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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.
http://www.reuters.co.uk/newsArticle.jhtml?type=healthNews&storyID=4959906§ion=news
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Cognitive-behavioral therapy, hypnosis can help soothe irritable bowel syndrome
7/28/2004
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.
http://rdu.news14.com/content/headlines/?ArID=52106&SecID=2
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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
Background
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.
Methods
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
Results
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.
Conclusions
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.
http://www.biomedcentral.com/1471-2296/5/22
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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."
Gastroenterology 2005;129:86-97.
http://www.medscape.com/viewarticle/510885?src=mp
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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."
http://www.eurekalert.org/pub_releases/2005-09/uom-hae092705.php
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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.
http://www.radionetherlands.nl/features/science/060320rf
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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.
Smith GD.
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.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16684163&query_hl=7&itool=pubmed_docsum
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Mind-Body Treatments Ease Irritable Bowel
05.25.06
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.
http://www.forbes.com/forbeslife/health/feeds/hscout/2006/05/25/hscout532907.html
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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]
http://www.medscape.com/viewarticle/536306?src=mp
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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
patients.
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.
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