Why You Might Be Judging Your IBS Progress Too Soon
You have tried things. The capsules, the weeks without wheat, the app that asks you to breathe out for longer than feels natural. And somewhere around the second or third week of each one there is a moment, usually late in the evening after a bad day, when you take stock and quietly decide it is not doing anything. You do not announce it. You just stop opening the app.
That moment of taking stock is the thing worth looking at this week, because there is a piece of research that suggests it tends to arrive too early, and that the way improvement from this kind of work actually shows up is slower and stranger than most people expect.
This week's research: the difference kept growing after the treatment stopped
A team at the University of Washington in the United States, led by Charles Bombardier, ran a randomised controlled trial of something called hypnotic cognitive therapy. That is cognitive therapy and clinical hypnosis delivered together as one treatment, rather than either on its own. They recruited 127 adults living with long-standing chronic pain following spinal cord injury, and randomly assigned them to one of two groups. One group had six weekly one-hour sessions with a psychologist, delivered by telephone or by video call, and were asked to practise at home in between by listening to recordings of their own sessions. The other group carried on with whatever care they were already getting.
Two things need saying straight away. This was not a study of people with irritable bowel syndrome (IBS), and it was done in the United States. I am including it because of what it shows about timing, not because it tells you anything about gut symptoms directly.
The researchers measured average pain at the end of the six weeks of sessions, and then again six weeks after that, at the twelve week mark. At the end of treatment there was a difference between the groups, and it was small: roughly half a point on a nought to ten scale. Then they looked again six weeks later, with no further sessions in between, and the difference had not faded. It had grown, to around eight tenths of a point. Depression scores improved more in the therapy group at both points. Delivery by telephone and delivery by video performed much the same as each other.
Keep the size of that in proportion. A difference of under one point on a ten point scale is a modest average shift, and the honest way to read it is as a real but small effect. What makes it worth your time is when the effect showed up.
Why this matters for you. Almost everything you have ever taken for symptoms works hardest while you are taking it and then wears off. That is the model of treatment you carry around without noticing, and it is the model you are using when you take stock at three weeks and conclude that nothing is happening. Here the pattern ran the other way: the gap between the groups was wider after the appointments had finished than on the day they ended. That is what it looks like when what is being developed is a skill rather than suppressing a symptom. The same shows up in the long-term follow-up of gut-directed hypnotherapy trials in IBS, where the improvement people report is commonly still there a year later rather than fading once the course ends.
What is actually being trained, and why it takes a while
IBS is classified as a disorder of gut-brain interaction, and the phrase is precise rather than decorative. The gut and the brain are in constant two-way conversation, along the nervous system, through hormones, and through the immune system. In IBS that conversation has become oversensitive: ordinary gut activity that would pass unnoticed in someone else arrives loud and is processed as pain or urgency. Researchers call the gut side of that visceral hypersensitivity and the brain side central pain processing, and both are physical, measurable things rather than imagination.
If what has changed is how signals are processed, then what psychological work has to do is retrain the processing. And processing is trained the way anything else is trained, by repetition over weeks, with most of the repetitions happening away from the appointment. That is exactly what the participants in this trial were doing at home between sessions, and it is why the benefit was still accumulating after the last one. We looked at the home practice side of this recently in Can Hypnotherapy For Your Gut Work From A Recording?, which is about whether people can realistically keep that practice going at all.
It is also why my own work is cognitive behavioural hypnotherapy rather than hypnosis on its own. It brings together cognitive behavioural therapy, mindfulness and gut-directed hypnotherapy, all working on the same maintaining cycle from different angles: what you do with the thoughts, how you sit with the sensations, and the direct settling of gut sensitivity itself. Gut-directed hypnotherapy carries a strong recommendation in the 2021 British Society of Gastroenterology guideline for IBS, and the National Institute for Health and Care Excellence (NICE) lists it as an option for IBS that has not responded to pharmacological treatment after twelve months, where the picture is described as refractory. Long-term follow-up in those trials commonly finds the benefit people report is still present a year on. What the guidelines will not tell you, and what no honest practitioner can tell you either, is what any of it will do for you specifically.
Your top tip this week
Book the check-in, not the verdict. Pick one thing you are going to practise, then open your calendar and put a single date on it, three weeks out, and write "review" next to it. Between now and that date, the only question you are allowed to ask yourself at the end of a day is whether you did the practice, not whether it worked. This matters because a daily verdict is not measurement, it is worry wearing a clipboard, and it will always be swayed by whatever your gut happened to do that afternoon. Deciding in advance when you will judge something is the difference between giving it a fair run and abandoning it on the evidence of one rough Tuesday.
The takeaway
The question you have probably been asking is whether you are the sort of person who sticks at things. It's better to ask have you been checking the scoreboard far too often, and calling the match at half time. Changing that comes from retraining how your gut and brain talk to each other and it arrives on more slowly than a tablet does, and some of it turns up after you have stopped doing the work.
Wherever you are right now
If you have not had a firm diagnosis yet, that is the first step and it is worth taking before anything else. A positive diagnosis from your general practitioner (GP) rules out what needs ruling out, and it is the gate the recommended support sits behind.
If you were diagnosed a while ago and are still struggling, you are the person the guidelines had in mind. Note roughly when your diagnosis was, because the guidance on what to consider next is anchored to how long it has been since first-line treatment.
If you are a GP or a gastroenterologist reading this, the referrer brief for gut-directed hypnotherapy, with the guideline positions set out honestly and the limits stated, is available on request.
If you would like the science in plain English once a week, plus one thing to try, join Gut Feelings at mindyourguts.co.uk/free-relaxation-page. The free relaxation recording comes with it.
About Mind Your Guts
Mind Your Guts is the Irritable Bowel Syndrome (IBS) blog written by Kathryn Dunn, a cognitive behavioural hypnotherapist based in York and working online. One piece of gut-brain research each week, in plain language, and one thing worth trying. More at mindyourguts.co.uk/gut-feelings.
Twelve Minutes of Calm. A free relaxation recording, about twelve minutes, for the times you want to feel calmer. It is a general relaxation recording rather than a treatment for anything. Download it at mindyourguts.co.uk/free-relaxation-page and you will also join Gut Feelings, my weekly email, which carries each new post to your inbox along with a bit extra.
Hypnotherapy works alongside conventional medical care, never in place of it. This blog shares research for general information and is not a substitute for medical advice. Always consult your GP or another relevant health professional. If your symptoms are new, changing, or accompanied by warning signs such as bleeding, unexplained weight loss, or persistent pain, please see your GP.
