Adapted from episode 133 of The Perfect Stool podcast with Dr. Ali Navidi, a licensed clinical psychologist and co-founder of GI Psychology where he has helped develop innovative treatments combining Clinical Hypnosis and Cognitive Behavioral Therapy (CBT) for patients with GI disorders and chronic pain, and Lindsey Parsons, EdD, and edited for readability.
Lindsey:
So I’m curious how, as a psychologist, you ended up with a focus on GI issues?
Dr. Ali Navidi:
That is a great question, that kind of cuts right to it. Well, I can tell you, I did not expect that to be the case. I came in as a generalist. I just enjoyed treating all different kinds of patients, different ages, kids to elderly. Yeah, there was no plan to focus on GI. If someone had told me that while I was starting, I don’t think I would have believed them. But what I did have was a love of clinical hypnosis as a tool in therapy. And at the time, at the beginning, I didn’t realize what an amazing tool it was for the GI and how much research there was already supporting it. I slowly discovered that, and slowly started to use it with patients. And it was just such an incredible response that I just kept doing it and adapting it, building it, and eventually it became like 80% of my practice, because the gastroenterologists in the area would find out about me, and then they would tell other gastros, and it was like, those are all the people that were coming to me. And there was no one else, there was no one else in the area that was trained to do this stuff. So I really felt bad turning any of these people away.
Lindsey:
Yeah, and so initially, these weren’t people who had come to you for GI issues? They were seeing you for other things, but they had a GI issue, just by chance, and you happened to realize that that could also be dealt with?
Dr. Ali Navidi:
Yeah, I had done a training years and years back about treating IBS with clinical hypnosis.
Lindsey:
Oh, okay.
Dr. Ali Navidi:
It was part of a larger training in clinical hypnosis. And I was like, this is interesting, but I’m never going to use it. So I just put it in my back pocket, and it turned out to be useful. But yeah, the first patient I used it with was someone I was treating for anxiety, and I already knew they responded well to hypnosis, and they were talking about going through this process of figuring out what was going on with their gut, and they had gotten scans and tests and then scoped, and they didn’t find anything, and eventually they came back to them with this diagnosis of IBS. And that’s why I said, “Well, you know, I’ve done this training, so if you want, we could try this thing.” And it ended up working.
Lindsey:
Wow, wonderful. And was that person a person who tended towards loose stool and diarrhea, or towards constipation . . . or . . . I’m curious?
Dr. Ali Navidi:
I’m going back into my memory banks, I want to say it was IBS-D.
Lindsey:
Yeah, because I can imagine that that’s probably more the type that would be associated with anxiety, because when you’re nervous, the bowels tend to loosen.
Dr. Ali Navidi:
Yeah, I found that while IBS-C is treatable with these techniques, IBS-D tends to respond even better, and it might be good to get into the model behind why this works, because the anxiety is a part, but there’s more.
Lindsey:
Yeah.
Dr. Ali Navidi:
Not just anxiety. And I think that’s a big misunderstanding. A lot of times with patients, they’ll be like, “Well, I don’t think I’m that anxious. I don’t think that’s the reason this is happening,” And it’s more than just anxiety.
Lindsey:
So yeah, go ahead and delve in.
Dr. Ali Navidi:
Yeah, so basically, there’s four elements to understand. First off, something you’re super familiar with is the brain-gut axis. So that communication system between the brain and the gut and between the gut and the brain. I was just looking at your podcast list, and you’ve got quite an impressive list. You’ve been doing this for a while, and you’ve covered a lot of interesting stuff. A lot of what I saw is from the gut up, what’s happening in the gut, how it affects the brain and how it affects the body. In my world, it’s what’s going on in the brain and how that affects the gut. So the elements are the brain gut axis – so this powerful communication between the brain and the gut, and then hypervigilance, catastrophizing and something called visceral hypersensitivity. And so when I talk about hypervigilance, I’m not talking about general hypervigilance, I’m talking about body focused.
Lindsey:
Yeah
Dr. Ali Navidi:
And so usually people lock in on something. Maybe there’s a certain area of the gut where they usually get pain or discomfort, maybe that’s in the upper GI. But there’s an area where they’re getting symptoms, could be nausea, it could be pressure, bloating. So there’s this hypervigilance, and then when they notice there’s something happening there, then they’re like, “Oh, oh, man.” And then they start catastrophizing. And then that anxiety feeds down into the gut, and it can cause a worsening of those symptoms. And then before that gets sent back to the brain, we’ve got visceral hypersensitivity, which is essentially the brain turning up the volume on those sensations and distorting them. So what might feel like a little bit of bloating can feel like an intolerable amount of bloating. What might just be hunger cues could be pain or the feeling of digestion could also turn into pain or nausea. So there’s an amplification and distortion that’s occurring. And so you’ve got all these four elements happening.
Lindsey:
Yeah, in my list of podcasts, the most recent one I published was Ashok Gupta, The Gupta program, and that is a brain retraining program, specifically. And I’m doing the program because I have autoimmune SIBO, so I figured, why not give it a try? But it’s an interesting question, because I would also say, I don’t feel like I’m anxious about this. I feel like I’ve got it roughly under control. It flares up. I treat it. Yeah, I bloat a decent part of my meals, but I also overeat a decent part of my meals. So, you know, I’m curious, if you are somebody who doesn’t feel like you’re hypervigilant of your symptoms, would that be somebody who’s probably not such a good candidate for this kind of treatment, or not a necessary component?
Dr. Ali Navidi:
Not a necessarily the case. So people will differ in how they’re acting out these different variables. Like I said, there’s the hypervigilance, and there’s catastrophizing. But let’s not forget about our good friend, visceral hypersensitivity. And this is a tricky one, because most people have a very linear concept of how pain works in their body. It’s like something happens, the sensation of pain travels up to our brain, and we’re aware of the pain. When in actuality, it’s much more complex, and that sensation is processed in multiple areas of the brain in different ways. And the idea that our brain has this kind of tuning mechanism where it can turn up the volume, or it can even turn down the volume, and so it’s hard to say how much that is playing a role in somebody’s symptoms. And then there’s just this mind-body connection where there can be these feedback loops created, where what we expect to happen is being made to happen in some way. I’ve seen many patients that, you know, you talk to them, their self report and what you observe, you don’t see much hypervigilance. You don’t see much catastrophizing. They’re pretty level-headed people, so you believe them, just doesn’t seem to be the case, yet they still respond well to treatment.
Lindsey:
Yeah, I mean, to some extent, it really just shows the power of our brain to alter our physiology. Whether or not it was fully brain-caused, it can be brain-solved, right?
Dr. Ali Navidi:
Yeah, yeah. A lot of patients that I’ve had with functional dyspepsia, where they’ve got a lot of bloating, a lot of gas kind of decreases their appetite. It’s hard for them to eat big meals because it feels like it just kind of sits there. For example, when using hypnosis, a number of those patients, we’ve had experiences where they can literally feel the gas going away during the hypnosis session, and at the end of it, they’re like, “Wow, I feel hungry for the first time in however long.”
Lindsey:
That’s awesome. So if someone has GI issues, do you suggest they start with the gastroenterologist doing the full workup, or maybe starting with a psychological approach?
Dr. Ali Navidi:
Definitely want them to, at the very least, see their primary care. Often primary care, with a good history and a few simple tests, they don’t need a full workup. I think that’s what they’ve been finding more and more nowadays. They used to do a full workup on everybody, and they’re finding, I think, that that’s not really needed. With a good history and a few simple tests, they can usually figure out if it’s IBS or another of the DGBIs. So in case people don’t know, that’s a disorder of gut-brain interaction (DGBI), and it’s a class of maybe about 30 different disorders. So I would say definitely start with some sort of a physician, and then you can maybe come to us earlier, rather than later. What I think people do a lot of times is they’ll go to their doctor, doctor’s pretty sure it’s IBS. They do the few simple tests. They say, “Hey, it doesn’t look like there’s anything wrong with you.” And then the person responds with, “Yeah, but I’ve got all this pain, and you must have missed something.” So they want more. And so they complain enough that they’re going to get the endoscopy, they’re going to get the colonoscopy, they’re going to spend six months to a year chasing their tail before they end up seeing somebody like myself.
Lindsey:
Yeah, and so you mentioned a few simple tests. So I don’t see a lot of people getting anything related to GI from their primary. What simple tests are we talking about?
Dr. Ali Navidi:
I wish I remembered, because there are these certain kind of red flag things.
Lindsey:
Like fecal lactoferrin or calprotectin or things like that for checking for IBD?
Dr. Ali Navidi:
Yeah, exactly. They need to rule out IBD. At least rule out minimally IBD, they need to rule out something like Celiac. You probably know them.
Lindsey:
Yeah. Probably H. pylori, I would think, and then maybe occult blood, parasites, whatever, things like that.
Dr. Ali Navidi:
Yeah, and look at their blood and make sure there’s no indications that it’s maybe some kind of cancer or something like that.
Lindsey:
Right or maybe CRP to check for inflammation, things like that. Yeah, I do see all the time people who are like, “Yeah, they want to do a colonoscopy, and I’m young, and I think I can see the root cause of this, like I took a bunch of antibiotics,” or maybe they had food poisoning, something like that. And, “Do I really need to go get the colonoscopy?” and people wanting to avoid that. And I always sort of wonder, well, why don’t they just do a fecal lactoferrin? I mean, I don’t know how sensitive and specific it is for IBD, but there’s both calprotectin and fecal lactoferrin, if you do them both, then it seems like together, that would be a pretty good indication if you really need to do the colonoscopy. But I guess for a doctor who does colonoscopies every day, it’s probably like, no big deal for them, but for a person, you’re just like, “Oh my gosh, I’m going to have to drink this stuff, and then I’m going to have to go through this whole medical procedure, and it could be expensive” and yeah.
Dr. Ali Navidi:
And what you said reminded me there’s two main paths that you can develop these kinds of disorders. So IBS is the most well known of the DGBIs. Like I said, there’s a bunch of others. The two main paths are trauma, gut trauma, like they ate some bad sushi and they’re feeling sick, or they got a virus or they got a bacterial infection, and even though that has passed, their symptoms are remaining. And so the brain-gut has kind of learned a pattern, and now it’s just rolling with it. The other way this can happen is if they are going through something in their life, and it could be positive or negative stress. So if somebody’s getting married, somebody loses their job, they’re fighting with somebody in their family, like something that’s stressing them out, often is associated with the beginning of these. And then there’s certain classes of people that tend to be more vulnerable. So someone with an anxiety disorder, history of trauma, someone who’s on the autism spectrum or someone with a history of eating disorders. Those four groups, they all tend to be more vulnerable to developing these DGBIs.
Lindsey:
Interesting. Okay, so, yeah, tell me a bit more about the approach, about the hypnosis.
Dr. Ali Navidi:
So I’d say the majority of people may be listening to this, they hear hypnosis, and they’re immediately thinking of entertainment hypnosis. So what are they thinking of? They’re thinking of the movies with magic or mind control or a stage show. If we take all of that stuff, which is usually what most people know, and just put it to the side and say, “Okay, that’s entertainment hypnosis. What is clinical hypnosis?” Then you get something really interesting. What you get is a technique that has been studied for 40 years, for IBS, let’s say, if we just talk about IBS. It’s been studied for 40 years, and we’re talking about serious medical studies, randomized control trials, all that good stuff. It’s in the guidelines for the American College of Gastroenterology. In England, it’s kind of a standard of treatment, also. It’s really legitimate, and sadly, very few people with IBS would even think of it for their treatment. So what is it exactly? If it’s not entertainment hypnosis, it’s just deliberately teaching someone how to go into a state of trance. And trance is something that happens naturally, that everybody does. So I’m driving to my office. I drive the same way every time, and I’m listening my book on tape right now, and then I get there and I’m at the office. And how did I get there? I’m not sure what happened. I don’t know, but I know what happened in my book on tape. And that’s an example of trance. It’s happening all the time.
Lindsey:
Yeah. Or worse, you’re going somewhere else, but you still drive to your office.
Dr. Ali Navidi:
Yes, yes.
Lindsey:
Which is something I do a lot.
Dr. Ali Navidi:
Yeah. Or, like, you’re used to dropping your kids off and you drive to their school. So you’ve got this naturally occurring state, and so we’re just teaching people how to go into this state on purpose, rather than accidentally. And why do we care about trance? Well, it turns out that in trance, one of the things we can do is we can turn down that visceral hypersensitivity, turn that volume down. And there also seems to be more of an ability to access that brain-body connection in trance. So I’ll do a lot of work with patients with chronic pain. I’ll do a lot of work with patients with GI issues, also. Because in that trance, for whatever reason, they have a stronger ability to make shifts in that brain body connection.
Lindsey:
And then what about the cognitive behavioral therapy and how that plays in?
Dr. Ali Navidi:
Yes, so most people, I think, would have heard of cognitive behavioral therapy. For this kind of work, it’s not generic CBT. So CBT is cognitive behavioral therapy. It’s not generic CBT. It’s a more focused protocol, and I make that distinction, because a lot of patients get sent by their doctors, “Oh, you’ve got IBS, go get some CBT.” That’s a good instinct, but your standard CBT practitioner doesn’t know what to do with IBS. They don’t know what to do with functional dyspepsia or chronic functional nausea. They’ll treat the anxiety, they’ll treat the depression. But a lot of these patients will come back, and when we talk to them, we’ll say, “Okay, we’re going to use CBT in your treatment.” They’ll say, “Oh, yeah, I tried that. It didn’t work for me.” But what they tried was kind of general CBT, not those protocols that are specifically designed for GI problems.
Lindsey:
And what does that look like?
Dr. Ali Navidi:
Well, we want to address various components. So we want to address that habit of hypervigilance. We want to address the catastrophic thinking. We also want to address the various types of avoidance. You often will get avoidance of places and situations, like I don’t want to go on that car trip, or if I’m giving a talk at work, I’m worried that I’m going to have GI issues, so maybe I talk my way out of it or something. So there’s a lot of different kinds of avoidance that occur.
And then there’s also avoidance of foods, right? And some of that is legitimate, and some of that actually is based on factors that are not related to the food. The poor food gets lumped in there with a bunch of other things. And then there’s actually what’s called interoceptive avoidance. So they develop a kind of anxiety that’s associated with their body and specifically the sensations in their gut. So we want to address those levels of avoidance. I usually like to save the food until the end because while people’s systems are hypersensitized, if you try to introduce the foods back in, they’re just going to have a bad reaction to it. So what you do is, once you desensitize the system, turn down the visceral hypersensitivity, reduce the hypervigilance, the catastrophizing, get the system calmed down, then you can go back and start trying to reintroduce foods, and you’ve got a better chance of doing it without them having a negative reaction.
Lindsey:
Yeah, I see a lot of people who are down to a very small list of foods, and in almost every case, they’ll say, “Well, I had that once, and I had this reaction.” And I think, “Well, I suspect that that wasn’t the only thing that was at the meal.” Right? I mean, it’s not usually that you did a one item trial. And you might have had something else going on, like it may not actually be that food. But yeah, slowly but surely, they just keep crossing things off the list or entire categories, say it’s histamines, oxalates, categorically eliminating foods until they’re down to a ridiculously small number of foods.
Dr. Ali Navidi:
And then we’re in the realm of ARFID, avoidant/restrictive food intake disorder. It’s a type of eating disorder where they’ve limited what they’ll eat to such an extent that it’s affecting them in life, socially, physically, mentally. Yeah, and exactly, you hit it right on the head, exactly what you just said. So they’re having a meal. Maybe they’re just having a bad day. They’ve got a higher background level of anxiety for whatever reason that day. So that’s feeding also into their system, so their stomach is more reactive. They eat their slice of pizza, or whatever it is they eat, and they have a bad reaction. Then they conclude, “Well, it seems like pizza is bad for me.” So then the next time they have pizza, they come into that pizza with the level of anxiety and fear, which, of course, is going to cause more symptoms, and then those symptoms are going to confirm that they’re right and pizza is bad, and that’s how pizza gets crossed off the list, right?
Lindsey:
Yeah, I do find it’s interesting, because obviously, when you work with someone, you’re not seeing them, at least I’m not, I might see them every two to three months. So I’m not able to monitor their diet and the minutia of what items they eat and don’t eat on a regular basis. And there are some types of clients that restrict and just stay restricted. They can live off of 12 foods, if that’s what makes them feel good, they’ll live off of 12 foods for the next 10 years. And then there’s others that just kind of keep going, “Well, can I reintroduce? Can I reintroduce?” And I’m like, “Yeah, yeah, definitely reintroduce.” Sometimes I forget to say, “Hey, are you trying now to reintroduce some of these things?” Because you’re more interested in making sure their symptoms are gone than you are in reintroducing foods. But of course, it’s much better if people are pushing and saying, “Hey, When can I start retrying these foods?” Just a note to people out there.
Dr. Ali Navidi:
Yeah, and you’re right, it’s so much easier for me also when they have that desire, that excitement about reintroducing and they even start testing on their own.
Lindsey:
Yes, yes.
Dr. Ali Navidi:
Versus those other people you’re talking about that they’re firmly lodged into, “Okay, this is safe, and things outside of that aren’t safe, and I want to stay safe,” and almost have a belief that they’re injuring themselves if they have the wrong food, like it’s doing harm to them.
Lindsey:
Yeah, that actually makes me think of a podcast I was listening to that was talking about just physical pain, and that you might have a physical pain in doing some type of action or sport or whatever. And if your belief is that that physical pain is injuring you and is hurting you, then it will seem worse, and then if somebody tells you, “No, it’s just a pain, it’s just your brain’s perception of it, but it’s not actually making you any worse.” Then all of a sudden they were like, “Oh okay, well, now I can walk or now I can play tennis.”
Dr. Ali Navidi:
Oh, my god, yeah, you’re opening up a subject that I love to talk about. I work with a lot of patients with chronic pain also, and that’s one of the fundamental concepts that people should understand is that not all pain equals harm. And there’s a really cool story about that. Have you ever heard the story of the two nails?
Lindsey:
No.
Dr. Ali Navidi:
It’s kind of classic in the pain literature. Essentially, somebody’s working in a construction site, and they jump down, and they accidentally jump on one of these long nails that were sticking up out of a board. Goes through their boot and it’s sticking up the other side. They look down. They freak out. Everyone around them freaks out. Pick him up, they carry him, the guy is screaming and yelling and he’s in all this pain. And then you get to the hospital and they give him a bunch of painkillers. It’s not helping. They’re losing it. They cut off the boot and the nail had gone right between the toes. There was no harm, but there was lots of very, very real pain, because when the brain thinks it’s been harmed, it’s going to take those sensations and again, amplify and distort. So this person believed he had been badly harmed, and so his brain gave him the pain that it expected to see.
There’s another example. So the second nail is another construction worker who, I guess, was holding a nail gun, and it kind of went off accidentally, and, like, bashed him in the face, the back of it. Then for about a week or so, it was just kind of hurting, it was a dull pain, not too bad. Eventually, he was like, “This isn’t going away. I should probably go the doctor.” But no urgency there. I think they did maybe an MRI or something, maybe an x-ray, and they saw that he had shot it, and I guess it had ricocheted and come back and lodged in his sinus, and it had been there for at least a week, maybe two, and very minimal pain, because just the way things had happened, his brain did not expect to be finding any pain or much pain at all, right?
Lindsey:
Yeah, that makes me think of a trick that I do every time they take blood. I pinch above the arm where they’re taking the blood on the inside real hard, just as they’re poking me, and half the time I literally don’t feel the needle going in, because your brain can only interpret so many signals at one time, especially on the same arm, right?
Dr. Ali Navidi:
Yes, yes. That’s an awesome trick. Everyone should listen to that. And I think that follows what’s called the gate control theory of pain. It’s why, also, if a kid hurts themselves, knocks into something, if you kind of rub around it and give them all this other stimulus, their brain will mask the pain and the pain will decrease.
Lindsey:
Yeah, that’s why I sometimes see dads like punching kids in the shoulder when they hurt themselves, because it’s like, “Yeah, get over it.” It’s just a distraction.
Dr. Ali Navidi:
And there’s good truth in that. It actually works!
Lindsey:
Yeah! Okay, so I’ve been playing with the Reverie app, and they have this thing where you look up and then close your eyes and then keep looking up as you close them. And that’s supposed to be a test for being hypnotizable. So I’m wondering first, is everyone hypnotizable? Because you did mention everybody can be in a trance state, and how do you test for it? Or how do you find out?
Dr. Ali Navidi:
Yeah, that’s a great question, and what they were doing is what’s called the eye roll. That’s been around for a really long time. And so hypnosis is interesting because it’s probably one of the most studied concepts within psychology. I mean, if you go on to PubMed and just type in hypnosis, you will see thousands of articles, studies, various things have been done with hypnosis. So you’re asking about hypnotizability. That’s been really well studied. And so they’ve done population studies using these concepts. And so what they’ve found is that it’s a bell curve. It’s essentially a bell curve. And so you’ve got a few people on the end who are just amazing at it, a few people at the other end who it’s like talking to a brick wall for them in hypnosis. And then most people are average. The vast majority of people are average. And what I say to people is, “We don’t need you to be amazing. We just need you to not be terrible for this kind of treatment to work.” And so the vast majority of the people it can be helpful if you’re wanting to do chronic pain work, if you’re wanting to do GI work, we just need you to be average or better, and it can be helpful for you.
How do you test? There’s certain tests that have been developed over the years. The eye roll test is one of them. They’re kind of fun, actually. For example, there’s one called finger magnets, where you have them put their fingers out like this, and you give them some suggestions. And I’d say 95% of the time, the fingers come together, almost like they’re being pulled together by magnets. The thing to understand is that trance is natural, and it’s happening all the time. And how do people enter trance? Well, pretty much, you just need two things, focusing your attention and engaging your imagination, and that’ll usually do it. So for example, if you’re thinking deeply about all the different things you want to do today, and so you’ve focused your attention, and now you’re imagining your day, you’ll probably go into a light trance just doing that. If you’re reading a book, you’ve focused your attention, and maybe the story is really interesting, and you’re imagining the characters and all this stuff. You’re going to go into a trance just doing that. Does that answer your question?
Lindsey:
Yeah, yeah. I mean, I was curious too about the eye roll, because I don’t feel like I can do it. I mean, maybe I’m wrong, because, it seems like my eyes go down when I close my eyelids.
Dr. Ali Navidi:
Well, let me see, maybe it’s their instructions. Here’s how I do it, and it takes a little bit of practice. So what you do is, first you look up as if you’re looking through the top of your head, and then you slowly close your eyelids until you feel a flutter, while keeping, yep! Perfect, right there, yep! And then let your eyes relax. So that was it!
Lindsey:
Okay, yeah. I was wondering, because I didn’t do it super easily. But then there was a, “Are you hypnotizable?” little thing you could run through, and I did that, and one of the things was, “Your left arm is floating up, even though you’re not purposefully doing it.” And I’m just like, “I’m not going to just lift it, I’m not going to just lift it,” but I’m like, “I do feel like it’s being drawn up.”
Dr. Ali Navidi:
Nice!
Lindsey:
And then at the end, they tell you, you’re either a poet or, I don’t know, there were three people, you know, if you’re like a poet type. And I’m like, I am the least sort of poet-like person. I’m not very woo woo. So I just was sort of surprised that I was hypnotizable, because I thought, I’m not the kind of person I would expect to be.
Dr. Ali Navidi:
You do not need to be a woo woo poet person to be hypnotized. Absolutely not. We’ve worked with plenty of doctors and scientists and various medical professionals. I think the one factor they found to be really important is people’s ability for absorption. How good are you at getting absorbed in things that you do, the kind of person who could be working and then just lose track of time.
Lindsey:
Oh, yeah, that’s me.
Dr. Ali Navidi:
Right? Yeah, or, you know, you’re working for so long, and then you don’t even notice your body, and then you’re done, and you’re like, oh, and you’re like, all stiff and whatever, but you didn’t notice any of that stiffness, or any of that while you were working. That is the key. You don’t have to be woo woo, but if you have the ability to get absorbed in things, you’ll probably be pretty good at hypnosis.
Lindsey:
So are people who have ADHD, who are super distractible, are they not good candidates?
Dr. Ali Navidi:
Well, that is actually a misconception, because I think a lot of people with ADHD, they have this thing called ADHD hyperfocus.
Lindsey:
Right, right. But it’s usually on, like, computer games, isn’t it?
Dr. Ali Navidi:
Yeah! Well, it’s on things that they like, right? And that’s the problem with ADHD. They have real trouble getting focused on things that they don’t like, whereas people without ADHD can force themselves to lock in, whereas they have a lot of trouble doing that. But they can be amazing hypnotic subjects, because they really can get hyper focused if you can make the experience enjoyable for them.
Lindsey:
Yeah, so how long is a typical course of CBT hypnosis before a person will find resolution of their GI issues?
Dr. Ali Navidi:
Yeah, I don’t think I mentioned, so about four years ago, I responded to the fact that there was nobody out there that does this treatment. I think they did the numbers, and there’s like 500 in the world, right?
Lindsey:
Okay.
Dr. Ali Navidi:
Myself and another psychologist, we got together and created a bigger group practice called GI Psychology. And the idea of GI Psychology is that we were going to make this kind of treatment more accessible to people. We worked really hard to make it available. Now it’s available in all 50 states by telehealth. And so looking at the data from our practice, what we found is that, on average, people take about 10 sessions. That seems to be the average. To put in perspective, that’s a relatively short term treatment when you’re talking about behavioral health stuff.
Lindsey:
Yeah, for sure. And do you take insurance? Or is this all out of pocket?
Dr. Ali Navidi:
We’re out of network for insurance and our patients tend to get about half back.
Lindsey:
If they’ve got a non-HMO plan?
Dr. Ali Navidi:
Yeah, if they don’t have Kaiser or something like that.
Lindsey:
Right, right. Yeah.
Dr. Ali Navidi:
The other thing though, is that there’s something called a single case agreement. It’s also called a gap exception, and we help the patients get this. And basically you’re saying to the insurance company, “Hey, are there any other gut-brain therapists in network for you?” The answer is always no. And so when they grant that, and they grant it like 90% of time, then the patient gets reimbursed as if we’re in network for them. So they end up getting a lot more back.
Lindsey:
Okay, great! So I know that some people may have concerns about hypnosis, and maybe even more so if it might involve a child. So what would you say to reassure them about that?
Dr. Ali Navidi:
Yeah, I think that the concerns, for the most part, I think, rest in that category that we talked about at the beginning, which is entertainment hypnosis. If all I knew about hypnosis was the stuff I saw in movies and TV and stage shows, I would be concerned too! I wouldn’t want to do it! As long as they can understand that there’s a very big difference from what Hollywood is showing you about hypnosis and what it clinically is. So then we get common fears that you’re going to be under somebody’s control. Nobody would want that. But is that actually reasonable? When you’re daydreaming, you’re in a trance. Can somebody control you? Can somebody just suddenly tell you, like, “Hey, give me all your money!” No. Can you get stuck in a trance? If you’re watching a football game and you’re really into football, and you kind of zone everything else out, is somebody going to be able to control your mind, or are you going to get stuck in that state? No, of course not.
What I’m saying is this is actually a very natural thing that we’re teaching people to do. And what I tell my patients is, when they’re learning this, instead of losing control, they’re actually gaining more control over themselves, because we want to teach our patients self hypnosis, also. And what that means is, then they have this skill that they can use to decrease pain, to reduce GI symptoms. It’s a great way to calm down if you’re feeling stressed or anxious. I mean, I’ve had patients come back 5-10 years later and say, you know, I’m still using self hypnosis. They’re just using it for other things. They’re using it, you know, if they’re stressed or they need to figure something out and they need to get away from everything. And you brought up children. It turns out, children are even better at hypnosis, especially between like 8 to 12 years old. When we look at the data, children are even better at hypnosis, and they respond better to the treatment. So for example, adults, 75% of the time, they’re going to reach their treatment goals. That’s a super effective treatment, but kids are even better. They’re like 80-85%, are going to reach their treatment goals. They’re even better candidates for this kind of treatment.
Lindsey:
Yeah, that’s great. One thing that surprised me in using the Reverie app is that the introduction to moving you into a state of hypnosis is very quick. It’s like, do the eye thing, you’re in, basically and practically. And is that really the case in the therapeutic setting?
Dr. Ali Navidi:
Yes. So there’s stages to hypnosis. There’s the pre-hypnosis stage, where you want to explain things to people. Then there’s what’s called an induction. All that is, is the transition between normal consciousness and a trance state. Then they have what’s called a deepening so that’s where you’re getting deeper into the experience of the trance and kind of letting go of that outside world. And then there’s the intervention, whatever that intervention is going to be. And then there’s the re-alerting phase. They’re going to shift you back into your regular state of consciousness. There’s thousands and thousands of different ways to do that induction. It sounds like what they’ve chosen to do is a pretty rapid one, and based on what you’re saying, I don’t know what they’re doing for a deepener.
Lindsey:
Well, it’s probably just part of what they’re saying after that.
Dr. Ali Navidi:
Yeah, that’s probably not the way I would go with someone who’s learning hypnosis. Because just like anything in life, there’s a learning phase to hypnosis, and people will get better at it with practice. And so when people first start, you want to give them time to make that transition. And you want to work with them, which is the difference between an app and a human working with you. I want to work with them to figure out what works best for them. What’s the type of language? What’s the type of imagery? What’s the style that’s going to work for them? Because, like I said, there’s thousands of ways to do it. And then once people have been working with me for a while, they can go into trance in like a minute, once they’ve learned and trained themselves. But at the beginning, I would opt for a longer period of transition, to give people time.
Lindsey:
Yeah, and so if somebody’s experiencing GI issues, when do you think it’s gone beyond, my kid, when he’s nervous, for example, or me, when I’m nervous, I have to run to the bathroom, versus like, this is actually an issue that requires intervention of this kind.
Dr. Ali Navidi:
That’s a good question. I would say that when you start adapting your life to the problem. If you’re just going along and you’ve got to run to the bathroom every once in a while, but it doesn’t actually cause you to do anything different in your life, and it doesn’t really cause you a lot of stress or anxiety, or you’re not up at night thinking about what might happen tomorrow, or your life is not getting influenced by this. Just kind of keep on, keeping on. But once you start shifting your life around this problem, I think it’s time to start thinking about getting it treated. Because these problems are so treatable that it’s almost to me, like a no brainer. It’s a short term treatment, they’re highly effective, and they last. So when they do studies longitudinally, the results stay. These patients are not having to come back to keep this up. For the most part, they’re good to go. Very occasionally, they might come back, and it usually takes like one session to remind them of some of the skills they learned, and then they’re off and running again.
Lindsey:
Yeah, so we were talking a lot about the functional GI disorders and IBS and such, but I assume that there is also a mental component, even to the ones that are autoimmune, even IBD. Is there a role for hypnosis or CBT in those types of conditions?
Dr. Ali Navidi:
Yeah, there recently was a protocol that came out for IBD also, a hypnosis protocol, and it found that it was helpful for IBD patients. Patients with IBD, it’s a different type of treatment, obviously, it’s a different disorder. But there is a lot of overlap. There’s dealing with chronic pain. If you can help people get better at dealing with chronic pain, they’re going to have better quality of life. We know that stress is a big component in almost all the autoimmune disorders.
Lindsey:
Absolutely.
Dr. Ali Navidi:
When people are stressed, it’s going to be worse on their immune system. So if we can reduce that stress, they’re going to tend to do better. There’s also, I forget the right name for it, but basically I think of it as like an overlap. So you might have IBD, and then at different points in your life you’ve had flares, and that’s when your GI system is really going to be causing you trouble, and then the flares go away, or the flares are treated and they’re gone. But what happens with a lot of IBD patients is, they have a flare, the flare is treated, but some of the symptoms don’t go away. And that’s usually because they’ve developed a DGBI on top of the IBD symptoms. And so there’s an autoimmune component, and then there’s also a brain-gut component. The final part is that with IBD, there’s a lot of comorbid anxiety and depression. Especially for us, we understand IBD, we know what’s going on, and so treating that anxiety or depression with somebody who’s already familiar with IBD, and some of the challenges that are involved there, just tends to go better. So we do work with a lot of IBD patients. In fact, we’re working on a joint project with the Crohn’s and Colitis Foundation right now. We’re developing a therapeutic group, which is another option. So patients can see us individually, but we also have groups where we’re trying to teach patients core skills that are going to be useful for helping their gut, and that’s a much more financially accessible option than individually.
Lindsey:
And if someone’s doing work with, say, someone like me working on their gut health from a microbiome standpoint, or working with a GI doctor, maybe they’re taking their immunotherapy or steroids, or whatever they may be getting from their regular doctor. Would you recommend that they do all that first before coming to see you, or do it simultaneously or in sequence? Or see you first? What’s the best order for these things?
Dr. Ali Navidi:
I think, for the most part, it works well in conjunction. What we say is we play well with others, meaning we’re often dealing with patients that have complex medical issues.
Lindsey:
Yeah.
Dr. Ali Navidi:
They don’t just necessarily have IBS. They might also have SIBO. They might also have fibromyalgia, POTS, chronic migraines, other musculoskeletal issues. So there might be a lot going on, and so we frequently work with other providers on the treatment team. For example, there’s a naturopathic physician who specializes in SIBO. We’ve kind of worked together really well for many years, because often he’ll treat the SIBO and there will still be symptoms. There’s always something to treat, usually. It can be pretty resistant. We might have to do multiple rounds. So he’ll continue that treatment while we start the brain-gut therapy. And there tends to be really good results, because there’s often a brain-gut component in a lot of these problems.
Lindsey:
Any final thoughts before you tell us where people can find you?
Dr. Ali Navidi:
Yeah, I think my final thought is, I was in private practice for years and years, and I started this bigger practice because I just felt it was just a terrible shame that people might have these disorders, and they’re so treatable, and we have so much good evidence showing that these treatments work. They might go their whole lives and never get this treatment, and I thought that was really just a terrible thing. My hope is that people will understand that these treatments are out there, and that they don’t have to live with these symptoms, and that if they have a loved one that is going through this, let them know! People should not have to go through this, because these treatments, they really work well. And to answer that final question, the clinic is called GI Psychology, and that’s the website also, and they can get a free phone consult. We have a clinically trained person, they can answer all their questions, see if it’s the right treatment for them.
Lindsey:
Perfect. Great, well this was really interesting and useful, and I’m sure there are heaps of people who can benefit from this that I’ve seen and that are listening. So thank you.
Dr. Ali Navidi:
Yeah, I appreciate you providing this opportunity. Like I said, you’ve got so many great topics on here, so I’m just privileged to be one of the many, so thank you.
If you are struggling with bloating, gas, burping, nausea, constipation, diarrhea, soft stool, acid reflux, IBS, IBD, SIBO, candida overgrowth, fatigue or migraines and want to get to the bottom of it, that’s what I help my clients with. I see individual clients to help them resolve their digestive issues and you’re welcome to set up a free, 30-minute breakthrough session to see if you’d like to work with me. I also have my own two products, Tributyrin-Max, which is particularly helpful for loose stool and diarrhea as it slows your motility and firms up your stool, and SBI powder, which is an all around gut pathogen binder, which is super safe and won’t harm beneficial bacteria, and is usually the first line of treatment I educate my clients about in order to avoid stronger antimicrobial herbs.
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