Ep 204: Exploring solutions for Gut-Brain disorders in children, a conversation with Dr. Ali Navidi, GI psychologist

Dr. Navidi is a GI psychologist and on this episode, he discusses the connection between GI disorders and psychology in children. Dr. Navidi explains that many GI issues in children, often fall under disorders of gut-brain interaction. He emphasizes the effectiveness of treatments like clinical hypnosis and cognitive behavioral therapy (CBT) over traditional dietary changes like the FODMAP diet. Dr. Navidi  also discusses the potential side effects of restrictive diets and the potential benefit  of positive expectancy and mindfulness techniques in managing GI disorders. The episode offers a potential effective treatment for children experiencing chronic stomach pain.  

Dr Ali Navidi is a licensed clinical psychologist and the co-founder of GI Psychology, a clinic dedicated to helping children and adults with . His expertise lies in disorders of gut-brain interaction, where he works with children experiencing functional abdominal pain, IBS, constipation, and other GI-related concerns, helping families find safe and effective alternatives to restrictive diets.

You can learn more about his work at www.gipsychology.com

02:42 Common GI Disorders in Children

08:16 The Role of Diet in GI Disorders

12:54 The Brain-Gut Axis Explained

15:42 Hypnotherapy and Psychological Tools

22:46 Integrating Hypnosis and CBT

25:47 Meditation and Breathing Techniques

36:55 Normalizing Tummy Complaints in Children

40:30 Accessing GI Psychology Services

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Transcript

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Hello listeners. This is Dr Jessica Hochman. I'm excited to share that I am now booking sponsorships for your child as normal for this fall. If you have a product, service or a message that you think our listeners would benefit from, whether it's for parents, kids, healthcare or family life in general, this could be a great opportunity. You can find details on how to sponsor by checking the show notes. Just click the link that says how to sponsor an episode, and I'll let you know for a good match and get back to you. Hi everyone, and welcome back to your child is normal. I'm your host. Dr Jessica Hochman, today we're talking about something that I see all the time in pediatrics, stomach aches and digestive issues in kids. My guest is Dr Ali navidi. He's a GI psychologist who specializes in the connection between the brain and the gut. He explains how many children's stomach problems fall under disorders of gut brain interaction, and why psychological therapies like hypnosis, Cognitive Behavioral Therapy or CBT and mindfulness can also be effective tools. I really enjoyed this conversation with Dr navidi. His optimism and guidance bring hope to an area of health that can feel so frustrating for families, and I'm so excited to share his insights with you. And also, before we get started, if you could take a moment and leave a five star review for your child as normal wherever it is you listen to podcasts, I would be so appreciative. I want to take a moment to tell you about tiny health. Tiny health is the first and only at home microbiome test designed specifically for kids. So as a pediatrician, I'm often asked, Should I give my child probiotics? And if so, which one? And the truth is, everyone's microbiome is unique. So without testing, it's nearly impossible to know what your child may actually need. So that's where tiny health comes in. Their Easy at Home test gives you a clear snapshot of your child's gut microbiome, and you'll get back personalized science based recommendations. The results help you know exactly what supports may be helpful, and sometimes you'll find that your child doesn't need anything at all to try tiny health for your family, go to tinyhealth.com and use the code Dr, Jessica, D, R, J, E, S, S, I, C, A, for an exclusive discount. Dr navidi, welcome to your child is normal. Thank you so much for being here. Oh, my pleasure. I'm really looking forward to it. Thank you. I'm so excited to get into the work that you do, because I have to tell you, every day I am talking to people that have tummy troubles that I believe are related to their psychology. So I think the work that you're doing is really important. Thank you. And one of the things I guess, right off the bat, once a pediatrician like yourself has ruled out all those red flags, those tummy troubles, are very treatable, there's tons of research, and the effectiveness of those treatments is really high. So I'm really excited to talk more about that, because I think it's important for parents to know I love that you say it's treatable, because I think that's what's really difficult when parents hear that, the red flags have been ruled out that there's no real bad illness going on when it relates to the stomach, but a lot of parents feel at a loss. They're not sure how to make their kid feel better. So I'm so happy that you have an optimistic perspective on this absolutely and hey, don't take my word for it. There's been research over the last 40 years looking at the types of treatments that we do. These types of Gi disorders fall into a larger category called disorders of gut brain interaction, and that includes things like irritable bowel syndrome, that includes functional abdominal pain, that includes functional dyspepsia or nausea. There's about 20 different disorders of gut brain interaction. They're very common. A lot of kids will develop them at some point in their life, and they're also very treatable. And I'm just curious, how did you get into this field? Can you tell us a little bit about your background? How did you specialize in GI psychology? I'd love to tell you I had, like, this amazing master plan, and that this is what I was going to do, but I got into psychology, and one of the tools I really love is clinical hypnosis. And at the time, I wasn't aware that it had been studied for a really long time in terms of helping patients with GI problems. I only discovered that later, and then once, I started using clinical hypnosis and cognitive behavioral therapy in conjunction with each other to help these gi patients. Then I started getting more gi patients, and then the pediatric gastroenterologist in the area discovered me. They started referring more patients, and they told other doctors, and then before I knew it, it was pretty much like 80% of my caseload, because it turns out there are very few people that are trained to see kids, also trained in clinical hypnosis, also trained in working with GI. So if you put all those three things together, that's why I started the bigger practice called Gi. Psychology, I can see why doctors would love to refer to you, because if you're a primary care physician and you only have so much time per visit, and you've ruled out things that we can help in our medical toolbox, it's always very reassuring for me to have someone to refer to, to know that with confidence that they're going to get better. And what I would see, especially early on, is parents would get that diagnosis for their child, but there really wouldn't be options for them. And so then they would go and get a second opinion and a third opinion, and they'd get more tests, and they'd get scoped, and they'd do the medical merry go round for a year, two years, and then they'd finally find their way to see me, and I thought that was really sad, because these treatments actually don't take that long. On average, it's kind of like eight to 12 sessions to help somebody and kids respond better than adults. So about 70% of adults will reach their treatment goals. About 80% of kids are gonna reach their treatment goals. When you first described the typical diagnoses that you can help with, you mentioned IBS or irritable bowel syndrome, you mentioned functional dyspepsia. Can you describe the symptoms to people listening so that they might realize that their child may fit into one of these categories? Will you point out some of the symptoms to think about. Yeah, absolutely. So let's say functional abdominal pain is a super common one, and it's very straightforward. It's abdominal pain, pain in their stomach that when you get checked out, they can't find any structural reason. There's no physical problem that they can find, and they're just frequently having this pain, and it's not going away. After a week or a month, they're still having it. Irritable bowel syndrome is where you've got pain and then you also have either constipation or diarrhea or both, in which they're kind of cycling in between each other. Functional dyspepsia is more upper GI and so you get a lot more of bloating, and sometimes there's loss of appetite also, which can be also scary for patients, because their kids might not be eating as much, and that's always very scary. Do you find that for a good percentage of the kids that you treat, they also have more anxiety than you might expect from the average child? That's a great question. Yes. So there's four conditions that kind of go along with these types of Gi problems, kids with anxiety. So if they've already gotten anxiety disorder, or they're already anxious, they're more likely to get one of these gi disorders. Kids with a history of trauma also are much more likely to have these kinds of disorders. Kids that are on the autism spectrum are also much more likely to have these and then finally, any kid that has or has had an eating disorder is also very likely to have one of these disorders of gut, brain interaction. What I so appreciate hearing from you is your optimistic perspective that these conditions are treatable, because I find there's a lot of parents that are very frustrated. They go to the doctor, the doctor's ruled out run of the mill, constipation, thankfully, there's no IBD, there's no infection going on, and still, these tummy troubles persist, and they may get the diagnosis of IBS or irritable bowel syndrome, and parents and children feel frustrated because they think there's no great solution. So my question to you is, can you paint a picture for parents? Can you let parents know if you suspect a gut brain problem? What would be some sample recommendations that you would have for a family? Yeah, so of course, they're gonna get medically checked and rule out anything red flag. Once you know dr Hochman has given you that diagnosis, then I think a lot of people start looking at diet, and I would not start there, and paradoxically, like, that's what people think it's like, okay, stomach problems, let's look at what they're eating. Maybe they're sensitive to something. Maybe they're allergic very infrequently. Is that the case, there are specialized diets to help with these kinds of disorders. One of those diets is called the FODMAP diet. I am very hesitant to start a kid on a very strict diet, because that just seems, look, adults can barely do strict diets, and then they're very hard diets to stand so that would be something I might try later. And that's so interesting that you say that, because I will tell you that most gi doctors or gastroenterologists that I talk to, I do believe that's the first place that they start. Yeah, you recommend the FODMAP diet. There's some apps that give parents direction on what foods to avoid. But what I find is tricky with that. As you mentioned, there's so many foods on that list, and part of me wonders, okay. If this was an easy fix, great. Let's say a child finds out okay, when they have garlic and broccoli, their stomach is upset. Okay, we can avoid these foods, but it ends up being a really long list. I find it typically there's not a clear cut solution, and then there's a lot of uncertainty with how long they're supposed to stay off of these foods? Is it for a couple of months? Is it for years? There's not a lot of direction as to when to add those foods back in. So I agree with your point that this is a tempting direction to go in if I could choose another place to start and feel like the child may improve with symptoms, that sounds like an easier place to begin. Let's talk about the FODMAP diet. One is you're not dealing with the underlying problem. The underlying problem isn't that these foods are bad for this child. The FODMAP foods were chosen because they're the foods most likely to cause gas, and when the system is sensitized, then gas is going to be causing discomfort. So the idea is, if you remove the foods that are causing gas for this person, there's going to be less disturbance in the system, and it's going to bother them less. But the underlying problem is that the nervous system is sensitized, and if you can desensitize the system. You can eat all those FODMAP foods. There's nothing wrong with them. And then the other issue is when you take anxious kids and you put them on a diet and you tell them, Okay, stay away from all these foods, because they're going to cause pain, they are very likely to develop an eating disorder, specifically one called arfid. So that's avoidant, restrictive food intake disorder, and that's a very common disorder that we see in many of our patients that have these gi conditions, they've also developed arfid, meaning their list of foods that they're willing to eat is like you could fit it on a page. So if I hear what you're saying correctly, it's that if you find certain foods that do cause more gas in the system, and you remove them from the diet, you take out dairy, you take out the cruciferous vegetables, they feel better temporarily, but you're not really getting to the root of the issue. And then in turn, by taking out these foods and making a more restrictive diet on a kid who may be on the more anxious side to begin with, you may inadvertently make their anxiety even worse, yeah, which may make their symptoms in the long term, not better, yeah, and they're going to start applying that anxiety to the foods, which is not a place you want them to be okay. So that's a really interesting perspective, and I have to admit, not one that I typically hear, but it resonates with me. Yeah, I'm not saying there's a place for those diets. I think if you've got a really severe case, maybe you're doing both. You're working with a GI psychologist, you're on the diet, the diet is decreasing symptoms while you're working on the underlying effort to desensitize the system, and then as you desensitize the system, you start adding food back. Okay, I appreciate this a lot, because honestly, this conversation is changing the way I'm thinking about approaching IBS, and it makes sense to me. So now I'm curious the tools that you recommend for kids with brain, gut, psychologic disturbances. Can you explain the rationale behind the tools that you're recommending? Right? So basically, we want to understand three major things. One is that there's a powerful connection between the brain and the gut. It's called the brain gut axis. It's the intersection between the central nervous system and the enteric nervous system. It's how they interact with each other. And what that means is that what happens in the brain really does affect the gut powerfully, and then what happens in the gut can also actually affect the brain. But what we're talking about here is more brain down. And so what's going on in the brain that is going to affect the gut? Well, one of those things is hyper vigilance. And when you look at these patients, almost every single one of them is going to be hyper vigilant. That means it's kind of like this anxiety, where they're always scanning, always checking their body, and if it's a GI issue, they're always scanning their gut. They wake up in the morning, how does my stomach feel? You know, they eat something. How am I feeling? I'm not sure. And then if they notice something off, then they're catastrophizing. Then it's like, oh my god, I'm not going to make it. I can't go to school today, soccer practice. No, I can't do it. I don't want to go for that long car ride, right? And and so they're really scaring themselves and all that anxiety, it goes right down that brain gut axis, and it actually makes the symptoms worse. So they might have started off with a little twinge, but now there's a cramp. Now there's a pain right the feedback from the gut back up to the brain goes. Through something called visceral hypersensitivity. And what that is, is that the brain is actually amplifying and distorting the signal. And so I'll give you an example. A lot of my patients, they'll say, after I eat, my stomach hurts. And then after they've progressed through treatment, then they're they're saying to me, oh, after I eat, I realized that those are just the sensations of my stomach digesting, and their brain was misinterpreting it, amplifying and distorting it into pain. And I think that's something that people who've never dealt with these kinds of problems before, they don't really appreciate the power of the brain to transform signals. The brain can get things wrong. The brain can signal false alarms, and that's a big part of these problems, is that the brain is chronically sending a false alarm. You know, recently I had on my podcast. Lynn Lyons, she has a wonderful podcast for parents who have kids with anxiety. It's called fluster klux, and she wrote a book about hypnotherapy she was on just a few weeks ago. If anyone's listening who hasn't checked it out yet, I would definitely check it out. But she was talking about how the basis behind hypnotherapy is essentially delivering a different message to patients than they were otherwise telling themselves. So it sounds like in this case, if you can deliver that message to children, that these feelings that you're having, these are normal symptoms. This is just your body doing what it's supposed to be doing. It's digesting your food. Would that be an example of how you're delivering hypnotherapy to children? Absolutely, yes. How that message gets delivered is the art and science of hypnotherapy, right? Do we do it through stories? Do we do it through images? Do we do it through words? And how do we do that? That's why we train so much. But essentially, the message is your stomach is safe, your stomach is healthy. The signals you're getting are uncomfortable, but they're fine. It doesn't mean there's danger. I wouldn't necessarily directly say that, but that's what we're conveying to them in various ways. It's so true that the brain feeds the gut, and the gut sends signals back to the brain. I think probably anybody listening can think of a time when they got butterflies in their stomach before having a nerve wracking conversation with somebody, maybe some GI upset, before taking a big exam in college. I think it's very common to think of how the brain affects your stomach. It's interesting, because I think we all kind of know that, and we had many experiences of it. But when it comes to these problems, it seems like people automatically go to the food, or they go to I need some kind of medication. And I'm not saying there isn't a place for medication, but in terms of research, it's not nearly as effective as the treatments that we're talking about for these types of Gi problem. Interesting. And along the lines of food and medication, probiotics often get recommended, and peppermint oil often gets recommended. Is that something that you also recommend? Or what are your feelings on those recommendations? I mean, peppermint oil. I think there's some research showing it can be helpful. I don't know if it's super effective, but I think that at least there's some, I think, in terms of probiotics, that's a very complicated area. And then we're dealing with another area that can be tricky, something called SIBO, small intestine bacterial overgrowth. And essentially, there isn't supposed to be a ton of bacteria in the small intestines. And then if they find that there is that can also cause similar types of Gi problems. And so that's usually something that probably should get looked at, especially if you've got these chronic gi problems. Do you Do you have a lot of patients where there are mixed diagnoses, for example, I have a fair number of patients who have celiac, for example, or lactose intolerance, and they also have some elements of brain gut distress. Yeah, it's very common. And the reason it's common when you're talking about celiac or you're talking about inflammatory bowel disease patients, is because anytime you go through gi trauma, you're more likely to develop a brain gut problem. I think of it almost as like PTSD of the gut, right? So let's say you've got celiac, and you've spent years eating foods that are causing real problems in your gut, and you just don't know it. Your kid doesn't know it, your parents don't know it, but they've, they've had all this pain and discomfort, and then suddenly you figure it out, and you restrict gluten. You. Yeah, but there's still gi problems, but it's because all of that trauma in the past has created this hyper vigilant system where probably that visceral hypersensitivity is happening also. So the idea of hypnosis sounds really appealing to me. I love medical interventions where there's really no side effect that I can think of, and potentially a big upside. So for people that are listening, can people use your services? Yeah, so I got frustrated, and then five years ago, started this bigger practice, and we knew that this is such a rare specialty that we wanted to make ourselves available to people. So we've worked really hard making all the jigsaw puzzle of all the licenses work so that we can see patients in all 50 states, right? And we see them by telehealth. And then the next question a lot of people ask is, Does hypnosis work by telehealth? And it actually works great. And they've done some studies, and they find hypnosis is also effective. And also anecdotally, do you find yourself success with your patients? Oh, that's the reason I love doing this work so much. It's actually not terribly hard to treat these gi disorders versus give me a functional abdominal pain disorder any day over, let's say, like a really severe generalized anxiety that's going to take time, you know, that's going to take a lot of ups and downs in treatment, but a functional abdominal pain and IBS, they respond fairly quickly. And kids respond even better than adults, because they haven't had the problems for as long, and their minds are more flexible, so they're often seeing benefits after the fourth or fifth session, so a ton of success, and also, just as a therapist, it also opens the door for helping patients with other issues they might have, because after you've helped them with their GI disorder, there's a lot of trust, there's a lot of therapeutic momentum, and so you can help them with their anxiety or their phobia, or talking about someone the other day who's got a really severe Wasp phobia, and doesn't sound like a big deal, but if you live in an area where there's bees and wasps, they don't like to go outside, right? And so after you help them with their stomach, you can also help them with that too. I love it. I love that you say that you look forward and want to treat kids with functional abdominal pain, because I do honestly think a lot of doctors don't want to treat those patients, because in their minds and their experience, it's hard to see them get better. So I'm really happy too that someone like you exist because just nice to have hope for families. And there's so many people out there that need it, and that's the thing, these are very difficult patients. If you're not aiming at the right parts of the problem, and when you are, they're not hard to treat at all. They respond really well. And I like to joke that the one side effect of learning how to use clinical hypnosis is that they have a skill in terms of self hypnosis that they can use to calm themselves down for the rest of their life. And hearing you talk so passionately about hypnosis is that your favorite first go to for treating these types of patients. Our model is to integrate so to kind of simplify it, let's say we're using the clinical hypnosis to help calm them down and reduce the visceral hypersensitivity that distortion of the sensations, and then we're using a special form of cognitive Behavioral therapy to address the hyper vigilance and the catastrophizing, and then we're also treating all the avoidance that often comes with a lot of these patients. So they're avoiding situations, they're avoiding foods. They have fear of their own body, essentially. And can you explain for people who may not be aware, what is Cognitive Behavioral Therapy or CBT therapy. Yeah, cognitive behavioral therapy is the idea that what you think affects how you feel, and that affects what you do and how you act, and any one of those areas can be targets of intervention. So you could work on helping them shift their emotions, and that's gonna help change how they're thinking. You can help them learn to change how they're thinking, and that'll influence their emotions. You can help them change how they act. You know what I mean, and so cognitive behavioral therapy is a collection of tools to help patients make changes in those three variables. So I think sometimes it helps to paint a picture with an example. What if I come to you and I say, Dr navidi, my stomach really hurts. I noticed that my stomach always hurts right before I have a big event. I'm starting college next week. How would you talk to a patient like that? Yeah. So if we're going on the hypnosis side, that would be one thing. If we're going on the cognitive behavioral therapy side. So a lot of times, people just aren't aware of their thoughts. Their thoughts are happening really fast, and what they become aware of is that when they think of school, they feel nervous, right? And they're missing that piece of like, what precisely are the thoughts? And so maybe the thought is, you know, I'm gonna have to go to the bathroom in the middle of the day, and I'm just gonna be really embarrassing, and people are gonna hear me making noises in the bathroom, and then they're gonna make fun of me, right? Like there's this whole train of thoughts. And so now immediately, when they think of school, they're thinking of all that stuff super fast, and then they're feeling anxious, and then their stomach hurts worse. And then they try to basically start talking themselves out of going to school that day, right? And then we start building awareness of that pattern, and then giving them tools to shift those thoughts, to change the way they're thinking, to think about it in a more kind of logical, clear way that isn't blowing the problem up. It isn't catastrophizing. I have a good friend who had a lot of difficulty with IBS, a lot of stomach discomfort, especially around particular foods, and he, I'm happy to say, is now cured of his IBS, and he credits meditation to helping his symptoms. Have you ever tried implementing techniques like breathing exercises, meditation, mindfulness techniques to help patients with their symptoms? Absolutely, it's wonderful. One of the first skills we teach is usually something very simple, like diaphragmatic breathing. And I think if we're talking to all the parents out there and they've got a kid who has some of these GI issues, a really nice thing they can do without even having to come to somebody like myself, is if you go to YouTube, there's a lot of good videos for kids on how to do diaphragmatic breathing. So basically, it's a special way of breathing that activates the vagus nerve, which then sends you into rest and digest mode in terms of your nervous system. And it's a very valuable skill, and pretty much, I think every human should know how to do diaphragmatic breathing. I'm doing it right now. I'm putting my hands on my stomach and I'm taking some deep breaths. Yeah, we put your hand on your stomach sometimes, if you're just learning, you put it on your chest because you want to make sure your chest isn't moving a lot, right, and if it is moving, then you want to shift it more to your stomach, to your diaphragm, and then you just kind of breathe in and out at a nice, slow pace. And another thing a lot of times people get wrong about diaphragmatic breathing is that when they think deep breathing, they think a lot of air, and that's not what we want, because that's when we get people hyperventilating, and they start to feel a little dizzy, and they feel a little weird, and it's not going to help them, right? So we want, like, nice and slow, but we don't want to be taking in a ton of air. And do you recommend doing breathing like this, symptoms or just sort of habitually as part of your everyday routine, but all of the above. Yeah, so you want to start by training yourself to do it in a low stress time. So do it when you don't have symptoms, and you start to get good at it once you can reliably calm yourself down doing it, then start using it during those times when you have symptoms. I find this such helpful advice, because you can do this anywhere, anywhere you are. You can stop and take some breaths, and if that works to calm you down and help you feel better. What a great tool. Yeah, and I'll give a little bonus. If you go and do this with your kid, what you can teach them to do is do something called an anchor. So an anchor is, if you remember, in school, they taught you about Pavlov and the dogs, it's like ringing the bell. They start drooling. This is a similar concept, but you're linking some gesture or some movement to relaxing. So what you do is, every time you're going to practice your diaphragmatic breathing. Let's say you make a fist like this, and then you do your breathing, and you calm down. And then you make a fist, you do your breathing, you calm down over and over. Eventually, the brain learns whenever you make the fist, you're gonna calm down, so that then you make the fist, and you calm down without even doing the breathing. What a great tool. I think it's very helpful to hear that there are many options to consider, because while one thing might not work great for somebody, a different tool may work better for somebody else. So it's just nice to have a lot of options in the toolkit, so to speak. Yeah, so it's like cognitive behavioral therapy. A lot of doctors will hear that CBT is helpful. So we'll say, Okay, go see your local CBT, your cognitive behavioral therapist in your area, and they're gonna treat anxiety and they'll treat depression. But there's a specific way of using CBT to treat GI and most people aren't trained to do that, so a lot of times. Patients will come to us and they'll say, Oh, we already tried CBT. It didn't help. And we'll say, Well, maybe you didn't try it like this, and there's a specific way to kind of apply it. So that being said, meditation also is a wonderful tool. So you could say, CBT, meditation, clinical hypnosis. It's an amazing toolkit, because some people might do better with CBT. Other people respond better to meditation. Other people for them, clinical hypnosis is like the thing, right? And so you have different tools for different folks. I've been looking into your work, and I love that you stress the power of positive expectancy, that if the mind is trained to think positively, that our symptoms will follow suit and that things will improve. Can you talk more about that? Because that that way of thinking really resonates with me. I think that a lot of people, they just underestimate the power of the mind. I find that this way of thinking is really powerful and has a lot of potential to work. And I point this out because I have a lot of people in my life that do the opposite. They try to think in the negative. Because I think they do it as a protective mechanism, that if they think through the worst possible outcomes, well, then if something better than that happens, they won't be so disappointed in that. And psychologically they think that makes them feel better in the end. But I think the opposite. If I really think the best thing is gonna happen, and I look for the best things, those good things tend to happen, if that makes sense, 100% and this is kind of a side, but I can remember looking back at some journal entries I had written, and at one point I wrote, I want to have my own private practice, and that was years before I ever was close to doing that. And then, oh, I want to have this bigger group practice that really helps people. Like it was in my head, and I think I probably forgot that I wrote it, but I think so all those people in your life that do the opposite, I've got some advice for them, and they don't have to stop doing all their negative thinking. I just want to tweak it just a little, right? So you can say, Okay, you're thinking about doing X or Y. Have all your negative thoughts, and then pause and think about the best version of you, how you would handle it if those negative things happened. Then go on to think about what would happen if the best outcome occurred. I see so let's say my worry is I have stomach upset and I worry that I'm gonna go to the bathroom at school. Someone's gonna hear me, someone's gonna make fun of me. If that were to happen, could I handle next master fire scenario? And the answer is yes. I think we all could play out the worst case scenario and work through it some way or another, and imagine your best self walking out of that bathroom looking at and say, Hey, some days you have a bad day, and then just keep on going, right. But then also imagine you go to school, and maybe you don't need to go the bathroom, and you have a good time, and you chill out with your friends, and then you go home. Right? People are so uneven in the way they think about things, and they don't even realize it. They think they're being accurate, because I've thought of all the worst things, but have you really been accurate? Because you haven't thought of the good things and you haven't thought through how you would handle it if those bad things happen, their thinking just stops at the worst part of their imagination and doesn't go any further, yes, and I think, you know the line, you fake it till you make it, or you just keep smiling through the thing, even if it's hard, and then eventually you'll feel better. I think that's really true in a lot of situations. So if you're somebody listening and someone in your family does have a lot of psychological gi disturbances. Why not try to train the brain to think that even though it's hard right now, things are going to improve, you will heal yourself. Why not? You have nothing to lose? Yeah, you have nothing to lose. And actually, that's probably a more accurate view, based on all the research that we've done, is that if you can begin to change the way you think, about your gut, about the pain, if you can begin to shift your mindset, you're very likely to get over it. And you know the issue is a lot of times people have a lot of trouble doing it themselves, so if they can't pull it off themselves. There's people out there who have spent their lives learning how to help other people do this. But like you said, meditation amazing tool. There are great books on cognitive behavioral therapy for kids. There's little workbooks you can go and use that. There's apps for hypnosis. There's lots of things. Things that you can try, and if you can't manage to do it yourself, there's other people to help you. I think your approach, what you're describing, it sounds like there's very little downside, and only a potential big upside, and best case scenario, a big upside. So I think that the work you're doing makes a lot of sense to me. Well, thank you. Yeah, and the bonus for me is it's it's very satisfying to do this work. I had a 13 year old come and see me the other day, and obviously, not going into details, there was a lot of functional abdominal pain, and we were able to help him essentially get rid of that within two sessions, and it was pain that was starting to severely affect his life, meaning weight loss, avoiding situations, all kinds of secondary problems coming from it. And in just two sessions, he's feeling better, like, what's better than that? Right in terms of therapy? Oh, to feel like you're helping somebody and you're making a meaningful difference. Nothing better. I agree exactly. And I'm just curious, as a clinical psychologist, do you ever worry that you're potentially missing a medical diagnosis if a child isn't getting better? For example, yeah, I think that's something that's going through our minds. We actually just talking about this issue in our case, consultation meeting earlier today. That's why we make it a practice to get in contact with the doctors we want to start out treatment, just checking in and saying, Hey, this is who we are. This is what we're doing. This is our plan. Is there anything medically you think we should know, right? Because that's not our expertise, right? We rely on you. And then if we're running into trouble, we want to check in again. And then also, usually, at the end of treatment, we want to let you know how things went. I love that you use a collaborative approach. I think that's a great way to go. And I have to tell you, it's so nice to meet somebody who's so optimistic. This is an optimism based on experience. I have seen so many kids come in with their life kind of falling apart, not you know, often essentially homeschooled, not able to get to school, not able to do things and to see them get better and better pretty quickly, just over and over, seeing that happen over the years. So this is coming from just seeing so many kids get better, amazing. And so this podcast is called, your child is normal. So just as a fun question, or just as a thought, are there any normal tummy complaints that you hear from parents that you wish parents stopped worrying about, yeah, I think to certain extent, especially when the parent can see that there's a clear stressor, right? You know, there's something going on at school and their their tummy hurts. I think that would be a very normal tummy complaint. And I think what you want to do at that point is reassure them and explain to them in age appropriate language. Hey, sometimes when we're worried here, our tummy gets worried also, and it starts hurting, right? And maybe we don't need to be so scared about whatever it is because and then start talking to them about the issue that's scaring them, right? I love that advice. It's so true. Reassuring kids can go a long way. Hey, I see that your stomach hurts. I get it. Think about it. You're starting school. It's a big deal. That's a big transition, but once you get into the routine, let's see how things go, because I'll bet your stomach will start to feel better. Because I think sometimes parents will not knowing better, they'll get really anxious about the stomach, and they'll kind of transmit that anxiety and reinforce the kids anxiety. Googling things, they find things they're catastrophizing. They can't help it, but they leak it to their kids, and then all of a sudden, everybody's spiraling and worrying. So I think that's a really, really helpful piece of advice, that if there's an explanation for the tummy upset, instead of worrying, along with your kid, offer a reassuring, supportive voice that this is normal. What is that medical saying? If you hear hoof beats, think horses, not zebras. That I love that, saying, I agree with that, saying, you want to look for horses, not zebras, absolutely, yeah. And so you know your kid, you know it's Sunday night or it's Monday morning and school's restarting, and probably know they're anxious, and if they're talking about their stomach hurting, it's probably a horse. It's probably not a zebra. It's probably a brain, gut, stomach ache, and I'm curious for you. Dr navidi, if you are feeling anxious, what is your favorite go to calming ritual for yourself? Do you listen to music? Do you use hypnosis? What is your go to? Relaxation. I used, I use hypnosis, and I've done exactly what I was telling you about. So I have created an anchor over the years. And so right before this podcast, I was like, Oh, I hope I do well. And then I was like, Oh, I'm feeling a little jittery. Let me calm down. So I did my fist. I took a nice deep breath, I did my fist, and then I released it, and I just said, Relax and and I did, and I relaxed. And it happened because I trained my brain that that was the cue, and it knew exactly what to do. It knew exactly how to relax. That says a lot that you practice what you preach, who wouldn't want a way to kind of de stress within like less than 30 seconds. I'm biased, of course, but I think all humans should learn at least that skill, which is to have a really reliable anchor to calm themselves down. Yeah, I couldn't agree with you more. Now tell everybody, where can they find you so they've listened to you talk they're convinced they want to bring their child to talk to you or use your services. Remind everybody your website, any other resources that can steer parents in your direction? Yeah. So the website is gipsychology.com and we offer a free phone consultation, and that's someone who's clinically trained, who will answer all your questions, who will help you figure out if this is the right treatment for you or your or your child. And I encourage you, because there's nothing to lose by just doing one of those phone consultations and just seeing if it's right for you. And I'm just curious. I find that a lot of parents wonder this question, but do you take insurance, or is this service outside of insurance? So we're out of network and but it's not as bad as you might think, because there's two things that actually make it a lot better. The first is it's reimbursable, so the parents pay for the session. They get a super bill, and they could submit to their insurance and it's reimbursed, just like mental health. And so we found, on average, they get about 50% back. But there's also something called a single case agreement, and that's something with an insurance company, because we're such a rare specialty, we help the parents do this. You're submitting to the insurance and you're saying, hey, insurance company, do you have a gut brain therapist in network for me to see? And the answer is always no. And so about 90% of people who apply for these things get them approved. So yes, we're out of network, but it's actually not as bad as you might think, if you kind of go through this process, and we help them go through the process. I love that you work to make things more affordable for families, and I really appreciate that gi psychology offers virtual care across the United States. What a wonderful service. So thank you very much. I'm really proud of the work that you've done. Oh well, thank you so much, and it was a pleasure talking with you, and you're really helping us in our mission. Our mission is really to get the word out, because I think there's so many people whose kids will go through a very long time of bouncing around treatments and getting treatment by Dr Google when there's actually a treatment out there that's going to work for them, but they just don't know about it. I'm so happy to help get the word out. So I wish you more continued success, more growth, and hopefully you'll write a book soon. I think that would be good too. Well. Thank you so much. It was really a pleasure talking with you. Likewise. Thank you so much. Thank you so much for listening to your child as normal. I'm so grateful you're here and part of this community. If you're enjoying this podcast, it would mean the world if you shared an episode with a friend subscribed and left a five star review. And don't forget to follow me on Instagram at ask Dr Jessica for parenting tips and updates. See you next Monday. You.