|
|
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.
Reference List
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
Web: http://www.tlrltd.com
http://www.worldwidehealth.com/article.php?id=459&categoryID=66#disclaimer
--------------------
Heather is the Administrator of the IBS Message Boards. She is the author of Eating for IBS and The First Year: IBS, and the CEO of Heather's Tummy Care. Join her IBS Newsletter. Meet Heather on Facebook!
Print
Remind Me
Notify Moderator
|
|
|
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...
http://www.docguide.com/news/content.nsf/news/852571020057CCF6852572E300752C7A
--------------------
Heather is the Administrator of the IBS Message Boards. She is the author of Eating for IBS and The First Year: IBS, and the CEO of Heather's Tummy Care. Join her IBS Newsletter. Meet Heather on Facebook!
Print
Remind Me
Notify Moderator
|
|
|
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. vssierpi@utmb.edu
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.
http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=17362848&dopt=Abstract
--------------------
Heather is the Administrator of the IBS Message Boards. She is the author of Eating for IBS and The First Year: IBS, and the CEO of Heather's Tummy Care. Join her IBS Newsletter. Meet Heather on Facebook!
Print
Remind Me
Notify Moderator
|
|
|
Stress and the Emotional Motor System (EMS)
eCAM Advance Access published online on May 17, 2007
eCAM, doi:10.1093/ecam/nem046
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
Hypnotherapy
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.
http://ecam.oxfordjournals.org/cgi/content/full/nem046v1#SEC6
--------------------
Heather is the Administrator of the IBS Message Boards. She is the author of Eating for IBS and The First Year: IBS, and the CEO of Heather's Tummy Care. Join her IBS Newsletter. Meet Heather on Facebook!
Print
Remind Me
Notify Moderator
|
|
|
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.
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WFX-4NTB94D-B&_user=10&_coverDate=08%2F31%2F2007&_rdoc=24&_fmt=summary&_orig=browse&_srch=doc-info(%23toc%236806%232007%23998669997%23665145%23FLA%23display%23Volume)&_cdi=6806&_sort=d&_docanchor=&view=c&_ct=65&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=965355f4c1d74ce68cc7c763978cedfd
--------------------
Heather is the Administrator of the IBS Message Boards. She is the author of Eating for IBS and The First Year: IBS, and the CEO of Heather's Tummy Care. Join her IBS Newsletter. Meet Heather on Facebook!
Print
Remind Me
Notify Moderator
|
|
|
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."
Gastroenterology 2007;133:433-444.
http://www.medscape.com/viewarticle/562701
--------------------
Heather is the Administrator of the IBS Message Boards. She is the author of Eating for IBS and The First Year: IBS, and the CEO of Heather's Tummy Care. Join her IBS Newsletter. Meet Heather on Facebook!
Print
Remind Me
Notify Moderator
|
|
|
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. fmrahim@ksu.edu.sa
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]
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17684852&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
--------------------
Heather is the Administrator of the IBS Message Boards. She is the author of Eating for IBS and The First Year: IBS, and the CEO of Heather's Tummy Care. Join her IBS Newsletter. Meet Heather on Facebook!
Print
Remind Me
Notify Moderator
|
|
|
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]
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17767479&ordinalpos=47&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
--------------------
Heather is the Administrator of the IBS Message Boards. She is the author of Eating for IBS and The First Year: IBS, and the CEO of Heather's Tummy Care. Join her IBS Newsletter. Meet Heather on Facebook!
Print
Remind Me
Notify Moderator
|
|
|
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.
Gastroenterology 2007;133:1430-1436.
http://www.medscape.com/viewarticle/566101
--------------------
Heather is the Administrator of the IBS Message Boards. She is the author of Eating for IBS and The First Year: IBS, and the CEO of Heather's Tummy Care. Join her IBS Newsletter. Meet Heather on Facebook!
Print
Remind Me
Notify Moderator
|
|
|
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.
http://www.app.com/apps/pbcs.dll/article?AID=/20080205/LIFE11/802050317/1006/LIFE
--------------------
Heather is the Administrator of the IBS Message Boards. She is the author of Eating for IBS and The First Year: IBS, and the CEO of Heather's Tummy Care. Join her IBS Newsletter. Meet Heather on Facebook!
Print
Remind Me
Notify Moderator
|
|
Posts
