Do You Need a GI Psychologist? Here's What to Know Before Taking Your Gut to Therapy

Take it from someone who knows: Managing a chronic digestive disorder is a big freaking deal. Irritable bowel syndrome (IBS), Crohn's, and ulcerative colitis come with flare-ups of irksome GI symptoms like bloating or diarrhea when you least expect it, while celiac disease requires you to stick to a strict gluten-free diet for life.

According to the National Institute of Diabetes and Digestive and Kidney Diseases, a whopping 60 to 70 million Americans have some sort of digestive disorder. And no matter which one that is, it can be a lot to deal with not only physically, but also emotionally. The stress of wondering whether you'll get the runs while on a date or whether that pizza you ordered is *actually* gluten-free can exacerbate GI symptoms, leading to a vicious cycle where you're both constantly anxious and in gastric distress (thanks to a little thing called the gut-brain connection).

Enter the GI psychologist, a mental health professional who focuses on repairing the relationship between your brain and gut, and can help you cope with the reality of living with a lifelong digestive disease. Ahead, we'll explore how the gut-brain connection impacts your mental and gut health, and share how seeing a GI psychologist benefits both.

Experts Featured in This Article:

Christina T. Gentile, PsyD, is a board-certified clinical health psychologist at UCLA Health.

Amanda Hyne, LCSW, is an IBD advanced social work practitioner at the Susan and Leonard Feinstein IBD Clinical Center at Mount Sinai in New York City.

The Gut-Brain Connection

The gut and the brain are linked through the vagus nerve and have a bidirectional relationship. "The vagus nerve runs between the brain and the gut," explains Christina T. Gentile, PsyD, a board-certified clinical health psychologist at UCLA Health who specializes in digestive diseases. It's part of your parasympathetic nervous system, which controls a variety of bodily functions (including mood and digestion), and carries signals from your brain to your gut and vice versa, according to a study published in Frontiers in Psychology. In short, the connection between what's happening in your mind and in your stomach makes perfect sense.

Stress can trigger your vagus nerve and dysregulate the communication between your brain and gut, says Amanda Hyne, LCSW, an IBD advanced social work practitioner at the Susan and Leonard Feinstein IBD Clinical Center at Mount Sinai in New York City. Hence why emotions like anxiety can cause stomach pain and other symptoms like diarrhea and nausea. These GI woes can then make anxiety worse, triggering that aforementioned hamster wheel-style cycle.

People with digestive disorders are particularly at risk for these gut-brain communication issues. Research published in Gut Microbes finds IBS sufferers have symptom flare-ups when they're stressed. Studies from The Lancet Gastroenterology and Hepatology and Psychiatric Research and Clinical Practice, meanwhile, show that those with Crohn's, ulcerative colitis, and celiac disease have higher rates of anxiety and depression than the general population.

What Is a GI Psychologist?

A GI psychologist or GI therapist is a mental health provider with a specialized focus in GI conditions, explains Hyne. These practitioners can have a wide range of credentials, including licensed clinical social worker (like Hyne), a PhD in clinical psychology, or a doctor of psychology (PsyD) like Dr. Gentile.

GI psychology is a subspecialty of health psychology, notes Dr. Gentile. Health psychologists take a "biopsychosocial" approach to treatment. "They look at how different psychological, behavioral, cultural, social, and nutritional factors impact health and how stress, emotions, and behaviors impact chronic disease," Dr. Gentile says.

So what exactly does a GI therapist do? "We help people navigate stressors in a more helpful way and repair the communication between the brain and the gut that can sometimes get dysregulated," says Hyne. "We help calm the nervous system down and help people understand the reasons why that's helpful."

What makes GI psychologists different from traditional mental health practitioners is that their primary focus isn't treating psychiatric conditions or mental illness, Hyne says. Instead, "We're here to help support the emotional needs of the patient with non-pharmacological tools," Dr. Gentile explains. These tools can also help manage physical symptoms like abdominal pain, bloating, and irregular bowel movements, she adds.

Who Can Benefit From Seeing a GI Psychologist?

"GI psychologists have more niche areas of training [than health psychologists] and work with people who have chronic digestive diseases, including IBS, Crohn's disease, ulcerative colitis, celiac disease, and gastroesophageal reflux disorder [GERD]," says Dr. Gentile. If you have one of these conditions, haven't responded to traditional medications or treatments, are still experiencing GI symptoms, and find it difficult to navigate different aspects of your condition, then a GI psychologist might be able to help, Hyne says.

Working with a GI psychologist is typically meant to be short-term. "We usually see patients for around six to eight sessions," says Hyne. This is different from traditional therapy, where you may meet with your provider for months or years to dig deep into different issues.

In certain scenarios, it might actually behoove you to work with both a GI psychologist and a more general mental health professional, says Hyne. For example, if a patient with a digestive disorder also has a severe eating disorder or bipolar disorder, then they might need more intensive treatment — and that's what a primary therapist can address, Hyne says.

There's never a bad time to get started with a GI psychologist. "We can help people who are newly diagnosed manage the stress and burden of their condition, as well as those who've been diagnosed for years but still have unremitting symptoms," says Dr. Gentile. In some cases, such as with IBD, the disease can progress; you may need support years after you've been diagnosed if it's now impacting your quality of life, she adds.

What Does Working With a GI Psychologist Look Like?

"A GI or health psychologist focuses on teaching strategies to help you cope more adaptively with new realities, build resilience, and overall, help you live fully within the realities you have with your health needs," says Hyne. There are a few evidence-based therapies GI psychologists rely on, including cognitive behavioral therapy (CBT) and gut-directed hypnotherapy. CBT is a form of talk therapy that teaches you how to become aware of negative thoughts, while gut-directed hypnotherapy is a form of guided deep relaxation, Dr. Gentile says.

Here's what you'll learn how to do on your own from these two therapies:

Identify negative thoughts (and replace them)

Per the Mayo Clinic, CBT helps you become aware of negative thoughts when they happen so you can deal with them more effectively. A GI therapist will utilize a GI-focused form of CBT: "We're looking to identify patterns of what we call 'catastrophic thinking', the tendency to dwell in any sort of maladaptive thought patterns and behaviors that can worsen GI symptoms and contribute to more stress and anxiety," Dr. Gentile explains.

Here's an example: Let's say you have celiac disease and you're on a gluten-free diet to manage your condition. Your friend invites you out to a restaurant, and your immediate thought is that you won't be able to eat anything and you're going to have a terrible time. "Often we see patients catastrophizing, or thinking of the worst-case scenario — 'There's nothing I can have,' or 'I'm going to feel sick and miserable the whole time'," Hyne notes.

Instead of jumping to that worst-case scenario, CBT can help you reframe the situation and open up the possibility for positive things to happen, explains Hyne. In the case of the above scenario, that could involve looking at the menu in advance and identifying a couple of things you can eat or calling the restaurant to walk through the gluten-free options before you go, rather than immediately dismissing the restaurant altogether. This is a good example of how GI therapy can aid in the mental and emotional issues surrounding a digestive condition.

Relieve stress through diaphragmatic breathing

A GI psychologist may also use gut-directed hypnotherapy, which puts you into a deep state of psychological relaxation through diaphragmatic breathing, muscle relaxation, and guided imagery directed toward the gut, says Dr. Gentile.

"The goal is to reduce GI-related discomfort and anxiety related to the gut," she explains. "Essentially, it's another way of giving patients more agency with calming their digestive symptoms and having better quality of life." In this example, GI therapy can help address both physical symptoms and help quell anxiety/promote relaxation.

You can easily utilize some of one aspect of gut-directed hypnotherapy — diaphragmatic breathing — at home anytime you feel anxiety coming on. "Also called belly breathing, this is a really simple strategy taught to GI patients to help them manage stress and encourage relaxation," Hyne says. With diaphragmatic breathing, the stomach (rather than the chest) moves with each breath. The goal is to pay attention to each breath to help quiet the mind, she explains.

Some of the general benefits of diaphragmatic breathing include lowered heart rate and blood pressure, decreased muscle tension, reduced stress, increased energy, and strengthened immune system, Hyne says. For people with GI symptoms, activating the diaphragm also creates a gentle massaging action that can help manage physical symptoms, such as abdominal pain and urgency to go to the bathroom, she adds.

If you want to try diaphragmatic breathing, sit or lie down in a comfortable space, close your eyes if you'd like, and put one hand on your chest and one on your belly. "You want to feel the bottom hand rising and falling rather than the top hand," Hyne says. Then, inhale for four seconds and exhale for longer, around six seconds. "Exhaling longer helps increase the benefits," she says.

Hyne recommends doing this as often as you can, ideally about 15 minutes per day. If you're super busy, think about doing your deep breathing session as you're getting ready for bed so it starts to become a part of your regular routine, she suggests.

Where Do You Find a GI Psychologist?

Both Hyne and Dr. Gentile acknowledge that GI psychology is still a growing field, so it may not always be easy to find a practitioner in your area. One helpful resource they recommend: RomeGIPsych.org, which will show you if there are any GI therapists near you.

If you can't find one, Dr. Gentile says the next best thing is to find a health psychologist who has experience treating patients with other chronic medical conditions. "It might not be 100% like GI psychology, but it will be in the wheelhouse of looking at things from a biopsychosocial lens and how your medical diagnosis impacts your mind-body wellness," she says.

Christina Heiser is a New York City-based freelance writer who's been covering health, beauty, fitness, and nutrition for over a decade. Her work has appeared in PS, Women's Health, Shape, Parade, and more.