Revolutionizing IBS Care with Digital Behavioral Therapeutics
By Megan E. Riehl, PsyD | Associate Professor of Medicine, University of Michigan
Irritable bowel syndrome (IBS) is a chronic condition that affects millions worldwide, presenting a challenging combination of symptoms, stigma, and unmet healthcare needs. This multifaceted disorder of gut-brain interaction is characterized by abdominal pain, bloating, and altered bowel habits that can be unpredictable and anxiety-provoking. The American College of Gastroenterology highlights that the gold standard for treatment includes a combination of dietary modifications, pharmacotherapy, and brain-gut behavioral therapy (BGBT) for many patients with IBS. BGBTs are psychological treatments designed to target the brain-gut axis. These therapies aim to reduce symptoms by addressing the emotional, cognitive, and behavioral factors that affect gut health. With proven efficacy, these interventions remain inaccessible to many due to geographic, financial, and logistical barriers. For a significant number of people living with gastrointestinal conditions, these barriers prevent them from receiving the support they need to manage their condition effectively.
As a GI psychologist, I worked with a motivated team of physician champions and our business administration at the University of Michigan to develop a fully integrated GI Behavioral Health Program, which has seen growth and innovation over the last decade. As an early adopter of virtual care, we offered a hybrid model of in-person and teletherapy to improve accessibility throughout Michigan prior to the pandemic. As consumer interest and the value of brain-gut behavioral therapies grow, I have witnessed the transformative potential of virtual and digital health tools in GI care. As an example, whereas BGBTs were almost exclusively available in academic tertiary care centers, there are now services available nationwide from the comfort of a patient’s home through teletherapy (for example, GI Psychology is a virtual private practice with GI mental health providers offering care throughout the United States, www.gipsychology.com). However, this still does not reach enough individuals who are suffering from IBS.
I strongly believe the promise of Digital Therapeutics is not just about technology; it is about transforming and validating the needs of a patient.
Digital behavioral therapeutics (DBTs) represent innovation in GI healthcare. By leveraging BGBTs, such as GI-specific cognitive behavioral therapy (GI-CBT) and gut-directed hypnotherapy, these interventions are delivered via mobile apps and online platforms, making them accessible anytime and anywhere. Recent studies have demonstrated their efficacy in gastroenterological care and will continue to emerge as important areas of study.
A pivotal 2024 study in The American Journal of Gastroenterology explored the digitally delivered gut-directed hypnotherapy program, Nerva, by Mindset Health. This randomized controlled trial revealed significant reductions in IBS symptom severity and improvements in quality of life for participants using the digital program compared to an active control. Gut-directed hypnotherapy, traditionally requiring in-person sessions with trained therapists, becomes far more accessible through digital platforms, reducing geographical and financial barriers while maintaining effectiveness. This democratization of care ensures that a broader population of IBS patients can benefit from evidence-based therapies.
While the potential of digital therapeutics is clear, their implementation must address critical barriers. Consideration for untreated psychiatric co-morbidities, cognitive and intellectual impairment, and motivation must be considered prior to the use of digital therapeutics to address a GI condition. Digital literacy, socioeconomic disparities, and cultural sensitivity in treatment design are also essential considerations. To ensure these innovations do not exacerbate existing inequities, ethical and equity-centered frameworks must guide their development and deployment.
I strongly believe the promise of digital therapeutics is not just about technology; it is about transforming and validating the needs of a patient. While some will benefit from a self-guided app, others may need a product with tools that can offer personalized therapeutic content, real-time symptom tracking, and interactive support, which can foster greater patient engagement and adherence. The developers of digital therapeutics must engage the expertise of the clinicians who expertly deliver this care and have a keen ability to conceptualize how to engage both patients and the providers who will play an integral role in recommending these products. Further, it is clear that with gastroenterology clinics struggling to keep up with the demands of patients, integrating digital solutions into standard care pathways, may help to alleviate the burden of IBS on individuals and healthcare systems alike.
With innovation comes responsibility. Ensuring equitable access requires addressing disparities in technology availability and affordability. Healthcare providers and policymakers must work together to remove insurance coverage barriers and expand access to these transformative tools.
As we enter 2025, we will see new trends in digital behavioral therapeutics for those with GI conditions. Treatment protocols must be informed by science and research that validates their efficacy. Given the immense impact that IBS can have on one’s life, the integration of a digital solution holds immense promise in providing hope and relief to patients worldwide.
Resources:
D’Silva A, Hua N, Modayil MV, Seidel J, Marshall DA. Digital Health Interventions Are Effective for Irritable Bowel Syndrome Self-Management: A Systematic Review. Dig Dis Sci. 2024 Oct 14.
Brenner DM, Ladewski AM, Kinsinger SW. Development and Current State of Digital Therapeutics for Irritable Bowel Syndrome. Clin Gastroenterol Hepatol. 2024 Feb;22(2):222-234.
Anderson EJ, Peters SL, Gibson PR, Halmos EP. Comparison of Digitally Delivered Gut-Directed Hypnotherapy Program With an Active Control for Irritable Bowel Syndrome. Am J Gastroenterol. 2024 Jun 28.
Disclosure: Dr. Riehl is the co-author of Mind Your Gut: The Science-base, Whole-body Guide to Living Well with IBS, co-host of The Gut Health Podcast, and consultant for Mindset Health and GI Psychology.