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Overview of Published Research To Date on Hypnosis for IBS
By Olafur S. Palsson, Psy.D.
Whorwell PJ; Prior A; Colgan SM. Hypnotherapy in severe irritable bowel syndrome: further experience. Gut, 1987 Apr, 28:4, 423-5. This report summed up further experience with 35 patients added to the 15 treated with hypnotherapy in the 1984 Lancet study. For the whole 50 patient group, success rate was 95% for classic IBS cases, but substantially less for IBS patients with atypical symptom picture or significant psychological problems. The report also observed that patients over age 50 seemed to have lower success rate from this treatment.
Prior A, Colgan SM, Whorwell PJ. Changes in rectal sensitivity after hypnotherapy in patients with irritable bowel syndrome. Gut 1990;31:896. This study found IBS patients to be less sensitive to pain and other sensations induced via balloon inflation in their gut while they were under hypnosis. Sensitivity to some balloon-induced gut sensations (although not pain sensitivity) was reduced following a course of hypnosis treatment.
Koutsomanis D. Hypnoanalgesia in the irritable bowel syndrome. Gastroenterology 1997, 112, A764. This French study showed less analgesic medication use required and less abdominal pain experienced by a group of 12 IBS patients after a course of 6-8 analgesia-oriented hypnosis sessions followed by 4 sessions of autogenic training. Patients were evaluated at 6-month and 12-month follow-up.
Palsson, OS, Burnett CK, Meyer K, and Whitehead WE. Hypnosis treatment for irritable bowel syndrome. Effects on symptoms, pain threshold and muscle tone. Gastroenterology 1997;112:A803. Seventeen out of 18 patients with severe and treatment-refractory IBS who completed a 7-session standardized course of hypnosis treatment improved substantially. All central symptoms of IBS responded to treatment, including abdominal pain, diarrhea/constipation, and bloating. Psychological well-being also increased after treatment, with overall psychological symptoms, anxiety and somatization markedly decreased. Gut pain thresholds and smooth muscle tone, measured with a barostat and balloon inflation tests, were unchanged following treatment.
Vidakovic Vukic M. Hypnotherapy in the treatment of irritable bowel syndrome: methods and results in Amsterdam. Scand J Gastroenterol Suppl, 1999, 230:49-51.Reports results of treatment of 27patients of gut-directed hypnotherapy tailored to each individual patient. All of the 24 who completed treatment were found to be improve.
Galovski TE; Blanchard EB. Appl Psychophysiol Biofeedback, 1998 Dec, 23:4, 219-32. Eleven patients completed hypnotherapy, with improvement reported for all central IBS symptoms, as well as improvement in anxiety. Six of the patients were a waiting-control group for comparison, and did not show such improvement while waiting for treatment.
Palsson OS, Turner MJ, Johnson DA, Burnett CK, Whitehead WE. Hypnosis treatment for severe irritable bowel syndrome: investigation of mechanism and effects on symptoms. Dig Dis Sci 2002 Nov;47(11):2605-14.
© Copyright 2000-2003, Olafur S. Palsson, Psy.D. All Rights Reserved.
Am J Gastroenterol. 2002 Apr;97(4):954-61.
Hypnotherapy in irritable bowel syndrome: a large-scale audit of a clinical service with examination of factors influencing responsiveness.
Gonsalkorale WM, Houghton LA, Whorwell PJ.
Department of Medicine, University Hospital of South Manchester, United Kingdom.
OBJECTIVES: Hypnotherapy has been shown to be effective in the treatment of irritable bowel syndrome in a number of previous research studies. This has led to the establishment of the first unit in the United Kingdom staffed by six therapists that provides this treatment as a clinical service. This study presents an audit on the first 250 unselected patients treated, and these large numbers have also allowed analysis of data in terms of a variety of other factors, such as gender and bowel habit type, that might affect outcome. METHODS: Patients underwent 12 sessions of hypnotherapy over a 3-month period and were required to practice techniques in between sessions. At the beginning and end of the course of treatment, patients completed questionnaires to score bowel and extracolonic symptoms, quality of life, and anxiety and depression, allowing comparisons to be made. RESULTS: Marked improvement was seen in all symptom measures, quality of life, and anxiety and depression (all ps < 0.001), in keeping with previous studies. All subgroups of patients appeared to do equally well, with the notable exception of males with diarrhea, who improved far less than other patients (p < 0.001). No factors, such as anxiety and depression or other prehypnotherapy variables, could explain this lack of improvement. CONCLUSIONS: This study clearly demonstrates that hypnotherapy remains an extremely effective treatment for irritable bowel syndrome and should prove more cost-effective as new, more expensive drugs come on to the market. It may be less useful in males with diarrhea-predominant bowel habit, a finding that may have pathophysiological implications.
PMID: 12003432 [PubMed - indexed for MEDLINE]
Gastroenterology. 2002 Dec;123(6):1778-85.
Long-term improvement in functional dyspepsia using hypnotherapy.
Calvert EL, Houghton LA, Cooper P, Morris J, Whorwell PJ.
Department of Medicine, Wythenshawe Hospital, Southmoor Road, Manchester, United Kingdom.
BACKGROUND & AIMS: We have shown hypnotherapy (HT) to be effective in irritable bowel syndrome, with long-term improvements in symptomatology and quality of life (QOL). This study aimed to assess the efficacy of HT in functional dyspepsia (FD). METHODS: A total of 126 FD patients were randomized to HT, supportive therapy plus placebo medication, or medical treatment for 16 weeks. Percentage change in symptomatology from baseline was assessed after the 16-week treatment phase (short-term) and after 56 weeks (long-term) with 26 HT, 24 supportive therapy, and 29 medical treatment patients completing all phases of the study. QOL was measured as a secondary outcome. RESULTS: Short-term symptom scores improved more in the HT group (median, 59%) than in the supportive (41%; P = 0.01) or medical treatment (33%; P = 0.057) groups. HT also benefited QOL (42%) compared with either supportive therapy (10% [P < 0.001]) or medical treatment (11% [P < 0.001]). Long-term, HT significantly improved symptoms (73%) compared with supportive therapy (34% [P < 0.02]) or medical treatment (43% [P < 0.01]). QOL improved significantly more with HT (44%) than with medical treatment (20% [P < 0.001]). QOL did improve in the supportive therapy (43%) group, but 5 of these patients commenced taking antidepressants during follow-up. A total of 90% of the patients in the medical treatment group and 82% of the patients in the supportive therapy group commenced medication during follow-up, whereas none in the HT group did so (P < 0.001). Those in the HT group visited their general practitioner or gastroenterologist significantly less (median, 1) than did those in the supportive therapy (median, 4) and medical treatment (median, 4) groups during follow-up (P < 0.001). CONCLUSIONS: HT is highly effective in the long-term management of FD. Furthermore, the dramatic reduction in medication use and consultation rate provide major economic advantages.
Randomized Controlled Trial
PMID: 12454833 [PubMed - indexed for MEDLINE]
July 2003 (Volume 125, Number 1)
Cognitive-Behavioral Therapy Versus Education and Desipramine Versus Placebo for Moderate to Severe Functional Bowel Disorders
Drossman DA, Toner BB, Whitehead WE, et al.
Despite the fact that the use of antidepressants and other psychologic strategies may seem intuitive in the setting of moderate to severe functional bowel disease, conclusive data from well-designed trials have been lacking.
In this setting, Drossman and colleagues have conducted the largest randomized trial to evaluate the effectiveness of desipramine, a tricyclic antidepressant, as well as cognitive-behavioral therapy vs their control conditions (placebo and education, respectively) in women with moderate to severe functional bowel disorders. Additionally, these investigators assessed the clinical benefits of the active treatment regimens (desipramine or cognitive-behavioral therapy) in clinically meaningful patient subgroups (ie, with/without history of depression; with/without history of sexual or physical abuse; predominant diarrhea; predominant constipation; moderate vs severe disease).
This randomized, comparator-controlled, multicenter trial involved 431 adult women from the University of North Carolina and the University of Toronto who had moderate to severe symptoms of functional bowel disorders. Subjects received either psychologic (cognitive-behavioral therapy vs education) or antidepressant (desipramine vs placebo) therapy for a period of 12 weeks. Assessment of physiologic, clinical, and psychosocial parameters were conducted before and after end of therapy.
Overall, results suggest that the active psychologic treatment (ie, cognitive-behavioral therapy) was effective for women with functional bowel disorders, including irritable bowel syndrome, whereas the active antidepressant treatment (desipramine) appeared to only be effective in the management of those patients who were adherent (ie, able to stay on their medication). Specifically, by intention-to-treat analysis, cognitive-behavioral therapy was found to be significantly more effective than its placebo condition (education; P = .0001; responder rate, 70% vs 37%, respectively; number needed to treat [NNT], 3.1). By contrast, desipramine did not demonstrate significant efficacy vs placebo in the intention-to-treat analysis (P = .016; responder rate, 60% vs 47%, respectively; NNT, 8.1) but did show a statistically significant benefit in the per-protocol analysis (P = .01; responder rate, 73% vs 49%, respectively; NNT, 5.2). The latter was especially significant when subjects with nondetectable blood levels of desipramine were excluded.
Results of subgroup analyses demonstrated that cognitive-behavioral therapy had benefit over its control condition for all subgroups except those patients with depression. By contrast, subgroup analyses indicated that active antidepressant therapy (desipramine) was more beneficial than placebo for women with moderate vs severe symptoms, a history of abuse, without comorbid depression, and with predominant diarrhea.
The investigators highlighted several limitations associated with this study that should be considered. First, at least moderate side effects were observed in up to 25% of subjects taking desipramine, and thus some participants may have become unblinded. However, it should be noted that similar side effects occurred in up to 15% of participants receiving placebo as well. Additionally, dropouts occurred in 23% of patients allocated to treatment; therefore, data that anticipated treatment responses were "imputed" for several of these individuals. Finally, the fact that all patients fulfilling Rome I or II criteria for functional bowel disorders were included also warrants some consideration. Overall, however, as the study authors emphasize, these findings may be generalized to any patient who fulfills the selection criteria used in this trial, who is treated by their standardized psychologic protocol, or who is compliant in taking desipramine as prescribed.
Thus for women with moderate to severe functional bowel disorders, cognitive-behavioral therapy is effective and desipramine may be effective when taken adequately. It is important to note, however, that certain clinical subgroups are more or less amenable to these relative treatments.
American College of Gastroenterology 68th Annual Scientific Meeting
Baltimore, Wednesday, October 15, 2003
"Hypnosis for IBS"
Palsson and colleagues previously reported positive results associated with the use of hypnosis in patients with IBS. It was found that hypnosis (45 minutes every other week for 12 weeks as well as self-hypnosis techniques) improved both IBS symptoms (pain, bloating, and disturbed defecation) and psychologic parameters (somatization and anxiety scores). However, the real-world effectiveness of hypnotherapy presupposes motivated patients and ready access to an appropriately trained therapist.
During this year's meeting of the American College of Gastroenterology, Palsson and colleagues expanded on their previous work by reporting the results of a 3-month home hypnosis program for patients with IBS. The study authors compared the improvement (in multiple symptom parameters) of 19 patients with IBS treated with self-hypnosis (conducted via audio compact disc instruction) with 57 age-, sex-, and symptom severity-matched controls treated with standard medical therapy. Fifty-three percent of the hypnosis patients had improvement in overall IBS symptoms compared with 26% of the controls (10 of 19 vs 15 of 57; P < .05). Quality of life was also significantly improved among patients who underwent hypnosis, and these treatment differences were shown to persist at 6 months. These investigators also found that patients exhibiting greater degrees of anxiety were less likely to respond to hypnotherapy, suggesting that other methods of therapy may be more useful in this subset of patients with IBS."
17. Palsson OS, Turner MJ, Johnson DA, et al. Hypnosis treatment for severe irritable bowel syndrome: Investigation of mechanism and effects on symptoms. Dig Dis Sci. 2002;47:2605-2614.
18. Palsson OS, Whitehead WE, Turner MJ. Hypnosis home treatment for irritable bowel syndrome (IBS): exploratory study. Am J Gastroenterol. 2003;98:S274. [Abstract #822
Gut. 2003 Nov;52(11):1623-9.
Long term benefits of hypnotherapy for irritable bowel syndrome.
Gonsalkorale WM, Miller V, Afzal A, Whorwell PJ.
Department of Medicine, University Hospital of South Manchester, Manchester, UK.
BACKGROUND: and aims: There is now good evidence from several sources that hypnotherapy can relieve the symptoms of irritable bowel syndrome in the short term. However, there is no long term data on its benefits and this information is essential before the technique can be widely recommended. This study aimed to answer this question.
PATIENTS AND METHODS: 204 patients prospectively completed questionnaires scoring symptoms, quality of life, anxiety, and depression before, immediately after, and up to six years following hypnotherapy. All subjects also subjectively assessed the effects of hypnotherapy retrospectively in order to define their "responder status".
RESULTS: 71% of patients initially responded to therapy. Of these, 81% maintained their improvement over time while the majority of the remaining 19% claimed that deterioration of symptoms had only been slight. With respect to symptom scores, all items at follow up were significantly improved on pre-hypnotherapy levels (p<0.001) and showed little change from post-hypnotherapy values. There were no significant differences in the symptom scores between patients assessed at 1, 2, 3, 4, or 5+ years following treatment. Quality of life and anxiety or depression scores were similarly still significantly improved at follow up (p<0.001) but did show some deterioration. Patients also reported a reduction in consultation rates and medication use following the completion of hypnotherapy.
CONCLUSION: This study demonstrates that the beneficial effects of hypnotherapy appear to last at least five years. Thus it is a viable therapeutic option for the treatment of irritable bowel syndrome.
The remarkable effects of meditation on the brain
We think of the seat of the soul as the brain, in concert with the rest of the nervous system. The Dalai Lama speaks of a "luminous consciousness" that transcends death and which he thinks might not have brain correlates, but we believe even this must be realised neurally.
So an interesting question for neuroscientists is how do the brains of Buddhist practitioners or indeed any other wise, happy and virtuous people light up? How are the qualities of happiness, serenity and loving kindness that arise from the Buddhist practice of mindful meditation reflected in the brain? How does that subjective experience manifest itself?
Neuroscience is beginning to provide answers. Using scanning techniques such as PET and functional MRI, we can study the brain in action. We now know that two main areas are implicated in emotions, mood and temperament. The amygdala twin almond-shaped organs in the forebrain and its adjacent structures are part of our quick triggering machinery that deals with fear, anxiety and surprise. It is likely that these structures are also involved in other basic emotions such as anger. The second area comprises the prefrontal lobes, recently evolved structures lying just behind the forehead. These have long been known to play a major role in foresight, planning and self-control, but are now crucially implicated in emotion, mood and temperament.
With this knowledge in hand, a few prominent neuroscientists have begun to study the brains of Buddhists. The preliminary findings are tantalising. Richard Davidson at the Laboratory for Affective Neuroscience at the University of Wisconsin at Madison has found that the left prefrontal lobes of experienced Buddhist practitioners light up consistently (rather than just during meditation). This is significant, because persistent activity in the left prefrontal lobes indicates positive emotions and good mood, whereas persistent activity in the right prefrontal lobes indicates negative emotion. The first Buddhist practitioner studied by Davidson showed more left prefrontal lobe activity than anyone he had ever studied before.
We can now hypothesise with some confidence that those apparently happy, calm Buddhist souls one regularly comes across in places such as Dharamsala, India the Dalai Lama 's home really are happy. Behind those calm exteriors lie persistently frisky left prefrontal lobes. If these findings are widely confirmed, they will be of great importance.
Buddhists are not born happy. It is not reasonable to suppose that Tibetan Buddhists are such a homogeneous biological group that they are, uniquely among humans, born with a "happiness gene" that activates the left prefrontal cortex. The most reasonable hypothesis is that there is something about conscientious Buddhist practice that results in the kind of happiness we all seek.
What about the effect of Buddhist practice on the amygdala and other subcortical forebrain circuitry? This circuitry, you will recall, is involved in relatively automatic emotional and behavioural responses.
Now, thanks to important work by Joseph LeDoux at New York University, we know that a person can be conditioned via their amygdala and thalamus to be scared of things that really aren 't worth being scared of. We also know that it is extremely hard to override what the amygdala "thinks" and "feels" simply by conscious rational thought.
That said, there is some fascinating early work that suggests Buddhist mindfulness practice might tame the amygdala. Paul Ekman of the University of California San Francisco Medical Center, a renowned researcher on basic Darwinian emotions, is, like Davidson, in the early stages of studying Buddhist practitioners. So far, he has found that experienced meditators don 't get nearly as flustered, shocked or surprised as ordinary people by unpredictable sounds, even those as loud as gunshots. And Buddhists often profess to experience less anger than most people.
I believe research like this will eventually allow us to answer the question of whether Buddhist training can change the way the brain responds most importantly with negative emotions to certain environmental triggers. Antidepressants are currently the favoured method for alleviating negative emotions, but no antidepressant makes a person happy.
On the other hand, Buddhist meditation and mindfulness, which were developed 2500 years before Prozac, can lead to profound happiness, and its practitioners are deeply in touch with their glowing left prefrontal cortex and their becalmed amygdala.
From New Scientist Magazine 24 May 03
December 2002 • Volume 123 • Number 6
The growing case for hypnosis as adjunctive therapy for functional gastrointestinal disorders
Olafur S. Palsson
William E. Whitehead
In 1984, Whorwell et al.1 in Manchester, England, published a small but well-designed placebo-controlled trial of hypnosis as a treatment of irritable bowel syndrome (IBS). They randomized 30 patients with severe, refractory IBS to either 7 sessions of hypnotherapy or the same amount of psychotherapy plus placebo pills. The results indicated that hypnosis treatment had specific (nonplacebo) effects that substantially improved the central IBS symptoms of all the patients in that group (who showed far greater improvement than the control group). In a follow-up article,2 the investigators reported that clinical improvement was maintained in all the hypnotherapy patients during a 2-year posttreatment period.
A dozen other hypnosis studies on IBS, by the same group3–6 and by other investigators in several countries,7–14 have followed this initial trial. The additional studies have largely confirmed the high efficacy of hypnosis in IBS treatment, although the 100% response rate in the first study has generally not been equaled. This body of research has made hypnosis the most investigated psychologic treatment of IBS. In that regard, it is rivaled only by cognitive-behavioral therapy, which also shows a high success rate and substantial impact on IBS symptoms in some trials.15,16
Although some of these studies have been small and inadequate in design, hypnotherapy has emerged from the cumulative experience of this work not only as effective in improving the gastrointestinal (GI) symptoms that define IBS but also as a potent way to counter the quality of life impairment, disability, and excess health care costs associated with the disorder.3,4 This is most recently shown by the largest systematic assessment to date (250 consecutive patients) of the therapeutic impact of this treatment, reported in 2002 by the Manchester group.3 Based on the more than 50% average reduction in IBS severity, substantial reduction in anxiety and depression, significantly reduced health care costs and improved quality of life noted in this report, and good maintenance of symptom improvement beyond 2 years after treatment, it might be argued that hypnotherapy is more effective than any other single treatment modality for severe IBS.
In the present issue of GASTROENTEROLOGY, the Manchester group again presents a controlled trial of hypnotherapy,17 this time targeting functional dyspepsia (FD). The design closely parallels the group's 1984 controlled trial1 for IBS. As in that study, patients were randomized to either hypnotherapy or to an equal amount of supportive psychotherapy combined with placebo medication. However, the present study added a second side-by-side control group of patients randomized to standard medical treatment.
The hypnosis intervention used in this study is also largely identical in form and in content to what the Manchester group has used for many years for IBS, with some relatively small modifications to address FD symptoms.
The impact on FD from the hypnotherapy reported in their article closely mirrors the benefits of hypnosis seen for IBS. The mean reductions in symptoms were about the same as for IBS3 (59%) and continued to improve after treatment, reaching a remarkable average of 73% reduction in severity at 1-year follow-up (in contrast with the comparison groups). Greater decreases in medication use and improvement of quality of life after hypnotherapy were noted in this trial. As in the treatment of IBS, the therapeutic effects are generally well preserved at long-term follow-up.
Although replication of this first therapeutic trial for FD is needed, it expands considerably our knowledge of the potential for hypnotherapy as a treatment of functional GI problems. FD and IBS jointly account for more than half of the workload of gastroenterologists.18 Up to half of these patients are dissatisfied with standard treatment,19 which highlights a considerable unmet need for adjunctive or complementary treatments that can improve efficacy and patient satisfaction. With the present FD hypnotherapy study indicating that this treatment method may be as effective for FD as it is for IBS, it is becoming increasingly hard to ignore the notion that the skills of the hypnotherapist should be made routinely available to patients with functional GI disorders. The evidence consistently argues that wide availability of hypnotherapy would make management of these disorders more effective and would add broad benefits in improved emotional well-being and functional status of these patient groups. It might also produce large savings in cost of care for health care systems because of reduction in medication use and health care visits.
These potential advantages of hypnotherapy as adjunct in the management of IBS and FD raise the question whether it would be possible to implement routine adjunctive hypnosis management in mainstream care for GI disorders. The short answer is that, although feasible, it would, at least in the United States, require overcoming substantial practical and systemic obstacles.
Psychologic treatment is currently used only rarely as a therapeutic modality for functional GI patients, offered to less than 10% of all patients in primary care and gastroenterology clinics. Furthermore, this option is probably exercised mostly with patients who either present with significant psychologic symptoms or have not responded to conventional treatment. Many health maintenance organizations dissuade primary care physicians from routinely making outside referrals for psychologic treatment of functional GI disorders because of the higher up-front cost of such care. Reimbursement for psychologic treatment of functional GI disorders is furthermore limited or nonexistent in many insurance plans. All of these aspects of the health care system would have to be addressed and corrected to make hypnosis for FD and IBS widely available.
Perhaps an even more serious hindrance to widespread application of hypnotherapy for functional GI disorders is the limited availability of suitably trained and experienced clinicians. Only a very small proportion of physicians and nursing staff have the training or experience to administer hypnotherapy. Because of time pressures on physicians, such work may be impractical, especially in primary care settings, in which a series of 30-minute sessions with any one patient is likely to seem an unattainable luxury. Close collaborative ties with hypnotherapists do not exist in most medical settings. In the United States, mental health professionals, many of whom have little knowledge of functional GI disorders and therefore are often reluctant to undertake treatment of these disorders, practice much of clinical hypnosis.
Finally, popular perception of hypnosis, which even today carries an unfortunate and erroneous legacy of mystery and coercive influence over people from popular media and stage shows, may make some patients and physicians less receptive to considering this treatment option.
In light of the growing evidence of the value of hypnotherapy in enhancing care for functional GI disorders, it would seem timely to make a concerted effort to examine ways to remove these barriers and facilitate the availability of such treatment; for example, by providing systematic training to health professionals specifically in hypnotherapy for functional GI disorders, integrating hypnotherapy services, and enhancing reimbursement and referral patterns for such treatment.
The Manchester group, the pioneers in the domain of GI hypnosis, represents 1 model of how hypnotherapy can be effectively integrated with clinical gastroenterology. They have established a unit dedicated to medical hypnotherapy, working hand-in-hand with the gastroenterology service, and using 6 hypnotherapists who treat a large numbers of functional GI patients with hypnotherapy.
Apart from practical hindrances that continue to keep hypnotherapy from broad use for GI disorders, a number of important research questions remain unanswered about such treatment:
The mechanism of the impact of hypnosis on functional GI disorders remains obscure. Unlike pharmaceutic agents for IBS and FD, which have a clearly delineated mechanism of action, it is largely unknown how hypnotherapy produces its effects on GI symptoms. It is well documented that hypnosis can modulate GI functioning. The hypnotic state seems by its own virtue to increase oro-cecal transit time20 and quiet colonic motility.21 Experimental application of specific hypnotic suggestions and imagery can also have demonstrable effects on gastric secretion22 and transit time.20 Tests performed during hypnosis show decreased perception of discomfort in patients with IBS6 and FD.23 However, the research to date on posttreatment changes associated with hypnotherapy have provided very little evidence5,6,10,11 that overall changes in physiologic parameters such as pain thresholds, muscle tone, or autonomic functioning are central to the therapeutic effect, with the possible exception of increased pain thresholds for the most pain-sensitive subgroup of patients.5 Further work is needed to elucidate the main mechanism of action that produces improvement in GI symptoms.
Side-by-side comparisons with other psychologic treatments are still lacking. Various other psychologic treatments have also been reported to have a positive impact on IBS symptoms, including cognitive-behavioral therapy,15,16 interpersonal therapy,24 stress-management training,25,26 and psychodynamic therapy.27 It remains uncertain at this time whether hypnotherapy is superior to these alternative psychologic treatments because no side-by-side comparative studies have been conducted.
Combined effects with medications are unknown. To date, the research on hypnotherapy for FD has exclusively tested it as a monotherapy. The combination of this psychologic treatment with medications such as antidepressants and the 5-hydroxytryptamine modulating agents for IBS seems in order, if this type of treatment is to be considered as an adjunctive therapy in medical care. Such combination trials are also important because experience from non-GI trials of combined psychologic therapy and pharmacotherapy for headache28 and depression,29 for example, suggests that such a combined pharmacologic–psychologic approach is superior to either intervention alone.
It is unknown whether hypnotherapy for FD and IBS can be administered in an automated home-treatment format. Hypnosis is unlike most other psychologic treatments because it is largely a one-way talk therapy with very limited interactivity. For this reason, it can be used without a live therapist, and this is commonly done in the form of audiotaped home practice sessions that patients use between clinic visits. The availability and affordability of this therapy would be vastly increased if the same kind of face-to-face hypnosis treatment found effective for FD and IBS would also help patients when administered exclusively in a home-treatment audio format. No data have been presented to date to make it possible to conclude whether this is feasible.
In conclusion, although some of the studies to date on hypnotherapy for functional GI disorders have been small and lacking in methodological rigor, and many research questions remain unanswered, the cumulative and consistent evidence for efficacy of hypnotherapy for these disorders seems to warrant serious consideration of its use as a regular adjunct in primary care and gastroenterology treatment of patients with FD and IBS.
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29. Keller MB, McCullough JP, Klein DN Arnow B, Dunner DL, Gelenberg AJ, Markowitz JC, Nemeroff CB, Russell JM, Thase ME, Trivedi MH, Zajecka J. A comparison of nefazodone, the cognitive behavioral-analysis system of psychotherapy, and their combination for the treatment of chronic depression. N Engl J Med 2000;342:1462–1470.
Center for Functional Gastrointestinal & Motility Disorders, University of North Carolina, Chapel Hill, North Carolina
© 2002 by the American Gastroenterological Association
Dig Dis Sci. 2002 Nov;47(11):2605-14.
Hypnosis treatment for severe irritable bowel syndrome: investigation of mechanism and effects on symptoms.
Palsson OS, Turner MJ, Johnson DA, Burnelt CK, Whitehead WE.
University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7080 USA.
Hypnosis improves irritable bowel syndrome (IBS), but the mechanism is unknown. Possible physiological and psychological mechanisms were investigated in two studies. Patients with severe irritable bowel syndrome received seven biweekly hypnosis sessions and used hypnosis audiotapes at home. Rectal pain thresholds and smooth muscle tone were measured with a barostat before and after treatment in 18 patients (study I), and treatment changes in heart rate, blood pressure, skin conductance, finger temperature, and forehead electromyographic activity were assessed in 24 patients (study II). Somatization, anxiety, and depression were also measured. All central IBS symptoms improved substantially from treatment in both studies. Rectal pain thresholds, rectal smooth muscle tone, and autonomic functioning (except sweat gland reactivity) were unaffected by hypnosis treatment. However, somatization and psychological distress showed large decreases. In conclusion, hypnosis improves IBS symptoms through reductions in psychological distress and somatization. Improvements were unrelated to changes in the physiological parameters measured.
Randomized Controlled Trial
PMID: 12452403 [PubMed - indexed for MEDLINE]
Hypnosis May Help Irritable Bowel Syndrome Patients
Tue 27 April, 2004 21:10
NEW YORK (Reuters Health) - In patients with irritable bowel syndrome that does not respond to other treatments, hypnotherapy appears to be able to reduce colon symptoms after eating, according to Swedish researchers.
Irritable bowel syndrome symptoms are common after meals and related to an exaggerated gastrocolonic response, Dr. Magnus Simren and colleagues from Sahlgrenska University Hospital, Goteborg, report in Psychosomatic Medicine.
Twenty-eight patients with irritable bowel syndrome that had not responded to other treatments were randomly assigned to receive gut-directed hypnotherapy 1 hr/week for 12 weeks or supportive therapy (control subjects).
Hypnotherapy patients were given suggestions in the hypnotic state directed at normalizing gastrointestinal function, and included imagery of "a river flowing smoothly, or a blocked river flow that was cleared by the patient," the researchers elaborate. Patients were encouraged to practice their "hypnotic skills" at home between sessions.
Patients in the supportive group attended sessions on diet emphasizing "good and bad food items," and on relaxation training.
At study entry and at 3 months, the patients underwent a series of tests to determine colon function. All patients had similar function at the start of the trial.
After the treatment period, the hypnotherapy patients but not the control patients had lower responses on tests of colon sensitivity.
Based on their findings, the investigators conclude that hypnotherapy reduces the sensory and motor components of the gastrocolonic response in irritable bowel syndrome. "This could be one of perhaps several factors responsible for the good clinical efficacy of this treatment modality in these patients."
Psychosomatic Medicine, March/April 2004.
Cognitive-behavioral therapy, hypnosis can help soothe irritable bowel syndrome
By: Dr. Olafur S. Palsson, UNC Health Care
Irritable bowel syndrome (IBS) is a common gastrointestinal disorder that is characterized by abdominal pain associated with disturbed bowel functioning such as constipation, diarrhea or both. It affects 10-15 percent of the U.S. population, and is at least twice as common in women as in men.
The causes of IBS are poorly understood in spite of much research, and medical treatments have proven relatively ineffective for that reason. Our research team found in a study of more than 1,600 patients that only 51 percent of them were at least somewhat better six months after seeing a doctor for IBS.
Until recently, there were no medications available specifically for IBS, but doctors used more general medications to treat individual symptoms of the disorder. In the past few years, two prescription medications for IBS have been in use -- one for IBS where constipation is predominant and another for patients who have mostly diarrhea. However, these medications only help at best about half of patients.
The limited success of standard medical treatment has led researchers to seek different treatment alternatives for IBS. So far, the most promising of these have been psychological treatments.
Although it may at first seem far-fetched to treat bowel problems by talking to people, there are, in fact, a couple of good reasons for using psychological treatments for IBS. One is that studies have indicated that stress and other psychological symptoms substantially affect the bowel symptoms of many IBS sufferers. The other reason is that there is increasing evidence that a "dysfunction" in the brain's normal regulation of the sensations and activity of the bowels plays a role in causing IBS, and this problem might be correctible with psychological methods.
Many types of psychological treatment have been tested for IBS. The two that have been most consistently successful are cognitive-behavioral therapy and hypnosis. The majority of studies on both of these therapies have shown that they substantially improve all the central symptoms of IBS in up to 70-80 percent of treated patients and that the benefit often lasts for years after treatment.
Both hypnosis and cognitive-behavioral therapy typically require about 8-12 visits to a therapist. In cognitive-behavioral therapy, the therapists work to help patients to overcome distorted and negative thinking patterns that adversely affect life functioning and amplify symptoms, and help them to adopt more effective ways to handle life situations that aggravate the bowel problems.
Hypnosis uses a special altered mental state of heightened focus to produce its beneficial effects. Mental imagery and hypnotic suggestions are used to bring about overall relaxation of the bowels and the whole body, lessened sensitivity to gut discomfort, and increased mental control over bowel symptoms.
These psychological treatments have proven to have several important advantages that make it likely that they will be increasingly important in the care of IBS in the coming years. They often work well for patients who have not improved from regular medical treatment, they have no uncomfortable side effects and they produce long-term improvement in symptoms. Finally, they often enhance psychological well-being and quality of life in addition to improving gastrointestinal symptoms.
At the present time, the main limitations to widespread use of psychological treatments for IBS are the costs of treatment and the lack of therapists who are experienced in these specialized applications of hypnosis and cognitive-behavioral therapy. However, most communities have therapists who use these methods to treat IBS, and the costs may seem reasonable considering the probability of good improvement.
IBS sufferers who do not gain satisfactory symptom relief from standard medical treatment may therefore want to discuss these psychological treatment options with their doctor.
Olafur S. Palsson, Psy.D., is an associate professor of medicine in the Division of Gastroenterology and Hepatology at the University of North Carolina at Chapel Hill.
General practitioners believe that hypnotherapy could be a useful treatment for irritable bowel syndrome in primary care
Stephen Cox1 , Simon de Lusignan2 and Tom Chan3
1Gillets Surgery, Deanland Road, Balcome, West Sussex, RH17 6PH, UK
2Department of Community Health Sciences, St. George's Hospital Medical School, LONDON, SW17 0RE, UK
3Surrey and Hampshire Borders NHS Trust, Ridgewood Centre, Old Bisley Road, Camberley, Surrey, GU16 5QE, UK
BMC Family Practice 2004, 5:22 doi:10.1186/1471-2296-5-22
Irritable bowel syndrome is a common condition in general practice. It occurs in 10 to 20% of the population, but less than half seek medical assistance with the complaint.
A questionnaire was sent to the 406 GPs listed on the West Sussex Health Authority Medical List to investigate their views of this condition and whether they felt hypnotherapy had a place in its management
38% of general practitioners responded. The achieved sample shared the characteristics of target sample.
Nearly half thought that irritable bowel syndrome (IBS) was a "nervous complaint" and used a combination of "the placebo effect of personal care," therapeutic, and dietary advice. There is considerable divergence in the perceived effectiveness of current approaches. Over 70% thought that hypnotherapy may have a role in the management of patients with IBS; though the majority (68%) felt that this should not be offered by general practitioners. 84% felt that this should be offered by qualified hypnotherapist, with 40% feeling that this should be offered outside the health service.
General practitioners vary in their perceptions of what constitutes effective therapy in IBS. They are willing to consider referral to a qualified hypnotherapist.
© 2004 Cox et al; licensee BioMed Central Ltd.
Biofeedback Helpful in Outlet Dysfunction Constipation
By David Douglas
NEW YORK (Reuters Health) Aug 16 - Biofeedback training appears useful in improving the symptoms of constipation due to difficulty in evacuating the rectum, according to Italian and US researchers.
As lead investigator Dr. Giuseppe Chiarioni told Reuters Health, "In our open study we were able to show that unresponsive constipation with slowed colon transit secondary to paradoxical contraction of the pelvic floor on straining -- so-called pelvic floor dyssynergia -- may be successfully treated by biofeedback therapy. "
In the July issue of Gastroenterology, Dr. Chiarioni of the University of Verona and colleagues note that they evaluated the approach in 52 patients all of whom had delayed whole gut transit.
In total, 34 of the subjects had pelvic floor dyssynergia, 12 had slow transit only and 6 met only 1 of 2 criteria for pelvic floor dyssynergia. These two criteria were paradoxical pelvic floor contraction during attempted defecation, and inability to evacuate a 50 ml water-filled balloon within 5 minutes of rectal placement.
All received five weekly biofeedback sessions directed at increasing rectal pressure and relaxing pelvic floor muscles during straining as well as practice in defecating the balloon.
At 6 months, 71% of the pelvic floor dyssynergia group reported satisfaction and 76% reported three or more bowel movements per week. However, only 8% of slow transit-only patients reported similar results.
Follow-up at 24 months showed that the improvements were maintained in the pelvic floor dyssynergia group.
The researchers conclude, "Our data suggest that, for outlet dysfunction constipation, at least, biofeedback does provide a specific benefit."
"Our study," Dr. Chiarioni added, "should prompt the development of teaching programs devoted to the training of skillful biofeedback therapists."
Hypnotherapy an effective treatment for IBS
Contact: Jo Nightingale
University of Manchester
Medics at The University of Manchester have discovered a way to treat Irritable Bowel Syndrome (IBS) using hypnotherapy.
Up to eight million people in Britain suffer from IBS, with symptoms including diarrhoea, pain and bloating. The condition can seriously affect sufferers' quality of life and finding treatment can be difficult, leading many doctors to feel they can do little to help.
Research by Peter Whorwell, Professor of Medicine and Gastroenterology in the University's Medical School and Director of the South Manchester Functional Bowel Service, has been researching the use of gut-directed hypnosis for over 20 years. Most recently, two hundred and fifty patients who have suffered from IBS for over two years were given twelve one-hour sessions, during which they were given an explanation of how the gut works and what causes their symptoms.
"IBS is ideal for treatment with hypnosis, as there is no structural damage to the body," explained Professor Whorwell. "During the hypnotherapy, sufferers learn how to influence and gain control of their gut function, and then seem to be able to change the way the brain modulates their gut activity."
With a success-rate of about 70% Professor Whorwell believes that, although labour-intensive, hypnotherapy could be an extremely effective treatment for the condition; and a less expensive alternative to new, costly drugs coming onto the market.
"We've found it to help all the symptoms, whereas some of the drugs available reduce only a few," he said. "As IBS can be a life-long condition it could clearly be a very valuable option for patients; however it is not suitable for everyone and women tend to respond better than men."
Professor Whorwell has founded a dedicated unit at Wythenshawe Hospital which treats patients from all over the UK, as the treatment can only be carried out by a practitioner trained in gut-directed hypnotherapy and is not yet widely available on the NHS.
Former patient Sonia Pinnock said, "I suffered from IBS and was on medication for nearly 20 years, but could get little relief from my symptoms. Since visiting the clinic for 12 hypnotherapy sessions last year however they've disappeared completely – the difference it's made to my quality of life is indescribable."
Another happy patient Christine Walsh continued, "After my hysterectomy I suffered from IBS for about five years, and it totally ruined my quality of life. I couldn't plan holidays or leisure activities and at work I was often doubled-up in pain. But since having weekly hypnotherapy sessions for three months I've now been free from IBS for five and a half years - the treatment has totally changed my life."
Professor Whorwell concludes, "The term hypnosis was coined by a Manchester surgeon, James Braid, early in the nineteenth century, and it's been in and out of fashion ever since. I'd like to think that our Unit has brought hypnotherapy back to Manchester, and helped improve its legitimacy."
The effects of hypnotherapy on adults with IBS have been studied over a couple of decades by Dr Peter Whorwell and colleagues at the University Hospital of South Manchester in the UK. But thanks to a chance meeting between him and Dutch doctor Marc Benninga, who's a paediatric gastro-enterologist at the Academic Medical Centre in Amsterdam, new research is now under way, which explores the efficacy of hypnosis in children suffering from the debilitating chronic pain of IBS.
"We did a pilot study in 10 children," Dr Benninga explains, "we noticed it was successful in the majority of the children so then we needed a larger study".'
"Peter Whorwell described in his studies that during or after hypnotherapy the [typical for IBS] hypersensitivity of the gut will disappear. So we looked at hypersensitivity of the gut beforehand and in the week after stopping the intervention and hopefully there will be something showing it disappears. But then again, you can ask me, 'how does it work?' and I don't have an answer to that. It will be a question for further research."
More than 50 children have now been enrolled in the project, and randomly assigned to one of two groups.
Dr Benninga explains:
"One group is treated by a gastro-enterologist - that's me. I give them conventional treatment, a high-fibre diet in combination with keeping a pain diary, and I see them six times during three months."
The second group gets the conventional treatment plus 6 sessions of hypnotherapy with Dr Benninga's partner on the project, Carla Menko-Frankenhuis.
J Clin Nurs. 2006 Jun;15(6):678-84.
Effect of nurse-led gut-directed hypnotherapy upon health-related quality of life in patients with irritable bowel syndrome.
Lecturer, School of Health in Social Science, University of Edinburgh, Old Medical School, Edinburgh, UK.
Aims and objectives. This study quantified health-related quality of life in a group of irritable bowel syndrome patients and measures changes following a treatment programme of nurse-led gut-directed hypnotherapy.
Background. It is well recognized that health-related quality of life can be severely impaired in patients suffering form the irritable bowel syndrome. Current conventional treatment for irritable bowel syndrome is often unsatisfactory.
In contrast it has been shown that gut-directed hypnotherapy is an effective treatment of irritable bowel syndrome with up to three-quarters of patients reporting symptomatic improvement.
Design/method. Seventy-five patients (55 females/20 males, median age 37.1 years, age range 18-64) comprised the study group. Physical symptoms of irritable bowel syndrome were recorded using seven-day diary cards. On presentation the predominant symptoms were abdominal pain (61%), altered bowel habit (32.5%), and abdominal distension/bloating (6.5%) in the patient group. An irritable bowel syndrome quality of life questionnaire was used to define health-related quality of life. Psychological well-being was measured using the Hospital Anxiety and Depression Scale. Data analysis was carried out using MINITAB, Release 12 for Windows.
Results. Physical symptoms statistically improved after hypnotherapy. There were also significant statistical improvements (P < 0.001) in six of the eight health-related quality of life domains measured (emotional, mental health, sleep, physical function, energy and social role). These improvements were most marked in female patients who reported abdominal pain as their predominant physical symptom. Anxiety and depression improved following treatment.
Conclusion. Gut-directed hypnotherapy has a very positive impact on health-related quality of life with improvements in psychological well-being and physical symptoms. It appears most effective in patients with abdominal pain and distension. Relevance to clinical practice. This study demonstrates that by integrating complementary therapies into conventional care that gastrointestinal nurses have a potential role in the management of irritable bowel syndrome.
Mind-Body Treatments Ease Irritable Bowel
THURSDAY, May 25 (HealthDay News) -- Short courses of hypnosis therapy or cognitive therapy can calm the distressing symptoms of irritable bowel syndrome (IBS) for the estimated 15 percent of adult Americans who suffer from the disorder, a new study finds.
IBS isn't a life-threatening condition, but it's an uncomfortable nuisance, with symptoms including abdominal pain, cramps, bloating, food intolerances, constipation or diarrhea.
What's more, "patients with the more severe form of IBS may have heightened sensitivity to the side effects of medications [prescribed for the condition]," noted Dr. Emeran Mayer, a professor of medicine and physiology at the University of California Los Angeles. That means "there's a very important role for these kinds of [mind-body] approaches," he said.
Mayer moderated a "Mind and Body Effects on GI Health" panel on Wednesday, part of the Digestive Disease Week 2006 annual meeting in Los Angeles.
In one study, just four sessions of cognitive therapy helped ease patient's IBS symptoms, according to researcher Dr. Jeffrey M. Lackner, director of the behavioral medicine clinic and assistant professor of medicine at the University at Buffalo School of Medicine, SUNY.
In the study, Lackner's team assigned 59 patients to either a 10-week therapy course, a four-week course, or to a wait list. Both the short and long cognitive therapy sessions covered the same ground, but the short course included a self-study workbook developed just for the study.
Included in the instruction was information meant to undo some of the stressful habits that experts say people with IBS tend to have, including negative thinking patterns which can make them anxious and exacerbate symptoms. IBS patients also tend to have poor coping skills, which causes them to react more stressfully to life's ups and downs. "These people spend a lot of time in their head, engaging in worrisome thinking," Lackner said.
Instruction in muscle-relaxation training was included, and participants were encouraged to be more flexible in their problem-solving skills and to learn skills that would help them take control of their symptoms, such as learning to relax.
"Whether the patients went to 10 sessions or four, they achieved clinically significant improvements in symptom relief and quality of life and were satisfied [with the program]," Lackner said. Previous research by others has found the same benefits from cognitive therapy.
Seventy-four percent of those who took the long course said their symptoms improved moderately to substantially, and 73 percent of the short-course patients reported the same improvements.
Likewise, hypnotherapy -- which, among other things, involves techniques such as visualizing a fully functioning GI tract -- helped IBS sufferers reduce symptoms and improve quality of life, reported Dr. Magnus Simren, an associate professor and consultant at Goteborg University in Sweden.
He led two studies testing the therapy. In one trial, 87 patients with IBS were cared for in a university hospital; in another, 48 received care in a county hospital.
In each group, about half were assigned to receive "gut-directed" hypnotherapy for one hour a week for 12 weeks, in which the therapist concentrated on helping them with their IBS. The other half of patients were assigned to a control group that did not get hypnotherapy.
Simren evaluated the patients at the start of the study, right after treatment and then again at six and 12 months later, asking them to complete questionnaires focused on their quality of life, anxiety, depression and GI symptoms.
"The hypnotherapy groups improved significantly regarding GI symptoms," he said. "The control groups did not."
While 52 percent of those getting hypnotherapy improved significantly, just 32 percent of the control group participants improved.
Improvement was most marked for abdominal pain, bloating and distension; less so for bowel habits. Improvements lasted or even increased at the one-year mark. Anxiety and depression improved at one year in the smaller study of 48 patients, but not in the group of 87. The reason for that disparity in results is unclear, Simren said.
What's also unclear is just how hypnotherapy works to fight IBS. Simren's results are in line with other studies that have also found improvements, however. According to Mayer, hypnotherapy may alter the way the brain reacts to stress, reducing levels of body arousal.
According to Simren, patients eager for relief don't much care how hypnotherapy works, just that it does. "I tell them, 'This is how you can get control of your symptoms,'" he said. And most are satisfied with that explanation. "Patients are very open-minded," he said.
The therapy doesn't necessarily have to be ongoing, the experts speculated, especially once patients learn the new skills.
While patients don't have to find a therapist who has experience dealing with IBS, it helps, Simren and Lackner agreed. "It's very important that the therapist does have an interest in bodily symptoms, not just the mind," Simren said.
Biofeedback. Hu and colleagues evaluated the role of biofeedback in patients with functional constipation. In this prospectively designed study, patients meeting the Rome II criteria for chronic constipation were randomized to a usual care group (lifestyle and dietary recommendations along with general advice) or a biofeedback group (usual care and 6 sessions of biofeedback for presumed pelvic floor dysfunction every 2 weeks). Sixty patients entered the study and were randomly and equally assigned to 1 of the 2 treatment groups (95% women; mean age = 44 years).
Patients were not stratified on the basis of symptoms and neither anorectal manometry nor balloon expulsion testing were performed. After treatment, the number of complete spontaneous bowel movements increased in both groups to similar frequencies (1.3 per week at baseline to 2.5 per week). However, the biofeedback group had a significant reduction in straining, feelings of incomplete evacuation, bloating, and laxative use (P values not provided). The results of this study are intriguing because they support the view that pelvic floor dysfunction is a significant cause of constipation, either alone or in conjunction with normal-transit or slow-transit constipation. Thus, a treatment program for presumed pelvic floor dysfunction can yield significant benefits without the need to objectively measure patients using anorectal manometry.
Hu WH, Li JH, Chan AO, Wong NY, Wong SH, Hui WM. Biofeedback is an effective treatment for functional constipation: a randomized controlled study. Gastroenterology. 2006;130:A-287. [#S1931]
A 2005 review of 14 studies on IBS hypnotherapy, involving 644 people, concluded that it consistently improved symptoms in most patients. The six studies that used a control group--including hypnosis without any suggestion of pain relief--found improvement in 52 to 87 percent of
The benefits of hypnotherapy seem to last, a 2003 British study found. The researchers surveyed 204 patients up to six years after hypnotherapy, which had initially helped over two-thirds of them. Of those positive responders, 81 percent maintained the improvement, with no significant drop-off as the years passed.
Hypnotherapists can't explain exactly how the technique works. While IBS is exacerbated by stress, it is not a purely psychological disorder, says Olafur Palsson, associate professor of medicine at the University of North Carolina and author of a widely used hypnosis protocol. "The current understanding of IBS suggests that there is a problem in the way the brain and the gut interact in controlling bowel function," he says.The hypnotic suggestions seem to "help make that normal again."
"Hypnosis eases irritable bowel syndrome" is from the October 2006 issue of Consumer Reports on Health.
The Application of Clinical Hypnotherapy with the Primary IBS Patient
By Michael Mahoney, Clinical Hypnotherapist
22 December 2006
A Comparative Analysis of Clinical Outcomes in the Refractive IBS Patient vs. the Newly Diagnosed
The successful use of clinical hypnotherapy (CHT) for the treatment of patients with irritable bowel syndrome has been established in at least 14 published studies (1) (2) where it has been shown to produce significant reduction in the cardinal IBS symptoms and associated symptoms such as anxiety. The success of this treatment method in the clinical setting is contingent upon the protocol being gut-directed or gut-specific, i.e. directly addressing the digestive tract, balancing the dismotility and restoring its proper function while allowing the patient to take part in their own healing. Sufferers who consider hypnotherapy currently tend to do so as a 'last resort' rather than a first approach after diagnosis.
In treating IBS patients since 1991, I recognised a consistent trend in therapy outcomes and decided to investigate this further with an informal observational study. From September 2003 to January 2005, I assigned 40 patients with the same primary IBS diagnostic criteria into two groups.
The first group consisted of 20 IBS patients of long-standing, termed as refractory where no previous medical interventions provided relief. Age ranges for this group was 27 years to 66 years; average age was 42.2 years; comprised of 10 males average age 38.7 years, 10 females average age 45.6 years.
The second group included 20 newly diagnosed IBS patients with ages ranging from (24 years) to (64 years); average age (40.1 years), there were (10) males average age 40.2 years and (10) females average age 40.1years.
The newly diagnosed patients had no prior IBS treatment intervention upon their arrival to me, however, they may have presented with symptoms for varying degrees of time.
The clinical protocol (3) consisted of an initial intake consultation session, where the IBS patient discusses symptoms and concerns.
A life-style, QOL and symptom questionnaire was also completed at this time, and again upon therapy completion to assess improvement rating.
The intake session was followed by an introductory session, where the patient was apprised of the method of CHT and assurances were given. Following that, five gut-specific sessions were presented to the patient dealing with:
1) Building a foundation of self-esteem, relaxation and familiarity with the technique,
2) IBS and related symptoms, balancing of the digestive motility, the brain-gut connection,
3) pain, discomfort, bloating issues,
4) assurance that the patient always has control over their own healing and
5) reinforcement of previous sessions and resolution.
Standard treatment would allow for patients being seen five times over a 12 - 14 week period and all participants received a recording of each session which was listened to according to a specific schedule.
Psychological State and QOL of IBS Patient Prior to receiving CHT.
The intake information of the Refractory IBS Patient presented with two findings:
1. Higher Failure Expectation after years of frustration and unsuccessful treatment resolution.
2. Patients presented with more co-morbid emotional, psychological and physical symptomology and poor QOL, in addition to "basic" IBS symptoms. (4) This finding led me to believe that in many cases, if IBS is not initially treated on the psychological level, the condition usually escalates into a multi-faceted condition.
The intake information for the Newly Diagnosed presented with two findings:
1. Less expectation for either failure or success for therapy outcome.
2. General absence of comorbid psychological, emotional and additional physical symptomology.
Outcome of CHT treatment
Improvement levels for both patient groups were within the same symptom reduction range – with an average of 90% symptom reduction overall for 20 IBS and related symptoms listed.
However, refractory IBS patients who had received other forms of treatment first, had a longer recovery and symptom reduction time frame. It was found that for these patients, the time required to move forward to the next session became extended by an average of 1 to 3 weeks (or more in some cases) depending upon severity and longevity of symptoms and the resultant psychological issues. This group's confidence and self esteem was very low, and their ability to see things in perspective was significantly reduced. When talking about the psychological elements most of these patients wept. After sometimes years of pain and discomfort, and the following of unsuccessful treatment options it was clear this group of sufferers had become emotionally drained. Having presented with, for example, such symptoms as diarrhoea, 3 or more times a day, often uncontrollable and explosive for years, it was therefore not surprising that such patients presented with anxiety or various levels of depression.
Before these sufferers could even begin to work through the IBS, the hypnotherapy sessions first provided a strong emotional base that increased self-esteem, confidence, and allowed the sufferer to begin a journey of self improvement and management, and thereby equip themselves emotionally to move away from the symptoms and the familiarity of IBS thoughts and commence recovery initially at the emotional level.
The newly diagnosed group who received CHT as a first line of treatment showed a much quicker response towards their improvement in IBS symptoms, and did not require extensions in the standard protocol time frame.
It was my observation that early intervention with CHT may reduce or eliminate the multi-faceted component of IBS, thus leading to earlier/less prolonged symptom reduction. My findings appeared to confirm this trend that was observed early on. Since the subconscious mind does not have to deal with non-present comorbid complaints with the majority of newly diagnosed patients, the IBS symptoms are dealt with initially and directly and resolved more quickly. For the refractory patient, internal and emotional energies relegated to coping with the long-standing burden of IBS usually must first be dealt with by the subconscious before IBS issues can be addressed.
Implications and Conclusion
A negative aspect in all this is that in determining if CHT for IBS should be considered as a first line of treatment, it should be noted if the patient may have underlying "true" clinical psychological conditions that may become masked by the IBS related issues, and which will still need to be addressed directly. As assessment tools, the QOL intake session may provide an insight to this, as a pattern for onset of symptoms and onset of emotional trends may be correlated: simply put – the co-morbid psychological condition may be secondary to the ongoing, long-standing IBS. Another potential negative perspective is the availability of a trained clinical hypnotherapist whom the physician may refer the newly diagnosed patient to at the outset of diagnosis when indicated. However, for the primary IBS patient, this observation is promising.
This bears out a real look at providing CHT concurrently as a complementary therapy as a first line of treatment upon initial IBS diagnosis, and may prove to be a good defense in treating the whole person as the method has shown to improve the IBS symptom reduction rate, and may curtail or even eliminate possible further decline in QOL and psychological issues. (4)
So what does this tell us?
Further studies using clinical hypnotherapy initially alongside traditional medical interventions (medication) may prove helpful in considering the holistic nature of the condition and its optimal treatment. Can the experiences of the refractory IBS patient who may endure the emotional burdens of hopelessness, (5) treatment resolution frustration, elevated stress and anxiety levels secondary to IBS, negativity, reduced QOL, and other multiple areas of suffering be alleviated or even eliminated if a psychological approach such as CHT be administered in conjunction with conventional treatment recommendations upon the initial diagnosis of IBS? It is the finding of this practice that this can be achieved when hypnotherapy is delivered professionally, however further investigation should be encouraged.
1. Tan G, Hammond DC, Joseph G. Hypnosis and irritable bowel syndrome: a review of efficacy and mechanism of action. Am J Clin Hypn. 2005 Jan;47(3):161-78.
2. Hauser W. Medizinische Klinik I, Klinikum Saarbrucken gGmbH, Saarbrucken. Hypnosis in Gastroenterology. Z Gastroenterol 2003 May;41 5:405-12 PMID: 12772053
3. In 1996 Mahoney was invited to participate in a medical research study funded by the UK National Health Service which was monitored and audited by the local Health Authority Audit Commission. Medical centre GPs and hospital gastroenterologists screened 20 IBS patients: all were long-term sufferers, had undergone all medical diagnostic tests, and had taken prescription medications without attaining significant relief from their symptoms. Each patient underwent Mahoney's original protocol of the introductory and five subsequent hypnotherapy sessions. At the end of the project, feedback sheets from the patients indicated an overall reduction of 80% in symptom severity and frequency of presentation. In 1997, Mahoney developed new processes for IBS clinical protocol. Patients were monitored using audio tapes both during the program and for the next three subsequent years: 1998 through 2001. The final results of this study are intended for independent publication so that they may be subject to peer review and analysis. Success rates were close to or exceeding 90% for all symptoms and patients.
4. Spiegel BM, Gralnek IM, Bolus R, Chang L, Dulai GS, Mayer EA, Naliboff B. Clinical determinants of health-related quality of life in patients with irritable bowel syndrome. Arch Intern Med. 2004 Sep 13;164(16):1773-80.
5.Miller V, Hopkins L, Whorwell PJ. Suicidal ideation in patients with irritable bowel syndrome. Clin Gastroenterol Hepatol. 2004 Dec;2(12):1064-8.
6. Pinto C, Lele MV, Joglekar AS, Panwar VS, Dhavale HS. Stressful life-events, anxiety, depression and coping in patients of irritable bowel syndrome. J Assoc Physicians India. 2000 Jun;48(6):589-93.
7. Whitehead WE, Crowell MD. Psychologic considerations in the irritable bowel syndrome. Gastroenterol Clin North Am. 1991 Jun;20(2):249-67.
8. Lackner JM, Quigley BM. Pain catastrophizing mediates the relationship between worry and pain suffering in patients with irritable bowel syndrome. Behav Res Ther. 2005 Jul;43(7):943-57. Epub 2004 Sep 25.
9. Spiller RC. Potential future therapies for irritable bowel syndrome: will disease modifying therapy as opposed to symptomatic control become a reality? Gastroenterol Clin North Am. 2005 Jun;34(2):337-54.
10. Palsson OS, Drossman DA. Psychiatric and psychological dysfunction in irritable bowel syndrome and the role of psychological treatments. Gastroenterol Clin North Am. 2005 Jun;34(2):281-303.
Author: Michael Mahoney Clinical Hypnotherapist
Michael Mahoney is a member of the Primary Care Society for Gastroenterology, the Hypnotherapy Association, The British Council of Hypnotist Examiners, as well as the International Foundation for Functional Gastrointestinal Disorders, the European Association for Cancer Education and the International Functional Brain-Gut Research Group.
Serves patients through NHS, non-NHS and BUPA
He has research and patient trials experience showing success rates of 85% - 95% IBS symptom reduction using his Ongoing Progressive Session Induction Method (OPSIM).
In 2003 he was named first in the Independent on Sunday ‘Top Brass Section’ of leading hypnotherapists in the UK.
His hypnotherapy practice sponsored the UK’s first IBS Awareness evening at Liverpool University in 1997.
Contact the Author:
Tel: 01925 658 322
Hypnotherapy Highly Effective for Pediatric Irritable Bowel Syndrome and Functional Abdominal Pain: Presented at DDW
By Bruce Sylvester
WASHINGTON, DC -- May 22, 2007 -- Hypnotherapy is effective for the treatment of children with irritable bowel syndrome (IBS) and functional abdominal pain (FAP), investigators reported here at Digestive Diseases Week (DDW).
"The children we studied had very long-lasting symptoms, and hypnotherapy proved to be highly effective with this group," said lead investigator and presenter Arine Vlieger, MD, PhD, pediatrics fellow, St. Antonius Hospital, Nieuwegein, Netherlands.
FAP and IBS are among the most common reasons for consultation in pediatrics, with reported prevalence rates of 1% to 19%, according to Dr. Vlieger and colleagues. Treatment usually consists of education, reassurance and dietary advice. Among children treated with the standard approach, 25% to 66% continue to experience symptoms.
Gut-directed hypnotherapy has been shown to be highly effective in the treatment of adult patients with IBS. So Dr. Vlieger and colleagues conducted a study to evaluate this treatment approach in a pediatric population.
The investigators enrolled 53 children between the ages of 8 and 18 years who had been diagnosed with IBS or FAP. The subjects were randomized to standard therapy or to 6 hypnotherapy sessions of 30 minutes over a 3-month period. The endpoints of the study were pain intensity, pain frequency, as nausea, headache and appetite.
The investigators recorded findings at baseline and at 1, 2, and 3 months after randomization, and 6 and 12 months after therapy. They defined a cure as a greater than 80% improvement in pain.
At 3 months, the investigators observed a cure rate of 59% for treated subjects versus 12% in subjects receiving conventional therapy. After 1 year, the cure rate reached 85% for hypnotherapy-treated subjects and 25% for those receiving conventional therapy.
The authors concluded, "Gut-directed hypnotherapy is highly superior to conventional therapy in the treatment of children with longstanding FAP or IBS. Further studies are warranted to confirm our findings."
CHECK HERE FOR A GUT-DIRECTED HYPNOTHERAPY PROGRAM!
See the full study here...
Explore (NY). 2007 Mar-Apr;3(2):129-35. Related Articles, Links
Use of mind-body therapies in psychiatry and family medicine faculty and residents: attitudes, barriers, and gender differences.
Sierpina V, Levine R, Astin J, Tan A.
University of Texas Medical Branch, Galveston, TX 77555-1123, USA. firstname.lastname@example.org
A recent study in Digestion & Liver Disease noted that mind-body medicine (MBM) approaches to many health problems have been well documented in the literature, and efficacy has been well demonstrated in conditions such as irritable bowel syndrome. However, an apparent disconnect prevents more widespread adoption of such therapies into practice. Biofeedback, relaxation therapy, hypnosis, guided imagery, cognitive behavioral therapy, and psychoeducational approaches are the domain of MBM they examined in assessing physician attitudes, beliefs, and practices.
They found substantial reports that barriers to the use of MBM were largely based on lack of training, inadequate expertise, and insufficient clinic time. There was a high interest in both groups in learning relaxation techniques and meditation and lower interest in biofeedback and hypnosis.
Female physicians were significantly more likely to use MBM, both with patients and for their own self-care, and were less likely to be concerned that recommending these therapies would make patients feel that their symptoms were being discounted. Female physicians also had significantly higher beliefs about the benefits of MBM on health disorders in several of the conditions examined.
Stress and the Emotional Motor System (EMS)
eCAM Advance Access published online on May 17, 2007
Min/Body Psychological Treatments for Irritable Bowel Syndrome
Bruce D. Naliboff1,2,3, Michael P. Fresé1,2,3 and Lobsang Rapgay2
1UCLA Center for Neurovisceral Sciences and Women's Health, 2Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA and 3Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, CA, USA
There has been a long tradition of using hypnotherapy for the treatment of medical conditions. There are a variety of forms of hypnotherapy used in psychologic and medical treatment, but in IBS the primary form has followed a 7–12 session gut-directed hypnotherapy protocol initially developed by Whorwell (30,31). Gut-directed hypnotherapy involves two people initially, one of whom is inducing the hypnotic state and then offering specific suggestions for improved GI functioning. The clinical steps of the protocol involved: (i) the induction of overall physical relaxation with progress in muscle relaxation, (ii) ego strengthening using metaphors such as, the willow tree and (iii) gut-specific relaxation suggestion induced by placing one's warm hands on the gut. Ego strengthening is a psychologic exercise which fosters inner strength through sentence completion and visualization tasks (32). Suggestions are made to reduce fear of pain and discomfort and of pre-occupation with sensation in the gut. The final phase involves imagery to increase one's sense of control and self-efficacy over IBS symptoms.
In a recent review of the hypnotherapy literature in IBS, Whitehead reviewed 11 studies including five controlled trials (33). There were significant difficulties with most of the studies in terms of sample size and type of control conditions, but this review did conclude that the literature supports hypnosis to have a substantial positive impact on IBS, even for patients unresponsive to standard medical interventions. The median response rate was 87% and bowel symptoms generally improved by about 50%, as did psychologic and quality of life variables. The gains appeared to be long lasting as with the other psychologic treatments discussed earlier. It should also be noted that the hypnosis literature has not identified hypnotizability as a critical factor in outcome. As with other psychologic treatments the mechanism by which hypnotherapy works has not been established. Changes in visceral sensitivity were initially reported for this treatment but not consistently across studies.
How Does Cognitive Behavior Therapy for Irritable Bowel Syndrome Work? A Mediational Analysis of a Randomized Clinical Trial
Jeffrey M. Lackner, James Jaccard‡, Susan S. Krasner§, Leonard A. Katz, Gregory D. Gudleski and Edward B. Blanchard
Department of Psychology, Florida International University, Miami, Florida
Division of Gastroenterology, Department of Medicine, University at Buffalo, State University of New York, Buffalo, New York
Department of Psychology, University at Albany, State University of New York, Albany, New York
Department of Anesthesiology, University at Buffalo, State University of New York, Buffalo, New York
Received 23 July 2006; accepted 10 May 2007. Available online 24 May 2007.
Background & Aims: Although multiple clinical trials support the efficacy of psychological treatments for reducing irritable bowel syndrome (IBS) symptoms, the mechanisms responsible for symptomatic improvement are unknown. One hypothesis is that psychological treatments work by alleviating comorbid psychological distress implicated in the worsening of bowel symptoms and quality of life. An alternative hypothesis assumes that changes in distress are not strictly a cause but a consequence of IBS that will decrease with symptomatic improvement.
Methods: We evaluated these 2 hypotheses by applying structural equation modeling (SEM) to the data set of a large number (n = 147) of Rome II diagnosed participants randomized to CBT, psychoeducation, or wait list. Per Rome guidelines, the primary end point was global improvement of gastrointestinal (GI) symptoms measured 2 weeks after a 10-week regimen. Secondary end points were distress and quality of life (QOL).
Results: SEM analyses lend support to a model in which CBT is associated with improvements in IBS symptoms, but that therapeutic gains do not depend on changes in patients’ overall level of psychological distress. Symptom severity, but not clinical status (pain catastrophizing, predominant bowel habits, symptom duration, abuse, diagnosable psychiatric disorder) or relevant sociodemographic variables (eg, gender, age), moderated treatment outcome.
Conclusion: CBT has a direct effect on global IBS symptom improvement independent of its effects on distress. Improvement in IBS symptoms is associated with improvements in the QOL, which may lower distress. Symptom improvements are not moderated by variables reflecting the mental well-being of IBS patients.
Cognitive Behavior Therapy Improves Symptoms in Irritable Bowel Syndrome
By Michelle Rizzo
NEW YORK (Reuters Health) Sept 11 - Cognitive behavior therapy (CBT) has a direct effect on overall improvement of gastrointestinal symptoms in patients with irritable bowel syndrome (IBS), independent of its effects on distress, results of a study published in the August issue of Gastroenterology suggest. Improvement in IBS symptoms is linked to improvements in the quality of life, which may lower distress.
"Although multiple clinical trials support the efficacy of psychological treatments for reducing IBS symptoms, the mechanisms responsible for symptomatic improvement are unknown," Dr. Jeffrey M. Lackner, of the University at Buffalo, State University of New York, and colleagues write.
In the current study, the researchers examined 147 patients who were randomly assigned to CBT, psychoeducation, or placement on a wait list. The primary end point was the global improvement of GI symptoms. These were measured 2 weeks after a 10-week regimen. Secondary end points included distress and quality of life.
Results showed that CBT was associated with improvements in IBS symptoms. The therapeutic gains did not depend on changes in the patients' overall level of psychological distress. Treatment outcome was moderated by symptom severity, but not clinical status or sociodemographic factors.
"A non-drug behavioral self-management program (CBT) significantly improved primary symptoms of IBS (abdominal pain, diarrhea, and/or constipation), and...these improvements in gut symptoms did not occur because patients became less distressed," Dr. Lackner told Reuters Heath. "Instead, the reduction of distress was a result of their actual improvement in physical symptoms. These findings are impressive because they were found in some of the most challenging, complex patients who were severely affected by IBS symptoms and are more disrupted by them."
"We also found that there was a 'reciprocal' relationship between improvement in distress and quality of life such that as CBT improved IBS symptoms, patients felt less distressed and that this reduction of distress improved the quality of life," Dr. Lackner said.
"The immediate implication is that patients who fail to respond to simple lifestyle changes like eliminating foods or medications should not grow hopeless but have confidence their condition is treatable," the author said. "They can learn practical, concrete skills to take control and reduce symptoms that affect millions of Americans and are a source of considerable health care cost and personal suffering."
Dr. Lackner said that while the results of their study are encouraging, "they are based on a program that requires weekly doctor visits over 10 weeks."
"The challenge is to develop patient-administered behavioral treatments that can be used effectively and efficiently outside of a clinic setting," he said. "This will appeal to patients who live outside the range of the few specialty clinics where CBT is available."
East Mediterr Health J. 2007 Mar-Apr;13(2):301-8.
Hypnotherapy for irritable bowel syndrome in Saudi Arabian patients.
Al Sughayir MA.
Department of Psychiatry, College of Medicine, King Saud University, Riyadh, Saudi Arabia. email@example.com
This study investigated whether hypnotherapy provides a significant therapeutic effect in Saudi Arabian patients with irritable bowel syndrome. Patients (n=26) were consecutively recruited at a psychiatry outpatient clinic after diagnosis by a gastroenterologist and a medical evaluation for irritable bowel syndrome.
Each patient had 12 sessions of hypnotherapy over a period of 12 weeks (1 session per week). Patients completed a scale measuring symptom severity before and 3 months after the trial.
Hypnotherapy significantly enhanced a feeling of better quality of life more in male than in female patients, and bowel habit dissatisfaction was reduced more in female than in male patients.
PMID: 17684852 [PubMed - indexed for MEDLINE]
Aliment Pharmacol Ther. 2007 Sep 15;26(6):943-52.
Clinical trial: short- and long-term benefit of relaxation training for irritable bowel syndrome.
van der Veek PP, van Rood YR, Masclee AA.
Department of Gastroenterology, Leiden University Medical Centre, Leiden, The Netherlands.
BACKGROUND: Psychotherapy is effective in treating irritable bowel syndrome, but the effect of relaxation training, a brief psychological group intervention, is not known.
AIM: To determine the efficacy of relaxation training in a large cohort of irritable bowel syndrome patients.
METHODS: Ninety-eight irritable bowel syndrome patients were included in this randomized controlled trial. Forty-six patients received standard medical care (CON) and 52 received four 90-min sessions of relaxation training in small groups in addition to standard medical care. Irritable bowel syndrome symptom severity, medical consumption and quality of life were assessed at baseline in patients and in 38 healthy controls and evaluated in patients at 3, 6 and 12 months after intervention.
RESULTS: Irritable bowel syndrome symptom severity was significantly reduced in the relaxation training group compared to CON at 3, 6 and 12 months after treatment (time-by-treatment interaction, P = 0.002). The number needed to treat for long-term improvement was 5. Quality of life had improved (general health, P = 0.017; health change, P = 0.05). Frequency of doctor visits was reduced (P = 0.039).
CONCLUSIONS: Relaxation training is a brief group intervention that significantly improves symptom severity, general health perception and medical consumption in irritable bowel syndrome patients immediately after, as well as 6 and 12 months after intervention.
PMID: 17767479 [PubMed - in process]
Gut-Directed Hypnotherapy Effective for Persistent IBS in Children
NEW YORK (Reuters Health) Nov 19 - Gut-directed hypnotherapy is "highly effective" for children with longstanding functional abdominal pain or irritable bowel syndrome (IBS), clinicians from the Netherlands report in the November issue of Gastroenterology.
Given that gut-directed hypnotherapy is effective for adults with IBS, Dr. Arine M. Vlieger of St. Antonius Hospital, Nieuwegein, and colleagues tested its value in children. They randomly assigned 53 children, aged 8 to 18 years, with functional abdominal pain or IBS to hypnotherapy, 6 sessions over 3 months, or standard medical care plus 6 sessions of supportive therapy (control).
Dr. Vlieger and colleagues report that gut-directed hypnotherapy was "highly superior" to standard medical care, yielding a significantly greater reduction in pain scores (p < 0.001) recorded in weekly standardized abdominal pain diaries.
Specifically, at 1 year follow-up, pain intensity scores had deceased from 13.5 to 1.3 in the hypnotherapy group and from 14.1 to 8.0 in the control group.
"At 1 year, successful treatment was accomplished in 85% of the hypnotherapy group and 25% of the standard medical care group (p < 0.001), Dr. Vlieger and colleagues report.
"We advocate that hypnotherapy become the treatment of choice in children with persisting complaints of either functional abdominal pain or IBS in whom first-line therapies such as education and dietary advice have failed," they write.
The team suggests further studies be conducted to see whether hypnotherapy might also be a treatment option for children with other functional gastrointestinal disorders.
Behavioral therapy may ease irritable bowel syndrome
By KAREN PALLARITO • HEALTHDAY • February 5, 2008
When drugs and dietary changes don't provide relief from the pain, bloating and other unpleasant gastrointestinal symptoms of irritable bowel syndrome, patients may want to try a different approach.
Recent studies show that using one's own thoughts in a process called cognitive behavioral therapy may help ease symptoms. Likewise, using hypnosis to visualize the pain and imagine it seeping away can be a powerful treatment strategy, too.
"Research indicates that the probability of achieving benefits is excellent with either approach, even for patients who haven't improved from standard medical care," said Olafur S. Palsson, a clinical psychologist and associate professor of medicine at the University of North Carolina at Chapel Hill's Center for Functional GI & Motility Disorders.
As many as 45 million Americans may have irritable bowel syndrome, or IBS, the International Foundation for Functional Gastrointestinal Disorders reports. Sixty percent to 65 percent of IBS sufferers are women.
In addition to pain and discomfort, people with IBS experience chronic or recurrent constipation or diarrhea — or bouts of both. While the exact cause of the condition isn't known, symptoms seem to result from a disturbance in the interaction of the gut, brain and nervous system, according to the foundation.
Doctors generally advise patients to avoid certain foods that may exacerbate symptoms. Several different medications may be recommended for relieving abdominal pain, diarrhea and constipation. But these approaches don't always provide adequate relief.
"For some people, medications and dietary changes are the perfect match, but most of our patients — the great, great majority of patients — have not responded to medications and dietary changes," said Jeffrey M. Lackner, assistant professor of medicine at the University of Buffalo, State University of New York, and a behavioral medicine specialist whose research focuses on gastrointestinal disorders, particularly IBS.
For many patients, cognitive behavioral therapy, which uses the power of the mind to replace unhealthy beliefs and behaviors with healthy, positive ones, may be the answer. But, Lackner observed, very few facilities around the country specialize in this type of treatment.
Recognizing this, he and his colleagues set out to devise and test a treatment program that IBS patients could administer themselves.
Seventy-five women and men were divided into three groups. One group was placed on a "wait list" for 10 weeks while they monitored their symptoms. Another group received the standard treatment of 10 cognitive behavioral therapy sessions over 10 weeks. The third group had once-a-month therapy sessions over four months and practiced relaxation and problem-solving exercises at home.
Not surprisingly, people on the wait list did not do well at all, while those in the 10- and four-week sessions showed significant improvement. "They said at the end of treatment they had achieved adequate relief from pain and adequate relief from bowel problems, and a significant proportion of patients said they improved their symptoms," Lackner explained.
While more studies are needed, the findings suggest that traditional and self-administered cognitive behavioral therapy both provide adequate relief and improve symptoms, said Lackner, who first reported the findings at large meeting of GI professionals.
Hypnosis may be another option. A pair of Swedish studies presented at that same meeting found that patients who received "gut-directed hypnotherapy" had significant improvement in symptoms compared with those who did not receive this intervention.
Hypnosis treatment has been reported to improve symptoms of the majority of treated IBS patients in all published studies, noted UNC's Palsson.
For patients who've tried the diet-and-drug regimen to no avail, Palsson said he would recommend either of these two psychological treatments.
"If a patient's main goal is substantial relief of bowel symptoms, hypnosis is probably the better choice," he said, for the research literature strongly suggests that it improves the gastrointestinal symptoms far more reliably.
On the other hand, he added, if a patient wants to cope better with the illness or improve mental well-being, then cognitive behavioral therapy is equally good or perhaps even the better treatment option.
Evid Based Complement Alternat Med. 2008 Mar;5(1):41-50.
Mind/Body psychological treatments for irritable bowel syndrome.
Naliboff BD, Fresé MP, Rapgay L.
UCLA Center for Neurovisceral Sciences and Women's Health, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA and Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
Currently, the goal of treatment for those with irritable bowel syndrome (IBS) is to improve the quality of life through a reduction in symptoms. While the majority of treatment approaches involve the use of traditional medicine, more and more patients seek out a non-drug approach to managing their symptoms. Current forms of non-drug psychologic or mind/body treatment for IBS include hypnotherapy, cognitive behavioral therapy and brief psychodynamic psychotherapy, all of which have been proven efficacious in clinical trials. We propose that incorporating the constructs of mindfulness and acceptance into a mind/body psychologic treatment of IBS may be of added benefit due to the focus on changing awareness and acceptance of one's own state which is a strong component of traditional and Eastern healing philosophies.
PMID: 18317547 [PubMed - in process]
Called by some "the best kept secret in Gastroenterology" the IBS Audio Program 100 developed by Michael Mahoney, Clinical Hypnotherapist at Guardian Medical Centre in Cheshire England is now used by Irritable Bowel Syndrome (IBS) sufferers in 41 countries.
From the early days of 1998 when the IBS Audio Program 100 was first released it was impossible to foresee the impact that this home use audio program would have on the lives of so many people around the world.
IBS is a common digestive condition which affects up to 1 in 5 of the population of the UK and USA, with varying degrees of severity in most other countries. It impacts the individual resulting in lost working days, increased costs to employers and health care providers and insurance companies.
While medical science has no known cure for the condition, or a reason of why the condition begins in the first place, it has been widely recognised for more than 20 years in the medical world that hypnotherapy can be an effective treatment option to reduced frequency and severity of presenting symptoms. Hypnotherapy has recently been listed as a treatment option for IBS in the UK's National Institute for Health and Clinical Excellence (NICE) guidelines.
The IBS Audio Program 100 was developed specifically for the IBS condition, to manage both the physical and the emotional aspects of IBS, which are commonly reported by IBS sufferers.
IBS can cause chronic and sever physical symptoms such as pain,wind constipation diarrhoea,nausea, urgency for the toilet, alternating bowel habit, and spasm along with other symptoms. The IBS Audio Program 100 also addresses the often neglected emotional aspects of IBS, including loss of confidence and self esteem, weepiness, reduced memory and concentration and more.
Coupled with an effective listening schedule and progress log the program brings real hope and understanding to the IBS sufferer. It also comes complete with an informational CD 'The IBS Companion' for those living with the IBS suffer, but who do not have the IBS condition themselves, this has also proved useful to co-workers and other family members to understand the IBS condition for fully.
Michael Mahoney the author and developer of the program is delighted. "The IBS Audio Program 100 has and is making positive differences to the majority of its users. While there is no such thing as a magic wand, many users have suggested it maybe the next best thing." The problem is, said Mahoney, "IBS sufferers go through the health-care system, and are often told there is nothing else that can be done for them, and they will have to live with it. Many have found the IBS Audio Program 100 through word of mouth, and through desperation, and as a last resort."
For comprehensive information about the program check here http://www.helpforibs.com/hypnosis/selfhyp1.asp
Leading gastroenterologists are calling for hypnotherapy to be used more widely in treating irritable bowel syndrome. Images such a fast-flowing river in the gut slowing down and soothing the bowel may be able to significantly improve IBS symptoms, say researchers at King's College London. In one study at Withington Hospital, 12 weeks of hypnotherapy helped 71 per cent of patients ease their IBS symptoms for five years after the treatment.
What to do: Sitting quietly, imagine your whole body becoming softer and heavier, limb by limb. Visualise a soothing river flowing through your gut. Imagine the river flow first at the "current speed" of your bowel, then slow it down to the "imagined" speed needed for symptoms to cease.
1: J Psychosom Res. 2008 Jun;64(6):621-3.
Hypnotherapy for irritable bowel syndrome: the response of colonic and noncolonic symptoms.
University of Manchester, Manchester, United Kingdom.
There is now good evidence that hypnotherapy benefits a substantial proportion of patients with irritable bowel syndrome and that improvement is maintained for many years. Most patients seen in secondary care with this condition also suffer from a wide range of noncolonic symptoms such as backache and lethargy, as well as a number of musculoskeletal, urological, and gynaecological problems. These features do not typically respond well to conventional medical treatment approaches, but fortunately, their intensity is often reduced by hypnosis.
The mechanisms by which hypnosis mediates its benefit are not entirely clear, but there is evidence that, in addition to its psychological effects, it can modulate gastrointestinal physiology, alter the central processing of noxious stimuli, and even influence immune function.
PMID: 18501263 [PubMed - in process]
Int J Clin Exp Hypn. 2009 Apr;57(2):162-73.
Using art to help understand the imagery of irritable bowel syndrome and its response to hypnotherapy.
Carruthers HR, Miller V, Morris J, Evans R, Tarrier N, Whorwell PJ.
University of Manchester, United Kingdom.
A medical artist asked 109 patients if they had an image of their IBS pre- and posthypnotherapy, making precise watercolor paintings of any images described.
Results were related to treatment outcome, symptoms, anxiety, depression, and absorption (hypnotizability); 49% of patients had an image, and a wide variety were recorded and painted. Imagery was significantly associated with gender (p < .05), anxiety (p < .05), noncolonic symptomatology (p < .05), and absorption (p = .001); 57.8% of responders compared with 35.5% of nonresponders to hypnotherapy had an image of their disease (p < .05) before treatment, and color images were associated with better outcomes (p = .05) than monochrome ones.
All images changed in responders, often becoming more nonspecific in nature.
Inquiring about IBS imagery helps to identify potential responders and nonresponders to hypnotherapy and may also provide insights into how patients think about their illness.
PMID: 19234964 [PubMed - in process]
Int J Clin Exp Hypn. 2009 Jul;57(3):279-92.
Hypnotherapy for functional gastrointestinal disorders: a review.
Miller V, Whorwell PJ.
University of Manchester, Manchester, United Kingdom.
Patients with functional gastrointestinal disorders, such as irritable bowel syndrome, functional dyspepsia, and noncardiac chest pain, can suffer from a range of severe symptoms that often substantially erode quality of life.
Unfortunately, these conditions are notoriously difficult to treat, with many patients failing to improve despite being prescribed a wide variety of conventional medications. As a consequence, the potential benefits of hypnotherapy have been explored with evidence that this approach not only relieves symptoms but also appears to restore many of the putative psychological and physiological abnormalities associated with these conditions toward normal.
These observations suggest that this form of treatment has considerable potential in aiding the management of functional gastrointestinal disorders and should be integrated into the ongoing medical care that these patients are receiving.
PMID: 19459089 [PubMed - in process]
Z Gastroenterol. 2009 Nov;47(11):1153-9. Epub 2009 Nov 6.
Hypnotherapy for irritable bowel syndrome--a systematic review
[Article in German]
Hefner J, Rilk A, Herbert BM, Zipfel S, Enck P, Martens U.
Abteilung Innere Medizin VI, Psychosomatische Medizin und Psychotherapie, Universität Tübingen.
The Irritable bowel syndrome (IBS) is a highly prevalent functional disorder with a remarkable clinical and economic impact. Several pathogenetic factors of IBS are discussed and summarised within a bio-psycho-social model. Data from published hypnotherapeutic interventions with approximately 800 patients show long-lasting symptom relief.
The underlying mechanisms of action are not well understood. Nine mechanism studies show influences of hypnosis on colorectal sensitivity, colorectal motility and mental strain (anxiety, depression, maladaptive cognitions). Results are often contradictory and effects of hypnosis on several of the proposed pathogenetic factors are not examined at all.
This paper reviews previous studies on hypnotherapy in IBS patients with a focus on symptom relief and mechanisms of action.
PMID: 19899024 [PubMed - in process]
Clin Gastroenterol Hepatol. 2010 Feb 17.
Rapid Response to Cognitive Behavior Therapy Predicts Treatment Outcome in Patients With Irritable Bowel Syndrome.
Lackner JM, Gudleski GD, Keefer L, Krasner SS, Powell C, Katz LA.
Division of Gastroenterology, Department of Medicine, University at Buffalo, State University of New York, Buffalo, New York.
BACKGROUND & AIMS: Cognitive behavior therapy (CBT) is an empirically validated treatment for irritable bowel syndrome (IBS), yet it is unclear for whom and under what circumstances it is most effective. We investigated whether patients who achieved a positive response soon after CBT onset (by week 4), termed rapid responders (RRs), maintain treatment gains compared with non-rapid responders. We also characterized the psychosocial profile of RRs on clinically relevant variables (eg, health status, IBS symptom severity, distress).
METHODS: The study included 71 individuals (age, 18-70 y) whose IBS symptoms were consistent with Rome II criteria and were of at least moderate severity. Patients were assigned randomly to undergo a wait list control; 10 weekly 1-hour sessions of CBT; or four 1-hour CBT sessions over 10 weeks. RRs were classified as patients who reported adequate relief of pain, adequate relief of bowel symptoms, and a decrease in total IBS severity scores of 50 or greater by week 4.
RESULTS: Of patients undergoing CBT, 30% were RRs; 90% to 95% of the RRs maintained gains at the immediate and 3-month follow-up examinations. Although the RRs reported more severe IBS symptoms at baseline, they achieved more substantial, sustained IBS symptom reduction than non-rapid responders. Both dosages of CBT had comparable rates of RR.
CONCLUSIONS: A significant proportion of IBS patients treated with CBT have a positive response within 4 weeks of treatment; these patients are more likely to maintain treatment gains than patients without a rapid response. A rapid response is not contingent on the amount of face-to-face contact with a clinician.
Copyright © 2010 AGA Institute. Published by Elsevier Inc. All rights reserved.
PMID: 20170751 [PubMed - as supplied by publisher]
Even The Most Severe Symptoms Rapidly Relieved By Self-Directed Behavioral IBS Treatment
Article Date: 13 May 2010 - 5:00 PDT
Nearly one-third of patients with irritable bowel syndrome (IBS) who underwent a novel behavior treatment developed by a University at Buffalo behavioral scientist achieved significant relief within four weeks of beginning treatment.
These patients, called "rapid responders" maintained their improvement at a three-month follow-up, despite reporting more severe IBS symptoms when they started the treatment.
Results also showed that the amount of "face time" spent with a therapist during the 10-week treatment regimen didn't have an effect on rapid response.
The study is published in the current issue of the journal Clinical Gastroenterology and Hepatology.
"These results are important, because conventional wisdom states that benefit from behavioral treatments is tied to the amount of treatment patients receive," says first author Jeffrey Lackner, PsyD, associate professor in the Department of Medicine, UB School of Medicine and Biomedical Sciences, and director of its Behavioral Medicine Clinic.
"In some patients this assumption does not prove to be true," he continues. "Regardless of whether patients received two or four sessions of behavioral treatment, a significant proportion rapidly achieved significant relief of severe IBS symptoms and maintained these gains for at least three months."
Irritable bowel syndrome is a chronic, debilitating disorder affecting 25 million people in the U.S. - 14-24 percent of women and 5-19 percent of men. In the past, there had been no reliable, satisfactory medical treatment for the full range of IBS symptoms, which can cause severe physical and psychological distress and deprive sufferers of their quality of life.
Lackner is principal investigator on an $8.9 million, seven-year, multi-site clinical trial funded by the National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK) to test the treatment, which proved effective during his pilot study. The UB trial is the largest IBS clinical trial conducted to date, and one of the largest behavioral trials without a drug component funded by the NIH.
The current study involved 71 participants from its UB site who were randomized to receive either four one-hour sessions with a behavioral therapist over 10 weeks, 10 one-hour sessions over 10 weeks or to a "wait" group, which served as a control.
Researchers were interested in knowing if patients who showed significant improvement soon after beginning treatment maintained that improvement at three months after the 10-week intervention, and if so, how these rapid responders were different from the non-rapid responders.
Lackner says they found a strong connection between participants' beliefs about their IBS symptoms and their rapid response and maintenance of improvement.
"Rapid responders were more likely to attribute their symptoms to their own specific behavior, express more confidence in their ability to make specific behavior changes necessary to control IBS symptoms and have stronger motivation to participate in a self-management program," says Lackner.
"One might assume that the therapist-directed, time-intensive and highly structured weekly cognitive behavior therapy would be more likely to promote a more rapid response. That turned out not to be the case."
In addition, 92.5 percent of rapid responders showed an enduring benefit that lasted well over three months with little evidence of deterioration.
"This suggests that rapid response is a relatively robust, clinically meaningful and enduring clinical phenomenon," says Lackner. "The enduring nature of the response to treatment argues against the idea that the results are due to placebo."
He continues: "The study has implications for designing clinical trials that test the effectiveness of medical therapies. Generally speaking, the approach has been to test two treatments side by side. This horse race approach is useful, but may not provide information about the more pressing question of: which treatment works best for which patient?
"Our study suggests that what goes on during treatment may be more important to understanding the course of outcome than factors such as the severity of their illness, age, gender and education level. Generally speaking, these variables are not reliable predictors of outcome."
Additional authors on the paper from UB are Gregory D. Gudleski, PhD, Susan S. Krasner, PhD, Catherine D. Powell and Leonard A. Katz, MD, and Laurie Keefer, PhD, from Northwestern University.
University at Buffalo
In IBS, A Patient's Response To Hypnotherapy Can Be Predicted By Color Test
Article Date: 08 Dec 2010 - 1:00 PST
When people with irritable bowel syndrome (IBS) were asked to relate their mood to a color, those choosing a positive color were nine times more likely to respond to hypnotherapy than those who chose a negative color or no color at all. Researchers writing in the open access journal BMC Complementary and Alternative Medicine suggest that these findings could be used to predict responders to treatment.
Peter Whorwell worked with a team of researchers from the University of Manchester, UK, to carry out the study using a color chart called the 'Manchester Color Wheel' which allows patients to choose colors that have previously been defined as positive, neutral or negative. He said, "Our unit has been providing hypnotherapy for the treatment of IBS for over twenty years with approximately two thirds of patients responding to treatment. Unfortunately, patients may require as many as twelve one hour sessions of therapy to secure a response and therefore this results in the treatment being relatively expensive to provide. Consequently it would be very useful to be able to predict responders".
Speaking about the results Whorwell said, "Being able to describe mood in terms of a positive color is a sign of an active imagination, which is an important component of hypnotic ability". The hypnotherapy provided in Professor Whorwell's Unit is called gut-focused hypnotherapy. The technique aims to give a patient control over their gut and they have shown that following a course of treatment actual changes in gastrointestinal function can be demonstrated.
Mood color choice helps to predict response to hypnotherapy in patients with irritable bowel syndrome Helen R Carruthers, Julie Morris, Nicholas Tarrier and Peter J Whorwell BMC Complementary and Alternative Medicine (in press)
Demystifying Meditation: Brain Imaging Illustrates How Meditation Reduces Pain
ScienceDaily (Apr. 11, 2011) — Meditation produces powerful pain-relieving effects in the brain, according to new research published in the April 6 edition of the Journal of Neuroscience.
"This is the first study to show that only a little over an hour of meditation training can dramatically reduce both the experience of pain and pain-related brain activation," said Fadel Zeidan, Ph.D., lead author of the study and post-doctoral research fellow at Wake Forest Baptist Medical Center.
"We found a big effect -- about a 40 percent reduction in pain intensity and a 57 percent reduction in pain unpleasantness. Meditation produced a greater reduction in pain than even morphine or other pain-relieving drugs, which typically reduce pain ratings by about 25 percent."
For the study, 15 healthy volunteers who had never meditated attended four, 20-minute classes to learn a meditation technique known as focused attention. Focused attention is a form of mindfulness meditation where people are taught to attend to the breath and let go of distracting thoughts and emotions.
Both before and after meditation training, study participants' brain activity was examined using a special type of imaging -- arterial spin labeling magnetic resonance imaging (ASL MRI) -- that captures longer duration brain processes, such as meditation, better than a standard MRI scan of brain function. During these scans, a pain-inducing heat device was placed on the participants' right legs. This device heated a small area of their skin to 120° Fahrenheit, a temperature that most people find painful, over a 5-minute period.
The scans taken after meditation training showed that every participant's pain ratings were reduced, with decreases ranging from 11 to 93 percent, Zeidan said.
At the same time, meditation significantly reduced brain activity in the primary somatosensory cortex, an area that is crucially involved in creating the feeling of where and how intense a painful stimulus is. The scans taken before meditation training showed activity in this area was very high. However, when participants were meditating during the scans, activity in this important pain-processing region could not be detected.
The research also showed that meditation increased brain activity in areas including the anterior cingulate cortex, anterior insula and the orbito-frontal cortex. "These areas all shape how the brain builds an experience of pain from nerve signals that are coming in from the body," said Robert C. Coghill, Ph.D., senior author of the study and associate professor of neurobiology and anatomy at Wake Forest Baptist.
"Consistent with this function, the more that these areas were activated by meditation the more that pain was reduced. One of the reasons that meditation may have been so effective in blocking pain was that it did not work at just one place in the brain, but instead reduced pain at multiple levels of processing."
Zeidan and colleagues believe that meditation has great potential for clinical use because so little training was required to produce such dramatic pain-relieving effects. "This study shows that meditation produces real effects in the brain and can provide an effective way for people to substantially reduce their pain without medications," Zeidan said.
Funding for the study was provided by the Mind and Life Institute in Boulder, Colo., and the Center for Biomolecular Imaging at Wake Forest Baptist.
The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Wake Forest Baptist Medical Center, via EurekAlert!, a service of AAAS.
1. F. Zeidan, K. T. Martucci, R. A. Kraft, N. S. Gordon, J. G. McHaffie, R. C. Coghill. Brain Mechanisms Supporting the Modulation of Pain by Mindfulness Meditation. Journal of Neuroscience, 2011; 31 (14): 5540 DOI: 10.1523/JNEUROSCI.5791-10.2011
Hypnosis as health care quietly gains ground
The last decade has produced a number of studies suggesting benefits
By Rachael Rettner
updated 8/21/2011 1:32:16 PM ET
In 1987, Marilyn Bellezzo was diagnosed with irritable bowel syndrome (IBS), a disorder that was, for her, debilitating.
"I was housebound," Bellezzo said. She spent hours curled up on the bathroom floor, suffering from abdominal pain and diarrhea. "I had to raise my children through the bathroom door," said the now 59-year-old resident of Glen Ellyn, Ill.
Over the next 12 years, Bellezzo tried medications and diets, to no avail. Then as a last resort, she started listening to audio tapes designed to treat IBS through hypnosis.
They made a difference. Now, she says her symptoms are virtually gone.
"I went from that level of severity to just having an occasional episodes lasting a few minutes," Bellezzo said.
Over the last decade, more and more research shows there are benefits of hypnosis for medical problems. In addition to IBS, a number of rigorous studies have found the practice is effective at mollifying chronic pain and reducing stress and anxiety before surgery. Studies have also shown hypnosis reduces health care costs — patients who use it stay in the hospital for shorter periods and use less medication.
So why don't more people and hospitals use hypnosis? Part of the reason may be its stigma — patients and doctors may think of it more as "hocus pocus" than science. Another reason may be problems with the quality of hypnosis studies, leading doctors to be wary that it wastes time and money.
All of these are misperceptions, its advocates say.
"Hypnosis is sort of the good kid with the bad reputation," said Julie Schnur a clinical psychologist and assistant professor at Mount Sinai School of Medicine in New York. "It’s a fantastic procedure and can be very effective and very helpful to patients, but does come with this baggage," Schnur said.
The concept of hypnosis might call to mind an entertainer lulling an audience member with a shiny pendulum, and then getting them bark like a dog.
But in medicine, hypnosis means putting a patient in an enhanced state of relaxationduring which the patient is more open to suggestions, said Harold Pass, an associate professor of clinical psychiatry at Stony Brook University Medical Center in New York. The patient is not asleep, nor unconscious, and does not lose control over his or her actions, Pass said.
"People do not turn into a zombie, they will not quack like a duck, there are no swinging pocket watches," Schnur said. "It's using your mind and your thoughts to help yourself feel better."
During a session, the patient is first brought into a trancelike state of highly focused attention. Some say people move into and out of this state every day, said Mark Jensen, vice chair for research in the Department of Rehabilitation Medicine at the University of Washington Medical Center, and liken it to being completely absorbed, as in watching a sunset.
"It doesn’t feel foreign or strange at all," said Bellezzo, who now works for the hypnotherapist who treated her. "It basically feels like that period of time right before you fall asleep." You're still aware of everything, but your attention is very focused, she said.
In this state, brain changes occur that make people better able to alter their perceptions, Jensen said. For example, a hypnotherapist may ask a patient to change the location, intensity or quality of their perception of pain, Jensen said, for example, imagining a burning sensation instead feels like water.
Hypnosis has its risks. Although rare, reactions such as headaches, nausea and anxiety happen to some people, according to the Mayo Clinic. And the use of hypnosis in patients with certain mental illnesses, or to help any patient relive earlier life events remains controversial because these uses might create false memories.
How well does it work?
Hypnosis is not magic — it alleviates symptoms, but doesn’t cure disease. And for chronic pain suffers, it rarely eliminates their pain, Jensen said.
And although not everyone can be hypnotized, studies show 70 to 80 percent of chronic pain patients experience pain relief that lasts for hours, Jensen said.
Michael Clark, director of the Pain Treatment Program at John Hopkins University, said there isn't overwhelming evidence that hypnosis is effective for chronic pain, but there is evidence nonetheless. Clark has recommended the therapy to patients who are open to it.
"A lot of the alternative therapies like hypnosis, meditation, acupuncture, Tai Chi — those types of therapies or approaches, they really don’t have any serious risk associated with them," Clark said. "They may not have a huge evidence base, but the risk-benefit equation is favorable."
According to a 2008 review article in the journal Nature, "there is an emerging body of evidence that hypnotherapy is clinically effective for the treatment of IBS." Several well-designed studies have shown long-term benefits for patients, including reductions of abdominal pain, anxiety and depression, the researchers said.
In 2007, Schnur and colleagues conducted a study of 200 breast cancer patientswho needed surgery. About half underwent a 15-minute hypnosis session before their surgery; the other half talked with a psychologist about their thoughts and feelings pre-surgery.
Patients who underwent hypnosis required less sedative during the surgery, and because they were more relaxed, their surgeries lasted10 fewer minutes on average. They experienced less pain, nausea, fatigue and emotional upset following the surgery, Schnur said. The researchers calculated the hospital could save about $770 per cancer patient by employing hypnosis before surgery.
Why isn't it used more?
Patients and doctors may have misperceptions about hypnosis. They may think it's flaky and not realize it is supported by scientific evidence, Schnur said. Doctors may be unfamiliar with hypnosis because it's not taught in medical school and they may not read about it in journals, said Janet Konefal, assistant dean for complementary and integrative medicine at the University of Miami Miller School of Medicine.
Doctors and hospital administrators may have misunderstandings about how much hypnosis will cost, who can administer it and how long it will take, Schnur said. But sessions can take as little as 15 minutes, and anyone licensed to perform medical services could be trained to provide hypnosis, she said.
Still, hypnosis for some conditions, such as IBS, may take longer, and the limited number of trained clinicians may restrict the number of patients who can try it, according to the 2008 Nature paper.
And studies have shown mixed results. For example, a 2009 Cochrane reviewfound that while hypnosis seemed to be helpful in treating IBS, research on its effectiveness suffered from poor design and small sample sizes, so results should be interpreted with caution.
The Mount Sinai group is considering alternative ways to deliver hypnosis, such as over the Internet (perhaps through a video chat) or though a cellphone application.
Bellezzo said she also uses hypnosis to treat her chronic pain.
"Whenever I get that [pain], I play one of the sessions," Bellezzo said. "Within 15 minutes, I'm pain-free. It's absolutely amazing."
Pass it on: Mounting evidence seems to show that hypnosis helps patients, but the practice still faces a stigma and suffers from lack of high-quality research showing its benefits.
Am J Gastroenterol.
2011 Oct 4.
Effects of Gut-Directed Hypnotherapy on IBS in Different Clinical Settings-Results From Two Randomized, Controlled Trials.
Lindfors P, Unge P, Arvidsson P, Nyhlin H, Björnsson E, Abrahamsson H, Simrén M.
1] Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden  Department of Internal Medicine, Gävle County Hospital, Gävle, Sweden  Department of Gastroenterology, Sabbatsbergs Hospital, Stockholm, Sweden.
Gut-directed hypnotherapy has been found to be effective in irritable bowel syndrome (IBS). However, randomized, controlled studies are rare and few have been performed outside highly specialized research centers.
The objective of this study was to study the effect of gut-directed hypnotherapy in IBS in different clinical settings outside the traditional research units.
The study population included IBS patients refractory to standard management. In study 1, patients were randomized to receive gut-directed hypnotherapy (12 sessions, 1 h/week) in psychology private practices or supportive therapy, whereas patients were randomized to receive gut-directed hypnotherapy in a small county hospital or to serve as waiting list controls in study 2. Gastrointestinal symptom severity and quality of life were evaluated at baseline, at 3 months follow-up and after 1 year.
We randomized 138 IBS patients refractory to standard management, 90 in study 1 and 48 in study 2. In both the studies, IBS-related symptoms were improved at 3 months in the gut-directed hypnotherapy groups (P<0.05), but not in the control groups (ns). In study 1, a significantly greater improvement of IBS-related symptom severity could be detected in the gut-directed hypnotherapy group than in the control group (P<0.05), and a trend in the same direction was seen in study 2 (P=0.17). The results seen at 3 months were sustained up to 1 year.
Gut-directed hypnotherapy is an effective treatment alternative for patients with refractory IBS, but the effectiveness is lower when the therapy is given outside the highly specialized research centers.
Am J Gastroenterol advance online publication, 4 October 2011; doi:10.1038/ajg.2011.340.
[PubMed - as supplied by publisher]
Hypnosis effective in treating irritable bowels
Published: Tuesday, Apr 3, 2012, 16:07 IST
Place: Stockholm | Agency: IANS
Hypnosis can be highly effective in treating the irritable bowel syndrome (IBS), characterised by abdominal pain, abdominal distension and bloating.
Studies based on 346 patients conducted by The Sahlgrenska Academy, Sweden, showed that hypnotherapy alleviated symptoms in 40% of those affected — and that the improvement was long-term.
Researcher Magnus Simrén and colleagues at The Sahlgrenska Academy have conducted two studies to evaluate a form of treatment that could be used in ordinary healthcare, according to a Sahlgrenska statement.
In one of the studies, published in the American Journal of Gastroenterology, 138 patients with IBS received hypnotherapy treatment for one hour a week over 12 weeks. The study showed that 40% registered a satisfactory lowering of symptoms, compared with 12% in the untreated control group.
"The treatment involves the patient learning to control their symptoms through deep relaxation and individually adapted hypnotic suggestions. The idea is for the patient to then use this technique in their everyday life," says Simrén.
The positive effect was sustained for the entire year for which the study ran and led to an improvement in the quality of life experienced by the treatment group.
In the other study, presented in the Scandinavian Journal of Gastroenterology, 208 patients who had previously received hypnotherapy were examined.
The results showed that 85% of those who had been helped by hypnosis still felt the benefits of the treatment up to seven years later - and that the majority still actively use the technique in their everyday lives.
"In this group, use of the healthcare system as a result of stomach and bowel symptoms had also reduced by 70%," says Simrén.
Gut-directed group hypnotherapy improved quality of life in patients with IBS
Moser G. Am J Gastroenterol. 2013;doi:10.1038/ajg.2013.19.
March 4, 2013
Patients with refractory irritable bowel syndrome indicated better illness-related quality of life after undergoing gut-directed group hypnotherapy in addition to medical treatment in a recent study.
Researchers randomly assigned 100 adult patients with refractory IBS to receive either supportive talks with medical treatment (SMT, controls) or to undergo 10 weekly 45-minute sessions of gut-directed group hypnotherapy (GHT) within 12 weeks, in addition to SMT. Patients’ quality of life was measured via the 26-item IBS impact scale (IBS-IS) before and after intervention, and after 12 months of follow-up. General quality of life, psychological status and changes to individual IBS symptoms also were assessed.
Intervention was performed in 46 GHT cases and 44 controls. More than half (60.8%) of the GHT group experienced improved quality of life compared with 40.9% of SMT controls (P=.046). During 12 months of follow-up, 54.3% of the GHT group had sustained improvement compared with 25% of the SMT group (P=.004).
Severe IBS, as indicated by IBS-IS scores of 4 or lower, was observed in 76.1% of GHT patients and 75% of the SMT group at baseline. After 5 weeks, 71.7% of GHT patients scored greater than 4 (indicating mild-to-moderate IBS) compared with 40% of the SMT group. Changes to IBS-IS were statistically significant over time only for GHT recipients (P=.007). Binary regression analysis incorporating age, sex or IBS type and duration indicated that only GHT intervention was predictive of improvement within the treatment period (OR=2.5, 95% CI, 1.1-5.8).
Both groups experienced reductions in abdominal pain, flatulence and constipation. GHT patients indicated significantly better quality of life via Short Form (36) Health Survey (P=.006) and better physical well being (P=.023), psychological well being (P=.046) and life satisfaction (P=.049) upon treatment completion compared with SMT.
“GHT is highly effective, even in treatment-refractory IBS, and is superior to SMT alone,” the researchers concluded. “Given that IBS drug developments have been disappointing, GHT is a useful and harmless therapy option with no side effects. It can be learned and provided by specialized physicians, psychologists and psychotherapists, and can be made available for more patients with severe and/or refractory IBS in specialized centers.”
A WARRINGTON based clinical hypnotherapist has received the backing of his local MP on his groundbreaking work, which could help save the NHS money.
During a meeting with Warrington South MP David Mowat, internationally acclaimed hypnotherapist Michael Mahoney highlighted the problems caused by a common gastrointestinal disorder that can affect up to 1 in 5 of the population at some time in life.
Irritable Bowel Syndrome or IBS is a gastrointestinal condition, which can cause diarrhoea, pain, bloating, nausea, constipation and a number of other associate symptoms. Medical research is divided as to why IBS develops and to date there is no definitive cure. Medications, supplements and diets may provide only short term relief, but for many, symptoms can continue after many treatment options have failed.
The on-going physical symptoms often result in the emotional issues of anxiety, travel concerns, frustration, decreased confidence and self-esteem to name a few. Because the symptoms can be so resistant to treatment, IBS places a large burden upon the nation's health service.
IBS affects both adults and children, with sufferers visiting their GPs more frequently. Referrals to hospital gastroenterology departments are made where expensive tests are carried out to exclude more serious conditions that can mimic IBS symptoms. The IBS diagnosis is one of exclusion and is usually made when nothing abnormal can be found.
IBS can result in increased absenteeism from work or school, bringing higher costs to employers, students miss college and later, university classes and younger children miss school, sabotaging their education. And after a year or so of ineffective treatment, the medical investigations may start again, and so the expensive cycle continues.
IBS is not classified as a serious condition that can result in death, but medical experts agree that the Quality of life (QoL) of an IBS sufferer is restricted to varying degrees, dependent upon the frequency and presentation of the IBS symptoms.
However it has been well researched that clinical hypnotherapy can significantly decrease the symptoms and frequency of IBS.
Michael has been helping IBS sufferers to live a normal life since 1991 when he saw his first IBS sufferers in the Warrington area. He has achieved this through his original gut-specific protocol, which manages and even eliminates the IBS condition completely for over 90% of his patient population. Most of his IBS sufferers were severe cases, having had IBS for many years with nothing else addressing the condition until they completed Mahoney's protocol.
Mahoney is now based at Woolston Surgery, Woolston Neighbourhood Hub, Warrington WA1 4PN.
During his meeting with Mr Mowat Michael explained the benefits of using hypnotherapy for the IBS condition. In fact hypnotherapy is one of the talking therapies recommended in the National Institute for Health and Clinical Excellence (NICE) guidelines after 12 months of non-effective pharmacological treatment.
He also explained the high costs of IBS on the NHS and business, and the benefits of hypnotherapy, and how this effective method worked generally, but more specifically with the IBS condition.
Michael said, "The meeting was very valuable. Mr. Mowat very quickly understood the frustrations of this forgotten patient population, and was very positive in his encouragement of my work. Far from being hurried, I was listened to, important questions were asked and answered, and I felt Mr. Mowat understood the gravity of this often trivialised condition. I am delighted that my work, and its benefits for IBS sufferers everywhere, has taken a positive step forward today."
Mr Mowat said: "Michael's work is a fine example of what can be done with persistence and a dedication to those who suffer, while finding a possible innovative solution to NHS budget costs. It is encouraging to find dedication like this within my constituency."
Michael has researched the IBS condition and developed specific hypnotherapy processes which are used in his successful IBS Audio Program 100 for adults. This recorded audio program is now helping IBS sufferers in over 45 countries. Michael was invited to Buckingham Palace garden party in 2011 as a result of his 'innovative health solutions' referring to his home use audio recordings, of which IBS is one.
Michael developed the first IBS training workshops for hypnotherapists in the country, and runs an IBS clinic in Warrington. He is co- owner and principal of Cambridge College of Hypnotherapy, and Cheshire College of Hypnotherapy, providing diploma training to those wanting to join the hypnotherapy profession.
Listen to samples of Michael Mahoney's program for IBS, and learn more here http://www.helpforibs.com/shop/books/hypnoibs.asp
Article source: http://www.warrington-worldwide.co.uk/articles/15534/1/MPs-support-for-pioneering-IBS-work/Page1.html
Gut-directed hypnotherapy improved remission maintenance for UC
Keefer L. Aliment Pharmacol Ther. 2013;38:761-771.
September 5, 2013
Patients with ulcerative colitis in remission were more likely to maintain remission if they underwent gut-directed hypnotherapy in a recent study.
Researchers randomly assigned 54 adult patients with ulcerative colitis (UC) in remission at enrollment to seven weekly, 40-minute sessions of gut-directed hypnotherapy (HYP; n=26) or attention control (n=28). All participants self-reported more than one flare per year, had documented flares within the previous 1.5 years and were receiving a stable dose of maintenance therapy for more than 1 month before the study.
Disease status and quality of life were measured at baseline and at 2, 20, 36 and 52 weeks after completing therapy. Patients provided sociodemographic and medical information, completed daily symptom diaries at baseline and during treatment, and responded to questionnaires assessing disease activity, physical and mental health and perceived stress levels.
Laurie Keefer, PhD
“As a health psychologist, I would see patients who would loosen up on their self-care when they were in remission, and it seemed like having a pleasant, simple tool like hypnotherapy could help keep them in touch with their disease self-management,” researcher Laurie Keefer, PhD, associate professor and director of the Center for Psychological Research in GI at Northwestern University Feinberg School of Medicine, told Healio.com.
Flares occurred in eight patients in the HYP group and 15 among controls. HYP patients had a greater number of days to clinical relapse than controls on one-way Anova analysis (F=4.8, P=.03). More treated patients maintained remission for 1 year (68% vs. 40% of controls; P=.04) in chi-square analysis. Investigators calculated via Cox proportional hazards model that controls were at 2.11 times the risk for flares compared with HYP recipients (P=.09).
Quality of life and assessments of psychological factors, stress levels and medication adherence did not differ significantly between groups.
“Hypnotherapy works as an adjunct treatment in inflammatory bowel disease,” Keefer said. “It may help keep patients in remission a little longer, especially those patients who have frequent flares or who have functional symptoms on top of their IBD.”
Listen to a Gut-Directed Hypnotherapy Program Here
Is tummy trouble keeping your child out of school? It could be Irritable Bowel Syndrome
By Sandra Walsh
PUBLISHED: 19:03 EST, 23 September 2013 | UPDATED: 03:10 EST, 24 September 2013
Debilitating: It's suggested that 20% of children suffer from IBS symptoms
The common cold regularly tops the list of reasons for school absence - no surprise there. But the second most cited cause is irritable bowel syndrome (IBS).
One mother who knows only too well how debilitating the condition can be is Claire McKee. Her son Elliott first developed symptoms when he started full-time at school at the age of four.
'He started getting bad tummy aches,' recalls Claire. 'Every night he would be clutching his tummy and crying in agony. I would try to cuddle him to sleep.
'In the mornings Elliott would spend ages in the loo, suffering frequent bouts of diarrhoea. It was awful watching him in pain and not being able to do anything.
'He'd be terrified he wouldn't be able to get to the loo in time at school or that his classmates would notice the smell.'
Claire's GP ordered blood tests to rule out serious digestive disorders such as coeliac and Crohn's disease. These came back clear. Elliott was then referred to a dietician, who suggested eliminating various foods to see if the problem was a food allergy or intolerance. Again the results were negative.
It was only after talking to a friend, a long-term sufferer of irritable bowel syndrome, that Claire put two and two together.
'It was a lightbulb moment,' says Claire, from Billingshurst, West Sussex. 'Elliott's symptoms matched my friend's almost exactly.'
The symptoms of IBS are triggered when muscles in the large intestine become sensitised and contract. The underlying cause is unknown, but stress can be a trigger.
'I realised Elliott's problems had coincided with him starting full-time at school,' says Claire. 'He didn't get on with his new teacher and that's when it began.
'Yet when we'd gone to Portugal in the school holidays, the symptoms disappeared.
'It was a relief to realise that Elliott didn't have some horrible illness, but a shock to find out there was no cure.'
While as many as one adult in three will suffer from IBS at some point, many don't realise children can also be affected. Indeed, one study suggested that 20 per cent of children suffer from IBS symptoms. The peak ages are from four to 12.
So how can parents tell if their child has a simple tummy ache or IBS?
Surprising: The second most cited cause for school absence is IBS
Surprising: The second most cited cause for school absence is IBS
'Most children will have bowel upsets and tummy aches when they're having a stressful time but it usually goes away,' says Professor Nick Read, a gastroenterologist and adviser to the IBS Network.
'To be diagnosed with IBS requires symptoms going on for a month or two.'
Children should first be screened for coeliac and Crohn's. 'Once these have been ruled out, IBS is the usual diagnosis,' he says. 'Children don't suddenly get IBS at 15; they've probably always had it but it was put down to “toddler diarrhoea” or tummy troubles.
'The problem is that IBS is simply a name for a collection of symptoms that have no medical cause.'
One theory is that because IBS tends to be more common in the West, our diets, high in refined carbohydrates such as white bread, cakes and pasta, may play a part.
There are certain predisposing factors, adds Dr Aminda De Silva, a gastroenterologist at the Royal Berkshire hospital. 'Gastrointestinal infections are one, dietary sensitivities another, but the key thing is stress.'
Although there is no cure, there is plenty you can do to help, says Professor Read. 'The doctor must try to understand the child and find out the cause of the stress. This might mean working with the parents.'
For adults, guidelines from the National Institute for Health and Care Excellence (NICE) suggest hypnotherapy or counselling, and while they don't specifically refer to children under 18, 'there's good evidence that these are helpful', he adds. 'The key is getting teenagers to understand what's happening in their lives to make the symptoms happen.'
Precautions: If you suspect your child might have IBS, have them screened first for coeliac and Crohn's
Precautions: If you suspect your child might have IBS, have them screened first for coeliac and Crohn's
Children with IBS often dread going to school and live in fear of their friends finding out, says Michael Mahoney, a hypnotherapist with 25 years' experience who specialises in IBS and works with children in the North-West via GP referral.
'One main fear is that they won't be able to get to the loo in time, and that can make them fearful of leaving the house at all.
'It's usually safe to say that the symptoms are learned responses and perhaps began as a result of previous gastro-intestinal upset, but lingered on.'
Mr Mahoney adds: 'Sometimes the symptoms could also be a subconscious way for the child to obtain focus on themselves. Parents of younger children, especially, may actually contribute to symptoms continuing.
'I try to teach children that every thought has a physical response, and that they can learn to get rid of negative thoughts to reduce anxiety and IBS symptoms.'
Children with IBS are often advised to change their diet as some foods can trigger an attack, perhaps because they are harder to digest. They should also avoid caffeine, found in some fizzy drinks, which elevates the stress hormone cortisol.
Dr Peter Irving, a gastroenterologist at Guy's and St Thomas' Hospital and The London Clinic, has had promising results with a diet devised in Australia. The 'Low Fodmap' diet restricts foods containing poorly absorbed sugars called FODMAPs.
'It works on the principle that not all sugars can be absorbed within the small intestine,' says Dr Irving.
'As a result, they are rapidly fermented by bacteria in the bowel which draws in fluid and produces gas.
'This can cause symptoms including bloating, abdominal pain and diarrhoea.'
Foods containing FODMAPs include honey, apples, pears, stone fruit such as peaches, onions, garlic, cabbage, beans and sweeteners such as sorbitol.
Research at King's College Hospital found that 75 per cent of those on the diet saw their symptoms improve.
Elliott, now 12, has learnt to manage his symptoms through trial and error. Certain foods, such as apples, seem to make matters worse, so he avoids these. 'He's doing well,' says Claire.
Read more: http://www.dailymail.co.uk/health/article-2430193/Irritable-Bowel-Syndrome-cause-childs-tummy-trouble.html#ixzz2fw5eKZQP
Michael Mahoney's hypnotherapy program for children with IBS
Relaxation intervention improves symptoms, may help treat IBS, IBD
Kuo B, et al. PLOS ONE. 2015;doi:10.1371/journal.pone.0123861.
Participation in a relaxation response based mind-body group intervention was associated with improvements in disease-specific measures, trait anxiety and pain catastrophizing in patients with irritable bowel syndrome and inflammatory bowel disease, according to study findings.
The quality of life in patients with IBS and IBD is often significantly affected and influenced by stress and resiliency associated with these conditions.
Braden Kuo, MD, of the gastrointestinal unit at Massachusetts General Hospital, and colleagues sought to assess the impact of a 9-week relaxation-response based mind-body group intervention in patients with IBS (n = 19) and IBD (n = 29). The intervention focused on relaxation-response and the building of cognitive skills. They assessed symptom questionnaires and inflammatory markers before and after the intervention, and again at short-term follow-up.
Results indicated significant improvements in Pain Catastrophizing Scale scores post-intervention for IBD and at short-term follow-up for both IBS and IBD (from 10.7 at baseline to 5.0 at week-13, P = .02 for IBS; and from 14.8 to 9.6, P < .01 for IBD).
In addition, significant improvements were observed in Trait Anxiety scores from baseline to week-10 (from 39.0 to 33.7, P = .02 for IBS; and from 39.3 to 33.6, P < .01 for IBD). IBS-QOL scores increased from a mean of 67.1 at baseline to 74.8 at week-10 (P = .01) and to 80.6 at week-13 (P < .001); IBS Symptom Severity Index scores significantly decreased from a mean of 215 at baseline to 154 at week-5 (P < .01), 128 at week-10 (P < .001) and 147 at week-13 (P = .01); and IBD Questionnaire scores increased from a mean of 171 at baseline to 185 at week-10 (P < .01) and sustained at 184 at week-13 (P = .02).
Compared with 1,059 genes altered with the intervention among those with IBD, 119 genes were altered in those with IBS. Reduced expression of intervention response genes was significantly associated with inflammatory response, cell growth, proliferation and oxidative stress-related pathways in those with IBD. Significant upregulation of cell cycle regulation and DNA damage related gene sets were observed after the intervention in those with IBS.
Top focus molecules identified in IBS were TNF, AKT and NF-κB; whereas inflammation (VEGF-C, NF-κB) and cell cycle and proliferation (UBC, APP) associated genes emerged as top focus molecules in IBD, according to the researchers.
“Observed gene expression changes suggest that NF-κB is a target focus molecule in both IBS and IBD — and that its regulation may contribute to counteracting the harmful effects of stress in both diseases. Larger, controlled studies are needed to confirm this preliminary finding,” Kuo and colleagues wrote.
Disclosure: The study was supported by a grant from the CDC and the International Foundation for Functional Gastrointestinal Diseases. The researchers report being a consultant for, receiving funding from and serving on the boards of Basis, Civitas Therapeutics, Furiex, Genova Diagnostics, Given Imaging, Lantheus Medical Imaging, Onyx Pharmaceuticals and Shire Human Genetic Therapies.
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World Congress of Gastroenterology 2017
News > Conference News
At-Home Cognitive Therapy Relieves IBS Symptoms
January 15, 2018
ORLANDO — A self-administered protocol for cognitive behavioral therapy that requires minimal clinician contact can be just as effective at relieving the symptoms of irritable bowel syndrome (IBS) as traditional therapy delivered in a clinical setting, new research shows.
With this protocol, "for the most part, symptom improvement is sustained out to 3 months and 6 months," said investigator Jeffrey Lackner, PsyD, from the University of Buffalo School of Medicine in New York.
These findings — which received an American College of Gastroenterology Governors Award for Excellence in Clinical Research — suggest that home-based treatments could be used to relieve chronic constipation, diarrhea, bloating, gas, and other IBS symptoms in more patients without increasing clinician time or the use of healthcare resources.
In April 2017, the National Institute for Health and Care Excellence (NICE) in the United Kingdom updated its guidelines on the diagnosis and treatment of IBS in adults. Patients who continue to experience IBS symptoms despite at least 12 months of pharmacologic treatment should be referred for cognitive behavioral therapy, hypnotherapy, or psychological therapy, the guidelines state.
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"The problem is that only a small fraction of people receive cognitive therapy in accordance with practice guidelines," said Dr Lackner. Therefore, "there is a demand for treatments that maintain efficacy but are more efficient to implement."
"One strategy is to decrease therapist contact time using home-based treatments," he said here at the World Congress of Gastroenterology.
For their study, Dr Lackner and his colleagues randomized 438 adults with moderate to severe IBS, diagnosed using Rome III criteria, to four 1-hour sessions of self-administered therapy, 10 sessions of standard psychiatrist- or psychologist-led therapy, or four sessions of education only. They assessed symptom relief at 12 weeks, 3 months, and 6 months.
A Durable Response
Significantly more patients in the self-administered therapy group than in the education-only group responded to the intervention — defined as moderate or substantial improvement — at 12 weeks (67.8% vs. 46.2%; P < .05) and at 3 months (63.8% vs. 49.2%; P < .05). At 6 months, the difference did not meet the threshold for significance (63.2% vs 50.5%; P < .07).
Patients' self-reported improvements closely mirrored the global assessments of gastroenterologists blinded to group assignment. At 12 weeks, the clinicians identified as responders 63% of the patients in the self-administered therapy group and 43% of the education-only group. They also identified 60% of patients in the standard therapy group as responders.
"Cognitive behavior therapy appears to have an enduring effect that protects against relapse and recurrence in a sizable sample," Dr Lackner reported.