Gut-Focused Therapy

Mental health professionals trained in psycho-gastroenterology (GI psychology for short) help their patients by understanding the full picture of a person’s struggles with their health (what’s called the bio-psycho-social approach) and then they offer evidence-based treatments.

The therapy is often focused on factors that affect the gut-brain connection in order to help people to build skills to decrease & manage their GI symptoms and build stress resilience. Therapy can also include addressing struggles related to anxiety, depression and trauma.

There are a few types of therapy that are proven to be helpful for many GI conditions.

  • Cognitive Behavioral Therapy (CBT) is a common type of therapy & there’s a specialized form of CBT called Gut-Focused CBT.  This type of therapy has the most research supporting it for helping people with chronic GI issues.  

    It’s different from the type of therapy shown on TV or in a movie.  It’s a short-term, skills-based approach to treatment.

    There are 4 core components that are most common.

    1 | Education
    Learning about the gut-brain connection & how stress, anxiety, depression & even past trauma are connected to GI symptoms.

    2 | Skills for Difficult Thoughts & Feelings
    This is a core component because people with GI disorders can be vulnerable to getting hijacked into unhelpful thinking patterns.  In GI-CBT this is done through learning how to catch and change negative and irrational thought patterns. 

    A common & toxic thought pattern is called “catastrophizing”.  This way of thinking distorts reality in a way that overestimates how bad symptoms or the diagnosis itself will be (terrible, horrible, catastrophic).  At the same time, this type of thinking makes the person underestimate their ability to cope.  

    3 | Decreasing Avoidance Patterns
    This is about finding better ways to cope when things are hard.  Avoidance & distraction are typical, auto-pilot ways to handle stress in the short term but don’t work out too well if overused.  It’s common for people with GI struggles to find themselves overly avoiding potentially triggering foods or overly avoiding potentially embarrassing social situations.  Treatment can help to re-establish more safety around these stressful triggers and situations.

    4 | Relaxation Training
    A therapist helps to teach specific relaxation techniques based on the symptoms you experience.  Regular relaxation practice can be quite helpful for many GI disorders because these practices activate the parasympathetic nervous system associated with the “rest & digest” response & vagus nerve.  The therapist can help provide accountability to build a regular practice that can provide long-term support.


    Based on your specific situation and symptoms a therapist will create a treatment plan from these types of core components and then therapy is focused on learning these skills in session and practicing them in between sessions.  A typical course of CBT is somewhere between 4-8 sessions.  You “graduate” treatment once you’ve built these skills up and are able to continue with them on your own. 

    You can read more info here (Cognitive Behavioral Therapy for IBS)

    (NOTE: most of GI psych is written for IBS but applies to many other disorders including upper GI disorders & IBD).

  • Acceptance and Commitment Therapy (ACT) is similar to CBT.  It’s also evidence-based and effective for many of the same problem areas CBT is used for treatment.  When it comes to GI conditions the research shows it’s also helpful, we just don’t have as many studies yet as we do for CBT.  Just like CBT, ACT is also a short-term, skills-based approach.  

    The goals are the same in this type of treatment but the approach and tools taught are different.  In GI-ACT the core components of education & relaxation training remain but the other two aims tend to be different

    Skills for Difficult Thoughts & Feelings
    In GI-ACT this is done through learning to “unhook” from negative thought patterns and acceptance based skills to be more effective in regulating and processing difficult emotions.

    Decreasing Avoidance Patterns
    In GI-ACT people are helped to stop overly avoiding potentially triggering foods & situations as well to regain a sense of safety through gaining clarity on their core values and developing confidence to turn toward uncomfortable situations rather than avoid.

  • There is a proven link between living through trauma & developing chronic illnesses later in life.  If you’ve experienced trauma, either as an adult or in growing up in a dysfunctional or abusive environment, it might be best to consider other approaches to therapy than the two noted above.

    Trauma often requires some deeper levels of treatment to more fully address the dysregulation trauma leaves behind that is likely making your GI problems worse.  Here are some types of therapy that could be useful for you…

    • Emotion-Focused Therapy (EFT)

    • Accelerated Experiential Dynamic Psychotherapy (AEDP)

    • Eye Movement Desensitization Reprocessing (EMDR)

    • Cognitive Processing Therapy (CPT)

    • Interpersonal Therapy

    • Psychodynamic Therapy

    • Trauma Focused Therapy

What’s the Evidence? | Current Research

Of all the three core mind-body treatments (aka gut-brain behavioral therapies) Gut-Focused CBT is the most intensely studied.  Though Gut-Focused ACT has less research at this point, it’s widely considered to also be quite effective if done with a trained professional.

Functional Disorders
(aka Disorders of the Gut-Brain Interaction - DGBI)

Since GI psychology is still a small field currently and research budgets are limited, most of the studies to date have been focused on IBS.  Currently there are over 20 randomized control trials (RCTs) focused on IBS. These and other supporting studies show gut-focused therapy to be highly effective.  For other common DGBI, the results have been promising and suggestive that the positive benefits seen in IBS are likely similar in these other conditions.  The clinical experience of expert clinical psychologists in the field as suggests that gut-focused therapy is effective for IBS as well as the other DGBI. The results from these studies have compelled some medical institutions to promote GI-CBT as a first-line treatment for IBS & other DGBIs.

A broad summary of the evidence is that ~70% of people see significant improvement in GI symptoms.  The average amount of reduction in symptoms is approximately 50%.  In addition, well-being increases as the disruption in life that the GI symptoms cause also reduces. 

How long the positive effects last is called the durability of the treatment.  The durability of GI-CBT & GI-ACT are quite good because once the skills are learned they can be used indefinitely.  The longest durability data so far is 1 & 2 years post-treatment and these studies show a significant amount of participants were able sustain the benefits.  

For IBD

There are less studies on structural & inflammatory conditions like IBD but from what has been studied it shows that there are similar improvements in quality of life & building effective coping skills, but not as much benefit on GI symptoms as is seen in DGBIs like IBS.

It’s important to note that there is significant overlap between IBD and DGBIs.  Current estimates hold that approximately 40% of people with IBD also have a DGBI like IBS.  In addition, people that have IBD and also a psychiatric diagnosis (like depression or an anxiety disorder) tend to be more vulnerable worsening GI symptoms over time.  Due to these two factors, gut-brain behavioral therapies are also quite helpful for people suffering from Crohn’s Disease or Ulcerative Colitis as well.

Finding a Therapist

Many of the professionals trained in GI psychology work in academic medical centers.  Most people don’t have the ability to be seen in those centers but it may still be possible to find a therapist with this training and experience.  

The best place to start is this directory - the GI Psych Directory

If you’re looking for trauma-informed therapy, click ‘Open Advanced Search Options’ & use the filter to find therapists that have experience with any of the following…

  • Eye Movement Desensitization Reprocessing (EMDR)

  • Interpersonal Therapy

  • Psychodynamic Therapy

  • Trauma Focused Therapy

Note: If you can’t find someone in your state & you live in the US you have two further options…

#1 | The private practice company GI Psychology has therapists that are licensed in every US state.  


# 2 | Check this map
If you live in a state colored blue, that’s good news.  That means you’ll be able to see a psychologist (someone with a degree of PhD or PsyD) from any other blue-colored state. 
You can go back and search for any psychologist in any other blue state & this will greatly increase your options.

A Back-Up Plan

Option #1 

If you can’t find a specialist in GI psychology in the directory above then your next best option would be to use a popular therapist directory called Psychology Today.  You can apply the following filters to narrow down your choices:

  • Under ‘Issues’ select chronic illness

  • Under ‘Types of Therapy’ select Acceptance & Commitment (ACT), Cognitive Behavioral (CBT), Mindfulness-Based MBCT

    • If you’re looking for trauma-informed treatment you can use the list provided above

  • Under ‘Insurance’ select your insurance (though you may be able to work with other therapists not in this list using your insurance ‘out-of-network’ benefits)

Option #2

There are now online options becoming available that combine medical & psychological GI care through one service.

Oshi Health is an option for this.