Is It Just Stress?
What Stress Can — and Can’t — Explain About IBS
You are sitting in a meeting.
Your stomach tightens.
You notice the nearest bathroom.
Then you notice the sensation again.
Within seconds, your attention has shifted. You are no longer fully listening to the conversation. You are monitoring your gut, calculating your options and wondering whether you can leave without anyone noticing.
Someone says:
“It's probably just stress.”
You may have heard that before.
And it can feel dismissive — as though the discomfort is imaginary, exaggerated or somehow your fault.
IBS is not “all in your head”.
But your brain and nervous system are part of the biology of IBS.
That distinction matters.
The more useful question is not:
“Is IBS physical or psychological?”
It is:
How might the gut, brain and wider nervous system influence one another — and where might that give us useful ways to intervene?
IBS is real, physical — and involves gut-brain interaction
IBS is classified as a disorder of gut-brain interaction, or DGBI.
That does not mean there is nothing physically happening.
Quite the opposite.
Modern DGBI models recognise that symptoms may involve different combinations of:
gastrointestinal motility
visceral hypersensitivity
mucosal and immune function
the gut microbiome
the processing of visceral signals within the nervous system and brain. [1,2]
Different people with the same IBS diagnosis may have different combinations of these processes.
One particularly important feature is visceral hypersensitivity.
This means that normal digestive sensations — such as gas, stretching or intestinal movement — may be experienced as unusually uncomfortable or painful.
The sensation is real.
At the same time, how strongly that sensation captures your attention, what you expect it to mean and how your nervous system responds can influence your experience of it.
This is why treating the gut and working with the brain are not competing ideas.
They are different ways of working with an interconnected biological system.
For a broader introduction, read: Understanding the Gut-Brain Axis]
Fact or fiction: does stress cause IBS?
Fiction: “IBS is caused by stress. If you just relax, it will go away.”
That is far too simplistic.
IBS is a complex condition involving multiple interacting processes. Stress is not necessarily what originally caused your IBS, and having symptoms does not mean you are failing to cope with life.
Fact: some stress states can influence IBS symptoms and the way they are experienced.
Studies examining responses to acute mental stress in people with IBS have reported increases in gastrointestinal symptoms and changes in motility. However, findings involving autonomic and hormonal responses are less consistent and vary according to the individual and the type of stressor being studied. [3]
That nuance matters.
Stress is often talked about as if it is one thing — and automatically harmful.
It isn’t.
What do we actually mean by stress?
In the model I use with clients, stress is an umbrella term for a whole-mind/body state produced when the brain and body respond to a perceived demand, challenge or threat.
That stress state can be adaptive or overwhelming.
A manageable work deadline, for example, might activate your system enough to help you focus and perform.
I define that motivating feeling state as pressure.
A meaningful challenge that feels achievable may produce eustress — an adaptive stress state that can support motivation and performance.
That is very different from a situation that is appraised as potentially harmful or beyond your ability to manage.
So telling somebody with IBS simply to “reduce your stress” is often too vague to be useful.
We first need to understand what their system is responding to.
Stressor, stress and anxiety are not the same thing
In the model I use with clients, I define a stressor as an internal or external event — real or imagined — that activates the sympathetic nervous system.
Stressors can include routine demands, challenges and threats.
The stress response is the coordinated whole-body response to a demand, challenge or perceived threat. It can involve changes in autonomic and hormonal activity, attention, thinking, emotions, sensations and behaviour.
Stress is the whole-mind/body state experienced as these processes unfold.
That distinction helps separate what happens from how your system responds.
For example:
A stressor occurs — perhaps an important meeting, a difficult conversation or an unexpected gut sensation.
Your brain and body respond according to how that situation is appraised.
Your stress state changes, which may involve shifts in autonomic activity, attention, thinking, emotions and physical sensations.
Gut function and symptom experience may also be influenced.
Anxiety is more specific.
In the model I use, anxiety is a full-body stress state triggered by an anticipated future danger — a risk — or by uncertainty about a possible future danger.
That distinction can be particularly useful in IBS.
A gut sensation happening now is one thing.
The thought:
“What if I urgently need the toilet halfway through this meeting?”
concerns something that might happen in the future.
That possible future danger is a risk.
The thought representing it is what I call a worry thought.
If that risk is appraised as sufficiently threatening, an anxiety state may follow.
And that state may then influence attention, autonomic activity and the experience of what is happening in the gut.
This does not mean anxiety caused the original gut sensation.
It means there can be interaction in both directions.
Why gut sensations can become harder to ignore
One useful way of understanding this is to think of the gut and brain as two departments within the same organisation.
They are continually exchanging information.
Most digestive signals require very little conscious attention.
Food moves.
The bowel stretches.
Gas shifts.
The digestive tract contracts.
Much of this happens without you needing to think about it.
But IBS research suggests that some people show increased attention towards gastrointestinal sensations and greater vigilance towards symptom-related, pain and threat cues. [4]
That matters because previous experience and context can influence what captures our attention.
If a particular abdominal sensation has repeatedly been followed by severe pain, diarrhoea or an urgent search for a bathroom, experiencing something similar again may understandably attract attention more quickly.
Context can matter too.
A small amount of abdominal movement while relaxing at home may have a very different impact from the same sensation ten minutes before an important presentation when you do not know where the nearest bathroom is.
The physical sensation does not have to be imaginary for its meaning, importance or perceived urgency to vary.
What we should avoid is turning this into the simplistic claim that:
“Your brain is creating your IBS.”
IBS involves an interacting biological system.
What might happen during an IBS flare-up?
An IBS flare-up rarely has one simple cause.
Food, illness, disrupted sleep, hormonal changes, bowel motility and other physiological factors may all contribute.
But once symptoms begin, another process can sometimes become involved.
One possible sequence might look like this:
You notice a digestive sensation.
Your attention shifts towards it.
Previous difficult experiences become relevant.
The sensation is interpreted as potentially threatening.
Attention narrows further around the gut.
Autonomic arousal may increase.
The sensation becomes harder to ignore.
That increased symptom experience encourages further monitoring.
I describe this to clients as a symptom–threat–symptom loop.
It is a clinical model.
It is not a claim that every IBS flare follows those eight steps or that we can know exactly what is happening neurologically in an individual person.
Nor does it mean your brain is deliberately producing symptoms.
One useful way of understanding what may be happening is that repeated painful, urgent or embarrassing experiences can create learned expectations and threat associations around particular gut sensations or situations.
When similar sensations occur again, previous experience may influence attention, prediction and threat appraisal.
This is one way a disorder of gut–brain interaction may become self-reinforcing.
Understanding that gives us somewhere else to intervene.
What role does the autonomic nervous system play?
The autonomic nervous system, or ANS, helps regulate many of the body’s background functions, including aspects of digestion.
Its sympathetic and parasympathetic branches continuously adjust their activity according to what the body needs.
Importantly, the sympathetic nervous system is not simply a danger system.
It helps mobilise the body whenever increased activity, effort or alertness is required — including ordinary activities such as standing, moving, concentrating and responding to manageable demands.
During perceived threat, however, autonomic activity forms part of a broader stress response involving physiological, hormonal, attentional and behavioural changes.
Research supports an association between autonomic function and gastrointestinal function in DGBIs, including IBS. But the findings are complex: studies do not show one single autonomic pattern that applies to every person with IBS. [3,5]
So statements such as:
“IBS means your sympathetic nervous system is stuck on.”
or:
“You just need to increase your vagal tone.”
are too simplistic.
The vagus nerve is an important parasympathetic communication pathway between brain and gut.
But it is one component of a much broader gut–brain communication system involving neural, hormonal, immune and microbial signalling.
What does working with stress in IBS actually involve?
It is not about eliminating every stressor from your life.
That would be neither possible nor desirable.
Demands and challenges are part of normal living, and manageable stress responses can be adaptive.
Instead, I find it more useful to ask:
What is my system responding to?
Is it:
an ordinary demand?
a meaningful challenge?
excessive pressure?
a present danger?
a possible future danger or risk?
uncertainty about what might happen?
a gut sensation that has become associated with threat?
That precision gives you more useful options than simply telling yourself to “calm down”.
Depending on the person, working with these processes may involve:
understanding how the gut and brain communicate
recognising symptom-related vigilance
developing more flexible responses to gut sensations
learning ways to support nervous-system regulation
responding differently to uncertainty and worry thoughts
reducing unnecessary monitoring of symptoms
gradually rebuilding confidence around activities that IBS has made difficult
distinguishing situations that genuinely require action from situations where repeated threat monitoring is no longer helping
None of this involves pretending symptoms do not matter.
And it is not a replacement for medical assessment, medication, dietary treatment, physiotherapy or other appropriate healthcare.
Where does gut-directed hypnotherapy fit?
Gut-directed hypnotherapy (GDH) is a specialised form of clinical hypnotherapy using focused attention, hypnotic suggestions and guided imagery directed towards gastrointestinal symptoms and gut–brain processes.
It is not stage hypnosis.
You remain aware and involved, and you retain your ability to choose how you respond to suggestions.
GDH is one of a number of recognised brain-gut behavioural therapies used in DGBI care. The Rome Foundation supports integrating these approaches with appropriate gastroenterological care, and the American College of Gastroenterology suggests gut-directed psychotherapies for global IBS symptoms. [6,7]
That does not mean psychological treatment replaces medical treatment.
It means that because IBS is a disorder of gut–brain interaction, different treatments may appropriately target different components of the condition.
What might GDH actually be changing?
This is where scientific caution matters.
There are several proposed mechanisms.
Small studies have reported changes involving areas such as visceral sensitivity, colonic motility, the post-meal gastrocolic response and central processing of visceral signals following gut-directed hypnosis. [9]
Those findings are interesting.
But they do not establish one definitive mechanism that explains why GDH helps some people.
So I would be cautious about claims such as:
“GDH stimulates the vagus nerve.”
“Hypnosis directly normalises peristalsis.”
“GDH rewires the gut-brain axis.”
“Hypnosis switches off the stress response.”
Those statements sound impressive.
The science is not yet that precise.
A more accurate position is:
The clinical evidence that GDH can improve IBS symptoms is stronger than the evidence explaining exactly how those improvements occur.
That distinction matters.
What does the clinical evidence show?
A 2025 systematic review and meta-analysis examined 12 studies involving 1,158 people with IBS.
All 12 studies favoured gut-directed hypnotherapy over their comparison condition, although not every individual result was statistically significant.
The pooled analysis found a statistically significant improvement in abdominal pain. The analysis also suggested improvement in global IBS symptoms, although there was considerable variation between studies. [8]
That is encouraging evidence.
It is not evidence that GDH works for everyone.
Response can vary according to the person, treatment protocol, delivery format and how improvement is measured.
That is why I would avoid universal claims such as:
“GDH works for 80% of people with IBS.”
The more responsible message is that GDH is an evidence-based option for IBS, recognised within contemporary brain-gut treatment approaches, with a growing evidence base supporting clinically meaningful benefit for some people.
Where does recalibration fit?
In my work, I use the term recalibration to describe the therapeutic direction rather than to claim a single biological mechanism.
By recalibration, I mean:
gradually shifting the gut–brain axis so that normal gut sensations are less likely to be interpreted as threats, the nervous system becomes easier to regulate, and digestive function and emotional wellbeing can improve.
That may involve changes in how sensations are attended to and interpreted, reduced symptom-related vigilance, greater confidence around previously difficult situations, and more flexible responses when symptoms appear.
It is a clinical framework for understanding the direction of change.
It is not a claim that we can observe a single “recalibration circuit” in the brain.
So, is IBS “just stress”?
No.
IBS is not “just stress.”
And it is not simply the consequence of failing to manage stress properly.
IBS is a disorder of gut–brain interaction involving real biological processes.
At the same time, stress states, anxiety, attention, previous experience, autonomic activity and threat appraisal may influence how gut symptoms are experienced in some people.
The goal is to understand more precisely how stress states, gut symptoms and the wider gut–brain system may interact for you.
That understanding can reduce self-blame and support more informed decisions about treatment.
My Gut-Brain Recalibration Programme uses an integrated approach, with gut-directed hypnotherapy at its core, to help people with IBS work with these gut–brain processes.
Find out more about the Gut-Brain Recalibration Programme.
Book Your Discovery Call
If you would like to learn more about the gut-brain recalibration and how the Gut-Brain Recalibration Program is structured, you are invited to book a 30-minute Zoom call with Tony.
The call costs NZ$49.
If you later enroll in the full programme, the NZ$49 fee is deducted from the full programme price.
Book Your Discovery Call, NZ$49 (Comes Off Your Programme Price)
References
1. Drossman DA, Hasler WL. Rome IV—Functional GI Disorders: Disorders of Gut-Brain Interaction. Gastroenterology. 2016;150(6):1257–1261. doi:10.1053/j.gastro.2016.03.035.
2. Drossman DA. Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features, and Rome IV. Gastroenterology. 2016;150(6):1262–1279.e2. doi:10.1053/j.gastro.2016.02.032.
3. Schaper SJ, Stengel A. Emotional stress responsivity of patients with IBS — a systematic review. Journal of Psychosomatic Research. 2022;153:110694. doi:10.1016/j.jpsychores.2021.110694.
4. Akbari R, Salimi Y, Dehghani-Aarani F, Rezayat E. Attention in irritable bowel syndrome: A systematic review of affected domains and brain-gut axis interactions. Journal of Psychosomatic Research. 2025;191:112067. doi:10.1016/j.jpsychores.2025.112067.
5. Ali MK, Chen JDZ. Roles of Heart Rate Variability in Assessing Autonomic Nervous System in Functional Gastrointestinal Disorders: A Systematic Review. Diagnostics. 2023;13(2):293. doi:10.3390/diagnostics13020293.
6. Keefer L, Ballou SK, Drossman DA, Ringstrom G, Elsenbruch S, Ljótsson B. A Rome Working Team Report on Brain-Gut Behavior Therapies for Disorders of Gut-Brain Interaction. Gastroenterology. 2022;162(1):300–315. doi:10.1053/j.gastro.2021.09.015.
7. Lacy BE, Pimentel M, Brenner DM, Chey WD, Keefer LA, Long MD, Moshiree B. ACG Clinical Guideline: Management of Irritable Bowel Syndrome. American Journal of Gastroenterology. 2021;116(1):17–44. doi:10.14309/ajg.0000000000001036.
8. Adler EC, Levine EH, Ibarra AN, Boparai ES, Hung Y-Y, McCrary QD, Lee JK. Gut-Directed Hypnotherapy for Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis. Neurogastroenterology & Motility. 2025;37. doi:10.1111/nmo.70037.
9. Häuser W. Gut-directed hypnosis and hypnotherapy for irritable bowel syndrome: a mini-review. Frontiers in Psychology. 2024;15:1389911. doi:10.3389/fpsyg.2024.1389911.
Disclaimer: This article is for general information and education only and is not a substitute for medical advice, diagnosis or treatment. Please consult your GP, gastroenterologist or another appropriately qualified health professional about persistent, changing or concerning gastrointestinal symptoms.