How far out of your comfort zone will you go this IBS awareness month?

In case you didn’t know, April is IBS awareness month. But who are we kidding? If you’re reading this post and suffer from debilitating gut issues then EVERY month is likely IBS awareness month for you! Between the constant hypervigilance, social anxiety and memorising the location of every public toilet in the immediate vicinity, there’s just no getting away from it.

Thankfully in my decades-long struggles with IBS, I’ve discovered ways to use my hyperawareness to my advantage and put some distance between me and my symptoms. This month that distance is 450 miles to be precise! I’ll be spending world IBS day this year in one of my favourite places, the very North West tip of the Scottish Highlands. My destination is one of the remotest beaches in the UK with no direct road. It’s at least a 4-mile hike from the nearest facilities and as far out of my comfort zone as I ever thought possible.

Ad: This post is sponsored by Nerva, my go-to hypnotherapy app for IBS, but all words are my own.

Jump to:

• Step 1: Recognise Hypervigilance in IBS
• Step 2: Combat Catastrophic Thoughts
• Step 3: Increase IBS Resilience
• Nerva app, I never leave home without it!
• Nerva Audio Clip
• Comments

When you live with chronic IBS a road trip like this takes guts! (Pun intended) You have to feel pretty confident that you’re in control and are prepared to handle whatever your digestion throws at you. Whilst meticulously planning in toilet stops to break up the journey helps, it takes a deeper awareness of how the mind and body work to set the wheels in motion.

Does this sound like a journey you could get on board with? In this post, I’ll talk about the 3 most important things I’ve learned to use to my advantage when tackling my IBS. You might be surprised to hear that none of them relies on restricting my diet. I’ll also share my go-to tool that I never leave home without and give you a 10% discount code (affiliate link) so that you can try it for yourself.

If you’re ready to get comfortable with being uncomfortable then it’s time to identify what’s holding you back and use these top tips to reset your gut/brain axis. Maybe you’ll finally be able to take that trip you’ve been dreaming of, whether it’s to the edge of the world or the end of your road. Let’s take the first step…

Step 1: Recognise Hypervigilance in IBS

Although it’s well documented [1,2] I only came across the idea of hypervigilance in IBS a few years ago, when I first started the Nerva app. (Affiliate link). I’d had my fair share of dismissive doctors and negative or inconclusive tests so I was reluctant to open up to the idea that my mind might be playing a bigger role in my symptoms than I’d like to admit. 

Don’t worry, I’m not suggesting it’s “all in your head”. But based on my experiences and a whole lot of scientific research, I've learned that the mind/gut connection plays a crucial part in learning how to live and cope with IBS. It’s taken me decades to realise that my social anxiety, awkwardness and quirks were trauma responses to my condition. I’d hate for you to take that long to recognise these responses in yourself and understand how they can impact your quality of life. Let’s start to unpack it together.

What is hypervigilance?

Hypervigilance is a stress/trauma response that creates a heightened state of awareness and sensitivity to internal and external stimuli. [1,2] Common signs and symptoms include;

• Visual disturbances.
• Aversion or overreaction to sound or movement.
• Jumpiness.
• Profuse sweating.
• Palpitations.
• Erratic, shallow breathing.
• Muscle pain, cramps and tension.
• Constant feeling of fear or unease.
• Fight, flight or freeze response.
• Fatigue.

It often results in extreme thought patterns and behaviours of self-preservation as a way of avoiding real or perceived dangers. 

Hypervigilance is a symptom rather than a condition in itself. It can be brought on by 

• Fear
• Trauma
• Combat [3]
• Violence [4]
• Abuse
• Chronic pain

It is often associated with PTSD sufferers. As such, IBS sufferers may often assume it doesn’t apply to them, particularly if they don’t resonate with the idea of experiencing an overly traumatic event. [5]

What does hypervigilance look like in IBS sufferers?

Whilst we often associate hypervigilance with external stimuli such as loud noises, fear of strangers or feeling under threat in our immediate surroundings this is not always the case.

Although being physically out of our comfort zones is a common trigger for many of us, the inner workings of our gut can be just as stressful. This particularly applies when we have a history of pain or living with a chronic illness.

Research has shown IBS sufferers to be acutely more aware of the everyday sensations within the digestive system, known as visceral hypersensitivity. Experiencing a heightened perception of pain and increases in pressure, gas and stool movement is common. [6] 

Being on constant high alert to what’s going on, both inside and outside our bodies can often feel overwhelming and exhausting.

Hypervigilance in IBS sufferers can manifest as:

• Obsessively checking or needing to know the distance and location of public bathrooms en route or in the immediate vicinity.
• Hyper awareness and anxiety at the distance or number of obstacles between you and the bathroom, e.g "what if I don’t make it on time or someone else is in there when I need to go".
• Positioning yourself physically closer to the bathroom or avoiding travelling a perceived safe distance away from a bathroom.
• Irrational fear and avoidance of potential IBS triggers such as food, drink, physical exertion and travel.
• Your eye's are drawn to your triggers everywhere you go. Trigger foods jump out at you on the menu and you spot them on other peoples plates. Even when they're not a "threat" to you just noticing them makes you anxious.
• Avoiding social situations such as eating out, travel or parties where you feel the environment is out of your control.
• Withdrawing or zoning out of the world around you to closely monitor internal thoughts and feelings.
• Continuous scrutiny of bodily sensations to check for issues before they arise such as oncoming bowel movements or potential flare-ups.
• Hyperfocus on natural bodily rhythms and sensations, e.g “my stomach is rumbling, everyone must be able to hear it, it’s so embarrassing, it only makes this noise when I’m in a flare-up, I need to get home before it starts”.
• Ignoring or mistrusting your body's natural cycles and urges. This may result in frequent, unproductive trips to the toilet, “just in case”, or attempting to strain/ force bowel movements before they’re ready to come naturally.

How many of these patterns do you recognise in yourself?

How does hypervigilance affect IBS?

Hypervigilance puts our nervous system into a constantly frazzled state of fight or flight. [7] Stress has a direct effect on our digestive system and typically makes our gut worse. This puts us into a stress/symptom cycle.

 Stress symptom cycle = symptoms = stress and stress = more symptoms.

Not only can the impact of these intrusive thoughts increase our stress levels but they can lead to many lifestyle behaviours that affect not only digestion but our long-term physical and mental health. [8] Examples include; 

• Food aversion, restriction and avoidance.
• Irregular eating patterns.
• Sleep disturbances.
• Limiting movement, exercise, time outdoors or away from home.
• Avoiding social interactions.
• Withdrawing from friends and family.
• Going it alone rather than seeking help from medical professionals.
• Self-medicating without professional support or guidance.

Do any of these sound familiar?

Handling hypervigilance

Recognising these thoughts and behaviours in yourself is the first step towards tackling them. Once you’re aware of how and when hypervigilance can affect you it becomes easier to spot when it’s happening and take action. We’ll go into more detail throughout this post but things to consider include:

• Distraction and defusion techniques - Actively shifting your focus from a negative thought pattern. Observing and evaluating rather than automatically believing and reacting to intrusive thoughts.
• Gut-directed hypnotherapy - Rebalances the automatic stress responses that are not usually under your conscious control. This helps flip the switch from a state of fight or flight into rest and digest mode. [9]
• Cognitive behaviour therapy or CBT - Talking therapy that identifies troubling situations, thoughts, beliefs, feelings and actions. Breaking down how these are connected and how this affects you. [10] 

These tools and techniques can help to break the pattern of hypervigilance. Once we realise these trauma responses don’t need to be our default state we can begin to replace them. The next step is to rewrite our experience with a narrative that supports our IBS management.

Every one of us has a unique experience with our condition. Our treatment and recovery plan should reflect that. Speaking to a professional about your options is a great place to start. I’m not qualified to tell you what will work for your unique circumstances but I hope that sharing what’s worked for me will at least give you a place to start. 

I’ve been documenting my experiences with gut-directed hypnotherapy and writing Nerva app reviews for the past few years. It’s helped me more than I ever imagined possible and was exactly what I personally needed to tackle my stress-related symptoms and flare-ups.

Step 2: Combat Catastrophic Thoughts

The stress and anxiety brought on by a chronic illness or hypervigilance can often lead to catastrophic thinking. Catastrophic thinking has the power to impact pain, how we perceive and cope with illness and overall quality of life. [11] 

What is catastrophic thinking?

Catastrophizing or catastrophic thinking is when we jump straight to the worst-case scenario, even when this conclusion is unfounded or extremely unlikely. It’s much more than being negative or a glass half empty person. 

Catastrophic thinking is a form of cognitive distortion. [12] Energy and attention is narrowly focused on negative outcomes. Based on nothing more than a gut feeling our mind can twist any scenario from something manageable into something catastrophic. The facts and reality of an event have no relevance to the outcome we imagine and rational thinking is temporarily suspended.

Signs of catastrophizing include;

• Blowing things out of proportion.
• Thinking the absolute worst of a situation or outcome.
• Extreme worry and anxiety over things that haven’t happened.
• Expectations of unmanageable events or consequences.
• Thoughts that are not based on fact.
• Irrational thoughts about yourself and others.
• Acting rashly in an attempt to avoid or prevent the imagined outcome.
• Relying on damaging coping strategies including self-harm, addiction or disordered eating.

During my wellness journey I’ve realised that catastrophic thinking has plagued me since childhood, how about you?

As with hypervigilance, catastrophizing is a symptom, rather than a stand-alone disorder, and may be associated with conditions such as;

• Depression
• Anxiety disorders
• OCD
• PTSD
• Chronic pain
• Chronic illness

IBS sufferers are at an increased risk of depression and anxiety disorders as we struggle to cope with chronic pain and illness. [13]  No wonder then that catastrophizing can quickly become the norm.

What does catastrophic thinking look like in IBS sufferers?

Catastrophic thinking in IBS is well documented and researched. Studies suggest that those with conditions such as IBS, fibromyalgia or others that cause chronic pain, experience an increase in catastrophic thoughts and a decrease in overall quality of life. [11,14]

Catastrophizing thoughts for an IBS sufferer will often revolve around;

• Inability to manage their condition.
• Difficulty coping with symptoms.
• Intolerance to pain.
• Failure to thrive beyond their (typically small) comfort zone.
• Expecting test results and clinical investigations to be positive for disease.
• Worrying they have been misdiagnosed or serious conditions have been overlooked.
• Assuming medical procedures, treatments and medication will be ineffective.

An example of this behaviour is experiencing mild gut symptoms whilst at work and immediately assuming you’re going to have a full-on flare-up. You convince yourself you’ll be incontinent and embarrass yourself in front of everyone, even if it’s never happened to you before. This may lead to fleeing to the nearest toilet to wait it out or going home as soon as possible. The real-world consequences of these actions, such as annoying your colleagues or getting into trouble with the boss, pale into insignificance compared with the imagined catastrophe. 

Another example would be of someone assuming their stomach pain is the result of undetected cancer or a fatal disease, despite clear test results and reassurances from medical professionals.

How many times have thoughts like these ruined your day?   

How does catastrophic thinking impact IBS?

The sympathetic nervous system responds to threats, real or imagined, by putting us in a state of fight or flight. Although many catastrophic thoughts will likely never become reality, the fear response we experience is real. This puts us constantly on edge, even though the majority of us rarely need to rely on this survival response in our day-to-day lives. 

Catastrophic thinking can cause extreme anxiety. Not only does this mental strain increase our stress levels it can stop us from taking the physical actions required to help ourselves and our condition. Feelings of despair or hopelessness are common and can make us believe there is no way forward out of our situation.

Catastrophic thoughts often feel very plausible, even in the absence of any evidence to the contrary. This can cause us to act irrationally, out of character or in a way that does not help or serve our greater good. [15]

Impacts of catastrophic thinking on IBS may include;

• Food aversion and avoidance.
• Withdrawing from social life and hobbies.
• Higher than average incidences of sick days.
• Impeded job security or career progression.
• Obsessive monitoring of food and symptoms.
• Health anxiety and frequent trips to the doctor.
• Excessive spending on drugs and supplements regardless of credibility or effectiveness.
• Dismissing medication or treatment options. 
• Mistrusting medical professionals.
• Refusing or avoiding medical help and interventions.
• Indefinitely postponing or opting out of major life events such as career opportunities, marriage or children for fear of not being able to cope.
• Sense of foreshortened future.

[16]

How many of these behaviours do you recognise in yourself? I've scored yes to all of them in the past.

Reframing catastrophic thoughts

Have you ever tried to stop thinking about something just by willpower alone? Tell yourself not to think about a pink elephant on a bicycle and suddenly it’s the only thing you can see in your mind’s eye. The same is true of reframing our catastrophic thoughts.

It’s easier to work on replacing one thought for another rather than trying to dismiss the thought entirely. This is where treatments such as CBT and gut-directed hypnotherapy come in. These therapies encourage us to look at our thoughts and fears from a different angle. [10, 17]

• Our thoughts and feelings are not facts.
• Thoughts, feelings and behaviours are interconnected.
• What we think can have a negative or positive effect on how we feel. 
• How we feel influences our behaviour.
• Habits and behaviour can improve or impair the way we feel.

To shift catastrophic thoughts from the extreme we can try asking ourselves these questions;

• Is the worst happening right now?
• What about this thought is fact?
• What about this thought is false?
• Is there an alternative thought that’s closer to the truth?

For IBS sufferers reframing catastrophic thoughts might look like this,

Catastrophic thought = I didn’t manage to go to the toilet before I left the house.

Reframed thought = I didn’t need to go to the toilet before I left the house. 

Catastrophic thought = I’ll definitely need to go to the toilet urgently whilst I’m out.

Reframed thought = I may need to go to a public toilet whilst I’m out. 

Catastrophic thought = One day I will have an accident in public because I can’t control my bowels.

Reframed thought = I’ve never had an accident in public before because I have more control over my bowels than I realise. 

Are you having a thought right now that could be reframed into one that serves you better?

Step 3: Increase IBS Resilience

Increasing resilience is something that we can all attempt to do for ourselves. For the most part, it requires us to take small but significant actions to help us to;

• Improve our mindset and outlook.
• Cope better with our condition.
• Bounce back from setbacks.

Resilience is something that can be learned, practised and developed. It may not come naturally at first but with focus and intent, it can be an opportunity for significant personal growth.

Clinical research has shown that resilience in IBS patients is lower than that of the general population. [18] This is associated with increased symptom severity, hyperresponsiveness to stress and lower quality of life.

What is IBS resilience?

Resilience is the ability to adapt and respond to stress. Once any immediate stress (or threat as our nervous system see's it) has passed our resilience is what allows us to keep going. Being resilient doesn’t mean we have to go it alone, grin and bear it or soldier on regardless. It’s about putting together the right tools and team to support you, as and when you need it. 

Having a plan in place to increase resilience doesn’t mean that we must only ever be positive or that we won’t experience difficulties. Flare-ups will happen, our health may fluctuate and stressors will come and go. The resilience that we’ve nurtured along the way is what keeps us fighting in the face of adversity and moving forward. 

In terms of IBS, resilience is our ability to;

• Recover from flare-ups.
• Go about our daily life without constantly anticipating a relapse.
• Eat the widest possible variety of foods and fibre without fear.
• Exposure to food, situations and stimuli outside of our comfort zone.
• Maintain a decent quality of life whilst navigating symptoms and flare-ups.
• Experimenting with proven treatment options until we find what works.
• Adapt to changes in our health, condition and circumstances.
• Use medication, tools, resources and medical interventions to support symptom management and treatment goals.
• Asking for and accepting help when we need it.

It's important to point out that some aspects of our resilience may not always be within our control. Lack of access, finances, resources, opportunities and support will all impact how resilient we are able to become. Those experiencing health, social, economic and environmental inequalities are most at risk of poor health outcomes. This particularly applies to those in marginalised, underserved and underrepresented communities.

How resilient do you feel most days?

How to become more resilient.

There are four core components of increasing resilience as laid out by The American Psychological Association. These are;

• Connection
• Wellness
• Healthy Thinking
• Purpose

Connection

• Prioritizing healthy relationships with people that genuinely care about you. 
• Finding trustworthy people, groups or support networks.
• Keeping communication open during times of difficulty. 
• Enjoying hobbies and activities with others.

Wellness

• Taking care of the body with decent nutrition, hydration, sleep and exercise.
• Taking care of the mind with meditation, breathing exercises, yoga and relaxation. 
• Avoiding negative coping methods like alcohol or drugs.
• Manage stress rather than attempt to avoid it.

[19, 20, 21] 

Healthy Thinking 

• Keep irrational or catastrophic thoughts in perspective.
• Use distraction or defusion techniques to break the cycle of negative thinking.
• Change how you see and respond to stress rather than try to change the stressor.
• Don’t be afraid of change. Accept is a natural part of life and focus on what you can do to help yourself instead.
• Remind yourself how far you’ve come and what you’ve learned on the way.
• Try to remain hopeful about the future.

[22]

Purpose

• Join a club, charity, church or community where you can offer your help, skills or support to others.
• Break problems down into more manageable tasks and be proactive about working towards your goals.
• Ask yourself, “What’s one thing I can do today to help myself through this”?
• Use everything you’ve learned and overcome in the past as a source of strength, support and motivation in the future, for yourself and others.

Can you see how even just a few of these mindset shifts or actions could make a difference to your IBS resilience?

Whilst much of this work can be done individually, it’s important to recognise when we might need professional help. If you find that you’re struggling with your condition or feel unable to cope then reaching out to a professional is a must.

Nerva app, I never leave home without it!

The one way I’ve been able to continually help myself recognise the thoughts and behaviours that worsen my condition was to research the mind/gut connection. Before learning about how the gut/brain axis affects IBS I was hyper-focused on restricting my diet.

Whilst dietary management helped me to identify the food associated patterns to my symptoms it completely overlooked the bigger picture. Once I realised how my thoughts and behaviours impacted my gut and vice versa it opened up a world of possibility that no longer relied on when and what I ate.

I now have the support I need to defuse catastrophic thinking and snap me out of a hyper stress response. I’ve found a way to increase my resilience and handle whatever life or my gut throws at me. [23] What’s more, the one tool that provides all this fits neatly into my pocket and comes with me everywhere I go. That’s not something I could ever say about my dietitian!

So exactly what is it that’s accompanying me to the wilds of Scotland on a 900 mile round trip, besides the dog? What have I been using that’s helped me progress from the end of my road onto an epic road trip? The thing I refuse to leave home without is the Nerva app by Mindset Health. (Affiliate link).

The Nerva app is a complete gut-directed hypnotherapy program delivered to your smartphone in short daily sessions. 

Nerva Audio Clip

Listen to a short clip to get a feel for the Nerva IBS program.

Please note: You will not be hypnotised by listening to this brief clip. This audio has been abridged to give you a general feel for the narrator, tone and pace of what to expect from the Nerva app.

The main program lasts for 6 weeks and is followed by a maintenance plan and flare-up toolkit to ensure you’re not left high and dry. In 20 minutes a day, you’re guided through one of a variety of relaxing scenes designed to get you thinking more positively about your condition and reset your gut/brain connection.

The hypnotherapy sessions are supported by a variety of deep breathing exercises and concise articles that cover everything from IBS diagnosis to overcoming hypervigilance. This whole package works in synergy to tackle your condition and symptoms from every angle. Additionally, research shows that gut-directed hypnotherapy is as effective as a low FODMAP diet in treating the symptoms of IBS. [24]

Although I’ve been using the app since 2020 I still rely on the handy flare-up toolkit when acute stress strikes. During long journeys, busy work weeks and before social events I’ll dip back into the toolkit. Listening to a session or focusing on my breathing help to get my gut back on track. 

If you’ve been here for a while you’ll know that I swear by Nerva. I often write about my experiences with the app and credit it with the biggest shift and improvements to my health and wellbeing since my IBS diagnosis. If you’re ready to take that trip, go on that date or simply just leave the house with confidence then go here for your free Nerva trial and 10% discount. This makes the entire program less than the price of a single in-person session with a therapist, with the added protection of a *30-day money-back guarantee.

Let me know in the comments below how far you plan on going outside of your comfort zone this month? Hoping to see you on a beach at the top of the world soon. Last one in is a rotten egg!

Sponsored Post Declaration

Ad: This post is sponsored by Nerva. Qualifying purchases made through my affiliate links may result in me receiving financial compensation. I appreciate your choosing to purchase through my links and support the work that I do in this way.

Sincerest thanks to the team at Nerva for allowing me to share my honest thoughts without attempting to interfere with the content.

Reviews are based on my experience of the app in Sept 2020 and its updated version in September 2021. The program, sessions, app structure and pricing are subject to change at any time without notice and may not be as described here. Please see the official Nerva website for the most up to date information and pricing.

*30-day money-back guarantee applies to website purchases only provided you have attempted the program and listened to at least 7 sessions. Not valid on direct app store purchases.

References and further reading

[1] Murray, Charles D R et al. “Effect of acute physical and psychological stress on gut autonomic innervation in irritable bowel syndrome.” Gastroenterology vol. 127,6 (2004): 1695-703. doi: 10.1053/j.gastro.2004.08.057

[2] Bruce D et al. “Longitudinal Change in Perceptual and Brain Activation Response to Visceral Stimuli in Irritable Bowel Syndrome Patients”. Gastroenterology, Vol 131, 2 (2006): 352-365. https://doi.org/10.1053/j.gastro.2006.05.014

[3] Matthew O et al. “Eye tracking and visual attention to threatening stimuli in veterans of the Iraq war”. Journal of Anxiety Disorders, Vol 24, 3 (2010): 293-299. https://doi.org/10.1016/j.janxdis.2009.12.006

[4] Smith, Nichole A et al. “Keeping Your Guard Up: Hypervigilance Among Urban Residents Affected By Community And Police Violence.” Health affairs (Project Hope) vol. 38,10 (2019): 1662-1669. doi: https://dx.doi.org/10.1377%2Fhlthaff.2019.00560

[5] Taft, Tiffany H et al. “Initial Assessment of Post-traumatic Stress in a US Cohort of Inflammatory Bowel Disease Patients.” Inflammatory bowel diseases vol. 25,9 (2019): 1577-1585. https://dx.doi.org/10.1093%2Fibd%2Fizz032

[6] Dong, Wen Zhu et al. “Study of visceral hypersensitivity in irritable bowel syndrome.” Chinese journal of digestive diseases vol. 5,3 (2004): 103-9. https://doi.org/10.1111/j.1443-9573.2004.00168.x

[7] Qin, Hong-Yan et al. “Impact of psychological stress on irritable bowel syndrome.” World journal of gastroenterology vol. 20,39 (2014): 14126-31.  https://dx.doi.org/10.3748%2Fwjg.v20.i39.14126

[8] Chang, Lin. “The role of stress on physiologic responses and clinical symptoms in irritable bowel syndrome.” Gastroenterology vol. 140,3 (2011): 761-5. doi:10.1053/j.gastro.2011.01.032 https://dx.doi.org/10.1053%2Fj.gastro.2011.01.032

[9] Gonsalkorale, W M et al. “Long term benefits of hypnotherapy for irritable bowel syndrome.” Gut vol. 52,11 (2003): 1623-9. https://dx.doi.org/10.1136%2Fgut.52.11.1623

[10] Hauser, Goran et al. “Cognitive behavioral approach to understanding irritable bowel syndrome.” World journal of gastroenterology vol. 20,22 (2014): 6744-58. https://dx.doi.org/10.3748%2Fwjg.v20.i22.6744

[11] Sherwin, LeeAnne B et al. “The association of catastrophizing with quality-of-life outcomes in patients with irritable bowel syndrome.” Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation vol. 26,8 (2017): 2161-2170. https://dx.doi.org/10.1007%2Fs11136-017-1554-0

[12] Lam, Novem Ching-Yee et al. “Cognitive impairment in Irritable Bowel Syndrome (IBS): A systematic review.” Brain research vol. 1719 (2019): 274-284. https://doi.org/10.1016/j.brainres.2019.05.036

[13] Eijsbouts, C et al. “Genome-wide analysis of 53,400 people with irritable bowel syndrome highlights shared genetic pathways with mood and anxiety disorders.” Nat Genet 53, 1543–1552 (2021). https://doi.org/10.1038/s41588-021-00950-8

[14] Hunt, Melissa & Milonova, Marina & Moshier, Samantha. “Catastrophizing the Consequences of Gastrointestinal Symptoms in Irritable Bowel Syndrome”. Journal of Cognitive Psychotherapy. 23. (2009) 160-173. http://dx.doi.org/10.1891/0889-8391.23.2.160

[15] Kozlowska, Kasia et al. “Fear and the Defense Cascade: Clinical Implications and Management.” Harvard review of psychiatry vol. 23,4 (2015): 263-87. https://dx.doi.org/10.1097%2FHRP.0000000000000065

[16] Ballou, S, and L Keefer. “The impact of irritable bowel syndrome on daily functioning: Characterizing and understanding daily consequences of IBS.” Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society vol. 29,4 (2017): 10.1111/nmo.12982. https://dx.doi.org/10.1111%2Fnmo.12982

[17] Peters, S.L., Muir, J.G. and Gibson, P.R. Review article: “gut-directed hypnotherapy in the management of irritable bowel syndrome and inflammatory bowel disease”. Aliment Pharmacol Ther, 41 (2015) : 1104-1115. https://doi.org/10.1111/apt.13202

[18] Park, S H et al. “Resilience is decreased in irritable bowel syndrome and associated with symptoms and cortisol response.” Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society vol. 30,1 (2018): 10.1111/nmo.13155. https://doi.org/10.1111/nmo.13155

[19] Breit, S et al. “Vagus Nerve as Modulator of the Brain–Gut Axis in Psychiatric and Inflammatory Disorders”. Frontiers in Psychiatry vol 9 (2018) https://doi.org/10.3389/fpsyt.2018.00044

[20] Kavuri, Vijaya et al. “Irritable Bowel Syndrome: Yoga as Remedial Therapy.” Evidence-based complementary and alternative medicine : eCAM vol. 2015 (2015): 398156. https://dx.doi.org/10.1155%2F2015%2F398156

[21] Chu, I-Hua et al. “Effects of Yoga on Heart Rate Variability and Depressive Symptoms in Women: A Randomized Controlled Trial.” Journal of alternative and complementary medicine (New York, N.Y.) vol. 23,4 (2017): 310-316. https://doi.org/10.1089/acm.2016.0135

[22] Kok, Bethany E et al. “How positive emotions build physical health: perceived positive social connections account for the upward spiral between positive emotions and vagal tone.” Psychological science vol. 24,7 (2013): 1123-32. https://doi.org/10.1177/0956797612470827

Full text PDF: https://peplab.web.unc.edu/wp-content/uploads/sites/18901/2018/11/koketal2013.pdf

[23] Peter J, Tran US, Michalski M, Moser G (2018) The structure of resilience in irritable bowel syndrome and its improvement through hypnotherapy: Cross-sectional and prospective longitudinal data. PLOS ONE 13(11): e0202538. https://doi.org/10.1371/journal.pone.0202538

[24] Peters, S.L et al. “Randomised clinical trial: the efficacy of gut-directed hypnotherapy is similar to that of the low FODMAP diet for the treatment of irritable bowel syndrome”. Aliment Pharmacol Ther, 44 (2016): 447-459. https://doi.org/10.1111/apt.13706