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Irritable bowel syndrome (IBS) is now classified as a disorder of gut-brain interaction (DGBI), reflecting the complex two-way relationship between the brain and digestive system – far beyond the outdated idea of it being ‘just a gut issue’.
Yet despite this understanding, many patients still aren’t receiving care that addresses both sides of the equation.
A key insight from the State of IBS Report 2025 highlights this disconnect: while nearly 99% of respondents said their symptoms worsen with stress or anxiety, only 11.8% reported being offered psychological therapies by a healthcare practitioner.
This isn’t just a missed opportunity – it points to a shortfall in how we support patients with chronic, stress-responsive conditions.
The self-reinforcing stress-symptom loop
Stress isn’t just a trigger for IBS; it plays a self-reinforcing role, driving symptom flare-ups, which then contribute to increased anxiety, creating a cycle that’s hard to break. Interventions that address this gut-brain interaction – like gut-directed hypnotherapy (GDH) and cognitive behavioral therapy (CBT) – can interrupt this loop. And yet, many patients never hear about them.
Patients are missing key conversations
In fact, over half of respondents (52.1%) said their healthcare provider did not discuss the gut-brain connection at all during diagnosis or treatment planning, and only 14.5% said it was discussed in detail — despite its inclusion in the American Gastroenterological Association (AGA) quality indicator guidelines.
This lack of communication may contribute to the underutilization of effective therapies, leaving patients without a clear understanding of how stress and gut symptoms interact.
Importantly, this gap isn’t due to lack of evidence. Gut-directed hypnotherapy is supported by over 35 years of clinical research, and has demonstrated effectiveness in targeting both GI symptom severity and psychological distress. Still, barriers like cost, access to trained providers, and lack of awareness remain.
A path toward integrative, informed care
Brain-gut therapies should be a routine part of IBS management, not an afterthought. While pharmacologic and dietary interventions remain important, care that addresses the gut-brain connection can be critical for long-term symptom improvement – especially in stress-responsive patients.
When patients understand that stress and symptoms are biologically linked, they feel more empowered and engaged in their care. But education alone isn’t enough – they also need access to evidence-based tools they can use consistently.
This is where clinicians can play a pivotal role. Even a brief conversation about brain-gut therapies during diagnosis or treatment planning can validate a patient’s experience and open the door to effective, self-managed options like gut-directed hypnotherapy (GDH).
At Nerva, we’ve worked to make evidence-based GDH accessible via a digital, self-guided program that patients can use at home – without the need for months-long waitlists or high out-of-pocket costs. For patients with barriers to in-person therapy, this kind of digital solution can increase adherence, reduce symptom burden, and improve quality of life.
If you’re not sure how to start the conversation, our Research & Resources page includes downloadable guides and patient education materials designed specifically for use in clinical settings.
