Launch HN: Mindset Health (YC S19) – Hypnotherapy apps for chronic conditions
We're Alex & Chris, brothers from Melbourne, Australia, and the founders of Mindset Health (https://www.mindsethealth.com). We create mobile apps to help people manage chronic health conditions at home. Our programs use hypnosis-based techniques, developed by clinicians, to help people manage conditions like anxiety, depression & Irritable Bowel Syndrome (IBS).
Mindset Health came out of a difficult period after Chris and I wound down our first startup. During this time, we experienced a lot of anxiety and stress. I ended up being prescribed anti-anxiety medication, but the side effects and the lack of control I felt caused me to look for non-pharmacological options, like CBT and biofeedback.
Someone we trusted recommended hypnotherapy. Chris and I were skeptical about hypnosis (the 'being made to cluck like a chicken' reputation), but after coming around to the benefits of meditation a couple of years before, we were open enough to say we'd look more into the science. We ended up spending a few weeks diving deep into the hypnosis research and were surprised at what we found. Since many HN readers are probably as skeptical as we were, we're going to saturate the rest of this post with references. Hopefully not too many!
Contrary to stereotypes of stage shows with outlandish mind control stunts, hypnosis simply involves becoming focused enough to become more receptive to new ideas or perspectives. Turns out that not only can this help with areas like smoking cessation [1], but conditions like anxiety [2], depression [3], IBS [4], sleep issues [5] and chronic pain [6] can be improved using hypnosis-based treatments. Like many topics in neuroscience, the mechanisms behind hypnosis are still being explored, but a 2016 brain scan study by the Stanford School of Medicine identified changes in brain activity related to absorption, executive control, and awareness [7] which is thought to create a more effective context for the delivery of therapeutic techniques like CBT [8].
It took some time but we decided to look into booking sessions with local 'hypnotherapists' to try it for ourselves. However, many of the people we came across weren't psychologists or qualified practitioners, and most of this wasn't covered by insurance. So we switched to trying pre-recorded sessions from a well-regarded psychologist who practices hypnosis. Those sessions were deeply relaxing and absorbing. Through using them I was able to learn coping skills helped me stop taking my anxiety medication.
This experience gave Chris and me an idea: could we help more people access hypnotherapy by removing the stigma and barriers to trying it? Calm and Headspace had succeeded at doing so for meditation. Similarly to how meditation has become a powerful self-care habit for a healthy mind, perhaps hypnotherapy could become a tool for self-managing chronic health conditions.
Chronic and mental health conditions account for a massive portion of the global healthcare cost (80–90% of the $3.5 trillion annual healthcare spend in the United States [9,10]). For many of these conditions, treatment is more about managing symptoms than 'curing' the condition, meaning that patients are reliant on drugs, surgeries, and/or restrictive diets for long periods of their life - with all of the cost and side effects involved.
We decided to make our idea into reality, and began Mindset Health with the intention of helping people with these conditions strengthen their self-regulation skills and reduce reliance on pharmacological interventions. We currently have two apps that use hypnotherapy to help people manage health conditions (with more on the way, including chronic pain and smoking cessation).
The first app is called Mindset (https://www.mindsethealth.com/mindset), which is based on the work of Dr Michael Ya...
76 comments
[ 5.0 ms ] story [ 137 ms ] threadWell worth the time to try and record it yourself, for yourself.
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.
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.
But certainly I don’t see it as a cause to exclude low fodmap people from trying the app.
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.
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.
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 incredibly grateful I never heard about this before trying an elimination diet. The simple fact is that if I pursued and did not also restrict my diet I would be destroying my body and likely end up sicker than I was before. If you have IBS please pursue a real diagnosis and treat or manage any underlying 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.
1. https://www.beyondceliac.org/celiac-disease/related-conditio...
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.
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)?
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/
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!
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?
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.
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.
Very specific cases was what I meant. Focusing on those for which there is evidence.
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.
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.
That's really great to hear! Let us know if he has any feedback.
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.
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.
On the anecodtoal I know someone who has had significant success using hypnotherapy for public speaking.
Definitely worth exploring.
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).
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?
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.
They've provided a lot of peer-reviewed research, which makes it difficult to hold the skeptical line.
You should absolutely be skeptical of ALL research. A responsibility of other researchers is to evaluate the methods used and claims made in papers. The peer review journal is not a perfect process and nor are research processes more generally.
Most research cannot be reproduced ... So be skeptical of any and all claims made! (i.e. the reproducibility crisis)
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.
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.
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?
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).
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.
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.
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.
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.
A free trial would be far more compelling.
FYI I'd be using this on Android.
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.