Irritable Bowel Syndrome Message Boards

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. Fres�1,2,3 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

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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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