The Gut Feeling: How Anxiety Affects Your Digestive System

Woman clenches her stomach experiencing pain and anxiety, demonstrating how therapy at La Jolla Therapy Center can help you or child improve your anxiety, stomach GI issues, and improve quality of life.

It was a Tuesday afternoon when my client walked into my therapy office clutching her stomach, with a pale, pained look on her face. “I don’t know what’s wrong with me,” she whispered. “Every time I get anxious, my stomach feels like it’s tying itself in knots. I’ve been to my doctor, a GI specialist, and even tried changing my diet. Nothing helps.”

As a therapist that specializes in anxiety, I see cases like this more often than most would expect. She’d undergone every medical test under the sun, but all turned out normal. Yet her symptoms persisted: bloating, nausea, cramping, irregular bowel movements, and diarrhea. What my client was experiencing wasn’t “just in her head,” as she feared. It was anxiety, manifesting physically through her gastrointestinal (GI) system.

In my years of practice, I’ve come to understand that the gut isn’t just a digestion machine—it’s also deeply connected to our emotions, particularly anxiety. Let’s explore how this intricate relationship works, and why healing the mind can often be a key step in healing the body.

The Gut-Brain Axis: More Than a Metaphor

When people say they have a “gut feeling,” they’re often speaking more literally than they realize. The gut and the brain are connected through a two-way communication means that your brain can influence your digestion—and your gut can influence your mood. complex communication network called the gut-brain axis, primarily via the vagus nerve. This

The GI tract is home to a vast network of neurons known as the enteric nervous system (ENS), sometimes referred to as the “second brain.” It regulates digestion, but it also sends signals to the central nervous system. That’s why when you're stressed or anxious, you might experience physical symptoms like butterflies in your stomach, urgency to use the bathroom, or even full-blown diarrhea.

Anxiety’s Impact on the GI System

When someone like my client experiences anxiety, the body goes into fight-or-flight mode. This stress response, designed to help us survive threats, diverts resources away from "non-essential" systems like digestion. In short bursts, this can be helpful—but chronic anxiety keeps the digestive system in a state of dysfunction.

Here are a few ways anxiety commonly affects the GI system:

• Changes in Motility: Anxiety can speed up or slow down the movement of food through the digestive tract, leading to symptoms like diarrhea or constipation.

• Increased Sensitivity: The gut may become hypersensitive to normal digestion processes, making mild gas or bloating feel intensely painful.

• Altered Gut Microbiome: Ongoing stress and anxiety can disrupt the balance of good bacteria in your gut, contributing to inflammation and further digestive distress.

• Increased Acid Production: Chronic stress may increase stomach acid levels, exacerbating reflux, ulcers, or gastritis.

  
  

Many of my clients are surprised to learn that their chronic stomach issues are not due to what they’re eating—but rather what they’re thinking and feeling.

The Psychological Toll

Digestive disorders are often accompanied by intense emotional consequences. People may begin to fear social events, travel, or even leaving the house due to unpredictable symptoms. This creates a vicious cycle: anxiety triggers GI symptoms, which in turn cause more anxiety.

This cycle can lead to conditions like:

• Irritable Bowel Syndrome (IBS): Often diagnosed when no structural cause for GI symptoms is found, IBS is highly correlated with anxiety and depression.

• Avoidance behaviors: People may start restricting foods unnecessarily or isolating themselves to avoid embarrassment, leading to nutritional deficiencies and loneliness.

• Health anxiety: The fear that symptoms indicate a serious illness can heighten distress and further exacerbate physical symptoms.

  
  

As a therapist, my role is to help clients break this cycle—not by dismissing their physical symptoms, but by validating their experience and working on the underlying anxiety.

Therapeutic Approaches to Healing

Treatment begins with education. Understanding how anxiety and the gut interact can be incredibly empowering for clients. From there, I often use a blend of therapeutic strategies, including:

1. Cognitive Behavioral Therapy (CBT)

CBT helps clients recognize and reframe anxious thought patterns that fuel the gut-brain loop. For example, “If I eat this, I’ll have a flare-up and ruin my day” becomes “I can handle discomfort if it comes, and I have tools to manage it.”

2. Mindfulness-Based Stress Reduction (MBSR)

Mindfulness helps regulate the nervous system, bringing the body out of fight-or-flight mode. Simple practices like belly breathing or body scans can calm the vagus nerve and ease digestive symptoms.

3. Exposure Therapy

For those avoiding certain situations due to fear of GI symptoms, gentle exposure work helps them regain confidence and freedom in their daily life.

4. Somatic Approaches

I often incorporate somatic techniques that help clients tune into their body’s signals and respond with compassion instead of fear. Tension and anxiety can be “stored” in the gut, and learning to soften those responses makes a huge difference.

Beyond Therapy: A Holistic Approach

Mental health professionals can also collaborate with dietitians, primary care providers, and GI specialists for comprehensive care. Sometimes, clients benefit from dietary adjustments or medications, but the psychological component remains crucial.

I often tell my clients, “Your gut isn’t broken. It’s just trying to speak to you.” Listening—really listening—to what your body is saying can lead not just to symptom relief, but to deeper self-awareness and healing.

After several months of therapy and learning to manage her anxiety, my client began to notice a shift. Her stomach stopped being her enemy. She still had occasional flare-ups, but she no longer lived in fear of them. “It feels like I finally trust my body again,” she said during one of our sessions.

Anxiety doesn’t just live in the mind—it lives in the body, especially in the gut. But healing is possible, and it often begins with recognizing the powerful connection between our thoughts, our feelings, and that unmistakable gut feeling.

Our San Diego, California based counseling practice specializes in helping teens and adults who struggle with anxiety. Through counseling, we help kids and young adults overcome the negative thought cycles, the constant comparison game, and worst-case scenarios that accompany the anxious brain. Additionally, we offer other mental health services, primarily for perfectionists, overachievers or others who don’t feel like they 100% fit in. More specifically we offer treatment for anxiety/OCD, and depression at La Jolla Therapy Center. If you don’t live around San Diego or the commute makes in-person therapy impossible, all of our services are available via online therapy to anyone physically located in California. Therefore, we work with clients from Sacramento to Palo Alto or even Mountain View. You and your family deserve to finally feel less overwhelmed, so let’s get started!