What is talk therapy and how does it support gut health?

How does stress impact my gut health?

IBS and other digestive conditions may lead to symptoms like stomach pains, bloating, gas, constipation and/or diarrhoea, as well as a lack of confidence or self-esteem. Stress and worry about these symptoms act as triggers themselves, disrupting the normal function of the digestive system and leading to more stress-related stomach pains. This is because when we’re stressed, the sympathetic nervous system (SNS) – our body's ‘fight or flight’ response – diverts blood away from the gut to the limbs, providing the energy to fight or run away. This, effectively, shuts down digestion and is why we're prone to losing our appetites or developing gut symptoms when we’re nervous or under pressure.

Read 10 diet and lifestyle tips to help manage stress.

How can talking therapy help minimise anxiety-related stomach pains?

CBT and gut-directed hypnosis are two behavioural interventions most commonly applied in this area and are used because they may help reduce physical symptoms, as well as reduce anxiety and depression. The techniques used in CBT involve learning how your thoughts, behaviour and symptoms impact each other, and providing practical ways to help you feel more positive. Gut-directed hypnosis provides another tool for coping with abdominal discomfort.

How does the brain and gut communicate?

More information passes between your brain and gut than any other body system and there is a two-way information highway to facilitate this. The key players are your enteric nervous system, your vagus nerve and your gut microbiome. The vagus (meaning ‘wandering’) nerve is the major component of the gut-brain axis and it travels from the base of the brain to your gut. It is also the main structural feature of the parasympathetic nervous system (PSNS), which is the part of the nervous system responsible for the ‘rest and digest’ system – the flipside of your fight-or-flight response. This means that while the SNS prepares the body for action, the PSNS returns it to a state of calm.

How does talking therapy influence the gut-brain axis?

Talking therapies work on two main pathways. Working with a therapist, you will learn about the mechanisms that influence symptoms as well as develop skills to help you more effectively cope, self-regulate and be more resilient.

What evidence is there that talking therapies help gut conditions?

The complex and multifaceted relationship between our brain, stress levels and gut opens up the possibility that talking therapies, especially those designed to manage stress, may be effective tools to support gut health. In fact, studies on IBS have already demonstrated this. A study published in 2019 looked at the effectiveness of CBT via phone or online for IBS symptoms versus treatment as usual (TAU). The study included 558 patients who were randomised to either:

• Phone (eight one-hour sessions with a therapist alongside TAU)
• Web (eight online modules and five 30-minute calls with a therapist and TAU)
• TAU only

Those who received CBT were provided with education on how the gut works and techniques for addressing unhelpful thoughts and managing stress. Patients were followed up a year later, and those who had received therapy reported significantly fewer symptoms, an improved quality of life and better social functioning than those who received TAU only. In another IBS study, emotional expression and awareness training significantly reduced participants' physical symptoms.

Gut-directed hypnosis is also a recognised gut-brain therapy for patients with moderate to severe IBS.

What does this mean in practice?

Usually when people start experiencing gut symptoms, including stress-related stomach pain, they assume the problem is their diet and may start to eliminate certain foods. Though some foods may trigger gut symptoms in people who are sensitive to them, it is important to remember the link between the gut and the brain. Learning how to manage unhelpful thoughts, and accepting and processing your emotions, may offer a healthier way to cope.

Here are some tips to harness the power of the mind to ease gut symptoms:

• Don’t work at the same time as you eat. Work can be stressful and therefore impair digestion.
• Practise long, slow exhalations (often known as ‘vagal breathing') – this can stimulate the vagus nerve, helping to turn on that rest-and-digest response. Try this for a minute before meals or when you are faced with stressful situations.
• Try to manage stress by easing back on unnecessary commitments, getting enough sleep and perhaps trying a meditation app to help ease the pressure you may be experiencing.
• Consider therapy. Sometimes the things that stress us most are too big for one person to manage. A professional may provide expert support and guidance to help lighten the load.

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What do you do to support your gut health? Would you try talk therapy? Comment below and let us know...

This article was reviewed on 26 March 2024 by Kerry Torrens.

Kimberley Wilson is a chartered psychologist and visiting lecturer working in private practice in central London. She is a governor of the Tavistock & Portman NHS Mental Health Trust and the former chair of the British Psychological Society's Training Committee in Counselling Psychology – the group responsible for monitoring and assessing the standards of counselling psychology training across the UK.

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