The Hypnotherapy is interesting. But the Wikipedia page [1] says "there was insufficient evidence to support its efficacy."

And in the research paper, there are also statements like "the current evidence is limited" [2], "it is unlikely hypnosis will be helpful to all clients" [3] or "the number of patients enrolled in the studies has tended to be low and lacking long-term follow-up" [4].

So, I think for some people Hypnotherapy may work. But it may be risky to pay a lot of money upfront for the therapy.

[1] https://en.wikipedia.org/wiki/Hypnotherapy [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5786848/ [3] https://www.ncbi.nlm.nih.gov/books/NBK66430/ [4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2752362/

The efficacy and amount of evidence definitely varies per condition - I wouldn't say it's a pancea for every health condition and there's more research to be done for sure.

As we build these programs we'll focus on where there is the most evidence and conduct our own research to further back up the work we're doing. Thanks for checking it out!

Can you point us to the conditions for which the strong evidence of efficacy exists?

Isn't it a bit backward to enter an industry when the entire basis of efficacy is highly suspect? You mentioned that the mechanism of action was that hypnotherapy 'focuses people so they are more open to new ideas and perspectives'; how is that supposed to assist in the treatment of IBS?

I second the request, and consider a lack of answer to be somewhat damning.

For the most part I feel that the 'general' HN toward various forms of therapy is often a bit too harsh. If research indicates that an approach works for 'some types of cases', HN comments often criticize it for not working across the board. Or a lack of overwhelming evidence is considered enough reason to reject the whole thing.

My personal 'minimum' is that there should be some evidence, that isn't too shoddy, that an approach works.

If that minimum isn't met and if users can try an approach for free (like this app?), I feel the placebo effect makes it too easy for people to end up paying anyways, and that makes the product all but snake-oil.

An app like that will always have to generalize, thus limiting its efficacy to either light or very specific cases. That's why I'm interested to see how they can manage to personalize their offering.

The subscription model however seems counterproductive - the business side wants to continue subscriptions as long as possible while the stated goal is to solve a problem thus minimizing subscriptions. I wonder if a 'pay it forward' model would work. So that if it was effective for you, you could pay for a month of a stranger's subscription.

Yeah we're actively trying not to generalize,which was a big reason we split the IBS program into its own product (Nerva). We plan on continuing the issue-specific product development rather than building a broad app including all issues.

Interesting idea - I'll see if there's a way we could implement this. We've definitely tried to align ourselves with building an effective program, if you pay through the website and don't see an improvement in symptoms after the program, you can get a full refund.

If it were strongly effective in treating any one of those use cases then the app would be an absolute hit! They have, so far, declined my invitation to provide evidence. It seems like a relatively simple concept to test in a double blind study.

Sorry about the delay, we're based in Melbourne, Australia so time zones are an issue. The two most researched areas include IBS and Chronic Pain, which is why they're the first focuses for us.

Here are some studies on IBS using hypnotherapy: - https://onlinelibrary.wiley.com/doi/full/10.1111/apt.13706 (the study we're based off) - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1773844/ (5 year effects showed) - https://pubmed.ncbi.nlm.nih.gov/25736234/ (1000 patients, 76% responding) - https://pubmed.ncbi.nlm.nih.gov/24840368/ (meta analysis of IBS hypnotherapy studies)

In terms of how hypnotherapy works for IBS, the exact mechanism isn't known. It's been shown to help with reducing visceral hypersensitivity and improving intestinal motility, thought to be due to utilising the gut-brain connection.

And for pain management: - https://www.semanticscholar.org/paper/Controlled-trial-of-hy... (fibromalgia) - https://pubmed.ncbi.nlm.nih.gov/16025734/ (disability related pain) - https://pubmed.ncbi.nlm.nih.gov/19459087/ (low-back pain)

There's also more research into other areas including: erectile disfunction, exam anxiety, depression, etc.

The harder part with a double blind study is developing the placebo side, since from a patients perspective it's very easy to know if you're getting the psychological treatment (hypnotherapy) or not. It's possible using a sham treatment or something similar, or using a waitlist or active control.

> An app like that will always have to generalize, thus limiting its efficacy to either light or very specific cases.

Very specific cases was what I meant. Focusing on those for which there is evidence.

Yep this is our exact aim! I've responded with some of the studies above, if you have any questions about the studies or areas, I'd be more than happy to speak about them.

I've had good experiences with hypnotherapy, the most effective being a self-recorded audio. I took a more or less standard hypnotherapy text from Brian Alman and Peter T. Lambrou's book and adapted it to my needs. Experiencing my past self wishing me well, encouraging me, calming me was quite a bit more powerful and trustworthy than any abstract 'radio voice'.

Well worth the time to try and record it yourself, for yourself.

That’s really cool, its taking self-hypnosis to the next level. I personally dislike hearing the sound of my own voice haha but glad to hear you’re finding it helpful.

Haha, yes, I took a few tries to get the tone of the voice quite right. Maybe something for to explore in future releases of your app? A guided, self-created hypnotherapy session. Could take away the fear of and resistance to 'losing control' that many experience when the idea of being subjected to hypnosis comes up.

Yeah I think it’s a great idea - we’re really interested in expanding the level of personalisation our programs provide and this could be a feature. Definitely, it’s harder to fear losing control when it’s your own voice.

Can you explain how that is hypnotherapy? Sounds like self reflection?

Self-reflection, as I understand it, is pretty much the opposite of hypnotherapy. Self-reflection is analytical, while hypnotherapy is like having a dream. Except that you wrote and directed that dream beforehand.

I like to use the language of IFS therapy for the explanation. It assumes that we are made of a self and, in addition, different parts. The parts have different ages, different needs and different solutions, but they all want what is best for us. So in a person with e.g. fear of public speaking there might be a younger part that remembers how it got humiliated when speaking publicly, and there might be a managing part that tells them 'you're an adult, a professional, you have to get on stage, it's beneficial for your career'. The first one wants to protect them and the second one wants to let them thrive, they are both right, but there is still a conflict. With self-reflection it might happen that they just decide that the second one is right, and the first one has to shut up, but it doesn't solve the problem, it just exiles it even further.

With hypnotherapy and other techniques that use imagination, I first allow my body to relax, and ask the conflicting parts to calm down for a moment and see that calm is possible. I need >10 minutes for that, but once that is established, I can show both parts a scenario where the things that they fear will go wrong, go right. Then I aknowledge how that feels and slowly exit the session. Instead of shutting up an important part of me, I allow it to see that things can and will go right, and if they go wrong, it will be still acceptable. When you do it a dozen times, it kind of sticks.

This is of course a simplified explanation of just one kind of hypnotherapy.

I started using the Mindset app the last time I read about it on HN, maybe a month or so ago. I've found it to be very useful--in addition to therapy, meditation and self-help videos on YouTube--in helping me fight some depression, low self-esteem and guilt that I've been trying to resolve. I hope that your app catches on and more people realize that "focusing sessions" can help them detach from work, social media, and their own toxic thoughts about themselves.

Two pieces of feedback for you though. First, once someone does a program, it seems that there are unlimited "reinforcement stages" where you repeat the program again to reinforce the learnings. It would be nice to cap the reinforcement stages at say, 3 stages, to encourage users to feel a sense of completion and either try the other programs or just repeat the whole program again. Second, I think a program centered around facing one's past would be really useful--at least, I'd use it. Other than that, I think the app is really well done, and congratulations to you and Michael Yapko on your hard work.

Awesome, glad to hear you've found it so useful!

Yeah that's a great idea! I guess our thinking regarding the stages was to allow further progression if people wanted to keep listening longer than say 3 stages but allowing people to redo the entire program would accomplish the same while also allowing for that 'completion' feeling.

Thanks for the suggestion! We'll bring the idea up to Dr Yapko around developing some sessions for it.

This is great, guys! I have IBS, and there's always been a lack of research-backed options for alleviating symptoms besides the low-FODMAP diet. I actually have a friend who has tried this program and has had tremendous results, and it's cool to see that there's another app for broader purposes. Wishing you guys luck!

Thanks! The low FODMAP diet is a great option but there's many people who would prefer not to have to restrict their diet (myself included).

That's really great to hear! Let us know if he has any feedback.

Some say fecal transplants are also great (for many things including IBS), is that true from your research?

Fecal transplants are not currently an approved treatment for IBS but there has been some recent research indicating it could potentially be helpful in some cases: https://www.jwatch.org/na50649/2020/01/09/fecal-microbiota-t...

Very interesting. I’ve had promising initial results with hypnotherapy for bruxism, though I need to go a few more night doing hypnosis while tracking bruxism to see.

That's great to hear. It's actually one of the areas we're looking at building a product into due to the effectiveness of hypnotherapy with it.

I’m going to try the ibs version, as I have that too. Have tried low fodmap before incidentally, it helped.

I hope you enjoy and see results from the program - I'd love to hear your feedback and thoughts.

night time bruxism has a high correlation with all sorts of sleep disorders, from apnea to REM-sleep disorders

Why not on Android?

Particularly considering that these apps most probably only plays and controls audio files, a single codebase for both the platform would have been easy to consider.

Initially when we developed Mindset we could only program in Swift so Mindset was built for iOS only.

We are now moving to React Native so should be getting Mindset out on Android soon. Ideally we want to have a single codebase for all of our apps.

The lack of skepticism here is genuinely surprising.

Surprising in a good way or a bad way?

They've provided a lot of peer-reviewed research, which makes it difficult to hold the skeptical line.

Funnily enough I'm normally the one casting doubt on medical science research on HN. So, I somewhat agree with you, though my issue with the mainstream academic funding and peer review system is that it too often sidelines research that may be promising but may threaten the status quo and its beneficiaries (most commonly pharmaceutical companies), or cannot attract sufficient funding because it offers no path to large profits.

With that said, it's the best system we currently have, and where someone doubts the validity of the results of an accepted study, the onus is on them to explain why they should be questioned.

> The research they linked does not provide evidence for hypnotherapy as an effective solution, and itself states it as needing more research. See the top comment above.

Wikipedia is a notoriously unreliable and biased source of information on medical topics even slightly outside the establishment, and those statements mentioned in that top comment do not disprove efficacy, just point to the need for more research, which is always true for this field.

> So, I think for some people Hypnotherapy may work.

Great! So do I. No treatment like this works for 100% of people who try it, but for those for whom it does work, we should be very pleased.

> But it may be risky to pay a lot of money upfront for the therapy.

That's why this company's apps are great; they cost very little, compared to 1:1 professional hypnotherapy or other forms of therapy, and are paid monthly or quarterly and can be discontinued any time. There's even a 7-day free trial and a money-back guarantee if you pay via their website.

Congrats guys!

My parents sent me to a hypnotherapist when I was a kid for treatment of insomnia. Unfortunately, it didn't help, but it was an amazing experience.

We're just up the road in Sydney, and working on some sleep tech. I'd be keen to hear about your experience at YC as an alternative therapies company.

Great stuff guys.

I’ve had a look at some of the research papers but didn’t find any detail on these questions:

- Aside from direct physiological response to the hypnosis, is there also evidence of efficacy due through changes in behavior? I.e., greater adherence to diets or other lifestyle changes? I note that some of negative comments in this thread focuses on efficacy relative to diets like low FODMAP, but I can imagine these approaches could be complementary rather that dichotomous.

- Is much known about why it works on a psychophysiological level? I.e., a reduction in cortisol changes the way the digestive system functions, or a change in one’s beliefs about their place in the world leads to a change in the way certain food ingredients are rejected vs accepted by the body?

Thanks!

There hasn't been any research that I've found around increasing adherance to diets but it makes logical sense. If hypnosis amplifies CBT and increases the ability to learn then it make sense that it would help changing the attitudes and perceptions around behavior.

For IBS specifically, it's thought to work on the gut-brain axis by improving motility (i.e. the speed of transit of food through the digestive tract) and reducing gut sensitivity (a large portion of IBS patients have visceral hypnersensitivity). It has also been shown to improve psychological functioning by reducing levels of stress, anxiety and depression which often act as IBS triggers and worsen symptoms.

The comparatively effective treatment for IBS was essentially a taped hypnotherapy session - is the rest of the Nerva platform undergoing review? Will you discourage users who’ve used FODMAP, even inadvertently, from signing up?

Great question! The approach used in the study also used psychoeducation and breathing exercises as well and we’re in the early stages of an observational study into the Nerva program. What do you mean re discouraging users who’ve tried FODMAP?

I read their comment as perhaps meaning that the study showed fodmap + hypnotherapy was no more effective than fodmap + hypnotherapy. A result I found surprising. (Unless it means the problem was effectively solved in both case, so no more improvement was possible)

Ahhh I understand - that’s a good point. Many people follow the low FODMAP diet without the direction of a dietitian (against the recommendation on how to do it) and likely aren’t getting the full result so GDH will still provide benefit, as well as helping the psychological side of IBS.

Interestingly, it’s possible they both help with visceral hypersensitivity - FODMAPs ferment in your gut causing gas and your gut to expand and hypersensitive nerves could then be alerting the brain to potential (but false) danger, so by avoid FODMAPs you avoid this process. Hypnotherapy could potentially be coming at the same process but from the top down instead.

Yeah. Your final point could be true if both interventions fully resolved the issue, or at least as much as could be done. If not, it’s puzzling the combo didn’t lead to more improvement.

But certainly I don’t see it as a cause to exclude low fodmap people from trying the app.

Do you have a link to the studies on ibs being caused by hypersensitive nerves? Just going through onboarding in the app and was curious about that.

Yeah, no worries you can read a study about the role of visceral hypersensitivity in IBS here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5056566/

Please, if you have IBS try concrete treatments like elimination diets with a focus on FODMAPs. Hypnotherapy will not heal your gut.

The FODMAP diet is a great dietary option for managing IBS but gut-directed hypnotherapy has been shown to be just as effective as the diet for people who prefer a non-dietary option. The study we reference that found this result was run at Monash University who created the Low FODMAP diet.

Gluten isn’t a fodmap. Instead, fodmaps are present in almost all gluten containing foods. But sourdough bread has low fodmaps, but does have gluten.

So I think you’re conflating two issues. Celiac is an absolute intolerance of gluten, whereas fodmap ibs is based on being unable to digest large quantities. No one really knows why, and it’s not implausible some mechanism such as stress reduction or hypnotherapy would help.

Whereas for a celiac no such solution would work, there’s a real inability to digest. Perhaps in your case this extends to some fodmaps, but gluten isn’t a fodmap.

Also fodmap diets are generally elimination + reintroduction.

I am aware that gluten is not a FODMAP, I can not eat high fructose foods. Gluten causes my body to attack itself which has damaged my small intestine. That has caused fructose malabsorption.

Makes sense. I would note that people with celiac are much smaller than the group of people with IBS. For instance, I have a negative celiac test, no bowel inflammation, but do have IBS. And IBS in these cases is often linked to stress.

So while the app is inapplicable to your case, you’re overgeneralizing from your case to all cases.

(I would of course encourage anyone with IBS issues to get a gluten test. It’s important to rule out!)

I am actually Celiac as well and follow a strict gluten free diet so I know where you’re coming from. Although the cause of IBS is unknown, it’s a functional condition which means it’s problem with how the gut works but doesn’t lead to any damage. Instead, it’s thought that visceral hypersensitivity could be at play, where the nerves in the gut are overreacting to the gas and expansion caused by the fermentation of FODMAPs. IBD (and Celiac disease) on the other hand leads to gut damage and we would definitely recommend against using Nerva for that - it will not work.

Someone looking to fix their gas or regular diarrhea isn't going to be able to distinguish between gut inflammation and not. They're just going to be searching how to fix IBS. I don't see how your app would distinguish between these either, before posing as a treatment.

Nerva is for people have been diagnosed with IBS, not for people who have self-diagnosed themselves. Many conditions present similar symptoms like IBD, celiac disease etc so it’s important people are properly diagnosed before attempting any management options including the low FODMAP diet and GDH.

Nerva isn’t a treatment, it’s a program that teaches people self-regulation skills and relaxation exercises that can help them self-manage their symptoms.

Since you have done extensive research in this field - are there any hypnotherapy 'solutions' for overcoming fear of Public Speaking? Is it in realm of possibility at all?

It's definitely within the realm of possibility! There's been a lot of research in hypnosis for state anxity (i.e. before a test) so I think it makes logical sense that it would help with the fear of public speaking.

On the anecodtoal I know someone who has had significant success using hypnotherapy for public speaking.

Definitely worth exploring.

some form of CBT or mindfulness-related therapy might help too. With various anxiety issues, afaik there's quite a bit of evidence that these approaches can be very effective.

don't know about hypnotherapy though, other than that in my view EMDR is really not that different (and unlike hypnotherapy it is covered by insurance over here and I suspect most of Europe at least).

Do you have an Android version of Mindset?

If not, can you point us to the "pre-recorded sessions from a well-regarded psychologist who practices hypnosis" that worked for you (or similar)?

We're working on it! Until then you can listen to some of Dr Yapko's sessions on his website here: https://yapko.com/audio/

Great, thanks.

I'm curious to try this out, but I can't justify spending $97 for Nerva without any kind of trial period. A promise of a full refund isn't enough, unfortunately.

I'd love to learn more about that as we though the money-back guarantee would help assuage hesitation around trying the program - why doesn't it?

If you do want a free trial the mobile app store subscription has a free trial but doesn't come with a money-back guarantee (Apple's control).

In your view, what's more compelling - a free trial or money-back guarantee?

A money-back guarantee isn't compelling for me, for several reasons. First, I know that I would feel guilty asking for money back, and I want to avoid being in that situation. Second, I don't fully trust money-back guarantees. Third, that's ~$100 that I need to part with when I might see within 1 hour that the product is not a fit.

A free trial would be far more compelling.

FYI I'd be using this on Android.

Thanks for this feedback, it's really helpful! it's something we're thinking a lot about atm so this is great.

If you're interested, you can download the app from the Play Store and try the program with a 7-day free trial. Let us know what you think.

As someone with Celiac disease I know where you’re coming from but you’re conflating two different conditions.

Celiac disease occurs when your immune system damages your stomach lining in response to eating gluten. It’s why a strict gluten free diet is required. Many gluten contain foods also contain FODMAPs but that’s not what’s causing the immune response.

IBS on the other hand is a functional condition which means it’s problem with how the gut works but doesn’t lead to any damage of the gut/stomach lining. Instead, it’s thought that visceral hypersensitivity could be at play, where the nerves in the gut are overreacting to the gas and expansion caused by the fermentation of FODMAPs. By avoiding FODMAPs you limit this process and reduce symptoms - it’s thought that GDH helps with this process from the top-down and that’s potentially why the Monash study (creators of the Low FODMAP diet) found the response rate was so similar between the two treatment groups.

People with celiac often have IBS and are often misdiagnosed with IBS. [1] They are not disjoint problems and often difficult to differentiate. It seems really reckless to offer this as a treatment without requiring people to consult a physician for a proper diagnosis.

1. https://www.beyondceliac.org/celiac-disease/related-conditio...

Nerva is for people have been diagnosed with IBS, not for people who have self-diagnosed themselves. I definitely agree, many conditions present similar symptoms like IBD, celiac disease etc so it’s important people are properly diagnosed before attempting any management options including the low FODMAP diet and GDH.

Nerva isn’t a treatment, it’s a program that teaches people self-regulation skills and relaxation exercises that can help them self-manage their symptoms.

As someone who only suffers from IBS, I have had good results from elimination and low fodmap diet. However stress and anxiety also have a pretty big and equal effect as diet. Both go together for me and even if one of them messes up it, I get a flare up kind of reaction.

Marvelous. Thanks for providing the links. I will try it out.

No worries! I'm interested to hear your thoughts after you do.

Cool

Kind of weird that there's a review for the IBS app on the Mindset page. Also, when you tout what percent of reviews is 5-star, that actually made a flag go up in my mind. Reviews are notoriously easy to game, and app devs don't usually brag about reviews for this reason.

We actually had our IBS program within Mindset when we first launched it before we spun it out into it's own standalone app.

Interesting feedback! It's just one element of social proof, the written reviews are more valuable 100% as I would imagine their much harder to game. What social proof would be better in your opinion?

Thanks for responding! Makes sense about the IBS reference where it is, but presumably this can be replaced by a more current quote in time.

Regarding reviews, I think people are pretty jaded about this. Most of my startup friends whose apps had good reviews had gamed the system. App reviews are more meaningful for established companies like Box or Dropbox. In that case, you already know what the company does and you're just getting a rating of how well the mobile app of that company works. That is, if Dropbox had 2 stars and Box had 5, you'd figure probably something is better about Box.

But when it's some rando new company, the scale of reviews is so small that it could be 95% the founder and their friends/family. If there were a way to show what reviews were paid subscribers, that would be much more valuable. Sort of like Amazon's Verified Purchaser reviews. Still possible to game, but it would require the company to launder money through Apple (and lose 30% along the way).

Oooh good catch! We just uploaded the App Store reviews to our site but can just take out that one - cheers!

Yeah that's fair enough, imo I would think it's difficult to game 400+ ratings/reviews from friends and family but I can see where you're coming from.

I'm surprised Apple/Google don't do that - it's beneficial for both the user and us as a business. We could always do it for reviews on our site but it could always be gamed when it's not held accountable with a third-party like with Amazon reviews.