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Key takeaways:
- Baseline anxiety and depression did not predict abdominal pain response in 76,138 users of a digital program.¹
- Pain response held flat across psychological severity, from 52.2% in users with no symptoms to 53.1% in severe.¹
- Program completion rose with age, reaching 61% in users aged 65 to 74 versus 34% in under-45s.²
- Two filters APPs commonly apply at referral, psychological comorbidity and older age, are not supported by this data.¹ ²
Gut-directed hypnotherapy for IBS benefits a broader group of patients than common fit assumptions suggest, including those with anxiety or depression and adults over 65. In two real-world analyses of 131,900 users, neither psychological comorbidity nor older age predicted poorer engagement or abdominal pain outcomes.¹ ²
We presented this research at the GHAΩ and in one case, better.
Does anxiety or depression affect response to gut-directed hypnotherapy?
Baseline anxiety and depressive symptoms did not predict abdominal pain response to gut-directed hypnotherapy in 76,138 Nerva users.¹ Response rates barely moved across the range: 52.2% of users with no psychological symptoms met the ≥30% pain-response threshold, compared with 53.1% of those with severe symptoms. More than half of completers responded in every severity band.
What makes that flat line more striking is that the groups did not start in the same place. Baseline pain climbed steadily with psychological severity, from 51 mm to 66 mm on a 100 mm scale. The patients in most pain improved at the same rate as everyone else.¹
Should APPs refer patients with anxiety or depression for GDH?
You know the reflex: a patient with IBS and a PHQ-4 in the moderate range gets marked too complex for a behavioral program right now, and the plan becomes sort out the mood, then revisit the gut. This data does not support that sequencing.
It runs the other way too. A patient does not need visible distress to be a candidate. Symptom burden, preference, and access are better selection criteria than a mood score.
Is digital gut-directed hypnotherapy suitable for older adults with IBS?
Our second study showed that older adults engaged with digital gut-directed hypnotherapy more than younger users, not less. Across 131,900 enrolled Nerva users, program completion climbed steadily with age, from 34% in under-45s to 61% in the 65 to 74 band.² Abdominal pain response moved in the same direction: 51.0% of under-45s met the ≥30% threshold, compared with 58.8% of 65 to 74 year olds.²
This is not a small subgroup either. Of the full cohort, 13,454 users were aged 65 or older, 10.2% of everyone enrolled.²
Should APPs offer digital GDH to patients over 65?
The assumption that older patients will not manage a smartphone program is quietly shaping who gets offered one, and this data points the other way.² Age on its own is a poor predictor of who will finish.
Assess what actually applies: access to a smartphone, confidence using it, preference, and capacity to work independently. For a patient over 65 with no GI behavioral clinician within driving distance, digital delivery may be the most realistic route to gut-directed care.
Why does patient selection for gut-directed hypnotherapy matter for APPs?
Patient selection matters because APPs carry a large share of IBS follow-up visits, and that visit is where the "we have ruled everything out, so what now" conversation happens.
Gut-directed psychotherapies are suggested for global IBS symptoms in the 2021 ACG clinical guideline.³ But in practice, a behavioral intervention like hypnotherapy is too often held back as a last resort, offered only once antispasmodics, neuromodulators, or dietary restriction have all been tried and found wanting. The guideline does not frame it that way. It sits in the recommendations as an evidence-based option for the whole symptom picture, not just for the end of the line.
Nerva, built on research from Monash University, can be offered the same way: as a first-line option, or alongside the medical and dietary management a patient is already receiving.⁴
Both studies shared at the GHAPP conference were designed around the same question: which patients get quietly ruled out, and does the data support ruling them out? Psychological comorbidity and older age were both unrelated to poorer outcomes.¹ ² That widens the group you can offer something concrete to inside a single follow-up visit.
How do APPs refer a patient to Nerva?
Referring via the online form is secure and simple. Your patient gets their access details by email the same day, with no waitlist to sit on and no appointment to schedule. You can see who enrolled and how they are tracking, so the follow-up visit starts with data rather than guesswork. Co-signature requirements vary by practice and state, so check what applies in yours.
Bookmark the form so it’s ready for your next patient.
Frequently asked questions
Can APPs refer patients for gut-directed hypnotherapy?
APPs can refer patients with IBS for gut-directed hypnotherapy directly, including through digital programs such as Nerva that require no physician co-signature. Referring clinicians can see which of their patients enrolled and how they are progressing.
Is gut-directed hypnotherapy recommended in IBS guidelines?
Gut-directed psychotherapies are suggested for global IBS symptoms in the 2021 ACG clinical guideline, making them an evidence-based option rather than a last resort.³ Digital delivery extends the same modality to practices with no trained behavioral clinician nearby.
How does gut-directed hypnotherapy compare with the low FODMAP diet for IBS?
Gut-directed hypnotherapy produced symptom improvement similar to the low FODMAP diet in a randomized trial from Monash University, with benefit maintained at six months.⁴ It can be offered alongside dietary management rather than only after diet has been tried.
How long does gut-directed hypnotherapy take to work for IBS?
Nerva's gut-directed hypnotherapy protocol runs six weeks, with daily sessions of about 15 to 20 minutes. Patients in both real-world analyses were assessed at the end of that six-week program.¹ ²
How do you explain gut-directed hypnotherapy to a patient who thinks it means stage hypnosis?
Gut-directed hypnotherapy is a structured protocol of guided audio sessions targeting gut-brain signaling and visceral hypersensitivity, with the patient awake and in control throughout. Describing it as retraining an oversensitive gut-brain connection tends to land better than leading with the word hypnotherapy.
References
Hall C, Dabash O, Millar C, Rogers J, Peters SL. The influence of baseline psychological comorbidity on abdominal pain response to digital brain-gut behavioral program: a real-world analysis of 76,138 users with irritable bowel syndrome. Poster presented at: Gastroenterology & Hepatology Advanced Practice Providers (GHAPP) Ninth Annual National Conference; October 1–3, 2026; Chula Vista, CA.
Hall C, Dabash O, Millar C, Rogers J, Peters SL. Engagement and abdominal pain outcomes from a digital brain-gut behavioral program in older adults with irritable bowel syndrome: a real-world analysis of 131,900 enrolled users. Poster presented at: Gastroenterology & Hepatology Advanced Practice Providers (GHAPP) Ninth Annual National Conference; October 1–3, 2026; Chula Vista, CA.
Lacy BE, Pimentel M, Brenner DM, et al. ACG clinical guideline: management of irritable bowel syndrome. Am J Gastroenterol. 2021;116(1):17-44. doi:10.14309/ajg.0000000000001036
Peters SL, Yao CK, Philpott H, Yelland GW, Muir JG, Gibson PR. Randomised clinical trial: the efficacy of gut-directed hypnotherapy is similar to that of the low FODMAP diet for irritable bowel syndrome. Aliment Pharmacol Ther. 2016;44(5):447-459.
