Irritable Bowel Syndrome Message Boards | Hypnosis / Hypnotherapy/Cognitive-Behavioral Therapy

Gastroenterology
December 2002 � Volume 123 � Number 6

Editorials
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.

References

1. Whorwell PJ, Prior A, Faragher EB. Controlled trial of hypnotherapy in the treatment of severe refractory irritable-bowel syndrome. Lancet 1984;2:1232�1234.MEDLINE

2. Whorwell PJ, Prior A, Colgan SM. Hypnotherapy in severe irritable bowel syndrome: further experience. Gut 1987;28:423�425.MEDLINE

3. Gonsalkorale WM, Houghton LA, Whorwell PJ. Hypnotherapy in irritable bowel syndrome: a large-scale audit of a clinical service with examination of factors influencing responsiveness. Am J Gastroenterol 2002;97:954�961.MEDLINE
CROSSREF

4. Houghton LA, Heyman DJ, Whorwell PJ. Symptomatology, quality of life and economic features of irritable bowel syndrome�the effect of hypnotherapy. Aliment Pharmacol Ther 1996;10:91�95.MEDLINE

5. Houghton LA, Larder S, Lee R, Gonsalcorale WM, Whelan V, Randles J, Cooper P, Cruikshanks P, Miller V, Whorwell PJ. Gut focused hypnotherapy normalises rectal hypersensitivity in patients with irritable bowel syndrome (IBS) (abstr). Gastroenterology 1999;116:A1009.

6. Prior A, Colgan SM, Whorwell PJ. Changes in rectal sensitivity after hypnotherapy in patients with irritable bowel syndrome. Gut 1990;31:896�898.MEDLINE

7. Harvey RF, Hinton RA, Gunary RM, Barry RE. Individual and group hypnotherapy in treatment of refractory irritable bowel syndrome. Lancet 1989;1:424�425.MEDLINE

8. Galovski TE, Blanchard EB. The treatment of irritable bowel syndrome with hypnotherapy. Appl Psychophysiol Biofeedback 1998;23:219�232.MEDLINE

9. Vidakovic-Vukic M. Hypnotherapy in the treatment of irritable bowel syndrome: Methods and results from Amsterdam. Scand J Gastroenterol 1999;230(Suppl):49�51.

10. Palsson OS, Burnett CK, Meyer K, Whitehead WE. Hypnosis treatment for irritable bowel syndrome. Effects on symptoms, pain threshold and muscle tone (abstr). Gastroenterology 1997;112:A803.

11. Palsson OS, Turner MJ, Johnson DA. Hypnotherapy for irritable bowel syndrome: symptom improvement and autonomic nervous system effects (abstr). Gastroenterology 2000;118:A174.

12. Koutsomanis D. Hypnoanalgesia in the irritable bowel syndrome (abstr). Gastroenterology 1997;112:A764.

13. Zimmerman J. Assessment of the response to hypnotherapy in functional gastrointestinal disorders (FBD) (abstr). Gastroenterology 1999;116:A1108.

14. Simren M, Ringstrom G, Bjornsson E, Abrahamson H. Hypnotherapy reduces lipid-induced colonic hypersensitivity in the irritable bowel syndrome (IBS). Paper presented at: Annual Meeting of the American Gastroenterological Association; May 22, 2002; San Francisco, CA.

15. Greene B, Blanchard EB. Cognitive therapy for irritable bowel syndrome. J Consult Clin Psychol 1994;62:576�582.MEDLINE

16. Toner BB, Segal ZV, Emmott SD, Myran D. Cognitive behavioral treatment of irritable bowel syndrome: the brain-gut connection. New York: Guilford Press, 2000.

17. Calvert EL, Houghton LA, Cooper P, Morris, J, Whorwell PJ. Long-term improvement of functional dyspepsia using hypnotherapy. Gastroenterology 2002;123:1778�1785.ABSTRACT
FULL TEXT

18. Drossman DA, Li Z, Andruzzi E, Temple RD, Talley NJ, Thompson WG, Whitehead WE, Janssens J, Funch-Jensen P, Corazziari E, Richter JE, Koch GG. U.S. householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact. Dig Dis Sci 1993;38:1569�1580.MEDLINE

19. Thompson WG, Heaton KW, Smyth GT, Smyth C. Irritable bowel syndrome: the view from general practice. Eur J Gastroenterol Hepatol 1997;9:689�692.MEDLINE

20. Beaugerie L, Burger AJ, Cadranel JF, Lamy P, Gendre JP, Le Quintrec F. Modulation of orocaecal transit time by hypnosis. Gut 1991;32:393�394.MEDLINE

21. Whorwell PJ, Houghton LA, Taylor EE, Maxton DG. Physiological effects of emotion: assessment via hypnosis. Lancet 1992;340:69�72.MEDLINE

22. Klein KB, Spiegel D. Modulation of gastric acid secretion by hypnosis. Gastroenterology 1989;96:1383�1387.MEDLINE
ABSTRACT

23. Chiarioni G, Benini L, Bonfante F, Menegotti M, Salandini L, Vantini I. Prokinetic effect of a single session of gut-oriented hypnotherapy on gastric emptying in normal subjects and in dyspeptic patients (abstr). Gastroenterology 120:A133.

24. Guthrie E, Creed F, Dawson D, Tomenson B. A controlled trial of psychological treatment for the irritable bowel syndrome. Gastroenterology 1991;100:450�457.MEDLINE
ABSTRACT

25. Blanchard EB, Greene B, Scharff L, Schwarz-McMorris SP. Relaxation training as a treatment for irritable bowel syndrome. Biofeedback Self Regul 1993;3:125�132.

26. Shaw G, Srivastava ED, Sadlier M, Swann P, James JY, Rhodes J. Stress management for irritable bowel syndrome: a controlled trial. Digestion 1991;50:36�42.MEDLINE

27. Svedlund J. Psychotherapy in irritable bowel syndrome: a controlled outcome study. Acta Psychiatr Scand 1983;67(Suppl):1�86.MEDLINE

28. Holroyd KA, O'Donnell FJ, Stensland M, Lipchik GL, Cordingley GE, Carlson BW. Management of chronic tension-type headache with tricyclic antidepressant medication, stress management therapy, and their combination: a randomized controlled trial. JAMA 2001;285:2208�22015.MEDLINE

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

GASTROENTEROLOGY 2002;123:2132-2135

� 2002 by the American Gastroenterological Association

doi:10.1053/gast.2002.37286

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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.
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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.

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Contact the Author:
Tel: 01925 658 322

Web: http://www.tlrltd.com

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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!

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