08/08/04 02:41 PM
Cognitive-behavioral therapy, hypnosis can help soothe irritable bowel syndrome

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.


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