It’s a concept that is being mentioned more and more within the IBS community and medical professionals, but what does this mean? And how can you learn how to harness this biological process to relieve your IBS?
We’ve invited health psychologist Dr Megan Arroll and author of “Irritable Bowel Syndrome: Navigate Your Way to Recovery”[i] to explain more:
What is the relationship between brain and gut?
The workings of the gut, and the rate and force that this 9 meter-long tube contracts, squeezing food along the digestive tract, is controlled by the enteric nervous system, situated in the gut wall. This system is often referred to as the ‘Little Brain’. Our ‘Big Brain’ consists of the central nervous system (including our actual brain) and these two components communicate via the brain-gut-axis with the aid of neurotransmitters. Importantly, this communication is two-way, like a telephone connection, so if something’s not-quite-right, the Big Brain may upset the Little Brain and vice versa. The system that controls our response to stress (the hypothalamic-pituitary-adrenal system or HPA axis) is also involved in these communications, which is another reason why stress can affect the function of our guts so much.
The way in which these systems interact and talk to one another isn’t in our conscious awareness – we hardly notice the workings of our gut until something goes wrong. When everything works properly, food is moved along the gut until we have an easy bowel movement. However, we know that for millions of people worldwide, this isn’t the case.
For instance, if you have IBS, you might experience a change from your normal bowel habits to either diarrhoea or constipation, as well as having symptoms such as abdominal pain and bloating.
Over the past few decades we have also started to learn about the influence of the trillions of microorganisms that call our guts home, and how this community also has a say in brain-gut communications.
The gut microbiome is an exciting new frontier of research in our health, with early research showing that if we nurture the gut microbiome, we may be able to support mental health and manage stress.
For now, we do know that all these systems work together – hence stress that affects the Big Brain can also lead to changes in the microbiome, and vice versa events that affect this community such as infection and antibiotic use can have an impact on what was traditionally seen as mental health.
Why and how does all this affect people with IBS?
While there’s no one cause of IBS, research has shown that people who have experienced trauma in early life, illnesses such as gastroenteritis, overgrowth of certain bacteria in the bowel, frequent antibiotic use and those with a family history of IBS have a higher chance of also developing this condition. Any one of these factors can disrupt the gut microbiome. Topping this off with the hectic and unpredictable lives that we tend lead now, means that daily stresses can be a trigger for IBS symptoms, along with certain foods and behavioural habits.
Stress is a factor
Therefore, stress can definitely be a trigger for many people with IBS. But it’s not just the everyday life sources of stress that can result in IBS symptoms – the condition itself can lead to stress and feelings of anxiety, acting as a vicious loop for those with IBS.
Because the symptoms of IBS are embarrassing, even the thought of experiencing wind, bloating or needing the loo urgently can lead to heightened anxiety around travel, meetings, social events or at its most severe, leaving the house. Conditions such as IBS which are characterised by embarrassing symptoms have a much higher burden of ‘illness intrusiveness’ than those with less stigmatised symptoms, leading to reduced quality of life, higher feelings of isolation and for some, depression. Hence, we should use all the tools in our arsenal to combat IBS symptomatology, including psychological and cognitive techniques to manage stress.
How to take control of the gut-brain axis?
It’s not surprising considering all we know about the brain-gut axis and the effect of stress on IBS that techniques which help to calm stress and regulate the messages between the brain and gut are helpful in managing IBS symptoms.
Gut-directed hypnotherapy has been tested in many research studies and it has such strong evidence that the NHS suggests people with IBS should try it. This type of specialised hypnotherapy uses deep relaxation and mental imagery to help people visualise their guts when symptomatic, and then exert mental control to pacify the signals.
To start, the hypnotherapist will guide a patient into a state of deep relaxation, usually with a series of progressive physical exercises (e.g. tensing and relaxing muscles sequentially throughout the body from the toes to the fingers) and deep, diaphragmatic breathing. Once someone is in this so-called hypnotic state, they will be asked to create a picture in their minds of what guts feel like when IBS symptoms flare-up – this could be a raging white-water river, rollercoaster or anything else that feels out of control. Then, the therapist will steer the visualisation so that the thundering river gradually calms, its rapids reducing and finally the waters still.
If you’d like to visit a hypnotherapist for IBS there’s a very useful search tool on the Hypnotherapy Directory website (http://www.hypnotherapy-directory.org.uk/adv-search.html). In the advanced search tool, you can select ‘member of a professional body’ which returns the results for therapists who have been vetted by a professional organisation. Do ask any potential therapist however if they have experience of working with people with IBS, length of treatment they suggest and costs.
Although it is beneficial to see a professional hypnotherapist for these techniques, the Mindset app has a an IBS version called Nerva with a 7-day free trial of gut-directed hypnotherapy. The important thing here is to remember to tailor the exercises to the gut – placing your hand on your tummy and using its warmth to apply a sense of control over the gut can also help to calm flares.
Tackle Fears & Anxieties
It is worth tackling any fears and anxieties that have developed as a result of IBS – such as nervousness about going out, being on public transport or in new environments. Here, tools from cognitive behavioural therapy can help to break unhelpful thought cascades – this is when we go from zero to hero and imagine the worst case possible, e.g. not reaching the loo on time.
To start, take note of any thought patterns that catastrophise an upcoming situation, then:
- challenge each thought with evidence (has this ever happened before?) and
- logic (thinking through how you can cope if symptoms flare).
Breaking these negative thought patterns that have developed around IBS is an important step to getting your life back on track.