Gas. Bloating. Diarrhea. Cramps. The digestive system has many varied and unpleasant ways of asserting itself when the process isn't going smoothly—all well worth pondering as the holidays approach. But while everyone suffers the occasional Imodium moment, a surprisingly large number of people wrestle every day with more disabling disorders, from Crohn's disease to gastroesophageal reflux disease to irritable bowel syndrome, which by itself afflicts as many as 1 in 5 people. For many, severe pain and the unpredictable need for a bathroom can mean living life as prisoners in their own homes.
Medications offer relief for a number of gastrointestinal conditions. But some drugs have been withdrawn from the market or restricted—Zelnorm for IBS, for example, was pulled because it increased cardiac risks—and side effects can be a problem. So, researchers have recently taken an entirely new approach, focusing more on the head than on the plumbing. Studies have shown that mind-body techniques such as cognitive-behavioral therapy and hypnosis are effective at reducing the symptoms of irritable bowel syndrome, which causes pain and altered bowel movements; people being treated for Crohn's disease and ulcerative colitis, which feature inflammation of the intestinal tract, respond to the same techniques. Although there have been no head-to-head comparisons, "the results of these studies do look a little more impressive than pharmacological studies," says Nicholas Talley, a gastroenterologist who's chair of the Department of Internal Medicine at the Mayo Clinic in Jacksonville, Fla.
Stabbing pain. By helping people learn to change their thoughts about their conditions and relax the knot of anxiety tying up their gut, mind-body therapies have brought relief in mere weeks to people tormented for years by disabling bowel problems. "It's made a world of difference," says Teague Avey, 29, who was diagnosed with Crohn's five years ago after landing in a Chicago emergency room with pain so bad he felt like he was being stabbed in the gut. Following an eight-day hospital stay, Avey was put on an immunosuppressive drug to try to forestall a recurrence of the autoimmune disease, in which the tissues lining the digestive tract become painfully inflamed. But he had flare-ups every few months and missed work and canceled social plans when he felt an attack coming on. Then, he learned that researchers at Northwestern University were using hypnosis to treat symptoms in patients with various forms of inflammatory bowel disease. Over seven weeks last summer, Avey learned how to use visual images while under hypnosis to help him relax and ease the pain. He imagined his intestines as the walkways of a formal English garden, for example, and his easy stroll along them as how he'd like his system to work. At other times, he entered an imaginary cabin in the woods, where he felt safe and comfortable. Avey's symptoms have improved markedly since he completed the study.
No one knows precisely how hypnosis works on the body, says Laurie Keefer, the director of psychosocial research in gastroenterology at Northwestern's Feinberg School of Medicine. But it has been shown to alter pain perception and suppress the secretion of stress hormones. When people are in the extremely relaxed, focused state induced by hypnosis, they are open to therapeutic suggestions: in this case, that their digestive system will work smoothly, for example, or that their abdominal pain will grow weaker with time.
There's no question that stress and anxiety play a huge role in GI problems, and these gut reactions make perfect sense given humans' sensory architecture. Sandwiched between the layers of tissue lining the digestive system are hundreds of millions of interconnected nerve cells—more even than exist in the spinal cord. This gut-based nervous system has been dubbed the "second brain" because it regulates most digestive functions, like muscle contractions, peristalsis, and fluid secretion, without ever involving the "first" brain, though generally the two are in close communication. If the actual brain experiences a stressful situation, for example, it sends messages to the second brain, which releases chemical substances responsible for all that intestinal grief. Likewise, the digestive system, with a surface area as long as a football field, shoots out distress signals to the real brain when things are not working properly. "If I had to take a guess, I'd say GI input [to the brain] is responsible for about 80 percent of our sense of well-being," says Emeran Mayer, director of the Center for the Neurobiology of Stress at UCLA.
Anxiety. Perhaps nowhere is the GI-stress connection more apparent than with irritable bowel syndrome. It's called a "functional" disorder because, though it can cause severe pain, bloating, and altered bowel habits, there is no physical explanation as there is for Crohn's. As many as 60 percent of people with IBS suffer from anxiety disorders, and historically, many doctors dismissed their complaints as psychological.
Not anymore—though the solution, ironically, appears to lie in that direction. Research has shown that IBS sufferers have a heightened sensitivity to pain as well as "motility" problems like diarrhea and constipation. Stress, while it doesn't cause IBS, makes the symptoms worse. Two promising medications have failed to deliver: Besides the withdrawn Zelnorm, Lotronex has been restricted to women with debilitating IBS-related diarrhea because in rare instances it causes lethal bowel obstructions and intestinal damage. This has left IBS sufferers with few good treatment options beyond what over-the-counter medications, exercise, and avoiding certain foods can provide. But hypnosis and cognitive behavioral therapy offer hope.
Cognitive behavioral therapy, like hypnosis, teaches patients relaxation skills. It also focuses on getting them to identify and change overly negative or unrealistic thoughts, and to work on problem-solving skills so they can better handle stress. In a study published in August of 75 IBS patients who were randomly assigned to one of three groups, nearly three quarters of those who learned CBT skills mostly on their own using a manual, supplemented by four sessions with a therapist, reported significant improvement in quality of life and symptoms. A smaller proportion—61 percent—saw similar improvement after receiving 10 sessions with a therapist, but without a self-help manual. Only 7 percent of the control group, which received no treatment, experienced significant relief.
"You're tapping into people's sense of control over symptoms that have made them feel helpless," says Jeffrey Lackner, director of the Behavioral Medicine Clinic at the University at Buffalo School of Medicine, who led the National Institutes of Health-funded trial. Earlier this month, Lackner announced that he'd received an $8.5 million grant from the National Institute of Diabetes, Digestive and Kidney Diseases to fund a seven-year clinical trial to study his program in nearly 500 IBS patients at a number of sites. A program that emphasizes self-management, such as that practiced by the most successful group, could be a boon to patients: Insurers may refuse to cover what they consider psychological rather than medical treatments.
After a dozen years suffering with upset stomachs and painful diarrhea that left her taking Imodium "like candy," Melissa Brunner of Buffalo, 35, signed up for Lackner's study in 2006. She learned to identify the connection between her symptoms and stressful events and to use deep breathing and other relaxation skills to reduce her anxiety and give up the need for control. "You realize what you're stressing about and ask yourself whether you have any control over it," she says. "If you don't, there's no need to stress about it." Brunner still avoids fast food, but more than two years later, she pronounces herself "80 percent better."
It may take some time before the average GI doctor offers hypnosis. But if you're one of the millions of people unable to celebrate Thanksgiving with gusto, you might want to do some digging to find relief.