Megan Riehl, PsyD, creates a relaxing environment for her patients.

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During a recent appointment, she dimmed her office lights. Her patient sat comfortably and closed her eyes, and Riehl began to speak softly.

She invited her patient to relax and feel her body become comfortably heavy and warm. Riehl then counted from 1 to 20 to facilitate a deepening of the relaxation. She introduced peaceful nature imagery to encourage deeper relaxation.

She then invited her patient to imagine regularly functioning bowels, free of pain and discomfort. She suggested the patient will no longer pay attention to uncomfortable sensations in the intestines and that the bowels are functioning with ease. Riehl continued with this imagery for about 30 minutes until she counted her patient back to awareness.

Her patient opened her eyes feeling relaxed and refreshed.

This is a glimpse of a treatment that is achieving overwhelmingly positive results with patients with gastrointestinal problems such as irritable bowel syndrome (IBS), inflammatory bowel diseases (IBD) and refractory gastroesophageal reflux disease (GERD).

Riehl, a gastrointestinal health psychologist, is one of a handful of academic clinicians in the country specializing in the behavioral management of these conditions, which are driven by faulty connections in the brain and the gut, causing GI distress.

"Yesterday I had a patient who has been suffering with abdominal pain for years," Riehl says. "She had to quit her job, her family was affected, she was feeling completely hopeless. At the end of her first gut-directed hypnosis session, she was in tears, saying she had experienced relief from abdominal pain which she hadn't felt in 2½ years. She was feeling hopeful about this intervention."

Riehl answers questions about her practice.

How does gut-directed hypnotherapy work?

Riehl: Gastrointestinal disorders are complex, and the causes are different for every patient. But we do know that visceral hypersensitivity, sensitive nerve endings, in the gut cause patients with GI conditions to experience more pain and motility problems.

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Gut-directed hypnosis addresses this "miscommunication" between the brain and gut. It is a special mental state where a trained therapist guides a person into a focused state of awareness while feeling deeply relaxed. The technique uses suggestion, imagery and relaxation to produce a therapeutic effect.

Gut-directed hypnotherapy uses suggestions that are aimed at calming the digestive tract and prevents unnecessary focus on discomfort in the body. 

How do you prepare for gut-directed hypnosis?

Riehl: Before beginning the hypnosis session, I tell patients that one of the most beneficial things they can do is to allow their imagination to be as vivid as it can, to think about what things look, feel and sound like, and to immerse themselves in things I am suggesting. That gives people permission to spend time thinking about their gut as being healthy.

I let them know that it is perfectly normal for the mind to wander, and that they are learning a new skill. I also correct any misconceptions about hypnosis, such as concerns about being out of control. Medical hypnosis is not stage hypnosis, and even people who were previously skeptical typically find this to be a pleasurable experience.

Patients remain in complete control of their mind and body, and hypnosis introduces a deep level of guided relaxation with targeted suggestions to improve the function of the digestive tract.

How long are treatments?

Riehl: Patients go through a seven-session scripted protocol for about 30 minutes once every other week in the clinic. In between hypnotherapy sessions, I provide the patient with an audio recording they listen to daily as homework.

Are there studies to support the effectiveness of the treatment?

Riehl: There is significant research that shows gut-directed hypnotherapy is effective and results are long lasting.

SEE ALSO: Why IBS Causes Emotional Stress — and How to Manage It

Peter Whorwell, a pioneering gastroenterologist at the University of Manchester, introduced the first scripted hypnotherapy protocol for IBS patients in 1984. Since then, more than 30 studies have been published in the literature highlighting the benefits of this treatment. Results show significant improvements in symptoms, including abdominal pain, abdominal bloating and bowel dysfunction, and in severity.

Why can gastrointestinal disorders be difficult to treat, and how can hypnosis fit in a treatment plan?

Riehl: IBS is complex because everyone's digestive tract and microbiota is different. Symptoms for one person with IBS are driven by different factors than another person's. There is certainly a role for pharmaceuticals, but response rates vary and can sometimes produce uncomfortable side effects.

A patient with constipation who is prescribed medication may have alleviation from that problem, but now spend several hours in the bathroom with loose and frequent stool. It often comes down to weighing the costs and benefits. For some people, medication is required and necessary; others prefer nonpharmaceutical approaches.

Medical hypnosis is nonprobing and very specific to the type of disorder a patient has. For those who have failed traditional medical interventions for their GI condition, hypnosis is an option. Openness to hypnotherapy is more important than one's hypnotizability.

That said, patients with untreated psychiatric co-morbidities are typically not ideal for GI behavioral health treatment, which includes hypnosis.

What else can patients do to complement hypnosis treatments?

Riehl: Hypnosis provides patients with a healthy coping strategy that also addresses the manner in which stress affects the body.

GI behavioral health treatment may also include cognitive behavioral therapy, which aids patients in learning how their thoughts, emotions and behaviors impact their health. Patients may also learn additional stress management interventions and coping skills and set goals for healthy eating and exercise.

I would also suggest watching our diaphragmatic breathing demonstration video as an example of a brief relaxation strategy that activates the body's relaxation response.

More and more research supports the importance of self-care and managing stress when treating medical conditions.

Is hypnosis covered by insurance?

Riehl: Patients should contact their insurance provider, but generally speaking, GI behavioral health interventions, including hypnosis, are covered for many patients under health and behavior codes.

Visit the Michigan Medicine GI behavioral health website for more information about the program, treatments and research and to make an appointment with a Michigan Medicine gastroenterologist.