Written by Anuradha MascarenhasNew Delhi | October 10, 2025 11:52 AM IST 4 min readIn fact, a new report in The Lancet Gastroenterology and Hepatology says that behavioural therapies should be now considered as a treatmentNiranjan S*, 34, would relish the occasional butter chicken and crispy samosa. But every time he had them, he experienced bloating, gas and discomfort. He often brushed them off, saying he had a sensitive stomach, probably triggered by stress and spices. But repeated and continued flare-ups disrupted his life. There were days when he would suffer from cramping and abdominal pain to diarrhoea and constipation. He found it difficult to strike a balance between enjoying the food he loved and managing a gut that refused to listen.He then consulted Dr Ashwin Porwal, consultant colorectal surgeon, who diagnosed him with Irritable Bowel Syndrome (IBS), a chronic condition that affects the large intestine, causing recurrent abdominal pain, bloating and changes in bowel habits like diarrhoea, constipation or both, without any visible damage to the digestive tract. It usually happens because the gut-brain axis is disrupted, when the brain and gut cannot communicate with each other. This leads to increased sensitivity and altered muscle function of the gut. Intestinal muscles that contract too strongly or too weakly can lead to diarrhoea or constipation. “Niranjan had a tough time as excessive bloating and gas triggered headaches, insomnia and panic attacks,” Dr Porwal said.A gut microbiome test result of 0.75 indicated the presence of harmful bacteria in his gut. Then Niranjan was put through prebiotics and probiotics to encourage the growth of good bacteria and behavioural therapies to control his stress. “We guided the patient on how to manage hunger pangs and reduce screen time, advising him to avoid devices for at least one hour after waking up and two hours before bedtime. This took care of his anxiety. We also advised deep breathing, slow exhalation and drinking water. Of course sleep. The problem with IBS is there is no drug to cure it. But it can be managed by several lifestyle changes. For example, eating smaller meals and avoiding trigger foods, reducing stress that aggravates inflammation through practices like yoga and deep breathing. The gut-brain axis restoration plays a crucial role in both digestive and neurological improvement,” says Dr Porwal.New meta-analysis in The Lancet supports behavioural therapiesIn fact, a new report in The Lancet Gastroenterology and Hepatology says that behavioural therapies should be now considered as a treatment. “Some, such as IBS-specific cognitive behavioural therapy (CBT) or gut-directed hypnotherapy, have specific techniques and, therefore, are in their own class of brain–gut behaviour therapies. Others, such as stress management or relaxation training, are common or universal techniques that are present in most classes of brain-gut behaviour therapy,” the authors said.What is the brain-gut behaviour therapy?It is a specific type of behavioural therapy that modifies the way the brain processes gut-related sensations and stress responses to improve IBS symptoms.“This is important,” says Dr Suresh Jain, consultant gastroenterologist, “because IBS is not a disease but a common functional disorder often influenced by stress and emotional well-being. That is why stress-reducing practices such as meditation and mindfulness, along with managing overthinking, are frequently recommended to help alleviate symptoms.”Such therapies help patients understand the link between their thoughts, feelings and behaviours related to their GI symptoms. Hypnotherapy uses suggestions in a relaxed state to decrease sensitivity to GI sensations and improve gut functioning. Mindfulness training teaches patients to focus on the present moment and observe their thoughts and feelings without judgment, which can reduce anxiety about their symptoms.More trials neededStory continues below this adAuthors have called for larger, more rigorous trials to be conducted to confirm the effectiveness of different behavioural therapies and to identify which patients are most likely to benefit from them. Their findings are based on an updated meta-analysis which builds on a previous 2020 meta-analysis on the topic from the same authors, adding 26 new randomised controlled trials (RCTs) with 3,298 patients, for a total of 67 RCTs and 7,441 participants. The review compared the effectiveness of behavioural therapies against various controls such as receiving education, dietary advice or routine care, as well as against each other. While several behavioural therapies appeared effective, the authors argued for more rigorous trials, given some confounding factors.Anuradha Mascarenhas is a journalist with The Indian Express and is based in Pune. A senior editor, Anuradha writes on health, research developments in the field of science and environment and takes keen interest in covering women's issues. With a career spanning over 25 years, Anuradha has also led teams and often coordinated the edition. ... Read More© The Indian Express Pvt Ltd