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Hypnosis and Cognitive Behavioral Therapies for the Management of Gastrointestinal Disorders


Purpose of Review

To review the nature, current evidence of efficacy, recent developments, and future prospects for cognitive behavioral therapy (CBT) and gut-directed hypnotherapy, the two best established psychological interventions for managing gastrointestinal (GI) disorders.

Recent Findings

New large randomized controlled trials are showing that cost-effective therapy delivery formats (telephone-based, Internet-based, fewer therapist sessions, or group therapy) are effective for treating GI disorders.


CBT and hypnotherapy can produce substantial improvement in the digestive tract symptoms, psychological well-being, and quality of life of GI patients. However, they have long been hampered by limited scalability and significant cost, and only been sufficiently tested for a few GI health problems. Through adoption of more cost-effective therapy formats and teletherapy, and by expanding the scope of efficacy testing to additional GI treatment targets, these interventions have the potential to become widely available options for improving clinical outcomes for patients with hard-to-treat GI disorders.

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Fig. 1


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.

    Drossman DA. Functional gastrointestinal disorders: history, pathophysiology, clinical features and Rome IV. Gastroenterology. 2016.

  2. 2.

    Surdea-Blaga T, Baban A, Dumitrascu DL. Psychosocial determinants of irritable bowel syndrome. World J Gastroenterol. 2012;18(7):616–26.

    PubMed  PubMed Central  Article  Google Scholar 

  3. 3.

    • Labanski A, Langhorst J, Engler H, Elsenbruch S. Stress and the brain-gut axis in functional and chronic-inflammatory gastrointestinal diseases: a transdisciplinary challenge. Psychoneuroendocrinology. 2020;111:104501. An up-to-date review detailing the relevance of the brain-gut axis in functional gastrointestinal disorders and IBD.

    PubMed  Article  Google Scholar 

  4. 4.

    Van Oudenhove L, Crowell MD, Drossman DA, et al. Biopsychosocial aspects of functional gastrointestinal disorders. Gastroenterology 2016.

  5. 5.

    Sun Y, Li L, Xie R, Wang B, Jiang K, Cao H. Stress triggers flare of inflammatory bowel disease in children and adults. Front Pediatr. 2019;7:432.

    PubMed  PubMed Central  Article  Google Scholar 

  6. 6.

    Gracie DJ, Hamlin PJ, Ford AC. The influence of the brain-gut axis in inflammatory bowel disease and possible implications for treatment. Lancet Gastroenterol Hepatol. 2019;4(8):632–42.

    PubMed  Article  Google Scholar 

  7. 7.

    Konturek PC, Brzozowski T, Konturek SJ. Stress and the gut: pathophysiology, clinical consequences, diagnostic approach and treatment options. J Physiol Pharmacol. 2011;62(6):591–9.

    CAS  PubMed  Google Scholar 

  8. 8.

    Mayer EA, Tillisch K. The brain-gut axis in abdominal pain syndromes. Annu Rev Med. 2011;62:381–96.

    CAS  PubMed  Article  Google Scholar 

  9. 9.

    Molina-Torres G, Rodriguez-Arrastia M, Roman P, Sanchez-Labraca N, Cardona D. Stress and the gut microbiota-brain axis. Behav Pharmacol. 2019;30(2 and 3-Spec Issue):187–200.

    PubMed  Article  Google Scholar 

  10. 10.

    Dinan TG, Cryan JF. The microbiome-gut-brain axis in health and disease. Gastroenterol Clin N Am. 2017;46(1):77–89.

    Article  Google Scholar 

  11. 11.

    Tillisch K, Mayer EA, Labus JS. Quantitative meta-analysis identifies brain regions activated during rectal distension in irritable bowel syndrome. Gastroenterology. 2011;140(1):91–100.

    PubMed  Article  Google Scholar 

  12. 12.

    •• Ford AC, Lacy BE, Harris LA, Quigley EMM, Moayyedi P. Effect of antidepressants and psychological therapies in irritable bowel syndrome: an updated systematic review and meta-analysis. Am J Gastroenterol. 2019;114(1):21–39. This is the latest systematic review and meta-analysis of psychological therapies for IBS, concluding that they are effective for IBS treatment, with a collective number needed to treat of 4.

    PubMed  Article  Google Scholar 

  13. 13.

    • Laird KT, Tanner-Smith EE, Russell AC, Hollon SD, Walker LS. Short-term and long-term efficacy of psychological therapies for irritable bowel syndrome: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2016;14(7):937–47 e4. A recent systematic review and meta-analysis concluding that psychological therapies reduce bowel symptoms in IBS with a medium size effect that lasts at least 1 year after treatment.

    PubMed  Article  Google Scholar 

  14. 14.

    • Laird KT, Tanner-Smith EE, Russell AC, Hollon SD, Walker LS. Comparative efficacy of psychological therapies for improving mental health and daily functioning in irritable bowel syndrome: a systematic review and meta-analysis. Clin Psychol Rev. 2017;51:142–52. A companion review to the reference by the same authors above, finding that psychological therapies are effective for improving psychological symptoms and life functioning of IBS patients.

    PubMed  Article  Google Scholar 

  15. 15.

    Keefer L, Palsson OS, Pandolfino JE. Best practice update: incorporating psychogastroenterology into management of digestive disorders. Gastroenterology. 2018;154(5):1249–57.

    PubMed  Article  Google Scholar 

  16. 16.

    Person H, Keefer L. Brain-gut therapies for pediatric functional gastrointestinal disorders and inflammatory bowel disease. Curr Gastroenterol Rep. 2019;21(4):12.

    PubMed  Article  Google Scholar 

  17. 17.

    Lackner JM, Lou Coad M, Mertz HR, Wack DS, Katz LA, Krasner SS, et al. Cognitive therapy for irritable bowel syndrome is associated with reduced limbic activity, GI symptoms, and anxiety. Behav Res Ther. 2006;44(5):621–38.

    PubMed  Article  Google Scholar 

  18. 18.

    Lowen MB, Mayer EA, Sjoberg M, et al. Effect of hypnotherapy and educational intervention on brain response to visceral stimulus in the irritable bowel syndrome. Aliment Pharmacol Ther. 2013;37(12):1184–97.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  19. 19.

    Palsson OS, Whitehead W, Törnblom H, Sperber AD, Simren M. Prevalence of Rome IV functional bowel disorders among adults in the United States, Canada, and the United Kingdom. Gastroenterology. 2020;158(5):1262–73.

    PubMed  Article  Google Scholar 

  20. 20.

    Camilleri M, Ford AC. Pharmacotherapy for irritable bowel syndrome. J Clin Med. 2017;6(11).

  21. 21.

    • Rangan V, Ballou S, Shin A, Camilleri M, Lembo A, Beth Israel Deaconess Medical Center GIMWG. Use of treatments for irritable bowel syndrome and patient satisfaction based on the IBS in America Survey. Gastroenterology. 2019. A recent large survey of IBS patients, demonstrating their low satisfaction with existing pharmacotherapies for IBS and the substantial need for alternative therapy options such as brain-gut psychotherapies.

  22. 22.

    Lackner JM, Jaccard J, Keefer L, Brenner DM, Firth RS, Gudleski GD, et al. Improvement in gastrointestinal symptoms after cognitive behavior therapy for refractory irritable bowel syndrome. Gastroenterology. 2018;155(1):47–57.

    PubMed  PubMed Central  Article  Google Scholar 

  23. 23.

    •• Everitt HA, Landau S, O’Reilly G, et al. Assessing telephone-delivered cognitive-behavioural therapy (CBT) and web-delivered CBT versus treatment as usual in irritable bowel syndrome (ACTIB): a multicentre randomised trial. Gut. 2019;68(9):1613–23. This is the largest of all RCTs of brain-gut psychological treatment for GI disorders to date and demonstrates the therapeutic power of telephone CBT and web-based CBT for IBS treatment, two delivery format that can help make CBT more widely available to GI patients.

    PubMed  PubMed Central  Google Scholar 

  24. 24.

    Palsson OS. Hypnosis treatment of gastrointestinal disorders: a comprehensive review of the empirical evidence. Am J Clin Hypn. 2015;58(2):134–58.

    PubMed  Article  Google Scholar 

  25. 25.

    Flik CE, Laan W, Zuithoff NPA, van Rood YR, Smout AJPM, Weusten BLAM, et al. Efficacy of individual and group hypnotherapy in irritable bowel syndrome (IMAGINE): a multicentre randomised controlled trial. Lancet Gastroenterol Hepatol. 2019;4(1):20–31.

    PubMed  Article  Google Scholar 

  26. 26.

    Ljotsson B, Hedman E, Lindfors P, et al. Long-term follow-up of internet-delivered exposure and mindfulness based treatment for irritable bowel syndrome. Behav Res Ther. 2011;49(1):58–61.

    PubMed  Article  Google Scholar 

  27. 27.

    Whorwell PJ, Prior A, Colgan SM. Hypnotherapy in severe irritable bowel syndrome: further experience. Gut. 1987;28(4):423–5.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  28. 28.

    Everitt HA, Landau S, O'Reilly G, Sibelli A, Hughes S, Windgassen S, et al. Cognitive behavioural therapy for irritable bowel syndrome: 24-month follow-up of participants in the ACTIB randomised trial. Lancet Gastroenterol Hepatol. 2019;4(11):863–72.

    PubMed  PubMed Central  Article  Google Scholar 

  29. 29.

    Gonsalkorale WM, Miller V, Afzal A, Whorwell PJ. Long term benefits of hypnotherapy for irritable bowel syndrome. Gut. 2003;52(11):1623–9.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  30. 30.

    Aziz I, Palsson OS, Tornblom H, Sperber AD, Whitehead WE, Simren M. Epidemiology, clinical characteristics, and associations for symptom-based Rome IV functional dyspepsia in adults in the USA, Canada, and the UK: a cross-sectional population-based study. Lancet Gastroenterol Hepatol. 2018;3(4):252–62.

    PubMed  Article  Google Scholar 

  31. 31.

    Van Oudenhove L, Vandenberghe J, Geeraerts B, et al. Determinants of symptoms in functional dyspepsia: gastric sensorimotor function, psychosocial factors or somatisation? Gut. 2008;57(12):1666–73.

    PubMed  Article  Google Scholar 

  32. 32.

    Masuy I, Van Oudenhove L, Tack J. Review article: treatment options for functional dyspepsia. Aliment Pharmacol Ther. 2019;49(9):1134–72.

    PubMed  Article  Google Scholar 

  33. 33.

    • Orive M, Barrio I, Orive VM, et al. A randomized controlled trial of a 10 week group psychotherapeutic treatment added to standard medical treatment in patients with functional dyspepsia. J Psychosom Res. 2015;78(6):563–8. The largest RCT to date on brain-gut psychological treatment of FD, showing substantial benefits of CBT of adjunctive therapy.

    CAS  PubMed  Article  Google Scholar 

  34. 34.

    Haug TT, Wilhelmsen I, Svebak S, Berstad A, Ursin H. Psychotherapy in functional dyspepsia. J Psychosom Res. 1994;38(7):735–44.

    CAS  PubMed  Article  Google Scholar 

  35. 35.

    Calvert EL, Houghton LA, Cooper P, Morris J, Whorwell PJ. Long-term improvement in functional dyspepsia using hypnotherapy. Gastroenterology. 2002;123(6):1778–85.

    PubMed  Article  Google Scholar 

  36. 36.

    Durazzo M, Gargiulo G, Pellicano R. Non-cardiac chest pain: a 2018 update. Minerva Cardioangiol. 2018;66(6):770–83.

    PubMed  Article  Google Scholar 

  37. 37.

    Klimes I, Mayou RA, Pearce MJ, Coles L, Fagg JR. Psychological treatment for atypical non-cardiac chest pain: a controlled evaluation. Psychol Med. 1990;20(3):605–11.

    CAS  PubMed  Article  Google Scholar 

  38. 38.

    Mayou RA, Bryant BM, Sanders D, Bass C, Klimes I, Forfar C. A controlled trial of cognitive behavioural therapy for non-cardiac chest pain. Psychol Med. 1997;27(5):1021–31.

    CAS  PubMed  Article  Google Scholar 

  39. 39.

    Spinhoven P, Van der Does AJ, Van Dijk E, Van Rood YR. Heart-focused anxiety as a mediating variable in the treatment of noncardiac chest pain by cognitive-behavioral therapy and paroxetine. J Psychosom Res. 2010;69(3):227–35.

    PubMed  Article  Google Scholar 

  40. 40.

    van Peski-Oosterbaan AS, Spinhoven P, van Rood Y, van der Does JW, Bruschke AV, Rooijmans HG. Cognitive-behavioral therapy for noncardiac chest pain: a randomized trial. Am J Med. 1999;106(4):424–9.

    PubMed  Article  Google Scholar 

  41. 41.

    Jonsbu E, Dammen T, Morken G, Moum T, Martinsen EW. Short-term cognitive behavioral therapy for non-cardiac chest pain and benign palpitations: a randomized controlled trial. J Psychosom Res. 2011;70(2):117–23.

    PubMed  Article  Google Scholar 

  42. 42.

    Tyrer P, Tyrer H, Cooper S, Barrett B, Kings S, Lazarevic V, et al. Cognitive behaviour therapy for non-cardiac pain in the chest (COPIC): a multicentre randomized controlled trial with economic evaluation. BMC Psychol. 2015;3:41.

    PubMed  PubMed Central  Article  Google Scholar 

  43. 43.

    Jones H, Cooper P, Miller V, Brooks N, Whorwell PJ. Treatment of non-cardiac chest pain: a controlled trial of hypnotherapy. Gut. 2006;55(10):1403–8.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  44. 44.

    Miller V, Jones H, Whorwell PJ. Hypnotherapy for non-cardiac chest pain: long-term follow-up. Gut. 2007;56(11):1643.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  45. 45.

    Ng SC, Shi HY, Hamidi N, et al. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. Lancet. 2018;390(10114):2769–78.

    PubMed  Article  PubMed Central  Google Scholar 

  46. 46.

    Ananthakrishnan AN, Kaplan GG, Ng SC. Changing global epidemiology of inflammatory bowel diseases-sustaining healthcare delivery into the 21st century. Clin Gastroenterol Hepatol. 2020;18:1252–60.

    PubMed  Article  Google Scholar 

  47. 47.

    • Li C, Hou Z, Liu Y, Ji Y, Xie L. Cognitive-behavioural therapy in patients with inflammatory bowel diseases: a systematic review and meta-analysis. Int J Nurs Pract. 2019;25(1):e12699. A systematic review and meta-analysis evaluating the effects of CBT in the treatment of patients with IBD.

    PubMed  Article  Google Scholar 

  48. 48.

    •• Keefer L, Taft TH, Kiebles JL, Martinovich Z, Barrett TA, Palsson OS. Gut-directed hypnotherapy significantly augments clinical remission in quiescent ulcerative colitis. Aliment Pharmacol Ther. 2013;38(7):761–71. This was the first trial to demonstrate that psychological intervention may be able to affect the disease course in IBD.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  49. 49.

    Moss-Morris R, McAlpine L, Didsbury LP, Spence MJ. A randomized controlled trial of a cognitive behavioural therapy-based self-management intervention for irritable bowel syndrome in primary care. Psychol Med. 2010;40(1):85–94.

    CAS  PubMed  Article  Google Scholar 

  50. 50.

    Everitt H, Moss-Morris R, Sibelli A, Tapp L, Coleman N, Yardley L, et al. Management of irritable bowel syndrome in primary care: the results of an exploratory randomised controlled trial of mebeverine, methylcellulose, placebo and a self-management website. BMC Gastroenterol. 2013;13:68.

    PubMed  PubMed Central  Article  Google Scholar 

  51. 51.

    Ljotsson B, Falk L, Vesterlund AW, et al. Internet-delivered exposure and mindfulness based therapy for irritable bowel syndrome--a randomized controlled trial. Behav Res Ther. 2010;48(6):531–9.

    PubMed  Article  Google Scholar 

  52. 52.

    Ljotsson B, Hedman E, Andersson E, et al. Internet-delivered exposure-based treatment vs. stress management for irritable bowel syndrome: a randomized trial. Am J Gastroenterol. 2011;106(8):1481–91.

    PubMed  Article  Google Scholar 

  53. 53.

    Blanchard EB, Lackner JM, Sanders K, Krasner S, Keefer L, Payne A, et al. A controlled evaluation of group cognitive therapy in the treatment of irritable bowel syndrome. Behav Res Ther. 2007;45(4):633–48.

    PubMed  Article  Google Scholar 

  54. 54.

    Moser G, Tragner S, Gajowniczek EE, et al. Long-term success of GUT-directed group hypnosis for patients with refractory irritable bowel syndrome: a randomized controlled trial. Am J Gastroenterol. 2013;108(4):602–9.

    PubMed  Article  Google Scholar 

  55. 55.

    Lackner JM, Jaccard J, Radziwon CD, Firth RS, Gudleski GD, Hamilton F, et al. Durability and decay of treatment benefit of cognitive behavioral therapy for irritable bowel syndrome: 12-month follow-up. Am J Gastroenterol. 2019;114(2):330–8.

    PubMed  PubMed Central  Article  Google Scholar 

  56. 56.

    Kinsinger SW, Ballou S, Keefer L. Snapshot of an integrated psychosocial gastroenterology service. World J Gastroenterol. 2015;21(6):1893–9.

    PubMed  PubMed Central  Article  Google Scholar 

  57. 57.

    Riehl ME, Kinnucan JA, Chey WD, Stidham RW. Nuances of the psychogastroenterology patient: a predictive model for gastrointestinal quality of life improvement. Neurogastroenterol Motil. 2019;31(9):e13663.

    PubMed  Article  Google Scholar 

  58. 58.

    Lores T, Goess C, Mikocka-Walus A, et al. Integrated psychological care reduces healthcare costs at a hospital-based inflammatory bowel disease service. Clin Gastroenterol Hepatol. 2020.

  59. 59.

    Kiebles JL, Kwiatek MA, Pandolfino JE, Kahrilas PJ, Keefer L. Do patients with globus sensation respond to hypnotically assisted relaxation therapy? A case series report. Dis Esophagus. 2010;23(7):545–53.

    CAS  PubMed  Article  Google Scholar 

  60. 60.

    Riehl ME, Keefer L. Hypnotherapy for esophageal disorders. Am J Clin Hypn. 2015;58(1):22–33.

    PubMed  PubMed Central  Article  Google Scholar 

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Correspondence to Olafur S. Palsson.

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Palsson, O.S., Ballou, S. Hypnosis and Cognitive Behavioral Therapies for the Management of Gastrointestinal Disorders. Curr Gastroenterol Rep 22, 31 (2020).

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  • Cognitive behavioral therapy
  • Hypnotherapy
  • Brain-gut axis
  • Functional gastrointestinal disorders