Bowel Moments
Real talk about the realities of IBD...On the rocks! Hosts Robin and Alicia interview people living with Crohn's disease, ulcerative colitis, or indeterminate colitis (collectively knows as Inflammatory Bowel Diseases or IBD) and the medical providers who care for our community. Join us to meet people affected by IBD- we laugh, we cry, we learn new things, we hear inspiring stories, and we share a drink.
Bowel Moments
Clinical Hypnosis for IBD with Dr. Ali Navidi: Tools, Science, and Real Relief
Imagine being able to turn down the volume on gut pain, food fear, and medical anxiety—without white-knuckle coping or guesswork. We sit down with Dr. Ali Navidi, co-founder of GIpsychology.com and past president of the Northern Virginia Society of Clinical Hypnosis, to unpack how clinical hypnosis and gut-focused CBT help people with inflammatory bowel disease interrupt the gut-brain loop that keeps symptoms alive. No stage tricks here—just practical tools that retrain the nervous system, reduce visceral hypersensitivity, and restore a sense of control.
We explore the real differences between stage and clinical hypnosis and why trance is a natural state you already know how to access. Dr. Navidi explains how anchors—a simple conditioned cue—can trigger a calming response within seconds, whether you’re prepping for a colonoscopy, calling the insurance company, or navigating an unexpected flare. We dig into disorders of gut-brain interaction (DGBIs) that can drive symptoms even when labs look great, and why gut-focused CBT plus hypnosis outperforms one-size-fits-all mental health approaches for persistent GI distress.
Trauma and nocebo effects show up in subtle ways across the IBD journey. We get candid about medical trauma, memory reconsolidation, EMDR as a hypnotic protocol, and how conditioned food sensitivities form—like the “pizza panic” that lingers long after a flare. You’ll hear how to calm hypervigilance, rebuild trust with your body, and reintroduce foods safely. We also share details on a new eight-week telehealth group, created with the Crohn’s & Colitis Foundation and the American College of Gastroenterology, that pairs weekly skills training with recorded hypnosis sessions for daily practice.
Ready to try tools that actually change how your system reacts? Follow, share with a friend who needs hope, and leave a review to help others find the show. Your story might be the anchor someone else needs today.
Links:
- Information about the IBD Psychotherapy Group
- Information on Disorder of the Gut-Brain Interaction (DGBI)
- Great resources from GI Psychology
- Article in the Atlantic
- Dr. Navidi on the About IBD Podcast with Amber Tresca
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Hi, I'm Alicia. And I'm Ramen, and you're listening to Bowel Moments, the podcast sharing real talk about the realities of IDD. Serve. This week I talked to Dr. Ali Naviti. Dr. Naviti is one of the founders of GIpsychology.com and also a founder and past president of the Northern Virginia Society of Clinical Hypnosis. He's treated people living with GI disorders, chronic pain, and complex medical issues for over 10 years. We talked to him about clinical hypnosis and how that can be helpful to people living with inflammatory bowel disease and how it's integrated in with other types of mental health modalities. We talked to him about disorders of the gut-brain interaction, what those are and how they're treated. We talked to him about trauma and how clinical hypnosis may be able to help and how it also works with other types of treatment modalities. And finally, we talked to him about the therapy group that he's just started in coordination with the Crohn's colitis foundation and the American Gastroentological Association. This is a really cool new program that he started, and I'm excited to see what happens with it. Cheers. Hello, everyone. Welcome to Bowel Moments. I am unfortunately flying solo, guys. So it's just me, Alicia, but I am so very excited to be talking to Dr. Ali Navidi. Dr. Navidi, welcome to the show.
SPEAKER_00:Thank you, Alicia. I'm excited to be here.
SPEAKER_02:I am so excited to talk to you. Having a background, a bachelor's degree in psychology and being a social worker, of course, I am like gonna get super nerdy with you. So I'm really excited about that. But before we get into your career, the first very unprofessional question for you is what are you drinking?
SPEAKER_00:And I wish it was more fun. I'm I'm on a stimulant right now. So it's iced tea and hot tea if I need it.
SPEAKER_02:Okay, so tea time. And it looks like all black tea. So it's yeah, caffeine.
SPEAKER_00:I need that. Oh, yeah. I need that caffeine.
SPEAKER_02:I'm impressed that you are drinking caffeine at 630. Robin can do it. I cannot. Like I just stay awake all night.
SPEAKER_00:I've slowly developed over the years the insta-sleep ability. It's a great superpower. You should try it. It, you know, just boom, you're out.
SPEAKER_02:You know, if you could coach me on how you accomplish that, I would greatly appreciate it. Cause unfortunately, I stop sleeping well. I just lie there and stare at the ceiling and go, I really should be sleeping.
SPEAKER_00:Here, let me toss in a nerdy little psychology thing, you know, just because I can't help myself. The trick is actually counterintuitive. So I'll just give you a teaser and you could kind of look it up as you wish. But it actually relies more on sleep restriction. That when their sleep efficiency is bad, meaning they they spend a long time in bed and they're not necessarily sleeping, one of the best interventions is actually to restrict their sleep and force them to develop a bit of a sleep debt. And then once they've got enough of a debt, they're gonna naturally increase their efficiency. And then once they increase that efficiency, then you can pull back on the debt because now you've re-established good patterns of sleep. That's one of the like go-to interventions when we deal with uh variations of insomnia.
SPEAKER_02:I will try this. Okay. Well, so I did not have time, unfortunately, to mix myself a cocktail, but I had an open bottle of rose. And so I am drinking rose today. So tell us about your IBD story. What brought you into our community?
SPEAKER_00:There were kind of two phases to that. I think the first phase was I was just fascinated with clinical hypnosis. And this was when I was working in biotech. I wasn't a psychologist. I didn't major in psychology, majored in microbiology, and I was working in biotech. I think maybe at the time doing like yeast studying yeast exocytosis and some other really boring stuff. And eventually I realized it was really boring, and I really was loving psychology and specifically clinical hypnosis. And so, you know, I switched gears and long story short, ended up, you know, working as a psychologist and using clinical hypnosis and cognitive behavioral therapy as much as I could. But I didn't know that clinical hypnosis was this amazing tool uh for GI problems. I mean, we know that now because we're in the field, but then I had no idea. And I had my first IBS patient, and just it just worked amazingly. And then that led to more patients, and that led more doctors, and doctors referred, and and I learned more and I learned more. And then eventually that's what I was doing as a majority of my work. And then one day I got a patient that had IBD, and how ignorant I was, I didn't know the difference between IBD and IBS at the time, right? Like a lot of us, maybe in mental health. But I learned, and the patient had an amazing response to treatment and ended up saving them from surgery, and they were just kind of eternally grateful. And long story short, that ended up being an Atlantic article that was published about this patient. And you can look it up. It's a great story. It's it's really nice, the story about Zach. And and so that's how I found my way to IBD, right? That was that kind of two-step journey.
SPEAKER_02:Oh my gosh. Well, I will have to link to the article in the show notes. So if anybody's looking for it and wants to read it, I would definitely be curious to read it myself. So I'll find it. But so I listened to your episode with Amber Tresca on the About IBD podcast. And you told her a very interesting story about how you got interested in clinical hypnosis. So I'm wondering if you remember what you said on the podcast.
SPEAKER_00:Are you talking about me as a teenager buying that one book? Oh my gosh. Yeah, that was that was like a family vacation. And we were at a bookstore, I think, and I saw this book on clinical hypnosis, and I was like, that sounds cool. And I didn't know anything about that. So I got the book, I read it, and then I kind of lined up all you know, my my sisters and my cousins, and then one at a time we went and like went through that book and tried different things from the book, and some of them did really well, and some of them didn't. And it was a really old school book. It was like, you know, hypnosis has changed over the years. Back in the day, it was kind of like this authoritarian, you know, you will sleep, you know, that kind of thing. Now it's much more permissive, but yeah, that's how it started. And I remember my aunt was just amazing. She was amazing. I think I mentioned that in the other podcast. She was able to do stuff like she forgot her name, like she couldn't remember her name based on suggestion. And I think also some, I think it was like she forgot how to write. And that's the old school nature of that book, right? It was a lot of like stage hypnosis kind of stuff, like very flashy things that we wouldn't use clinically at all. But for a teenager, that was super fun.
SPEAKER_02:I love that so much. The reason that this tickled me so much is not, I mean, just a the like vision of you as a teenager, like having your family all line up and try this. But also, I will be very frank with you and tell you, I was considering, as my social work background, being a therapist and being a hypnotherapist because I also found a book when I was a teenager.
SPEAKER_00:No, was it the same book? Was it a little bit of a conviction? Oh my god.
SPEAKER_02:I don't think mine was clinical though. I think it was just like, and I and I tried hypnotizing my friends, and one of them, I scared her half to death because I basically hypnotized her into thinking her legs had gone numb and she plays basketball, and she was like, I can't feel my legs and started freaking out. So I'm I when I heard that on the her show, I had to just bring this up with like apparently this that book got around because I found the same one, I think, and just was absolutely marveled by it. Like I literally was like, Oh my god, what is this? I want to be a part of it. I am not a therapist, I do nothing with hypnosis, but I'm a big fan of it, and I think it's super cool to see how it's being utilized now. But I think a lot of people think it is like stage hypnosis, right? It's like I'm gonna quack like a duck. There's gonna be some sort of like implantation of something, understanding that everybody's situation is unique. But when somebody comes in and like and you're sitting down for a session with them, what does this look like? How do you introduce it? How do you start with a patient?
SPEAKER_00:Then we start with psychoeducation. We want people to really understand what we're talking about, what they're getting into. So the first thing to understand is we want to differentiate between clinical hypnosis and entertainment hypnosis. And the problem is everything most people know about hypnosis is entertainment hypnosis, right? And so if we take out all the mind control and all the magic and mysticism and kind of weird stuff, what do we have left? We have a very natural human state of consciousness called trance. We naturally go in and out of it. You know, the thing I always talk about is driving in my car. I go into trance, working out, I go into trance. My daughter makes fun of me all the time because when I'm watching TV, she can be like right over there and be like, ah, hey. And then it's like this delay like 30 seconds later, I'll turn to her and answer whatever question she was asking. Because in my mind, I'm in this zoned-in state, and her voice just seems so far away. And that is a very natural human ability. We all to some degree are able to go into trance. And so, what we're doing with hypnosis is we're just teaching people how to do something on purpose that they're already doing naturally. And that's why, even it, you know, dorky teenagers like us with just a book can help people go into trance because it's so natural for people to do it. It's almost like you have to mess up to not let them go into trance. Because that's another question I often get is like, yeah, hypnosis sounds great. It could help me with my pain, it could help me with this, but I don't think I can do it. Right. And my perspective on that is I think it's gonna be hard to keep you out of trance, right? Uh, because again, it it happens naturally. Like, even people listening to this podcast right now, at some point have zoned out and have thought of something that my what I said sparked in them. They went on a little internal trip and then they popped right back, right?
SPEAKER_02:Well, of course not. Everybody listens just with complete consciousness to this podcast that clearly doesn't happen, but you are correct. It has definitely like anytime you I drive and I'm like, How did I get here? Like, because I just kind of went into that state that isn't a natural state of being, and letting people know that this is natural, I think definitely helps people feel more comfortable that it's not you're not forcing it upon them. That it's just how is that trance state opening up a gate a little bit to your subconscious to be able to kind of say, How do we work together to see what's in there?
SPEAKER_00:And it turns out that in trance, our ability to focus and to let go of external distractions is vastly increased. And with that power of focus, if you then engage their imagination, that's when the magic happens. That's where we see the ability for people to profoundly calm themselves down or to numb their legs like you did to your friend, right? I bet she had no idea that she was capable of that, right? But think about the profound ability you awakened in her. If she learns to, if she ever learned to use that, she could numb anything she wanted. If she was in pain, just numb it out, then go to the doctor or do whatever she needs. Like that's like a superpower, but we all have access to it if we practice, if we trained. And that's one of the things I think I want people to get from this is hypnosis is in a way kind of like all of our birthright. It's all a capacity we have within us. It's just most people don't ever get the chance to develop it.
SPEAKER_02:I love that. I think that's such an interesting way of saying it. And it makes it feel like you said, like a power that we have that we just maybe haven't tapped into, and that we can go to somebody like you who can guide us into figuring out how do we tap into that to be able to help control symptoms or control reactions to testing or things like that. That can be super, super helpful to people who are having to navigate the healthcare system. I'm sure going into a more calm state anytime you call your insurance company for anything is certainly something that many people would really love to be able to do.
SPEAKER_00:100%. And actually, that reminds me, related to hypnosis is the idea of building an anchor. And this is another thing that I feel everybody should have. And what is an anchor? We all know anchors. Anchors are just Pavlovian responses, they're conditioned responses, right? So imagine a world where you develop an anchor so that within about 30 seconds, you could just completely calm yourself down in any situation. Who wouldn't want to have that, right? And that's one of the things that you can use hypnosis and just conditioning to help people develop, right? And especially someone with IBD who's got chronic medical issues, they're dealing with the insurance company, they're having to, you know, prep for something unexpectedly and drive five hours to get there. You know, there's a lot of these inconveniences that are gonna stress people out, except they're in a double bind because they know stress isn't good for their condition. So what do they do? So, as an example, having an anchor is a wonderful tool.
SPEAKER_02:It also provides a really nice visual that you can put to it. You're like, this is my anchor when I do this, like, and it's something you sort of can aim your brain at and say, like, when I think of this thing, the anchor gives a nice, like, I'm gonna look to this. I like the visual that goes along with that. Okay, so when somebody comes to you to work with you in just general, because you also you don't just do hypnosis or hypnotherapy, you also do other just CVT and other types of therapy that people maybe more associated as more traditional. But at what point do you introduce this as another tool in somebody's toolbox? What is it when you would say, I think this could be for you?
SPEAKER_00:So, what we'd want to do in general as therapists is we want to do an intake and really get a complete picture of the person and what they need and what's been the history. And and so then we can we can have this list of like, okay, these are the issues that are impacting you right now. And these are maybe some of the underlying things that might also benefit in the long run to be addressed. Where do you want to start? What's most important to you? What's going to make the most impact in your life? And then based on that, we want to come up with our treatment plan, right? And hypnosis is brought up in that part when we're treatment planning. As an example, patients will come in with, let's say, a lot of pain and no insight in terms of how stress and in their psychology influence their pain. Whereas someone else might come in with a lot of pain and a tremendous amount of insight. They know exactly what's stressing them out, they know how that stress affects their pain levels, right? And those two patients are going to be treated differently because the one isn't going to respond as well to the cognitive behavioral therapy, right? But the other might because they know the role that their thoughts are playing. Or the first person might need to do a lot more work to become even aware of their own thinking before they can even get to that stage of changing it. So there's a lot of different variables that are gonna play into when we introduce CBT, when we introduce clinical hypnosis. But I would say for the majority of patients, it's introduced pretty early. If after they learn what it really is and how it really works, they're still not interested. That's fine. We have many other tools to help. But I have to say, that one is like kind of the secret sauce. It makes everything else work better.
SPEAKER_02:It's so cool. Now I want to go back and be like a hypnotherapist. Okay, very cool. As you were talking, I was thinking, I bet it's really helpful to have somebody like you working with somebody as they're going through pelvic floor physical therapy as well. Because there is, I think there's some unconscious like clenching because people spend so much of their time sort of holding in potentially. And so that has a way of training your muscles. It could be interesting to see kind of how these two things interplay. The other thing is just, you know, pelvic floor physical therapy is potentially quite uncomfortable for some of our folks and invasive. And so it might be helpful to have those sort of tools to be able to help you get through that side of your care as well by using some of the tools you you sort of learn from you and in in your work with you. So we need to have you guys have like an office together.
SPEAKER_00:Well, I know a lot of the therapists in our practice, and by the way, the practice is GI psychology. The website is gisychology.com. But a lot of the therapists in the practice, they are working with patients who are in pelvic floor therapy because just from the fact of like a lot of patients with constipation, that can be a useful modality. And then pelvic floor therapy, if you if you've got GI problems or if you've got IBD, often that might be for various reasons, it might be something they need, right? And it does play really well with each other. And often we work with different kinds of PTs because we also deal with a lot of patients with chronic pain of various kinds. But what we found is when you align the mind with what you're trying to do with the body, it just works better.
SPEAKER_02:It's a nice segue into the other thing you put that you'd like to talk about. One of the things you put on is the brain-gut connection and how that functions and how you work with patients in that way. I know just again from layman's readings that you know, certainly there's like your gut produces quite a bit of like serotonin, for instance, than maybe like more than your brain. So, what do patients need to understand about that? And then how does IBD affect or sort of maybe haywire that a little bit?
SPEAKER_00:Yeah. It's a very multidimensional and complicated question. But I think to simplify it, one thing I think is useful is to think about all the different ways that the brain and gut are interacting with each other. So, as an example, patients with IBD, for reasons we're not quite sure of, have much higher rates of depression and anxiety. And we don't know if it's a chicken or the egg, which way it rolls, or if it rolls both ways, right? Being depressed dysregulates your immune system, and that makes you more likely to have IBD, or having IBD makes you more likely to be depressed and anxious. But either way, we see those correlations and we know that when we help the one, we help the other. So if patients are, let's say, helped with a biologic and their symptoms are reduced, that's going to help their depression and anxiety. And also, if we help their depression and anxiety, it often helps their symptoms, also, which is why behavioral health, which is what we do, is vastly underserving the IBD community because it's hard to find an IBD patient that couldn't use some amount of behavioral health intervention, right? Because that's just one aspect, right? So you have higher rates of depression and anxiety. And then you also have a higher rate of what are called disorders of gut brain interaction. And this can be a very frustrating problem for patients with IBD. As an example, this is where you might see that you do your blood tests and all your values look good, right? You're in remission, but your symptoms are not. You're still having pain or you're still having nausea or your, you know, diarrhea or constipation or whatever. And it's hard to understand why. And very often, the why, when the tests are clear, is that you've got a disorder of gut-brain interaction. And that is a nervous system disorder where your brain, your central nervous system, has gotten into this negative cycle with your GI system, in which the brain is seeing the GI, maybe it's the stomach, maybe it's the upper GI, whatever part of the GI, it's identified it as like a dangerous spot. And what happens is then you start directing hypervigilance and catastrophizing to the sensations from that spot, as well as something called visceral hypersensitivity, where the brain is like ramping up and distorting the sensations it's getting from that area. And that creates this cycle where anxiety is being sent down to the gut, causing more symptoms. And then those more symptoms are being sent up to the brain that are causing more anxiety and stress. So, anyway, this is a terrible cycle to get into. And it's the basis for a lot of problems, most notably irritable bowel syndrome is an example of a disorder of gut brain interaction. And if, you know, if you know that, it's incredibly common. One in 10 Americans have it. But a much higher percentage of patients with IBD have some variation of DGBI, like a disorder of gut brain interaction. Not necessarily IBS, but there's like 20 or so different ones. That is so interesting. You know, patients with IBD, they go through a lot of medical trauma. When they go through their flares, it's trauma. When they go through surgeries or other treatments, it can be traumatic and traumatic to the nervous system. And so whenever there's trauma, there's much more likely a chance to develop these nervous system disorders, these disorders of gut-brain interaction. And so that's the second kind of tier where patients with IBD need more behavioral health help. And this is why they need specialists. They don't need just regular mental health, because regular mental health is great for anxiety and depression, but they don't really know what to do with a DGBI.
SPEAKER_02:I think that's a really important point and why we need more GI psychologists as well, our GI mental health professionals. Is there a higher rate of disorders of gut-brain interaction or anxiety and depression when people are in flares? And the reason I ask this is because is there something about the inflammation that means that your gut is not able to absorb like the same amount of serotonin as it as it typically does? So is there any part of somebody having inflammation that's happening because of their disease that contributes to what might be happening mental health-wise?
SPEAKER_00:I believe so. Now, I'm not sure about like specific studies, but I believe that when people are in flare, they are more likely to have anxiety and depression. And again, it's the chicken and the egg. And we know that in an inflammatory system is gonna be more likely to cause depression. It's gonna be more likely to cause anxiety because the system in general is on high alert. And if you're like that for too long, it's not good. And you can get what's called depression secondary to anxiety. And so I think I think depression and anxiety reduce when treatment reduces inflammation. And then also when there's treatment for depression and anxiety, I think it helps in general with symptoms and inflammation.
SPEAKER_02:Well, and this also makes me question like if somebody gets to a point where they do believe they might need some sort of antidepressant or anti-anxiety medication, unfortunately, if there's inflammation in your gut, you're not absorbing the medication in the same way as you would when you don't have when the inflammation is calmed, when you have you're in more of a remission state. So do you end up with people that are then over-medicated because what they needed when they were in a flare is less than they need when they're not in a flare? So that this is all very curiosity questions.
SPEAKER_00:Well, I think it's just fascinating. This whole field of what's called psychoneuroimmunology. And it's how does the brain and the immune system interact? And for good or for bad, IBD patients are great examples of that, right?
SPEAKER_02:Yes, so fascinating how all of this works together and how, again, the brain is impacting the things that are happening with your inflammatory bowel disease. And so, what a cool career you have. I love this so much for you. You yourself have a private practice, you're part of the GI psychology, which is also other practitioners that are providing one-on-one counseling with folks and with specialties in inflammatory bowel disease, GI issues, and mental health. But what I think is super cool to talk about is that you have not just taken it as a one-on-one, but you really looked to work with the Crohn's and Kaleitus Foundation to put together a group setting. So I would love for you to talk about kind of how you got started with working with the Crowns and Kaleitis Foundation to put this together, how this differs from like a support group. Yes, and sort of what this could do for folks.
SPEAKER_00:Yeah. So GI Psychology was a group practice that started about five years ago. And the impetus was there were so many patients in need, so many patients with GI problems, and so very, very few trained therapists to help them. And so that's why we started GI Psych and we're in all 50 states and we're telehealth, and we don't kind of advertise directly. We work in basically in partnerships. So one of those partnerships is with the Crohn's and Clitus Foundation. The story of the group, first off, the group is is on mission, meaning it's a way to make treatment more accessible to folks that maybe couldn't afford or wouldn't be comfortable meeting one-on-one. And the group really started because I was looking at the research regarding clinical hypnosis and IBD. And I knew from my clinical experience that it was helpful, but I wasn't quite sure what the research said. And what I found really kind of blew me away was that there were studies showing that clinical hypnosis could directly reduce inflammatory load, not only reducing inflammatory load, but also reducing the severity and length of flares. And I was like, oh my gosh, this is amazing. And from there, we started to develop myself and another clinician began to develop a group, an eight-week group therapy. Difference between a group therapy and a support group. Support group is for support, therapy is to make an impact, make a change, specific changes. And the bonus of that is that it's reimbursable by insurance. So that's also nice, right? So I learned that, and then I thought, okay, we can do that, and we can help with stress and resilience, and we can start incorporating CBT concepts into the group. So we we came up with this wish list of all these things we wanted people to learn, and it was just so exciting. So then we built this up over months and months and months. And the really exciting thing is we got the Crohn's and Clitus Foundation excited about it also. And they've been a tremendous support and they just started getting the information out to their membership. I think they have like some kind of hotline. And if you go to that hotline, they'll tell you all about the group. But if you also just go to our website too and get a free phone consult, you can learn about it also. But it wasn't just the Crohn's and Clitus Foundation, also the American College of Gastroenterology has gotten behind it and they're also putting it out to their members. So it's been this amazing collaboration between the three organizations, and it's all centered on making this treatment available for patients with IBD.
SPEAKER_02:That is super cool. And I love that these two organizations have gotten behind this, and because it is so impactful, and you're right, not everybody can access, you know, a one-on-one therapist and it might not be within network for them or pay for it out of pocket. So I think this is really great. What's the structure around the group? You said it's an eight-week course. So every week do you have something that you focus on? Talk about how it works.
SPEAKER_00:Yeah. So there's eight weeks, and like I said earlier, we kind of said, okay, what would we most want our IBD patients to have as skills? And it's actually quite innovative in that we're doing something that has never been kind of successfully put together before, which is we're teaching some concept, right? Um, maybe it's a cognitive behavioral concept around resilience and self-efficacy. And then we're reinforcing that concept using a clinical hypnosis session. And so we're recording it. And then the homework is just to listen to that hypnosis session in between their sessions. So they're just reinforcing it every day for a week in a very kind of comfortable, relaxed way. And I love that integration between hypnosis and more kind of intellectual understanding.
SPEAKER_02:Oh, wow. That's super cool. I didn't realize that was how the clinical hypnosis was being included in the sessions. So I think this just got started or is about to get started. Where are you at with this?
SPEAKER_00:We just got enough to start our first group. So we're about to launch that group and we're recruiting for our second group right now. And I think we got a few already who are interested.
SPEAKER_02:Well, if anybody is interested in this, we'll make sure the information is down in the show notes so that they can find out where to find you. And I'm assuming there's probably a wait list to join if you've already started a session and and you're looking to fill the next one. Yeah. I'm curious about the people who have responded to this. Like, is there a variety of people? I'm just curious about the demographics of the people that have signed up. Has it been kind of universal?
SPEAKER_00:I kind of was looking at the we have got a little spreadsheet of everyone who's kind of shown interest. And it's fascinating because it's it's really people all over the country. That's the cool thing about telehealth, right? You could be in rural Alabama, and there's zero chance that there's any GI psychology support around you. Yeah, but you could join this group and get top-notch care, right? So it seems very diverse racially in terms of if my guesses are right about people's names, right? And then just people from all over the country. It's it's actually really lovely. I think the important thing, because you've got, you know, Crohn's and colitis, is that we are dealing in in kind of core fundamental principles that we kind of took some time to say, okay, what what are the most important things for people to know, regardless of where they are in their journey, whether they're, you know, they've had surgery or they haven't, if there's an ostomy or if there's not, you know, if they're very early diagnosed or whatever, we wanted principles that could that could help anyone who's got those diagnoses.
SPEAKER_02:And it'll be interesting to see how some of these principles are spread into things like support groups. So when somebody is going into a sport support group or is participating in a support group, that somebody might pull it out and say, you know, there's this result. Resilience, there's this idea of resilience. Like, here's some, you know, some tools that I've learned. And to be able to kind of pass that on, I think that could be really, really valuable to the community. So I know you haven't even started this yet, but is the vision to eventually be like, because if you have practitioners all over the country that can help people all over the country, is it eventually that you'll have kind of concurrent eight-week sessions happening at the same time or sort of staggered sessions? What's your bigger vision for this? Where do you want this to go?
SPEAKER_00:The bigger vision is we're running this first session, and our goal is to learn as much as we can from it and improve it from there. And to eventually, once we kind of go through a few iterations, then we want to train more of our clinicians to run groups so that again, like we don't become a block in terms of like, oh, we only have one person who knows how to run the group and they're out of space, too bad. We want to grow with demand so that nobody really should have to wait maybe more than a month or two to be able to get into a group.
SPEAKER_02:I think it does make sense to sort of start it with one, what did we learn? Revisit, what did we learn, revisit? So I think that's a great idea. I think it's going to be such a valuable tool for our community to be able to participate in this, if that's something that they are able to get in and something of interest to them. Going back to my comment around like if you're in inflammation and you know that you're not able to absorb things in the same way. Similarly, if somebody has just had surgery and they've lost their entire colon, you know, then does that change anything about gut-brain connection? Like if you're messing with the gut, how does that change things?
SPEAKER_00:And this reminds me also of what happens to patients also with eating disorders when they're going through what's called refeeding. So if you have somebody with, let's say, anorexia and they've kind of been not eating very much, kind of starving themselves, and then they're in treatment and they're getting better, they go through this refeeding process where they're starting to eat a no more of a normal amount, but reliably the gut is going to cause problems. Maybe it's constipation, maybe it's pain, maybe it's diarrhea, maybe it's nausea, right? But reliably these patients have problems because the gut is just kind of relearning how to function in its new state. And then there's a certain period where those problems are expected. And anything within that period is kind of normal physiologic, um, like readjustment. And then if they go beyond that period, then we have a sense like, okay, maybe they've developed a disorder of gut brain interaction as well because of the trauma that they've gone through in their gut. So a patient that's had surgery, there's absolutely going to be a period where the gut is readjusting and they need to talk to their doctor, their surgeon about what that period should look like, where things are kind of resettling and their body's trying to understand how to function in this new environment. Now, whatever that period is, now add maybe a half again. And but then if you go beyond that and there's still symptoms, then you might want to consider that from all the trauma of the surgery, you've also developed a disorder of gut brain interaction, which is in some sense good news because actually they are very, very treatable. And I think that's another thing I want people to understand is if they're a patient who there's no longer any physiological explanation for why they're having symptoms and they have a disorder of gut brain interaction, the research shows that between 70 to 80 percent are going to reach their treatment goals with the specialized treatments that we use, which is not a bad percentage.
SPEAKER_02:It's not. No, that's very helpful to be able to tell people and make sense. I'm curious, because when you said anorexia, it reminds me a little bit of our folks that you know, we do have a lot of folks that have like RFID or restrictive feeding food patterns. That definitely, as you were saying that, I was like, gosh, then you add that layer on top of it with our folks of already maybe there is some of that dysfunction that's happening. And then there's this whole other layer of now you've also coached your body almost to respond in a certain way, and that fear, that real, you know, visceral fear of food for a lot of our folks. Boy, that adds a layer, doesn't it?
SPEAKER_00:Yeah, and you're bringing up another issue. So, well, first let me respond to the RFID. Normally, we don't treat eating disorders, however, RFID is an exception because we see it in so many of our patients. So avoidant restrictive food intake disorder, RFID, whether it's full-on RFID or if it's just restricted eating that doesn't quite meet that criteria. We see a lot of that. And so we do help patients with RFID. The other issue, though, that this brings up is something called conditioned food sensitivity, which is a very important thing for anybody with IBD to understand. Because let's imagine a world where a patient is in a flare and then they try to eat. I always use pizza as an example. So we'll use pizza. So they try to have some pizza and they do not react well to the pizza. Later they get treatment and the flare subsides, and they're physiologically they're doing better, they're in remission. However, like in terms of their nervous system, they've had maybe one, two, three, four terrible experiences eating pizza. So, what can happen is then their brain unconsciously is becoming very anxious while they're eating the pizza. It's hyper-vigilant. And then if they notice any little thing going on in their stomach after or during their while they're eating the pizza, their brain starts catastrophizing. And that sends anxiety down the gut brain axis into the gut and is is likely to cause actual symptoms, even though the flare is gone and physiologically their body actually has no reason not to do well with the pizza. Their body has become conditioned to kind of freak out when it eats pizza. So it's a nervous system problem that's affecting the GI when they eat. So they've conditioned their body and their nervous system to respond badly to pizza. And then every time they eat pizza and they have a bad experience, it just reinforces it. And that's actually something we can help patients correct. And what we first do is we desensitize the system. We teach them how to calm down the brain that's hyper-vigilant and catastrophizing, and then calm down that what's called visceral hypersensitivity, which we talked just a teeny bit about. Anyway, we calm those things down. The system is calmed down now. Now they can eat pizza and they can slowly expose themselves to pizza again in a safe way and reintroduce it into their diet.
SPEAKER_02:When you're working with people with who have that disorder of the gut brain interaction, so that you know, the folks we just talked about, is that somebody that you would you would look to use something like a hypnotherapy with or a CBT with? Is there a different technique you use when there is this or disorders of the gut brain, or is it the same? It's just slightly a different way of doing it, basically.
SPEAKER_00:I think it's it's the same modalities of treatment, different ways of applying them. So both CBT, well, specific forms of CBT, gut-focused CBT, which is not bread and butter CBT, and clinical hypnosis, both have a lot of research behind them, supporting their use for DGBIs. Literally over 40 years of research, over hundreds of studies, you know, showing that they're effective. And we integrate the two. We're using hypnosis, we're using CBT. I'm actually working with another one of our therapists because that's a bit unique in the field, is that I think most people are using them like kind of like alternating. And we're we're focused on how can we learn to integrate them to make them even more effective. So we're working on kind of codifying how we do it, right? But yeah, they're used interchangeably, and it can vary depending on the patient and what they need, when and how.
SPEAKER_02:Okay, and I realize we jumped a little bit ahead. So I'm gonna ask you to do a little bit of remedial work with me. But so CBT, so cognitive behavioral therapy is a specific type of therapy that you use, a tool that you use when you're working with folks. So just do those super brief definition of CBT and then sort of it's how it's different, maybe, than when you're doing clinical hypnosis.
SPEAKER_00:CBT is a very popular, well-known treatment modality. Essentially, it's working off the idea that how we think affects how we feel and how we act, and that people can get into dysfunctional patterns of thought, dysfunctional patterns of feeling, dysfunctional patterns of acting and behaving. And they're all interconnected. And so CBT helps you untangle that mess of like, let's say you've got an anxiety disorder or something like that. How do we pull the different levers of how of behavior, of emotion, and thoughts and teach people how to kind of be their own therapist when it comes to helping themselves? And CBT has been studied for a lot of different disorders, and there's been specific research on how to use CBT for GI problems. And it's a different, you know, style of treatment, different techniques, different ways of doing things than just kind of regular CBT for an anxiety disorder. So that's my little spiel on CBT.
SPEAKER_02:Very helpful, just in case people have not heard of it, which seems unlikely. It feels like everybody knows about CBT now, but it is very, very commonly used. So, okay. When somebody is potentially like they've been living with the disease for a while, I'm sure there's a lot of people who are like, I've got this, I've had IBD for 20 years. I don't need to talk to a therapist, right? You know, I don't, I don't need a therapist. But one of the things you wrote is like, how is working with somebody who has the coaching that you have, the training that you have to work with people, how does that increase or improve like quality of life, essentially for folks? So I'd love to hear your thoughts on this one because I think there could be some folks that just don't realize that there's this things could be different and that you could potentially work with them to be able to do that.
SPEAKER_00:Well, I think we can kind of break it down into three categories. The first are these nasty little DGBIs, disorders of gut brain interaction that we've been talking about. And they can they can be very insidious, they could be causing symptoms when your inflammation is not happening. They can be causing symptoms and you might not know why. And it can cause you to go down a lot of useless paths for you know help when actually the problem is in the nervous system. But they can also make your symptoms worse than they need to be when you're in a flare, because the brain is very powerful, the nervous system is very powerful. And if it's working against you while your body's also working against you, that's a nasty combination. So that's one area that might not be obvious to people when they're thinking about getting help. The other way, of course, is depression and anxiety. And, you know, I think often we just say these words and people they're like, yeah, yeah, yeah, I know what depression. And they have this image of somebody like crying on a bed, not getting up. But that's not always what depression looks like. Sometimes depression is people feeling irritable, like a lot, or just feeling a little low, a little low energy, not quite as excited about things. There are subtle variations. People can feel anxiety so much they don't even recognize that it's anxiety, right? It's just like this is how I live, right? And sometimes they in they need like the right question at the right time to be like, wait, everyone doesn't feel like this all the time.
SPEAKER_02:So I feel that one very deeply. I feel a little targeted by that.
SPEAKER_00:And then the last one is something I think also people can miss, which is trauma. And when people think trauma, they think, you know, bad childhood, right? Bad things happening, sexual, physical, or war. That's not always how trauma shows up. You know, trauma can show up when you think that something is terribly wrong, that something has happened to you, that something really bad is going to happen to you. Think surgery, think flares, think people being really scared and out of control and these terrible moments in their lives, they can imprint themselves on their limbic system in a way that normal memories don't. And so then you get what's called implicit memories that kind of leak out anxiety or fear throughout people's day or that are being triggered like little mini flashbacks, so that they're overreacting to things in their lives. They're like, why did I react so strongly to that? And they don't even know why. And that might have might be because it triggered some underlying trauma that they've experienced.
SPEAKER_02:It's been discussed many times on the show about how fraught this whole living with IBD is because of all the potential opportunities for trauma. You know, a lot of times, I mean, we have people that have very dramatic entries into this community, you know, with hospitalizations and, you know, very significant symptoms, and some people even close to death because of, you know, the to the severity of their disease. And so it there's, you know, and that's just the entry point, you know. And then there's all along the way the surgeries and the people not believing you, the medical gaslighting, all these sort of small, and some of them not so small, sort of wounds, psychological wounds that kind of go along. So it definitely is a big part of this.
SPEAKER_00:That actually reminds me of something I didn't get a chance to mention, but I'm glad you did. You mentioned medical gaslighting. And I think sometimes it can rise to the level of gaslighting, sometimes it can be very deliberate, but I think sometimes it can also just be very inadvertent, right? Just a random comment by a doctor or a nurse when people are in a very vulnerable state, can really stick in their brain. And I think everybody's heard of the placebo effect. Not as many people have heard of the nocebo effect, which is the fact that these comments or these expectations by providers, if they're they're phrased in some kind of negative way, they can inadvertently cause damage to the person, to the patient.
SPEAKER_02:Yes. Well, and that's again going back to my comment about insurance too. That's just them participating in the healthcare system. Add in the trauma that can come with having an insurance company that it takes a lot of that control from you. You know, your comment about control really resonated with me because there is so much of this disease, or so much of these diseases, so much of living with chronic illness that is it feels out of control. It feels like these aspects of control are taken from you. And that's so destabilizing for people and so traumatic to have people make decisions on your behalf constantly and you feeling like you're not an active participant in that. I think that's really traumatizing for many people. I'm glad you brought up trauma. How does clinical hypnosis sort of tie in with something like EMDR? Like so when you have somebody that does have something that's just kind of sticking, and you know that something like EMDR, which we've covered in a couple of episodes, could potentially be helpful. How does that work together?
SPEAKER_00:I love it. Now you've activated my psychology nerd module. And so I'm gonna go off on a little tangent here. So I've had I've had many friends and colleagues in the field who are trained in EMDR and clinical hypnosis, some of them who are EMDR trainers themselves, right? Every single one of them who I've talked to have said basically the same thing, which is EMDR is a subset of hypnotic techniques. If you imagine hypnosis as a broad kind of umbrella with a lot of different techniques within it, EMDR is like a really good hypnotic protocol that's focused on trauma. And so there are other hypnotic protocols for trauma as well. And EMDR is one of them. So we have a lot of different tools for treating trauma using EMDR, using cognitive behavioral therapy as well. But the key with treating trauma, and I promise I won't go too far down this rabbit hole, is you go down that rabbit hole, I'll come with you. Okay, cool. So I think a lot of times people get stuck at the cognitive level, talking about the trauma, which can help and it can feel supportive. But in order to truly treat trauma, you have to go deeper. You have to go into the limbic system, you have to go and shift the implicit memories, the unconscious memories that are stored there. And that's something called memory reconsolidation. It's a whole very fascinating field of neurology and all this stuff. But I think the problem often with trauma is people want to talk about it, which is helpful, but not sufficient to truly resolve the trauma.
SPEAKER_02:Got it. Yeah. Because trauma doesn't just live in your brain, it lives like kind of throughout you. You know, it's like it's it affects you in lots of ways. That trauma comes out as anxiety or stomach acid issues or whatever it is. It can it can look very different.
SPEAKER_00:So people have you read that book, uh The Body Keeps the Score?
SPEAKER_02:I I did a whole CEU about it. I'm such a geek. It's I can send it to you. It was super fascinating. But it, you know, yeah, it comes out in sort of all these different ways. And so we had Robin and Hannah, Robin, obviously, the co-host of the show, and Hannah, one of our patients, that has come back a couple of times. We had them sort of talk through what they had done when they had done EMDR just to help people ex to know what to expect. And Robin was talking about how she went in thinking, okay, it's gonna be this thing, like this is the thing, and about how this whole other thing that had happened way back was the thing that sort of was actually really dug in there and came out, and about how she was so shocked. And she was said, I didn't even think that was a thing. Like in looking back, I don't know why that affected me so much. It was super interesting to hear her say that. I know with I think with Hannah's, it was a little more like present of things that were a little more close to home, but but Hannah's also much younger than Robin. And so it's one of those where, like, so like their interactions with the healthcare system are going to be different. Hers is going to be a little more present, and Robin, the thing that she kind of that came up for her was much more, you know, towards the beginning of her journey. So it was, it's super, super interesting.
SPEAKER_00:I love that point in therapy because that point in therapy where people begin to be introduced to their unconscious mind. And people who came in never knowing they really had one, they always thought that everything that was going on was right in the front, right? And then that story about Robin is just beautiful. And I've had so many patients experience that where we're working on some kind of trauma or some kind of issue, and they're like, Oh, I think it's probably gonna, this is probably gonna come up. And then something completely different shows up, and that tells you right that you're on the right track because that's not intellectual, right? When they get surprised, that means a different part of their mind is speaking to them at that point.
SPEAKER_02:So super interesting. You mentioned the like it's not intellectual. This group of folks with the inflammatory bowel disease community is so educated. There, I mean, they really do understand about their disease. They research, they look, they're on Reddit, they're asking questions. I mean, like it really is just a very, very educated group of folks.
SPEAKER_00:One of the things for some folks with like cognitive behavioral therapy is this sort of a tendency perhaps to intellectualize something and not necessarily that's why it's so powerful to combine CBT with clinical hypnosis because hypnosis is an experiential therapy. Yeah, they're they're feeling it, they're doing it, they're in their imagination, powerfully kind of experiencing something, whether that's a positive resource state or diving into some, you know, negative trauma, they're experiencing something. And so it pairs really well with CBT, which can be very intellectual, which is helpful, but it can cause some people to sometimes spin their wheels a bit and not make progress.
SPEAKER_02:Right. Yeah, it's like you know you should think a certain way. It doesn't necessarily stop you from continuing to think in the wrong way, you know. And so for some folks, having that combined between the two is definitely a way to kind of help people stop the propensity to perhaps like fall back on the intellectualizing. Unfortunately, I have to ask you the last question. What is your one piece of advice for the IBD community? And I did tell you you could have two, one for the patient community and one for the professional community, but that's up to you.
SPEAKER_00:I mean, the obvious piece of advice is get that behavioral health piece in place. Get your team fully, you know, vetted, find someone that you work well with that understands the disorder. That's the obvious piece of advice. The less obvious piece of advice is the idea of an anchor, because I think that can come in handy in so many difficult situations that it would be a shame if people didn't have it. And I can give super quick advice for how to develop that anchor. And I'll kind of go through it right now. I often use like a left fist. So you clench your left fist. So the idea is pair that left fist with some sort of relaxing thing. So if you're someone who meditates, or if you're someone who does breathing, or someone who does progressive muscle relaxation, whatever affect regulation tool you like to use, all you do is right before you do it, do your anchor, your left fist, then do the thing that relaxes you. And then when you're really relaxed, do the left fist again. And then repeat that over and over every time you do that that regulation. I usually have people do that at least 20 times, but by usually by the 10th time, just doing the left fist is gonna elicit that relaxation response. And at that point, you know you've built your anchor, and then you can use it. And every time you use it, you're gonna get better at it, you're gonna reinforce that pathway in your brain, making it more effective.
SPEAKER_02:Such a Pavlovian thing. Okay, I love that. Perfect advice for folks. Dr. Naviti, thank you so much for joining us. It's been so much fun to talk to you and to learn so much and to get nerdy with you a little bit. Thank you so much for joining us. Thank you, everybody else, for listening. And cheers, everybody.
SPEAKER_00:Cheers. Hi, this is Dr. Naviti. If you enjoyed this episode, please rate, review, subscribe, and share it with your friends.
