiological abnormalities with testing.

Irritable bowel syndrome (IBS), a chronic condition involving abdominal pain accompanied by symptoms like diarrhea, constipation and bloating, is the most common of these. Others include functional dyspepsia (stomach pain, bloating and nausea following meals) and certain cases of heartburn.

But the brain also can contribute to worsening symptoms of organic digestive disorders, such as Crohn’s disease or ulcerative colitis, where symptoms are the result of an autoimmune disorder causing inflammation in the gut. In some cases, patients with these disorders continue to experience abdominal pain or diarrhea even when inflammation is well controlled by medication.

The back-and-forth interaction between the brain and gut can create a vicious cycle. When planning to travel, attend a concert or party or simply appear in public, many people with chronic bowel conditions fear that they will pass gas or have an urgent need for a bathroom or sudden, severe pain. 

These fears can trigger physiological arousal in the body (the “fight or flight” response) and amplify awareness of sensations that might otherwise be ignored. This stress response can trigger contractions in the intestines and intensify pain sensations. These symptoms and associated anxiety can prevent individuals from enjoying social situations and enjoying life to the fullest.

What Brain-Gut Therapy Can Do

The brain-gut connection is more than theoretical. There’s research showing that when we change how the brain works—the goal of all psychotherapy—it can have profound effects on gastrointestinal symptoms.

Cognitive behavioral therapy (CBT), which changes patterns of thinking and behavior, has the most research support, with at least 20 randomized trials showing its effectiveness in curbing gut-­related symptoms. In these studies, typically 60% to 70% of patients are “treatment responders,” meaning that they report significant reductions in abdominal pain and improved bowel habits following CBT treatment.

Gut-directed hypnotherapy is the second most researched psychological treatment for IBS and has been validated by several randomized clinical trials. One of the largest observational studies of hypnotherapy for IBS involved 1,000 patients with severe symptoms that had failed to respond to prior medical treatment. Result: With hypnotherapy, 76% of patients reported clinically significant reductions in IBS symptoms.

While pain reduction is the most prominent benefit, patients also report improvements in bowel habits (more regular bowel movements and improvements in stool consistency) and relief from “non-colonic” symptoms such as fatigue, backaches, headaches and body aches. 

Why these treatments confer such benefits is unclear. They may reprogram the brain to tune out or dial down the perception of sensations coming from the gut and help normalize muscular contractions and secretions in digestive organs. 

CBT helps patients become aware of the connection between thinking patterns, behaviors and physical sensations in the body and learn to reframe unhelpful thinking patterns. 

For example, a patient who gets anxious about travel or parties days before may be encouraged to consider the real probability of an ill-timed episode and the coping strategies he/she might use should one occur. CBT often includes training in relaxation practices, such as mindfulness or diaphragmatic breathing, to reduce physiological stress and empower patients to manage ­symptoms.

With gut-directed hypnotherapy, patients achieve a deeply relaxed, focused and receptive mental state, where suggestions like a sensation of warmth in the abdominal area can soothe pain and reduce awareness of pain symptoms. Hypnotic suggestions also may modulate nerve function to prevent muscle spasm…or recalibrate the brain’s response to signals coming from the gut, easing hypersensitivity to normal sensations. 

Both treatments are relatively short-term, typically involving about seven to 12 sessions over the course of three months. But the benefits are often long-lasting. A number of studies show that improvements are maintained for a year or more, and in one trial of hypnotherapy, these benefits were maintained for up to five years. Health insurers often cover these treatments. 

Is Brain-Gut Therapy for You?

Brain-gut therapy has been shown to work for men, women and children with IBS. The most important question is, are you open to it and willing to become actively engaged? Both CBT and hypnotherapy are a kind of brain training, which demands regular practice—that is, homework—to be effective.   

Patients most often consider brain-gut therapy after standard medical treatment (such as laxative or antidiarrheal medications) and lifestyle modifications (such as exercise and diet changes) haven’t given them the results they want. 

People who prefer a drug-free approach may turn to brain-gut therapy earlier. The ideal situation is when a therapist and medical doctor are in regular communication and work together to help the patient. It’s best not to wait too long to seek treatment. The more unsuccessful treatment experiences you have, the more stressful the condition becomes. 

Your gastroenterologist may know of a mental health provider offering these treatments. Otherwise, look for a provider specializing in CBT or hypnotherapy who is also experienced working with patients with chronic health conditions. 

Best resources: The Rome Foundation, a nonprofit organization that researches and educates the public about functional gastrointestinal disorders, has a searchable directory of gastrointestinal mental health providers nationwide, RomeGIPsych.org. The website IBShypnosis.com lists providers who specialize in hypnosis.