October 8, 2025 • 52 mins
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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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_02 (00:00):
Hi, I'm Alicia.
And I'm Ramen, and you'relistening to Bowel Moments, the
podcast sharing real talk aboutthe realities of IDD.
Serve.
This week I talked to Dr.
Ali Naviti.
Dr.
Naviti is one of the founders ofGIpsychology.com and also a
founder and past president ofthe Northern Virginia Society of
(00:22):
Clinical Hypnosis.
He's treated people living withGI disorders, chronic pain, and
complex medical issues for over10 years.
We talked to him about clinicalhypnosis and how that can be
helpful to people living withinflammatory bowel disease and
how it's integrated in withother types of mental health
modalities.
We talked to him about disordersof the gut-brain interaction,
what those are and how they'retreated.
(00:43):
We talked to him about traumaand how clinical hypnosis may be
able to help and how it alsoworks with other types of
treatment modalities.
And finally, we talked to himabout the therapy group that
he's just started incoordination with the Crohn's
colitis foundation and theAmerican Gastroentological
Association.
This is a really cool newprogram that he started, and I'm
excited to see what happens withit.
Cheers.
(01:07):
Hello, everyone.
Welcome to Bowel Moments.
I am unfortunately flying solo,guys.
So it's just me, Alicia, but Iam so very excited to be talking
to Dr.
Ali Navidi.
Dr.
Navidi, welcome to the show.
SPEAKER_00 (01:21):
Thank you, Alicia.
I'm excited to be here.
SPEAKER_02 (01:23):
I am so excited to talk to you.
Having a background, abachelor's degree in psychology
and being a social worker, ofcourse, I am like gonna get
super nerdy with you.
So I'm really excited aboutthat.
But before we get into yourcareer, the first very
unprofessional question for youis what are you drinking?
SPEAKER_00 (01:37):
And I wish it was more fun.
I'm I'm on a stimulant rightnow.
So it's iced tea and hot tea ifI need it.
SPEAKER_02 (01:45):
Okay, so tea time.
And it looks like all black tea.
So it's yeah, caffeine.
SPEAKER_00 (01:49):
I need that.
Oh, yeah.
I need that caffeine.
SPEAKER_02 (01:52):
I'm impressed that you are drinking caffeine at
630.
Robin can do it.
I cannot.
Like I just stay awake allnight.
SPEAKER_00 (01:57):
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'reout.
SPEAKER_02 (02:06):
You know, if you could coach me on how you
accomplish that, I would greatlyappreciate it.
Cause unfortunately, I stopsleeping well.
I just lie there and stare atthe ceiling and go, I really
should be sleeping.
SPEAKER_00 (02:16):
Here, let me toss in a nerdy little psychology thing,
you know, just because I can'thelp myself.
The trick is actuallycounterintuitive.
So I'll just give you a teaserand you could kind of look it up
as you wish.
But it actually relies more onsleep restriction.
That when their sleep efficiencyis bad, meaning they they spend
a long time in bed and they'renot necessarily sleeping, one of
(02:38):
the best interventions isactually to restrict their sleep
and force them to develop a bitof a sleep debt.
And then once they've got enoughof a debt, they're gonna
naturally increase theirefficiency.
And then once they increase thatefficiency, then you can pull
back on the debt because nowyou've re-established good
patterns of sleep.
(02:58):
That's one of the like go-tointerventions when we deal with
uh variations of insomnia.
SPEAKER_02 (03:04):
I will try this.
Okay.
Well, so I did not have time,unfortunately, to mix myself a
cocktail, but I had an openbottle of rose.
And so I am drinking rose today.
So tell us about your IBD story.
What brought you into ourcommunity?
SPEAKER_00 (03:15):
There were kind of two phases to that.
I think the first phase was Iwas just fascinated with
clinical hypnosis.
And this was when I was workingin 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 doinglike yeast studying yeast
(03:38):
exocytosis and some other reallyboring stuff.
And eventually I realized it wasreally boring, and I really was
loving psychology andspecifically clinical hypnosis.
And so, you know, I switchedgears and long story short,
ended up, you know, working as apsychologist and using clinical
hypnosis and cognitivebehavioral therapy as much as I
(04:00):
could.
But I didn't know that clinicalhypnosis was this amazing tool
uh for GI problems.
I mean, we know that now becausewe'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 morepatients, and that led more
(04:20):
doctors, and doctors referred,and and I learned more and I
learned more.
And then eventually that's whatI was doing as a majority of my
work.
And then one day I got a patientthat had IBD, and how ignorant I
was, I didn't know thedifference between IBD and IBS
at the time, right?
Like a lot of us, maybe inmental health.
(04:41):
But I learned, and the patienthad an amazing response to
treatment and ended up savingthem from surgery, and they were
just kind of eternally grateful.
And long story short, that endedup being an Atlantic article
that was published about thispatient.
And you can look it up.
It's a great story.
It's it's really nice, the storyabout Zach.
And and so that's how I found myway to IBD, right?
(05:03):
That was that kind of two-stepjourney.
SPEAKER_02 (05:06):
Oh my gosh.
Well, I will have to link to thearticle in the show notes.
So if anybody's looking for itand wants to read it, I would
definitely be curious to read itmyself.
So I'll find it.
But so I listened to yourepisode with Amber Tresca on the
About IBD podcast.
And you told her a veryinteresting story about how you
got interested in clinicalhypnosis.
So I'm wondering if you rememberwhat you said on the podcast.
SPEAKER_00 (05:27):
Are you talking about me as a teenager buying
that one book?
Oh my gosh.
Yeah, that was that was like afamily vacation.
And we were at a bookstore, Ithink, and I saw this book on
clinical hypnosis, and I waslike, that sounds cool.
And I didn't know anything aboutthat.
So I got the book, I read it,and then I kind of lined up all
(05:50):
you know, my my sisters and mycousins, and then one at a time
we went and like went throughthat book and tried different
things from the book, and someof them did really well, and
some of them didn't.
And it was a really old schoolbook.
It was like, you know, hypnosishas changed over the years.
Back in the day, it was kind oflike this authoritarian, you
know, you will sleep, you know,that kind of thing.
(06:12):
Now it's much more permissive,but yeah, that's how it started.
And I remember my aunt was justamazing.
She was amazing.
I think I mentioned that in theother podcast.
She was able to do stuff likeshe forgot her name, like she
couldn't remember her name basedon suggestion.
And I think also some, I thinkit was like she forgot how to
(06:35):
write.
And that's the old school natureof that book, right?
It was a lot of like stagehypnosis kind of stuff, like
very flashy things that wewouldn't use clinically at all.
But for a teenager, that wassuper fun.
SPEAKER_02 (06:47):
I love that so much.
The reason that this tickled meso much is not, I mean, just a
the like vision of you as ateenager, like having your
family all line up and try this.
But also, I will be very frankwith you and tell you, I was
considering, as my social workbackground, being a therapist
and being a hypnotherapistbecause I also found a book when
I was a teenager.
SPEAKER_00 (07:07):
No, was it the same book?
Was it a little bit of aconviction?
Oh my god.
SPEAKER_02 (07:13):
I don't think mine was clinical though.
I think it was just like, and Iand I tried hypnotizing my
friends, and one of them, Iscared her half to death because
I basically hypnotized her intothinking her legs had gone numb
and she plays basketball, andshe was like, I can't feel my
legs and started freaking out.
So I'm I when I heard that onthe her show, I had to just
bring this up with likeapparently this that book got
around because I found the sameone, I think, and just was
(07:36):
absolutely marveled by it.
Like I literally was like, Oh mygod, what is this?
I want to be a part of it.
I am not a therapist, I donothing with hypnosis, but I'm a
big fan of it, and I think it'ssuper cool to see how it's being
utilized now.
But I think a lot of peoplethink it is like stage hypnosis,
right?
It's like I'm gonna quack like aduck.
There's gonna be some sort oflike implantation of something,
(07:56):
understanding that everybody'ssituation is unique.
But when somebody comes in andlike and you're sitting down for
a session with them, what doesthis look like?
How do you introduce it?
How do you start with a patient?
SPEAKER_00 (08:05):
Then we start with psychoeducation.
We want people to reallyunderstand what we're talking
about, what they're gettinginto.
So the first thing to understandis we want to differentiate
between clinical hypnosis andentertainment hypnosis.
And the problem is everythingmost people know about hypnosis
is entertainment hypnosis,right?
And so if we take out all themind control and all the magic
(08:28):
and mysticism and kind of weirdstuff, what do we have left?
We have a very natural humanstate of consciousness called
trance.
We naturally go in and out ofit.
You know, the thing I alwaystalk about is driving in my car.
I go into trance, working out, Igo into trance.
My daughter makes fun of me allthe time because when I'm
(08:52):
watching TV, she can be likeright over there and be like,
ah, hey.
And then it's like this delaylike 30 seconds later, I'll turn
to her and answer whateverquestion she was asking.
Because in my mind, I'm in thiszoned-in state, and her voice
just seems so far away.
And that is a very natural humanability.
(09:13):
We all to some degree are ableto go into trance.
And so, what we're doing withhypnosis is we're just teaching
people how to do something onpurpose that they're already
doing naturally.
And that's why, even it, youknow, dorky teenagers like us
with just a book can help peoplego into trance because it's so
(09:34):
natural for people to do it.
It's almost like you have tomess up to not let them go into
trance.
Because that's another questionI 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 Ithink it's gonna be hard to keep
you out of trance, right?
(09:55):
Uh, because again, it it happensnaturally.
Like, even people listening tothis podcast right now, at some
point have zoned out and havethought of something that my
what I said sparked in them.
They went on a little internaltrip and then they popped right
back, right?
SPEAKER_02 (10:11):
Well, of course not.
Everybody listens just withcomplete consciousness to this
podcast that clearly doesn'thappen, but you are correct.
It has definitely like anytimeyou I drive and I'm like, How
did I get here?
Like, because I just kind ofwent into that state that isn't
a natural state of being, andletting people know that this is
natural, I think definitelyhelps people feel more
comfortable that it's not you'renot forcing it upon them.
(10:31):
That it's just how is thattrance state opening up a gate a
little bit to your subconsciousto be able to kind of say, How
do we work together to seewhat's in there?
SPEAKER_00 (10:40):
And it turns out that in trance, our ability to
focus and to let go of externaldistractions is vastly
increased.
And with that power of focus, ifyou then engage their
imagination, that's when themagic happens.
That's where we see the abilityfor people to profoundly calm
(11:01):
themselves down or to numb theirlegs like you did to your
friend, right?
I bet she had no idea that shewas capable of that, right?
But think about the profoundability you awakened in her.
If she learns to, if she everlearned to use that, she could
numb anything she wanted.
If she was in pain, just numb itout, then go to the doctor or do
(11:24):
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 Ithink I want people to get from
this is hypnosis is in a waykind of like all of our
birthright.
It's all a capacity we havewithin us.
It's just most people don't everget the chance to develop it.
SPEAKER_02 (11:44):
I love that.
I think that's such aninteresting way of saying it.
And it makes it feel like yousaid, like a power that we have
that we just maybe haven'ttapped into, and that we can go
to somebody like you who canguide us into figuring out how
do we tap into that to be ableto help control symptoms or
control reactions to testing orthings like that.
That can be super, super helpfulto people who are having to
navigate the healthcare system.
(12:04):
I'm sure going into a more calmstate anytime you call your
insurance company for anythingis certainly something that many
people would really love to beable to do.
SPEAKER_00 (12:14):
100%.
And actually, that reminds me,related to hypnosis is the idea
of building an anchor.
And this is another thing that Ifeel everybody should have.
And what is an anchor?
We all know anchors.
Anchors are just Pavlovianresponses, they're conditioned
responses, right?
So imagine a world where youdevelop an anchor so that within
(12:36):
about 30 seconds, you could justcompletely calm yourself down in
any situation.
Who wouldn't want to have that,right?
And that's one of the thingsthat you can use hypnosis and
just conditioning to help peopledevelop, right?
And especially someone with IBDwho's got chronic medical
issues, they're dealing with theinsurance company, they're
(12:56):
having to, you know, prep forsomething unexpectedly and drive
five hours to get there.
You know, there's a lot of theseinconveniences that are gonna
stress people out, exceptthey're in a double bind because
they know stress isn't good fortheir condition.
So what do they do?
So, as an example, having ananchor is a wonderful tool.
SPEAKER_02 (13:16):
It also provides a really nice visual that you can
put to it.
You're like, this is my anchorwhen I do this, like, and it's
something you sort of can aimyour brain at and say, like,
when I think of this thing, theanchor gives a nice, like, I'm
gonna look to this.
I like the visual that goesalong with that.
Okay, so when somebody comes toyou to work with you in just
general, because you also youdon't just do hypnosis or
hypnotherapy, you also do otherjust CVT and other types of
(13:38):
therapy that people maybe moreassociated as more traditional.
But at what point do youintroduce this as another tool
in somebody's toolbox?
What is it when you would say, Ithink this could be for you?
SPEAKER_00 (13:48):
So, what we'd want to do in general as therapists
is we want to do an intake andreally get a complete picture of
the person and what they needand what's been the history.
And and so then we can we canhave this list of like, okay,
these are the issues that areimpacting you right now.
And these are maybe some of theunderlying things that might
(14:09):
also benefit in the long run tobe addressed.
Where do you want to start?
What's most important to you?
What's going to make the mostimpact in your life?
And then based on that, we wantto come up with our treatment
plan, right?
And hypnosis is brought up inthat part when we're treatment
planning.
As an example, patients willcome in with, let's say, a lot
of pain and no insight in termsof how stress and in their
(14:33):
psychology influence their pain.
Whereas someone else might comein with a lot of pain and a
tremendous amount of insight.
They know exactly what'sstressing them out, they know
how that stress affects theirpain levels, right?
And those two patients are goingto be treated differently
because the one isn't going torespond as well to the cognitive
behavioral therapy, right?
(14:54):
But the other might because theyknow the role that their
thoughts are playing.
Or the first person might needto do a lot more work to become
even aware of their own thinkingbefore they can even get to that
stage of changing it.
So there's a lot of differentvariables that are gonna play
into when we introduce CBT, whenwe introduce clinical hypnosis.
But I would say for the majorityof patients, it's introduced
(15:17):
pretty early.
If after they learn what itreally is and how it really
works, they're still notinterested.
That's fine.
We have many other tools tohelp.
But I have to say, that one islike kind of the secret sauce.
It makes everything else workbetter.
SPEAKER_02 (15:32):
It's so cool.
Now I want to go back and belike a hypnotherapist.
Okay, very cool.
As you were talking, I wasthinking, I bet it's really
helpful to have somebody likeyou working with somebody as
they're going through pelvicfloor physical therapy as well.
Because there is, I thinkthere's some unconscious like
clenching because people spendso much of their time sort of
holding in potentially.
And so that has a way oftraining your muscles.
(15:53):
It could be interesting to seekind of how these two things
interplay.
The other thing is just, youknow, pelvic floor physical
therapy is potentially quiteuncomfortable for some of our
folks and invasive.
And so it might be helpful tohave those sort of tools to be
able to help you get throughthat side of your care as well
by using some of the tools youyou sort of learn from you and
in in your work with you.
So we need to have you guys havelike an office together.
SPEAKER_00 (16:13):
Well, I know a lot of the therapists in our
practice, and by the way, thepractice is GI psychology.
The website is gisychology.com.
But a lot of the therapists inthe practice, they are working
with patients who are in pelvicfloor therapy because just from
the fact of like a lot ofpatients with constipation, that
can be a useful modality.
(16:34):
And then pelvic floor therapy,if you if you've got GI problems
or if you've got IBD, often thatmight be for various reasons, it
might be something they need,right?
And it does play really wellwith each other.
And often we work with differentkinds of PTs because we also
deal with a lot of patients withchronic pain of various kinds.
But what we found is when youalign the mind with what you're
(16:58):
trying to do with the body, itjust works better.
SPEAKER_02 (17:00):
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 isthe brain-gut connection and how
that functions and how you workwith patients in that way.
I know just again from layman'sreadings that you know,
certainly there's like your gutproduces quite a bit of like
serotonin, for instance, thanmaybe like more than your brain.
So, what do patients need tounderstand about that?
(17:21):
And then how does IBD affect orsort of maybe haywire that a
little bit?
SPEAKER_00 (17:26):
Yeah.
It's a very multidimensional andcomplicated question.
But I think to simplify it, onething I think is useful is to
think about all the differentways that the brain and gut are
interacting with each other.
So, as an example, patients withIBD, for reasons we're not quite
sure of, have much higher ratesof depression and anxiety.
(17:49):
And we don't know if it's achicken or the egg, which way it
rolls, or if it rolls both ways,right?
Being depressed dysregulatesyour immune system, and that
makes you more likely to haveIBD, or having IBD makes you
more likely to be depressed andanxious.
But either way, we see thosecorrelations and we know that
when we help the one, we helpthe other.
So if patients are, let's say,helped with a biologic and their
(18:12):
symptoms are reduced, that'sgoing to help their depression
and anxiety.
And also, if we help theirdepression and anxiety, it often
helps their symptoms, also,which is why behavioral health,
which is what we do, is vastlyunderserving the IBD community
because it's hard to find an IBDpatient that couldn't use some
(18:33):
amount of behavioral healthintervention, right?
Because that's just one aspect,right?
So you have higher rates ofdepression and anxiety.
And then you also have a higherrate of what are called
disorders of gut braininteraction.
And this can be a veryfrustrating problem for patients
with IBD.
As an example, this is where youmight see that you do your blood
(18:54):
tests and all your values lookgood, right?
You're in remission, but yoursymptoms are not.
You're still having pain oryou're still having nausea or
your, you know, diarrhea orconstipation or whatever.
And it's hard to understand why.
And very often, the why, whenthe tests are clear, is that
you've got a disorder ofgut-brain interaction.
(19:15):
And that is a nervous systemdisorder where your brain, your
central nervous system, hasgotten into this negative cycle
with your GI system, in whichthe brain is seeing the GI,
maybe it's the stomach, maybeit's the upper GI, whatever part
of the GI, it's identified it aslike a dangerous spot.
(19:38):
And what happens is then youstart directing hypervigilance
and catastrophizing to thesensations from that spot, as
well as something calledvisceral hypersensitivity, where
the brain is like ramping up anddistorting the sensations it's
getting from that area.
And that creates this cyclewhere anxiety is being sent down
(19:58):
to the gut, causing moresymptoms.
And then those more symptoms arebeing sent up to the brain that
are causing more anxiety andstress.
So, anyway, this is a terriblecycle to get into.
And it's the basis for a lot ofproblems, most notably irritable
bowel syndrome is an example ofa disorder of gut brain
interaction.
(20:18):
And if, you know, if you knowthat, it's incredibly common.
One in 10 Americans have it.
But a much higher percentage ofpatients with IBD have some
variation of DGBI, like adisorder of gut brain
interaction.
Not necessarily IBS, but there'slike 20 or so different ones.
That is so interesting.
You know, patients with IBD,they go through a lot of medical
(20:41):
trauma.
When they go through theirflares, it's trauma.
When they go through surgeriesor other treatments, it can be
traumatic and traumatic to thenervous system.
And so whenever there's trauma,there's much more likely a
chance to develop these nervoussystem disorders, these
disorders of gut-braininteraction.
(21:02):
And so that's the second kind oftier where patients with IBD
need more behavioral healthhelp.
And this is why they needspecialists.
They don't need just regularmental health, because regular
mental health is great foranxiety and depression, but they
don't really know what to dowith a DGBI.
SPEAKER_02 (21:18):
I think that's a really important point and why
we need more GI psychologists aswell, our GI mental health
professionals.
Is there a higher rate ofdisorders of gut-brain
interaction or anxiety anddepression when people are in
flares?
And the reason I ask this isbecause is there something about
the inflammation that means thatyour gut is not able to absorb
like the same amount ofserotonin as it as it typically
(21:39):
does?
So is there any part of somebodyhaving inflammation that's
happening because of theirdisease that contributes to what
might be happening mentalhealth-wise?
SPEAKER_00 (21:48):
I believe so.
Now, I'm not sure about likespecific 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 andthe egg.
And we know that in aninflammatory system is gonna be
more likely to cause depression.
It's gonna be more likely tocause anxiety because the system
(22:09):
in general is on high alert.
And if you're like that for toolong, it's not good.
And you can get what's calleddepression secondary to anxiety.
And so I think I thinkdepression and anxiety reduce
when treatment reducesinflammation.
And then also when there'streatment for depression and
anxiety, I think it helps ingeneral with symptoms and
(22:33):
inflammation.
SPEAKER_02 (22:34):
Well, and this also makes me question like if
somebody gets to a point wherethey do believe they might need
some sort of antidepressant oranti-anxiety medication,
unfortunately, if there'sinflammation in your gut, you're
not absorbing the medication inthe same way as you would when
you don't have when theinflammation is calmed, when you
have you're in more of aremission state.
So do you end up with peoplethat are then over-medicated
because what they needed whenthey were in a flare is less
(22:54):
than they need when they're notin a flare?
So that this is all verycuriosity questions.
SPEAKER_00 (22:58):
Well, I think it's just fascinating.
This whole field of what'scalled psychoneuroimmunology.
And it's how does the brain andthe immune system interact?
And for good or for bad, IBDpatients are great examples of
that, right?
SPEAKER_02 (23:16):
Yes, so fascinating how all of this works together
and how, again, the brain isimpacting the things that are
happening with your inflammatorybowel disease.
And so, what a cool career youhave.
I love this so much for you.
You yourself have a privatepractice, you're part of the GI
psychology, which is also otherpractitioners that are providing
one-on-one counseling with folksand with specialties in
inflammatory bowel disease, GIissues, and mental health.
(23:38):
But what I think is super coolto talk about is that you have
not just taken it as aone-on-one, but you really
looked to work with the Crohn'sand Kaleitus Foundation to put
together a group setting.
So I would love for you to talkabout kind of how you got
started with working with theCrowns and Kaleitis Foundation
to put this together, how thisdiffers from like a support
group.
Yes, and sort of what this coulddo for folks.
SPEAKER_00 (23:58):
Yeah.
So GI Psychology was a grouppractice that started about five
years ago.
And the impetus was there wereso 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 GIPsych and we're in all 50 states
(24:18):
and we're telehealth, and wedon't kind of advertise
directly.
We work in basically inpartnerships.
So one of those partnerships iswith the Crohn's and Clitus
Foundation.
The story of the group, firstoff, the group is is on mission,
meaning it's a way to maketreatment more accessible to
folks that maybe couldn't affordor wouldn't be comfortable
(24:41):
meeting one-on-one.
And the group really startedbecause I was looking at the
research regarding clinicalhypnosis and IBD.
And I knew from my clinicalexperience that it was helpful,
but I wasn't quite sure what theresearch said.
And what I found really kind ofblew me away was that there were
studies showing that clinicalhypnosis could directly reduce
(25:03):
inflammatory load, not onlyreducing inflammatory load, but
also reducing the severity andlength of flares.
And I was like, oh my gosh, thisis amazing.
And from there, we started todevelop myself and another
clinician began to develop agroup, an eight-week group
therapy.
(25:24):
Difference between a grouptherapy 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 thatit's reimbursable by insurance.
So that's also nice, right?
So I learned that, and then Ithought, okay, we can do that,
and we can help with stress andresilience, and we can start
(25:49):
incorporating CBT concepts intothe group.
So we we came up with this wishlist of all these things we
wanted people to learn, and itwas just so exciting.
So then we built this up overmonths and months and months.
And the really exciting thing iswe got the Crohn's and Clitus
Foundation excited about italso.
And they've been a tremendoussupport and they just started
(26:11):
getting the information out totheir membership.
I think they have like some kindof hotline.
And if you go to that hotline,they'll tell you all about the
group.
But if you also just go to ourwebsite too and get a free phone
consult, you can learn about italso.
But it wasn't just the Crohn'sand Clitus Foundation, also the
American College ofGastroenterology has gotten
behind it and they're alsoputting it out to their members.
(26:33):
So it's been this amazingcollaboration between the three
organizations, and it's allcentered on making this
treatment available for patientswith IBD.
SPEAKER_02 (26:43):
That is super cool.
And I love that these twoorganizations have gotten behind
this, and because it is soimpactful, and you're right, not
everybody can access, you know,a one-on-one therapist and it
might not be within network forthem or pay for it out of
pocket.
So I think this is really great.
What's the structure around thegroup?
You said it's an eight-weekcourse.
So every week do you havesomething that you focus on?
Talk about how it works.
SPEAKER_00 (27:04):
Yeah.
So there's eight weeks, and likeI said earlier, we kind of said,
okay, what would we most wantour IBD patients to have as
skills?
And it's actually quiteinnovative in that we're doing
something that has never beenkind of successfully put
together before, which is we'reteaching some concept, right?
(27:26):
Um, maybe it's a cognitivebehavioral concept around
resilience and self-efficacy.
And then we're reinforcing thatconcept using a clinical
hypnosis session.
And so we're recording it.
And then the homework is just tolisten to that hypnosis session
in between their sessions.
So they're just reinforcing itevery day for a week in a very
(27:49):
kind of comfortable, relaxedway.
And I love that integrationbetween hypnosis and more kind
of intellectual understanding.
SPEAKER_02 (27:58):
Oh, wow.
That's super cool.
I didn't realize that was howthe clinical hypnosis was being
included in the sessions.
So I think this just got startedor is about to get started.
Where are you at with this?
SPEAKER_00 (28:09):
We just got enough to start our first group.
So we're about to launch thatgroup and we're recruiting for
our second group right now.
And I think we got a few alreadywho are interested.
SPEAKER_02 (28:20):
Well, if anybody is interested in this, we'll make
sure the information is down inthe show notes so that they can
find out where to find you.
And I'm assuming there'sprobably a wait list to join if
you've already started a sessionand and you're looking to fill
the next one.
Yeah.
I'm curious about the people whohave responded to this.
Like, is there a variety ofpeople?
I'm just curious about thedemographics of the people that
have signed up.
Has it been kind of universal?
SPEAKER_00 (28:41):
I kind of was looking at the we have got a
little spreadsheet of everyonewho's kind of shown interest.
And it's fascinating becauseit's it's really people all over
the country.
That's the cool thing abouttelehealth, right?
You could be in rural Alabama,and there's zero chance that
there's any GI psychologysupport around you.
Yeah, but you could join thisgroup and get top-notch care,
(29:04):
right?
So it seems very diverseracially in terms of if my
guesses are right about people'snames, right?
And then just people from allover the country.
It's it's actually reallylovely.
I think the important thing,because you've got, you know,
Crohn's and colitis, is that weare dealing in in kind of core
(29:25):
fundamental principles that wekind of took some time to say,
okay, what what are the mostimportant things for people to
know, regardless of where theyare in their journey, whether
they're, you know, they've hadsurgery or they haven't, if
there's an ostomy or if there'snot, you know, if they're very
early diagnosed or whatever, wewanted principles that could
(29:45):
that could help anyone who's gotthose diagnoses.
SPEAKER_02 (29:48):
And it'll be interesting to see how some of
these principles are spread intothings like support groups.
So when somebody is going into asport support group or is
participating in a supportgroup, that somebody might pull
it out and say, you know,there's this result.
Resilience, there's this idea ofresilience.
Like, here's some, you know,some tools that I've learned.
And to be able to kind of passthat on, I think that could be
really, really valuable to thecommunity.
So I know you haven't evenstarted this yet, but is the
(30:10):
vision to eventually be like,because if you have
practitioners all over thecountry that can help people all
over the country, is iteventually that you'll have kind
of concurrent eight-weeksessions happening at the same
time or sort of staggeredsessions?
What's your bigger vision forthis?
Where do you want this to go?
SPEAKER_00 (30:24):
The bigger vision is we're running this first
session, and our goal is tolearn as much as we can from it
and improve it from there.
And to eventually, once we kindof go through a few iterations,
then we want to train more ofour clinicians to run groups so
that again, like we don't becomea block in terms of like, oh, we
(30:46):
only have one person who knowshow to run the group and they're
out of space, too bad.
We want to grow with demand sothat nobody really should have
to wait maybe more than a monthor two to be able to get into a
group.
SPEAKER_02 (30:59):
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 avaluable tool for our community
to be able to participate inthis, if that's something that
they are able to get in andsomething of interest to them.
Going back to my comment aroundlike if you're in inflammation
and you know that you're notable to absorb things in the
same way.
(31:19):
Similarly, if somebody has justhad 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 thegut, how does that change
things?
SPEAKER_00 (31:30):
And this reminds me also of what happens to patients
also with eating disorders whenthey'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 verymuch, kind of starving
themselves, and then they're intreatment and they're getting
better, they go through thisrefeeding process where they're
(31:52):
starting to eat a no more of anormal amount, but reliably the
gut is going to cause problems.
Maybe it's constipation, maybeit's pain, maybe it's diarrhea,
maybe it's nausea, right?
But reliably these patients haveproblems because the gut is just
kind of relearning how tofunction in its new state.
(32:14):
And then there's a certainperiod where those problems are
expected.
And anything within that periodis kind of normal physiologic,
um, like readjustment.
And then if they go beyond thatperiod, then we have a sense
like, okay, maybe they'vedeveloped a disorder of gut
brain interaction as wellbecause of the trauma that
(32:35):
they've gone through in theirgut.
So a patient that's had surgery,there's absolutely going to be a
period where the gut isreadjusting and they need to
talk to their doctor, theirsurgeon about what that period
should look like, where thingsare kind of resettling and their
body's trying to understand howto function in this new
environment.
(32:56):
Now, whatever that period is,now add maybe a half again.
And but then if you go beyondthat and there's still symptoms,
then you might want to considerthat from all the trauma of the
surgery, you've also developed adisorder of gut brain
interaction, which is in somesense good news because actually
(33:18):
they are very, very treatable.
And I think that's another thingI want people to understand is
if they're a patient who there'sno longer any physiological
explanation for why they'rehaving symptoms and they have a
disorder of gut braininteraction, the research shows
that between 70 to 80 percentare going to reach their
treatment goals with thespecialized treatments that we
(33:41):
use, which is not a badpercentage.
SPEAKER_02 (33:44):
It's not.
No, that's very helpful to beable to tell people and make
sense.
I'm curious, because when yousaid anorexia, it reminds me a
little bit of our folks that youknow, we do have a lot of folks
that have like RFID orrestrictive feeding food
patterns.
That definitely, as you weresaying that, I was like, gosh,
then you add that layer on topof it with our folks of already
(34:05):
maybe there is some of thatdysfunction that's happening.
And then there's this wholeother layer of now you've also
coached your body almost torespond 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'tit?
SPEAKER_00 (34:19):
Yeah, and you're bringing up another issue.
So, well, first let me respondto the RFID.
Normally, we don't treat eatingdisorders, however, RFID is an
exception because we see it inso many of our patients.
So avoidant restrictive foodintake disorder, RFID, whether
it's full-on RFID or if it'sjust restricted eating that
(34:40):
doesn't quite meet thatcriteria.
We see a lot of that.
And so we do help patients withRFID.
The other issue, though, thatthis brings up is something
called conditioned foodsensitivity, which is a very
important thing for anybody withIBD to understand.
Because let's imagine a worldwhere a patient is in a flare
(35:01):
and then they try to eat.
I always use pizza as anexample.
So we'll use pizza.
So they try to have some pizzaand they do not react well to
the pizza.
Later they get treatment and theflare subsides, and they're
physiologically they're doingbetter, they're in remission.
However, like in terms of theirnervous system, they've had
(35:22):
maybe one, two, three, fourterrible experiences eating
pizza.
So, what can happen is thentheir brain unconsciously is
becoming very anxious whilethey're eating the pizza.
It's hyper-vigilant.
And then if they notice anylittle thing going on in their
stomach after or during theirwhile they're eating the pizza,
(35:42):
their brain startscatastrophizing.
And that sends anxiety down thegut brain axis into the gut and
is is likely to cause actualsymptoms, even though the flare
is gone and physiologicallytheir body actually has no
reason not to do well with thepizza.
Their body has becomeconditioned to kind of freak out
(36:03):
when it eats pizza.
So it's a nervous system problemthat's affecting the GI when
they eat.
So they've conditioned theirbody and their nervous system to
respond badly to pizza.
And then every time they eatpizza and they have a bad
experience, it just reinforcesit.
And that's actually something wecan help patients correct.
And what we first do is wedesensitize the system.
(36:25):
We teach them how to calm downthe brain that's hyper-vigilant
and catastrophizing, and thencalm down that what's called
visceral hypersensitivity, whichwe talked just a teeny bit
about.
Anyway, we calm those thingsdown.
The system is calmed down now.
Now they can eat pizza and theycan slowly expose themselves to
pizza again in a safe way andreintroduce it into their diet.
SPEAKER_02 (36:47):
When you're working with people with who have that
disorder of the gut braininteraction, so that you know,
the folks we just talked about,is that somebody that you would
you would look to use somethinglike a hypnotherapy with or a
CBT with?
Is there a different techniqueyou use when there is this or
disorders of the gut brain, oris it the same?
It's just slightly a differentway of doing it, basically.
SPEAKER_00 (37:06):
I think it's it's the same modalities of
treatment, different ways ofapplying them.
So both CBT, well, specificforms of CBT, gut-focused CBT,
which is not bread and butterCBT, and clinical hypnosis, both
have a lot of research behindthem, supporting their use for
DGBIs.
(37:27):
Literally over 40 years ofresearch, over hundreds of
studies, you know, showing thatthey're effective.
And we integrate the two.
We're using hypnosis, we'reusing CBT.
I'm actually working withanother one of our therapists
because that's a bit unique inthe field, is that I think most
people are using them like kindof like alternating.
(37:48):
And we're we're focused on howcan we learn to integrate them
to make them even moreeffective.
So we're working on kind ofcodifying how we do it, right?
But yeah, they're usedinterchangeably, and it can vary
depending on the patient andwhat they need, when and how.
SPEAKER_02 (38:04):
Okay, and I realize we jumped a little bit ahead.
So I'm gonna ask you to do alittle bit of remedial work with
me.
But so CBT, so cognitivebehavioral therapy is a specific
type of therapy that you use, atool that you use when you're
working with folks.
So just do those super briefdefinition of CBT and then sort
of it's how it's different,maybe, than when you're doing
clinical hypnosis.
SPEAKER_00 (38:25):
CBT is a very popular, well-known treatment
modality.
Essentially, it's working offthe idea that how we think
affects how we feel and how weact, and that people can get
into dysfunctional patterns ofthought, dysfunctional patterns
of feeling, dysfunctionalpatterns of acting and behaving.
(38:48):
And they're all interconnected.
And so CBT helps you untanglethat mess of like, let's say
you've got an anxiety disorderor something like that.
How do we pull the differentlevers of how of behavior, of
emotion, and thoughts and teachpeople how to kind of be their
own therapist when it comes tohelping themselves?
(39:08):
And CBT has been studied for alot of different disorders, and
there's been specific researchon how to use CBT for GI
problems.
And it's a different, you know,style of treatment, different
techniques, different ways ofdoing things than just kind of
regular CBT for an anxietydisorder.
So that's my little spiel onCBT.
SPEAKER_02 (39:30):
Very helpful, just in case people have not heard of
it, which seems unlikely.
It feels like everybody knowsabout CBT now, but it is very,
very commonly used.
So, okay.
When somebody is potentiallylike they've been living with
the disease for a while, I'msure there's a lot of people who
are like, I've got this, I'vehad IBD for 20 years.
I don't need to talk to atherapist, right?
You know, I don't, I don't needa therapist.
But one of the things you wroteis like, how is working with
(39:51):
somebody who has the coachingthat 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 yourthoughts on this one because I
think there could be some folksthat just don't realize that
there's this things could bedifferent and that you could
potentially work with them to beable to do that.
SPEAKER_00 (40:10):
Well, I think we can kind of break it down into three
categories.
The first are these nasty littleDGBIs, disorders of gut brain
interaction that we've beentalking about.
And they can they can be veryinsidious, they could be causing
symptoms when your inflammationis not happening.
They can be causing symptoms andyou might not know why.
(40:31):
And it can cause you to go downa lot of useless paths for you
know help when actually theproblem is in the nervous
system.
But they can also make yoursymptoms worse than they need to
be when you're in a flare,because the brain is very
powerful, the nervous system isvery powerful.
And if it's working against youwhile your body's also working
(40:53):
against you, that's a nastycombination.
So that's one area that mightnot be obvious to people when
they're thinking about gettinghelp.
The other way, of course, isdepression and anxiety.
And, you know, I think often wejust say these words and people
they're like, yeah, yeah, yeah,I know what depression.
And they have this image ofsomebody like crying on a bed,
(41:15):
not getting up.
But that's not always whatdepression looks like.
Sometimes depression is peoplefeeling irritable, like a lot,
or just feeling a little low, alittle low energy, not quite as
excited about things.
There are subtle variations.
People can feel anxiety so muchthey don't even recognize that
it's anxiety, right?
It's just like this is how Ilive, right?
(41:37):
And sometimes they in they needlike the right question at the
right time to be like, wait,everyone doesn't feel like this
all the time.
SPEAKER_02 (41:45):
So I feel that one very deeply.
I feel a little targeted bythat.
SPEAKER_00 (41:51):
And then the last one is something I think also
people can miss, which istrauma.
And when people think trauma,they think, you know, bad
childhood, right?
Bad things happening, sexual,physical, or war.
That's not always how traumashows up.
You know, trauma can show upwhen you think that something is
terribly wrong, that somethinghas happened to you, that
(42:13):
something really bad is going tohappen to you.
Think surgery, think flares,think people being really scared
and out of control and theseterrible moments in their lives,
they can imprint themselves ontheir limbic system in a way
that normal memories don't.
And so then you get what'scalled implicit memories that
(42:34):
kind of leak out anxiety or fearthroughout people's day or that
are being triggered like littlemini flashbacks, so that they're
overreacting to things in theirlives.
They're like, why did I react sostrongly to that?
And they don't even know why.
And that might have might bebecause it triggered some
underlying trauma that they'veexperienced.
SPEAKER_02 (42:54):
It's been discussed many times on the show about how
fraught this whole living withIBD is because of all the
potential opportunities fortrauma.
You know, a lot of times, Imean, we have people that have
very dramatic entries into thiscommunity, you know, with
hospitalizations and, you know,very significant symptoms, and
some people even close to deathbecause of, you know, the to the
(43:15):
severity of their disease.
And so it there's, you know, andthat's just the entry point, you
know.
And then there's all along theway the surgeries and the people
not believing you, the medicalgaslighting, all these sort of
small, and some of them not sosmall, sort of wounds,
psychological wounds that kindof go along.
So it definitely is a big partof this.
SPEAKER_00 (43:34):
That actually reminds me of something I didn't
get a chance to mention, but I'mglad you did.
You mentioned medicalgaslighting.
And I think sometimes it canrise to the level of
gaslighting, sometimes it can bevery deliberate, but I think
sometimes it can also just bevery inadvertent, right?
Just a random comment by adoctor or a nurse when people
are in a very vulnerable state,can really stick in their brain.
(43:59):
And I think everybody's heard ofthe placebo effect.
Not as many people have heard ofthe nocebo effect, which is the
fact that these comments orthese expectations by providers,
if they're they're phrased insome kind of negative way, they
can inadvertently cause damageto the person, to the patient.
SPEAKER_02 (44:19):
Yes.
Well, and that's again goingback to my comment about
insurance too.
That's just them participatingin the healthcare system.
Add in the trauma that can comewith having an insurance company
that it takes a lot of thatcontrol from you.
You know, your comment aboutcontrol really resonated with me
because there is so much of thisdisease, or so much of these
diseases, so much of living withchronic illness that is it feels
(44:40):
out of control.
It feels like these aspects ofcontrol are taken from you.
And that's so destabilizing forpeople and so traumatic to have
people make decisions on yourbehalf constantly and you
feeling like you're not anactive participant in that.
I think that's reallytraumatizing for many people.
I'm glad you brought up trauma.
How does clinical hypnosis sortof tie in with something like
EMDR?
Like so when you have somebodythat does have something that's
(45:02):
just kind of sticking, and youknow that something like EMDR,
which we've covered in a coupleof episodes, could potentially
be helpful.
How does that work together?
SPEAKER_00 (45:09):
I love it.
Now you've activated mypsychology nerd module.
And so I'm gonna go off on alittle tangent here.
So I've had I've had manyfriends and colleagues in the
field who are trained in EMDRand clinical hypnosis, some of
them who are EMDR trainersthemselves, right?
Every single one of them whoI've talked to have said
(45:32):
basically the same thing, whichis EMDR is a subset of hypnotic
techniques.
If you imagine hypnosis as abroad kind of umbrella with a
lot of different techniqueswithin it, EMDR is like a really
good hypnotic protocol that'sfocused on trauma.
And so there are other hypnoticprotocols for trauma as well.
(45:56):
And EMDR is one of them.
So we have a lot of differenttools for treating trauma using
EMDR, using cognitive behavioraltherapy as well.
But the key with treatingtrauma, 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 peopleget stuck at the cognitive
(46:19):
level, talking about the trauma,which can help and it can feel
supportive.
But in order to truly treattrauma, you have to go deeper.
You have to go into the limbicsystem, you have to go and shift
the implicit memories, theunconscious memories that are
stored there.
And that's something calledmemory reconsolidation.
(46:41):
It's a whole very fascinatingfield of neurology and all this
stuff.
But I think the problem oftenwith trauma is people want to
talk about it, which is helpful,but not sufficient to truly
resolve the trauma.
SPEAKER_02 (46:54):
Got it.
Yeah.
Because trauma doesn't just livein your brain, it lives like
kind of throughout you.
You know, it's like it's itaffects you in lots of ways.
That trauma comes out as anxietyor stomach acid issues or
whatever it is.
It can it can look verydifferent.
SPEAKER_00 (47:08):
So people have you read that book, uh The Body
Keeps the Score?
SPEAKER_02 (47:12):
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 comesout 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 ourpatients, that has come back a
couple of times.
We had them sort of talk throughwhat they had done when they had
done EMDR just to help people exto know what to expect.
(47:32):
And Robin was talking about howshe went in thinking, okay, it's
gonna be this thing, like thisis the thing, and about how this
whole other thing that hadhappened way back was the thing
that sort of was actually reallydug in there and came out, and
about how she was so shocked.
And she was said, I didn't eventhink that was a thing.
Like in looking back, I don'tknow why that affected me so
(47:55):
much.
It was super interesting to hearher say that.
I know with I think withHannah's, it was a little more
like present of things that werea little more close to home, but
but Hannah's also much youngerthan Robin.
And so it's one of those where,like, so like their interactions
with the healthcare system aregoing to be different.
Hers is going to be a littlemore present, and Robin, the
thing that she kind of that cameup for her was much more, you
know, towards the beginning ofher journey.
So it was, it's super, superinteresting.
SPEAKER_00 (48:16):
I love that point in therapy because that point in
therapy where people begin to beintroduced to their unconscious
mind.
And people who came in neverknowing they really had one,
they always thought thateverything that was going on was
right in the front, right?
And then that story about Robinis just beautiful.
And I've had so many patientsexperience that where we're
(48:36):
working on some kind of traumaor some kind of issue, and
they're like, Oh, I think it'sprobably gonna, this is probably
gonna come up.
And then something completelydifferent shows up, and that
tells you right that you're onthe right track because that's
not intellectual, right?
When they get surprised, thatmeans a different part of their
mind is speaking to them at thatpoint.
SPEAKER_02 (48:56):
So super interesting.
You mentioned the like it's notintellectual.
This group of folks with theinflammatory bowel disease
community is so educated.
There, I mean, they really dounderstand about their disease.
They research, they look,they're on Reddit, they're
asking questions.
I mean, like it really is just avery, very educated group of
folks.
SPEAKER_00 (49:14):
One of the things for some folks with like
cognitive behavioral therapy isthis sort of a tendency perhaps
to intellectualize something andnot necessarily that's why it's
so powerful to combine CBT withclinical hypnosis because
hypnosis is an experientialtherapy.
Yeah, they're they're feelingit, they're doing it, they're in
(49:36):
their imagination, powerfullykind of experiencing something,
whether that's a positiveresource state or diving into
some, you know, negative trauma,they're experiencing something.
And so it pairs really well withCBT, which can be very
intellectual, which is helpful,but it can cause some people to
sometimes spin their wheels abit and not make progress.
SPEAKER_02 (49:57):
Right.
Yeah, it's like you know youshould think a certain way.
It doesn't necessarily stop youfrom continuing to think in the
wrong way, you know.
And so for some folks, havingthat combined between the two is
definitely a way to kind of helppeople stop the propensity to
perhaps like fall back on theintellectualizing.
Unfortunately, I have to ask youthe last question.
What is your one piece of advicefor the IBD community?
And I did tell you you couldhave two, one for the patient
(50:19):
community and one for theprofessional community, but
that's up to you.
SPEAKER_00 (50:22):
I mean, the obvious piece of advice is get that
behavioral health piece inplace.
Get your team fully, you know,vetted, find someone that you
work well with that understandsthe disorder.
That's the obvious piece ofadvice.
The less obvious piece of adviceis the idea of an anchor,
because I think that can come inhandy in so many difficult
(50:43):
situations that it would be ashame if people didn't have it.
And I can give super quickadvice for how to develop that
anchor.
And I'll kind of go through itright now.
I often use like a left fist.
So you clench your left fist.
So the idea is pair that leftfist with some sort of relaxing
thing.
So if you're someone whomeditates, or if you're someone
(51:04):
who does breathing, or someonewho does progressive muscle
relaxation, whatever affectregulation tool you like to use,
all you do is right before youdo it, do your anchor, your left
fist, then do the thing thatrelaxes you.
And then when you're reallyrelaxed, do the left fist again.
And then repeat that over andover every time you do that that
(51:27):
regulation.
I usually have people do that atleast 20 times, but by usually
by the 10th time, just doing theleft fist is gonna elicit that
relaxation response.
And at that point, you knowyou'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 thatpathway in your brain, making it
more effective.
SPEAKER_02 (51:48):
Such a Pavlovian thing.
Okay, I love that.
Perfect advice for folks.
Dr.
Naviti, thank you so much forjoining us.
It's been so much fun to talk toyou and to learn so much and to
get nerdy with you a little bit.
Thank you so much for joiningus.
Thank you, everybody else, forlistening.
And cheers, everybody.
SPEAKER_00 (52:03):
Cheers.
Hi, this is Dr.
Naviti.
If you enjoyed this episode,please rate, review, subscribe,
and share it with your friends.
Hi, I'm Alicia.
And I'm Ramen, and you'relistening to Bowel Moments, the
podcast sharing real talk aboutthe realities of IDD.
Serve.
This week I talked to Dr.
Ali Naviti.
Dr.
Naviti is one of the founders ofGIpsychology.com and also a
founder and past president ofthe Northern Virginia Society of
(00:22):
Clinical Hypnosis.
He's treated people living withGI disorders, chronic pain, and
complex medical issues for over10 years.
We talked to him about clinicalhypnosis and how that can be
helpful to people living withinflammatory bowel disease and
how it's integrated in withother types of mental health
modalities.
We talked to him about disordersof the gut-brain interaction,
what those are and how they'retreated.
(00:43):
We talked to him about traumaand how clinical hypnosis may be
able to help and how it alsoworks with other types of
treatment modalities.
And finally, we talked to himabout the therapy group that
he's just started incoordination with the Crohn's
colitis foundation and theAmerican Gastroentological
Association.
This is a really cool newprogram that he started, and I'm
excited to see what happens withit.
Cheers.
(01:07):
Hello, everyone.
Welcome to Bowel Moments.
I am unfortunately flying solo,guys.
So it's just me, Alicia, but Iam so very excited to be talking
to Dr.
Ali Navidi.
Dr.
Navidi, welcome to the show.
SPEAKER_00 (01:21):
Thank you, Alicia.
I'm excited to be here.
SPEAKER_02 (01:23):
I am so excited to talk to you.
Having a background, abachelor's degree in psychology
and being a social worker, ofcourse, I am like gonna get
super nerdy with you.
So I'm really excited aboutthat.
But before we get into yourcareer, the first very
unprofessional question for youis what are you drinking?
SPEAKER_00 (01:37):
And I wish it was more fun.
I'm I'm on a stimulant rightnow.
So it's iced tea and hot tea ifI need it.
SPEAKER_02 (01:45):
Okay, so tea time.
And it looks like all black tea.
So it's yeah, caffeine.
SPEAKER_00 (01:49):
I need that.
Oh, yeah.
I need that caffeine.
SPEAKER_02 (01:52):
I'm impressed that you are drinking caffeine at
630.
Robin can do it.
I cannot.
Like I just stay awake allnight.
SPEAKER_00 (01:57):
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'reout.
SPEAKER_02 (02:06):
You know, if you could coach me on how you
accomplish that, I would greatlyappreciate it.
Cause unfortunately, I stopsleeping well.
I just lie there and stare atthe ceiling and go, I really
should be sleeping.
SPEAKER_00 (02:16):
Here, let me toss in a nerdy little psychology thing,
you know, just because I can'thelp myself.
The trick is actuallycounterintuitive.
So I'll just give you a teaserand you could kind of look it up
as you wish.
But it actually relies more onsleep restriction.
That when their sleep efficiencyis bad, meaning they they spend
a long time in bed and they'renot necessarily sleeping, one of
(02:38):
the best interventions isactually to restrict their sleep
and force them to develop a bitof a sleep debt.
And then once they've got enoughof a debt, they're gonna
naturally increase theirefficiency.
And then once they increase thatefficiency, then you can pull
back on the debt because nowyou've re-established good
patterns of sleep.
(02:58):
That's one of the like go-tointerventions when we deal with
uh variations of insomnia.
SPEAKER_02 (03:04):
I will try this.
Okay.
Well, so I did not have time,unfortunately, to mix myself a
cocktail, but I had an openbottle of rose.
And so I am drinking rose today.
So tell us about your IBD story.
What brought you into ourcommunity?
SPEAKER_00 (03:15):
There were kind of two phases to that.
I think the first phase was Iwas just fascinated with
clinical hypnosis.
And this was when I was workingin 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 doinglike yeast studying yeast
(03:38):
exocytosis and some other reallyboring stuff.
And eventually I realized it wasreally boring, and I really was
loving psychology andspecifically clinical hypnosis.
And so, you know, I switchedgears and long story short,
ended up, you know, working as apsychologist and using clinical
hypnosis and cognitivebehavioral therapy as much as I
(04:00):
could.
But I didn't know that clinicalhypnosis was this amazing tool
uh for GI problems.
I mean, we know that now becausewe'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 morepatients, and that led more
(04:20):
doctors, and doctors referred,and and I learned more and I
learned more.
And then eventually that's whatI was doing as a majority of my
work.
And then one day I got a patientthat had IBD, and how ignorant I
was, I didn't know thedifference between IBD and IBS
at the time, right?
Like a lot of us, maybe inmental health.
(04:41):
But I learned, and the patienthad an amazing response to
treatment and ended up savingthem from surgery, and they were
just kind of eternally grateful.
And long story short, that endedup being an Atlantic article
that was published about thispatient.
And you can look it up.
It's a great story.
It's it's really nice, the storyabout Zach.
And and so that's how I found myway to IBD, right?
(05:03):
That was that kind of two-stepjourney.
SPEAKER_02 (05:06):
Oh my gosh.
Well, I will have to link to thearticle in the show notes.
So if anybody's looking for itand wants to read it, I would
definitely be curious to read itmyself.
So I'll find it.
But so I listened to yourepisode with Amber Tresca on the
About IBD podcast.
And you told her a veryinteresting story about how you
got interested in clinicalhypnosis.
So I'm wondering if you rememberwhat you said on the podcast.
SPEAKER_00 (05:27):
Are you talking about me as a teenager buying
that one book?
Oh my gosh.
Yeah, that was that was like afamily vacation.
And we were at a bookstore, Ithink, and I saw this book on
clinical hypnosis, and I waslike, that sounds cool.
And I didn't know anything aboutthat.
So I got the book, I read it,and then I kind of lined up all
(05:50):
you know, my my sisters and mycousins, and then one at a time
we went and like went throughthat book and tried different
things from the book, and someof them did really well, and
some of them didn't.
And it was a really old schoolbook.
It was like, you know, hypnosishas changed over the years.
Back in the day, it was kind oflike this authoritarian, you
know, you will sleep, you know,that kind of thing.
(06:12):
Now it's much more permissive,but yeah, that's how it started.
And I remember my aunt was justamazing.
She was amazing.
I think I mentioned that in theother podcast.
She was able to do stuff likeshe forgot her name, like she
couldn't remember her name basedon suggestion.
And I think also some, I thinkit was like she forgot how to
(06:35):
write.
And that's the old school natureof that book, right?
It was a lot of like stagehypnosis kind of stuff, like
very flashy things that wewouldn't use clinically at all.
But for a teenager, that wassuper fun.
SPEAKER_02 (06:47):
I love that so much.
The reason that this tickled meso much is not, I mean, just a
the like vision of you as ateenager, like having your
family all line up and try this.
But also, I will be very frankwith you and tell you, I was
considering, as my social workbackground, being a therapist
and being a hypnotherapistbecause I also found a book when
I was a teenager.
SPEAKER_00 (07:07):
No, was it the same book?
Was it a little bit of aconviction?
Oh my god.
SPEAKER_02 (07:13):
I don't think mine was clinical though.
I think it was just like, and Iand I tried hypnotizing my
friends, and one of them, Iscared her half to death because
I basically hypnotized her intothinking her legs had gone numb
and she plays basketball, andshe was like, I can't feel my
legs and started freaking out.
So I'm I when I heard that onthe her show, I had to just
bring this up with likeapparently this that book got
around because I found the sameone, I think, and just was
(07:36):
absolutely marveled by it.
Like I literally was like, Oh mygod, what is this?
I want to be a part of it.
I am not a therapist, I donothing with hypnosis, but I'm a
big fan of it, and I think it'ssuper cool to see how it's being
utilized now.
But I think a lot of peoplethink it is like stage hypnosis,
right?
It's like I'm gonna quack like aduck.
There's gonna be some sort oflike implantation of something,
(07:56):
understanding that everybody'ssituation is unique.
But when somebody comes in andlike and you're sitting down for
a session with them, what doesthis look like?
How do you introduce it?
How do you start with a patient?
SPEAKER_00 (08:05):
Then we start with psychoeducation.
We want people to reallyunderstand what we're talking
about, what they're gettinginto.
So the first thing to understandis we want to differentiate
between clinical hypnosis andentertainment hypnosis.
And the problem is everythingmost people know about hypnosis
is entertainment hypnosis,right?
And so if we take out all themind control and all the magic
(08:28):
and mysticism and kind of weirdstuff, what do we have left?
We have a very natural humanstate of consciousness called
trance.
We naturally go in and out ofit.
You know, the thing I alwaystalk about is driving in my car.
I go into trance, working out, Igo into trance.
My daughter makes fun of me allthe time because when I'm
(08:52):
watching TV, she can be likeright over there and be like,
ah, hey.
And then it's like this delaylike 30 seconds later, I'll turn
to her and answer whateverquestion she was asking.
Because in my mind, I'm in thiszoned-in state, and her voice
just seems so far away.
And that is a very natural humanability.
(09:13):
We all to some degree are ableto go into trance.
And so, what we're doing withhypnosis is we're just teaching
people how to do something onpurpose that they're already
doing naturally.
And that's why, even it, youknow, dorky teenagers like us
with just a book can help peoplego into trance because it's so
(09:34):
natural for people to do it.
It's almost like you have tomess up to not let them go into
trance.
Because that's another questionI 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 Ithink it's gonna be hard to keep
you out of trance, right?
(09:55):
Uh, because again, it it happensnaturally.
Like, even people listening tothis podcast right now, at some
point have zoned out and havethought of something that my
what I said sparked in them.
They went on a little internaltrip and then they popped right
back, right?
SPEAKER_02 (10:11):
Well, of course not.
Everybody listens just withcomplete consciousness to this
podcast that clearly doesn'thappen, but you are correct.
It has definitely like anytimeyou I drive and I'm like, How
did I get here?
Like, because I just kind ofwent into that state that isn't
a natural state of being, andletting people know that this is
natural, I think definitelyhelps people feel more
comfortable that it's not you'renot forcing it upon them.
(10:31):
That it's just how is thattrance state opening up a gate a
little bit to your subconsciousto be able to kind of say, How
do we work together to seewhat's in there?
SPEAKER_00 (10:40):
And it turns out that in trance, our ability to
focus and to let go of externaldistractions is vastly
increased.
And with that power of focus, ifyou then engage their
imagination, that's when themagic happens.
That's where we see the abilityfor people to profoundly calm
(11:01):
themselves down or to numb theirlegs like you did to your
friend, right?
I bet she had no idea that shewas capable of that, right?
But think about the profoundability you awakened in her.
If she learns to, if she everlearned to use that, she could
numb anything she wanted.
If she was in pain, just numb itout, then go to the doctor or do
(11:24):
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 Ithink I want people to get from
this is hypnosis is in a waykind of like all of our
birthright.
It's all a capacity we havewithin us.
It's just most people don't everget the chance to develop it.
SPEAKER_02 (11:44):
I love that.
I think that's such aninteresting way of saying it.
And it makes it feel like yousaid, like a power that we have
that we just maybe haven'ttapped into, and that we can go
to somebody like you who canguide us into figuring out how
do we tap into that to be ableto help control symptoms or
control reactions to testing orthings like that.
That can be super, super helpfulto people who are having to
navigate the healthcare system.
(12:04):
I'm sure going into a more calmstate anytime you call your
insurance company for anythingis certainly something that many
people would really love to beable to do.
SPEAKER_00 (12:14):
100%.
And actually, that reminds me,related to hypnosis is the idea
of building an anchor.
And this is another thing that Ifeel everybody should have.
And what is an anchor?
We all know anchors.
Anchors are just Pavlovianresponses, they're conditioned
responses, right?
So imagine a world where youdevelop an anchor so that within
(12:36):
about 30 seconds, you could justcompletely calm yourself down in
any situation.
Who wouldn't want to have that,right?
And that's one of the thingsthat you can use hypnosis and
just conditioning to help peopledevelop, right?
And especially someone with IBDwho's got chronic medical
issues, they're dealing with theinsurance company, they're
(12:56):
having to, you know, prep forsomething unexpectedly and drive
five hours to get there.
You know, there's a lot of theseinconveniences that are gonna
stress people out, exceptthey're in a double bind because
they know stress isn't good fortheir condition.
So what do they do?
So, as an example, having ananchor is a wonderful tool.
SPEAKER_02 (13:16):
It also provides a really nice visual that you can
put to it.
You're like, this is my anchorwhen I do this, like, and it's
something you sort of can aimyour brain at and say, like,
when I think of this thing, theanchor gives a nice, like, I'm
gonna look to this.
I like the visual that goesalong with that.
Okay, so when somebody comes toyou to work with you in just
general, because you also youdon't just do hypnosis or
hypnotherapy, you also do otherjust CVT and other types of
(13:38):
therapy that people maybe moreassociated as more traditional.
But at what point do youintroduce this as another tool
in somebody's toolbox?
What is it when you would say, Ithink this could be for you?
SPEAKER_00 (13:48):
So, what we'd want to do in general as therapists
is we want to do an intake andreally get a complete picture of
the person and what they needand what's been the history.
And and so then we can we canhave this list of like, okay,
these are the issues that areimpacting you right now.
And these are maybe some of theunderlying things that might
(14:09):
also benefit in the long run tobe addressed.
Where do you want to start?
What's most important to you?
What's going to make the mostimpact in your life?
And then based on that, we wantto come up with our treatment
plan, right?
And hypnosis is brought up inthat part when we're treatment
planning.
As an example, patients willcome in with, let's say, a lot
of pain and no insight in termsof how stress and in their
(14:33):
psychology influence their pain.
Whereas someone else might comein with a lot of pain and a
tremendous amount of insight.
They know exactly what'sstressing them out, they know
how that stress affects theirpain levels, right?
And those two patients are goingto be treated differently
because the one isn't going torespond as well to the cognitive
behavioral therapy, right?
(14:54):
But the other might because theyknow the role that their
thoughts are playing.
Or the first person might needto do a lot more work to become
even aware of their own thinkingbefore they can even get to that
stage of changing it.
So there's a lot of differentvariables that are gonna play
into when we introduce CBT, whenwe introduce clinical hypnosis.
But I would say for the majorityof patients, it's introduced
(15:17):
pretty early.
If after they learn what itreally is and how it really
works, they're still notinterested.
That's fine.
We have many other tools tohelp.
But I have to say, that one islike kind of the secret sauce.
It makes everything else workbetter.
SPEAKER_02 (15:32):
It's so cool.
Now I want to go back and belike a hypnotherapist.
Okay, very cool.
As you were talking, I wasthinking, I bet it's really
helpful to have somebody likeyou working with somebody as
they're going through pelvicfloor physical therapy as well.
Because there is, I thinkthere's some unconscious like
clenching because people spendso much of their time sort of
holding in potentially.
And so that has a way oftraining your muscles.
(15:53):
It could be interesting to seekind of how these two things
interplay.
The other thing is just, youknow, pelvic floor physical
therapy is potentially quiteuncomfortable for some of our
folks and invasive.
And so it might be helpful tohave those sort of tools to be
able to help you get throughthat side of your care as well
by using some of the tools youyou sort of learn from you and
in in your work with you.
So we need to have you guys havelike an office together.
SPEAKER_00 (16:13):
Well, I know a lot of the therapists in our
practice, and by the way, thepractice is GI psychology.
The website is gisychology.com.
But a lot of the therapists inthe practice, they are working
with patients who are in pelvicfloor therapy because just from
the fact of like a lot ofpatients with constipation, that
can be a useful modality.
(16:34):
And then pelvic floor therapy,if you if you've got GI problems
or if you've got IBD, often thatmight be for various reasons, it
might be something they need,right?
And it does play really wellwith each other.
And often we work with differentkinds of PTs because we also
deal with a lot of patients withchronic pain of various kinds.
But what we found is when youalign the mind with what you're
(16:58):
trying to do with the body, itjust works better.
SPEAKER_02 (17:00):
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 isthe brain-gut connection and how
that functions and how you workwith patients in that way.
I know just again from layman'sreadings that you know,
certainly there's like your gutproduces quite a bit of like
serotonin, for instance, thanmaybe like more than your brain.
So, what do patients need tounderstand about that?
(17:21):
And then how does IBD affect orsort of maybe haywire that a
little bit?
SPEAKER_00 (17:26):
Yeah.
It's a very multidimensional andcomplicated question.
But I think to simplify it, onething I think is useful is to
think about all the differentways that the brain and gut are
interacting with each other.
So, as an example, patients withIBD, for reasons we're not quite
sure of, have much higher ratesof depression and anxiety.
(17:49):
And we don't know if it's achicken or the egg, which way it
rolls, or if it rolls both ways,right?
Being depressed dysregulatesyour immune system, and that
makes you more likely to haveIBD, or having IBD makes you
more likely to be depressed andanxious.
But either way, we see thosecorrelations and we know that
when we help the one, we helpthe other.
So if patients are, let's say,helped with a biologic and their
(18:12):
symptoms are reduced, that'sgoing to help their depression
and anxiety.
And also, if we help theirdepression and anxiety, it often
helps their symptoms, also,which is why behavioral health,
which is what we do, is vastlyunderserving the IBD community
because it's hard to find an IBDpatient that couldn't use some
(18:33):
amount of behavioral healthintervention, right?
Because that's just one aspect,right?
So you have higher rates ofdepression and anxiety.
And then you also have a higherrate of what are called
disorders of gut braininteraction.
And this can be a veryfrustrating problem for patients
with IBD.
As an example, this is where youmight see that you do your blood
(18:54):
tests and all your values lookgood, right?
You're in remission, but yoursymptoms are not.
You're still having pain oryou're still having nausea or
your, you know, diarrhea orconstipation or whatever.
And it's hard to understand why.
And very often, the why, whenthe tests are clear, is that
you've got a disorder ofgut-brain interaction.
(19:15):
And that is a nervous systemdisorder where your brain, your
central nervous system, hasgotten into this negative cycle
with your GI system, in whichthe brain is seeing the GI,
maybe it's the stomach, maybeit's the upper GI, whatever part
of the GI, it's identified it aslike a dangerous spot.
(19:38):
And what happens is then youstart directing hypervigilance
and catastrophizing to thesensations from that spot, as
well as something calledvisceral hypersensitivity, where
the brain is like ramping up anddistorting the sensations it's
getting from that area.
And that creates this cyclewhere anxiety is being sent down
(19:58):
to the gut, causing moresymptoms.
And then those more symptoms arebeing sent up to the brain that
are causing more anxiety andstress.
So, anyway, this is a terriblecycle to get into.
And it's the basis for a lot ofproblems, most notably irritable
bowel syndrome is an example ofa disorder of gut brain
interaction.
(20:18):
And if, you know, if you knowthat, it's incredibly common.
One in 10 Americans have it.
But a much higher percentage ofpatients with IBD have some
variation of DGBI, like adisorder of gut brain
interaction.
Not necessarily IBS, but there'slike 20 or so different ones.
That is so interesting.
You know, patients with IBD,they go through a lot of medical
(20:41):
trauma.
When they go through theirflares, it's trauma.
When they go through surgeriesor other treatments, it can be
traumatic and traumatic to thenervous system.
And so whenever there's trauma,there's much more likely a
chance to develop these nervoussystem disorders, these
disorders of gut-braininteraction.
(21:02):
And so that's the second kind oftier where patients with IBD
need more behavioral healthhelp.
And this is why they needspecialists.
They don't need just regularmental health, because regular
mental health is great foranxiety and depression, but they
don't really know what to dowith a DGBI.
SPEAKER_02 (21:18):
I think that's a really important point and why
we need more GI psychologists aswell, our GI mental health
professionals.
Is there a higher rate ofdisorders of gut-brain
interaction or anxiety anddepression when people are in
flares?
And the reason I ask this isbecause is there something about
the inflammation that means thatyour gut is not able to absorb
like the same amount ofserotonin as it as it typically
(21:39):
does?
So is there any part of somebodyhaving inflammation that's
happening because of theirdisease that contributes to what
might be happening mentalhealth-wise?
SPEAKER_00 (21:48):
I believe so.
Now, I'm not sure about likespecific 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 andthe egg.
And we know that in aninflammatory system is gonna be
more likely to cause depression.
It's gonna be more likely tocause anxiety because the system
(22:09):
in general is on high alert.
And if you're like that for toolong, it's not good.
And you can get what's calleddepression secondary to anxiety.
And so I think I thinkdepression and anxiety reduce
when treatment reducesinflammation.
And then also when there'streatment for depression and
anxiety, I think it helps ingeneral with symptoms and
(22:33):
inflammation.
SPEAKER_02 (22:34):
Well, and this also makes me question like if
somebody gets to a point wherethey do believe they might need
some sort of antidepressant oranti-anxiety medication,
unfortunately, if there'sinflammation in your gut, you're
not absorbing the medication inthe same way as you would when
you don't have when theinflammation is calmed, when you
have you're in more of aremission state.
So do you end up with peoplethat are then over-medicated
because what they needed whenthey were in a flare is less
(22:54):
than they need when they're notin a flare?
So that this is all verycuriosity questions.
SPEAKER_00 (22:58):
Well, I think it's just fascinating.
This whole field of what'scalled psychoneuroimmunology.
And it's how does the brain andthe immune system interact?
And for good or for bad, IBDpatients are great examples of
that, right?
SPEAKER_02 (23:16):
Yes, so fascinating how all of this works together
and how, again, the brain isimpacting the things that are
happening with your inflammatorybowel disease.
And so, what a cool career youhave.
I love this so much for you.
You yourself have a privatepractice, you're part of the GI
psychology, which is also otherpractitioners that are providing
one-on-one counseling with folksand with specialties in
inflammatory bowel disease, GIissues, and mental health.
(23:38):
But what I think is super coolto talk about is that you have
not just taken it as aone-on-one, but you really
looked to work with the Crohn'sand Kaleitus Foundation to put
together a group setting.
So I would love for you to talkabout kind of how you got
started with working with theCrowns and Kaleitis Foundation
to put this together, how thisdiffers from like a support
group.
Yes, and sort of what this coulddo for folks.
SPEAKER_00 (23:58):
Yeah.
So GI Psychology was a grouppractice that started about five
years ago.
And the impetus was there wereso 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 GIPsych and we're in all 50 states
(24:18):
and we're telehealth, and wedon't kind of advertise
directly.
We work in basically inpartnerships.
So one of those partnerships iswith the Crohn's and Clitus
Foundation.
The story of the group, firstoff, the group is is on mission,
meaning it's a way to maketreatment more accessible to
folks that maybe couldn't affordor wouldn't be comfortable
(24:41):
meeting one-on-one.
And the group really startedbecause I was looking at the
research regarding clinicalhypnosis and IBD.
And I knew from my clinicalexperience that it was helpful,
but I wasn't quite sure what theresearch said.
And what I found really kind ofblew me away was that there were
studies showing that clinicalhypnosis could directly reduce
(25:03):
inflammatory load, not onlyreducing inflammatory load, but
also reducing the severity andlength of flares.
And I was like, oh my gosh, thisis amazing.
And from there, we started todevelop myself and another
clinician began to develop agroup, an eight-week group
therapy.
(25:24):
Difference between a grouptherapy 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 thatit's reimbursable by insurance.
So that's also nice, right?
So I learned that, and then Ithought, okay, we can do that,
and we can help with stress andresilience, and we can start
(25:49):
incorporating CBT concepts intothe group.
So we we came up with this wishlist of all these things we
wanted people to learn, and itwas just so exciting.
So then we built this up overmonths and months and months.
And the really exciting thing iswe got the Crohn's and Clitus
Foundation excited about italso.
And they've been a tremendoussupport and they just started
(26:11):
getting the information out totheir membership.
I think they have like some kindof hotline.
And if you go to that hotline,they'll tell you all about the
group.
But if you also just go to ourwebsite too and get a free phone
consult, you can learn about italso.
But it wasn't just the Crohn'sand Clitus Foundation, also the
American College ofGastroenterology has gotten
behind it and they're alsoputting it out to their members.
(26:33):
So it's been this amazingcollaboration between the three
organizations, and it's allcentered on making this
treatment available for patientswith IBD.
SPEAKER_02 (26:43):
That is super cool.
And I love that these twoorganizations have gotten behind
this, and because it is soimpactful, and you're right, not
everybody can access, you know,a one-on-one therapist and it
might not be within network forthem or pay for it out of
pocket.
So I think this is really great.
What's the structure around thegroup?
You said it's an eight-weekcourse.
So every week do you havesomething that you focus on?
Talk about how it works.
SPEAKER_00 (27:04):
Yeah.
So there's eight weeks, and likeI said earlier, we kind of said,
okay, what would we most wantour IBD patients to have as
skills?
And it's actually quiteinnovative in that we're doing
something that has never beenkind of successfully put
together before, which is we'reteaching some concept, right?
(27:26):
Um, maybe it's a cognitivebehavioral concept around
resilience and self-efficacy.
And then we're reinforcing thatconcept using a clinical
hypnosis session.
And so we're recording it.
And then the homework is just tolisten to that hypnosis session
in between their sessions.
So they're just reinforcing itevery day for a week in a very
(27:49):
kind of comfortable, relaxedway.
And I love that integrationbetween hypnosis and more kind
of intellectual understanding.
SPEAKER_02 (27:58):
Oh, wow.
That's super cool.
I didn't realize that was howthe clinical hypnosis was being
included in the sessions.
So I think this just got startedor is about to get started.
Where are you at with this?
SPEAKER_00 (28:09):
We just got enough to start our first group.
So we're about to launch thatgroup and we're recruiting for
our second group right now.
And I think we got a few alreadywho are interested.
SPEAKER_02 (28:20):
Well, if anybody is interested in this, we'll make
sure the information is down inthe show notes so that they can
find out where to find you.
And I'm assuming there'sprobably a wait list to join if
you've already started a sessionand and you're looking to fill
the next one.
Yeah.
I'm curious about the people whohave responded to this.
Like, is there a variety ofpeople?
I'm just curious about thedemographics of the people that
have signed up.
Has it been kind of universal?
SPEAKER_00 (28:41):
I kind of was looking at the we have got a
little spreadsheet of everyonewho's kind of shown interest.
And it's fascinating becauseit's it's really people all over
the country.
That's the cool thing abouttelehealth, right?
You could be in rural Alabama,and there's zero chance that
there's any GI psychologysupport around you.
Yeah, but you could join thisgroup and get top-notch care,
(29:04):
right?
So it seems very diverseracially in terms of if my
guesses are right about people'snames, right?
And then just people from allover the country.
It's it's actually reallylovely.
I think the important thing,because you've got, you know,
Crohn's and colitis, is that weare dealing in in kind of core
(29:25):
fundamental principles that wekind of took some time to say,
okay, what what are the mostimportant things for people to
know, regardless of where theyare in their journey, whether
they're, you know, they've hadsurgery or they haven't, if
there's an ostomy or if there'snot, you know, if they're very
early diagnosed or whatever, wewanted principles that could
(29:45):
that could help anyone who's gotthose diagnoses.
SPEAKER_02 (29:48):
And it'll be interesting to see how some of
these principles are spread intothings like support groups.
So when somebody is going into asport support group or is
participating in a supportgroup, that somebody might pull
it out and say, you know,there's this result.
Resilience, there's this idea ofresilience.
Like, here's some, you know,some tools that I've learned.
And to be able to kind of passthat on, I think that could be
really, really valuable to thecommunity.
So I know you haven't evenstarted this yet, but is the
(30:10):
vision to eventually be like,because if you have
practitioners all over thecountry that can help people all
over the country, is iteventually that you'll have kind
of concurrent eight-weeksessions happening at the same
time or sort of staggeredsessions?
What's your bigger vision forthis?
Where do you want this to go?
SPEAKER_00 (30:24):
The bigger vision is we're running this first
session, and our goal is tolearn as much as we can from it
and improve it from there.
And to eventually, once we kindof go through a few iterations,
then we want to train more ofour clinicians to run groups so
that again, like we don't becomea block in terms of like, oh, we
(30:46):
only have one person who knowshow to run the group and they're
out of space, too bad.
We want to grow with demand sothat nobody really should have
to wait maybe more than a monthor two to be able to get into a
group.
SPEAKER_02 (30:59):
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 avaluable tool for our community
to be able to participate inthis, if that's something that
they are able to get in andsomething of interest to them.
Going back to my comment aroundlike if you're in inflammation
and you know that you're notable to absorb things in the
same way.
(31:19):
Similarly, if somebody has justhad 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 thegut, how does that change
things?
SPEAKER_00 (31:30):
And this reminds me also of what happens to patients
also with eating disorders whenthey'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 verymuch, kind of starving
themselves, and then they're intreatment and they're getting
better, they go through thisrefeeding process where they're
(31:52):
starting to eat a no more of anormal amount, but reliably the
gut is going to cause problems.
Maybe it's constipation, maybeit's pain, maybe it's diarrhea,
maybe it's nausea, right?
But reliably these patients haveproblems because the gut is just
kind of relearning how tofunction in its new state.
(32:14):
And then there's a certainperiod where those problems are
expected.
And anything within that periodis kind of normal physiologic,
um, like readjustment.
And then if they go beyond thatperiod, then we have a sense
like, okay, maybe they'vedeveloped a disorder of gut
brain interaction as wellbecause of the trauma that
(32:35):
they've gone through in theirgut.
So a patient that's had surgery,there's absolutely going to be a
period where the gut isreadjusting and they need to
talk to their doctor, theirsurgeon about what that period
should look like, where thingsare kind of resettling and their
body's trying to understand howto function in this new
environment.
(32:56):
Now, whatever that period is,now add maybe a half again.
And but then if you go beyondthat and there's still symptoms,
then you might want to considerthat from all the trauma of the
surgery, you've also developed adisorder of gut brain
interaction, which is in somesense good news because actually
(33:18):
they are very, very treatable.
And I think that's another thingI want people to understand is
if they're a patient who there'sno longer any physiological
explanation for why they'rehaving symptoms and they have a
disorder of gut braininteraction, the research shows
that between 70 to 80 percentare going to reach their
treatment goals with thespecialized treatments that we
(33:41):
use, which is not a badpercentage.
SPEAKER_02 (33:44):
It's not.
No, that's very helpful to beable to tell people and make
sense.
I'm curious, because when yousaid anorexia, it reminds me a
little bit of our folks that youknow, we do have a lot of folks
that have like RFID orrestrictive feeding food
patterns.
That definitely, as you weresaying that, I was like, gosh,
then you add that layer on topof it with our folks of already
(34:05):
maybe there is some of thatdysfunction that's happening.
And then there's this wholeother layer of now you've also
coached your body almost torespond 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'tit?
SPEAKER_00 (34:19):
Yeah, and you're bringing up another issue.
So, well, first let me respondto the RFID.
Normally, we don't treat eatingdisorders, however, RFID is an
exception because we see it inso many of our patients.
So avoidant restrictive foodintake disorder, RFID, whether
it's full-on RFID or if it'sjust restricted eating that
(34:40):
doesn't quite meet thatcriteria.
We see a lot of that.
And so we do help patients withRFID.
The other issue, though, thatthis brings up is something
called conditioned foodsensitivity, which is a very
important thing for anybody withIBD to understand.
Because let's imagine a worldwhere a patient is in a flare
(35:01):
and then they try to eat.
I always use pizza as anexample.
So we'll use pizza.
So they try to have some pizzaand they do not react well to
the pizza.
Later they get treatment and theflare subsides, and they're
physiologically they're doingbetter, they're in remission.
However, like in terms of theirnervous system, they've had
(35:22):
maybe one, two, three, fourterrible experiences eating
pizza.
So, what can happen is thentheir brain unconsciously is
becoming very anxious whilethey're eating the pizza.
It's hyper-vigilant.
And then if they notice anylittle thing going on in their
stomach after or during theirwhile they're eating the pizza,
(35:42):
their brain startscatastrophizing.
And that sends anxiety down thegut brain axis into the gut and
is is likely to cause actualsymptoms, even though the flare
is gone and physiologicallytheir body actually has no
reason not to do well with thepizza.
Their body has becomeconditioned to kind of freak out
(36:03):
when it eats pizza.
So it's a nervous system problemthat's affecting the GI when
they eat.
So they've conditioned theirbody and their nervous system to
respond badly to pizza.
And then every time they eatpizza and they have a bad
experience, it just reinforcesit.
And that's actually something wecan help patients correct.
And what we first do is wedesensitize the system.
(36:25):
We teach them how to calm downthe brain that's hyper-vigilant
and catastrophizing, and thencalm down that what's called
visceral hypersensitivity, whichwe talked just a teeny bit
about.
Anyway, we calm those thingsdown.
The system is calmed down now.
Now they can eat pizza and theycan slowly expose themselves to
pizza again in a safe way andreintroduce it into their diet.
SPEAKER_02 (36:47):
When you're working with people with who have that
disorder of the gut braininteraction, so that you know,
the folks we just talked about,is that somebody that you would
you would look to use somethinglike a hypnotherapy with or a
CBT with?
Is there a different techniqueyou use when there is this or
disorders of the gut brain, oris it the same?
It's just slightly a differentway of doing it, basically.
SPEAKER_00 (37:06):
I think it's it's the same modalities of
treatment, different ways ofapplying them.
So both CBT, well, specificforms of CBT, gut-focused CBT,
which is not bread and butterCBT, and clinical hypnosis, both
have a lot of research behindthem, supporting their use for
DGBIs.
(37:27):
Literally over 40 years ofresearch, over hundreds of
studies, you know, showing thatthey're effective.
And we integrate the two.
We're using hypnosis, we'reusing CBT.
I'm actually working withanother one of our therapists
because that's a bit unique inthe field, is that I think most
people are using them like kindof like alternating.
(37:48):
And we're we're focused on howcan we learn to integrate them
to make them even moreeffective.
So we're working on kind ofcodifying how we do it, right?
But yeah, they're usedinterchangeably, and it can vary
depending on the patient andwhat they need, when and how.
SPEAKER_02 (38:04):
Okay, and I realize we jumped a little bit ahead.
So I'm gonna ask you to do alittle bit of remedial work with
me.
But so CBT, so cognitivebehavioral therapy is a specific
type of therapy that you use, atool that you use when you're
working with folks.
So just do those super briefdefinition of CBT and then sort
of it's how it's different,maybe, than when you're doing
clinical hypnosis.
SPEAKER_00 (38:25):
CBT is a very popular, well-known treatment
modality.
Essentially, it's working offthe idea that how we think
affects how we feel and how weact, and that people can get
into dysfunctional patterns ofthought, dysfunctional patterns
of feeling, dysfunctionalpatterns of acting and behaving.
(38:48):
And they're all interconnected.
And so CBT helps you untanglethat mess of like, let's say
you've got an anxiety disorderor something like that.
How do we pull the differentlevers of how of behavior, of
emotion, and thoughts and teachpeople how to kind of be their
own therapist when it comes tohelping themselves?
(39:08):
And CBT has been studied for alot of different disorders, and
there's been specific researchon how to use CBT for GI
problems.
And it's a different, you know,style of treatment, different
techniques, different ways ofdoing things than just kind of
regular CBT for an anxietydisorder.
So that's my little spiel onCBT.
SPEAKER_02 (39:30):
Very helpful, just in case people have not heard of
it, which seems unlikely.
It feels like everybody knowsabout CBT now, but it is very,
very commonly used.
So, okay.
When somebody is potentiallylike they've been living with
the disease for a while, I'msure there's a lot of people who
are like, I've got this, I'vehad IBD for 20 years.
I don't need to talk to atherapist, right?
You know, I don't, I don't needa therapist.
But one of the things you wroteis like, how is working with
(39:51):
somebody who has the coachingthat 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 yourthoughts on this one because I
think there could be some folksthat just don't realize that
there's this things could bedifferent and that you could
potentially work with them to beable to do that.
SPEAKER_00 (40:10):
Well, I think we can kind of break it down into three
categories.
The first are these nasty littleDGBIs, disorders of gut brain
interaction that we've beentalking about.
And they can they can be veryinsidious, they could be causing
symptoms when your inflammationis not happening.
They can be causing symptoms andyou might not know why.
(40:31):
And it can cause you to go downa lot of useless paths for you
know help when actually theproblem is in the nervous
system.
But they can also make yoursymptoms worse than they need to
be when you're in a flare,because the brain is very
powerful, the nervous system isvery powerful.
And if it's working against youwhile your body's also working
(40:53):
against you, that's a nastycombination.
So that's one area that mightnot be obvious to people when
they're thinking about gettinghelp.
The other way, of course, isdepression and anxiety.
And, you know, I think often wejust say these words and people
they're like, yeah, yeah, yeah,I know what depression.
And they have this image ofsomebody like crying on a bed,
(41:15):
not getting up.
But that's not always whatdepression looks like.
Sometimes depression is peoplefeeling irritable, like a lot,
or just feeling a little low, alittle low energy, not quite as
excited about things.
There are subtle variations.
People can feel anxiety so muchthey don't even recognize that
it's anxiety, right?
It's just like this is how Ilive, right?
(41:37):
And sometimes they in they needlike the right question at the
right time to be like, wait,everyone doesn't feel like this
all the time.
SPEAKER_02 (41:45):
So I feel that one very deeply.
I feel a little targeted bythat.
SPEAKER_00 (41:51):
And then the last one is something I think also
people can miss, which istrauma.
And when people think trauma,they think, you know, bad
childhood, right?
Bad things happening, sexual,physical, or war.
That's not always how traumashows up.
You know, trauma can show upwhen you think that something is
terribly wrong, that somethinghas happened to you, that
(42:13):
something really bad is going tohappen to you.
Think surgery, think flares,think people being really scared
and out of control and theseterrible moments in their lives,
they can imprint themselves ontheir limbic system in a way
that normal memories don't.
And so then you get what'scalled implicit memories that
(42:34):
kind of leak out anxiety or fearthroughout people's day or that
are being triggered like littlemini flashbacks, so that they're
overreacting to things in theirlives.
They're like, why did I react sostrongly to that?
And they don't even know why.
And that might have might bebecause it triggered some
underlying trauma that they'veexperienced.
SPEAKER_02 (42:54):
It's been discussed many times on the show about how
fraught this whole living withIBD is because of all the
potential opportunities fortrauma.
You know, a lot of times, Imean, we have people that have
very dramatic entries into thiscommunity, you know, with
hospitalizations and, you know,very significant symptoms, and
some people even close to deathbecause of, you know, the to the
(43:15):
severity of their disease.
And so it there's, you know, andthat's just the entry point, you
know.
And then there's all along theway the surgeries and the people
not believing you, the medicalgaslighting, all these sort of
small, and some of them not sosmall, sort of wounds,
psychological wounds that kindof go along.
So it definitely is a big partof this.
SPEAKER_00 (43:34):
That actually reminds me of something I didn't
get a chance to mention, but I'mglad you did.
You mentioned medicalgaslighting.
And I think sometimes it canrise to the level of
gaslighting, sometimes it can bevery deliberate, but I think
sometimes it can also just bevery inadvertent, right?
Just a random comment by adoctor or a nurse when people
are in a very vulnerable state,can really stick in their brain.
(43:59):
And I think everybody's heard ofthe placebo effect.
Not as many people have heard ofthe nocebo effect, which is the
fact that these comments orthese expectations by providers,
if they're they're phrased insome kind of negative way, they
can inadvertently cause damageto the person, to the patient.
SPEAKER_02 (44:19):
Yes.
Well, and that's again goingback to my comment about
insurance too.
That's just them participatingin the healthcare system.
Add in the trauma that can comewith having an insurance company
that it takes a lot of thatcontrol from you.
You know, your comment aboutcontrol really resonated with me
because there is so much of thisdisease, or so much of these
diseases, so much of living withchronic illness that is it feels
(44:40):
out of control.
It feels like these aspects ofcontrol are taken from you.
And that's so destabilizing forpeople and so traumatic to have
people make decisions on yourbehalf constantly and you
feeling like you're not anactive participant in that.
I think that's reallytraumatizing for many people.
I'm glad you brought up trauma.
How does clinical hypnosis sortof tie in with something like
EMDR?
Like so when you have somebodythat does have something that's
(45:02):
just kind of sticking, and youknow that something like EMDR,
which we've covered in a coupleof episodes, could potentially
be helpful.
How does that work together?
SPEAKER_00 (45:09):
I love it.
Now you've activated mypsychology nerd module.
And so I'm gonna go off on alittle tangent here.
So I've had I've had manyfriends and colleagues in the
field who are trained in EMDRand clinical hypnosis, some of
them who are EMDR trainersthemselves, right?
Every single one of them whoI've talked to have said
(45:32):
basically the same thing, whichis EMDR is a subset of hypnotic
techniques.
If you imagine hypnosis as abroad kind of umbrella with a
lot of different techniqueswithin it, EMDR is like a really
good hypnotic protocol that'sfocused on trauma.
And so there are other hypnoticprotocols for trauma as well.
(45:56):
And EMDR is one of them.
So we have a lot of differenttools for treating trauma using
EMDR, using cognitive behavioraltherapy as well.
But the key with treatingtrauma, 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 peopleget stuck at the cognitive
(46:19):
level, talking about the trauma,which can help and it can feel
supportive.
But in order to truly treattrauma, you have to go deeper.
You have to go into the limbicsystem, you have to go and shift
the implicit memories, theunconscious memories that are
stored there.
And that's something calledmemory reconsolidation.
(46:41):
It's a whole very fascinatingfield of neurology and all this
stuff.
But I think the problem oftenwith trauma is people want to
talk about it, which is helpful,but not sufficient to truly
resolve the trauma.
SPEAKER_02 (46:54):
Got it.
Yeah.
Because trauma doesn't just livein your brain, it lives like
kind of throughout you.
You know, it's like it's itaffects you in lots of ways.
That trauma comes out as anxietyor stomach acid issues or
whatever it is.
It can it can look verydifferent.
SPEAKER_00 (47:08):
So people have you read that book, uh The Body
Keeps the Score?
SPEAKER_02 (47:12):
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 comesout 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 ourpatients, that has come back a
couple of times.
We had them sort of talk throughwhat they had done when they had
done EMDR just to help people exto know what to expect.
(47:32):
And Robin was talking about howshe went in thinking, okay, it's
gonna be this thing, like thisis the thing, and about how this
whole other thing that hadhappened way back was the thing
that sort of was actually reallydug in there and came out, and
about how she was so shocked.
And she was said, I didn't eventhink that was a thing.
Like in looking back, I don'tknow why that affected me so
(47:55):
much.
It was super interesting to hearher say that.
I know with I think withHannah's, it was a little more
like present of things that werea little more close to home, but
but Hannah's also much youngerthan Robin.
And so it's one of those where,like, so like their interactions
with the healthcare system aregoing to be different.
Hers is going to be a littlemore present, and Robin, the
thing that she kind of that cameup for her was much more, you
know, towards the beginning ofher journey.
So it was, it's super, superinteresting.
SPEAKER_00 (48:16):
I love that point in therapy because that point in
therapy where people begin to beintroduced to their unconscious
mind.
And people who came in neverknowing they really had one,
they always thought thateverything that was going on was
right in the front, right?
And then that story about Robinis just beautiful.
And I've had so many patientsexperience that where we're
(48:36):
working on some kind of traumaor some kind of issue, and
they're like, Oh, I think it'sprobably gonna, this is probably
gonna come up.
And then something completelydifferent shows up, and that
tells you right that you're onthe right track because that's
not intellectual, right?
When they get surprised, thatmeans a different part of their
mind is speaking to them at thatpoint.
SPEAKER_02 (48:56):
So super interesting.
You mentioned the like it's notintellectual.
This group of folks with theinflammatory bowel disease
community is so educated.
There, I mean, they really dounderstand about their disease.
They research, they look,they're on Reddit, they're
asking questions.
I mean, like it really is just avery, very educated group of
folks.
SPEAKER_00 (49:14):
One of the things for some folks with like
cognitive behavioral therapy isthis sort of a tendency perhaps
to intellectualize something andnot necessarily that's why it's
so powerful to combine CBT withclinical hypnosis because
hypnosis is an experientialtherapy.
Yeah, they're they're feelingit, they're doing it, they're in
(49:36):
their imagination, powerfullykind of experiencing something,
whether that's a positiveresource state or diving into
some, you know, negative trauma,they're experiencing something.
And so it pairs really well withCBT, which can be very
intellectual, which is helpful,but it can cause some people to
sometimes spin their wheels abit and not make progress.
SPEAKER_02 (49:57):
Right.
Yeah, it's like you know youshould think a certain way.
It doesn't necessarily stop youfrom continuing to think in the
wrong way, you know.
And so for some folks, havingthat combined between the two is
definitely a way to kind of helppeople stop the propensity to
perhaps like fall back on theintellectualizing.
Unfortunately, I have to ask youthe last question.
What is your one piece of advicefor the IBD community?
And I did tell you you couldhave two, one for the patient
(50:19):
community and one for theprofessional community, but
that's up to you.
SPEAKER_00 (50:22):
I mean, the obvious piece of advice is get that
behavioral health piece inplace.
Get your team fully, you know,vetted, find someone that you
work well with that understandsthe disorder.
That's the obvious piece ofadvice.
The less obvious piece of adviceis the idea of an anchor,
because I think that can come inhandy in so many difficult
(50:43):
situations that it would be ashame if people didn't have it.
And I can give super quickadvice for how to develop that
anchor.
And I'll kind of go through itright now.
I often use like a left fist.
So you clench your left fist.
So the idea is pair that leftfist with some sort of relaxing
thing.
So if you're someone whomeditates, or if you're someone
(51:04):
who does breathing, or someonewho does progressive muscle
relaxation, whatever affectregulation tool you like to use,
all you do is right before youdo it, do your anchor, your left
fist, then do the thing thatrelaxes you.
And then when you're reallyrelaxed, do the left fist again.
And then repeat that over andover every time you do that that
(51:27):
regulation.
I usually have people do that atleast 20 times, but by usually
by the 10th time, just doing theleft fist is gonna elicit that
relaxation response.
And at that point, you knowyou'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 thatpathway in your brain, making it
more effective.
SPEAKER_02 (51:48):
Such a Pavlovian thing.
Okay, I love that.
Perfect advice for folks.
Dr.
Naviti, thank you so much forjoining us.
It's been so much fun to talk toyou and to learn so much and to
get nerdy with you a little bit.
Thank you so much for joiningus.
Thank you, everybody else, forlistening.
And cheers, everybody.
SPEAKER_00 (52:03):
Cheers.
Hi, this is Dr.
Naviti.
If you enjoyed this episode,please rate, review, subscribe,
and share it with your friends.
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