Posted 2/26/2011 1:03 PM (GMT -6)
Hypnotherapy has in fact been proven successful at reducing or even eliminating all Irritable Bowel Syndrome symptoms. Over 15 years of solid scientific research has demonstrated hypnosis to be an effective, safe and inexpensive choice for IBS alleviation. <b>It has been so overwhelmingly successful in this regard that Adriane Fugh-Berman, MD, chair of the National Women's Health Network in Washington, DC, has said that hypnosis should be the treatment of choice for Irritable Bowel Syndrome cases which have not responded to conventional therapy.</b>
UNC IBS researcher.
Why Consider Hypnosis Treatment for IBS?
by Olafur S. Palsson, Psy.D.
Hypnosis is only one of several approaches to treating irritable bowel syndrome and may not be the most suitable option for all patients (click here for discussion of treatment options for IBS). However, hypnosis treatment has some advantages which makes it an attractive option for many IBS sufferers with chronic and severe symptoms:
- It is one of the most successful treatment approaches for chronic IBS. The response rate to treatment is 80% and better in most published studies to date.
- The treatment often helps individuals who have failed to get improvements with other methods (see for example: Whorwell et al., 1984, 1987; Palsson et al., 1997, 2000).
- It is a uniquely comfortable form of treatment; relaxing, easy and generally enjoyable.
- It utilizes the healing power of the person's own mind, and is generally completely without negative side effects.
- The treatment sometimes results in improvement in other symptoms or problems such as migraine or tension headaches, along with the improvement in IBS symptoms.
- The beneficial effects of the treatment last long after the end of the course of treatment. According to research, individuals who improve from hypnosis treatment for IBS can generally look forward to years of reduced bowel symptoms.
Whorwell PJ; Prior A; Faragher EB. Controlled trial of hypnotherapy in the treatment of severe refractory irritable-bowel syndrome.The Lancet 1984, 2: 1232-4.
This study is the earliest and perhaps the best study in this research area to date, as it was thoroughly placebo-controlled and showed dramatic contrast in response to hypnosis treatment above the placebo group. Thirty patients with severe symptoms unresponsive to other treatment were randomly chosen to receive 7 sessions of hypnotherapy (15 patients) or 7 sessions of psychotherapy plus placebo pills (15 patients). The psychotherapy group showed a small but significant improvement in abdominal pain and distension, and in general well-being but not bowel activity pattern. The hypnotherapy patients showed a dramatic improvement in all central symptom. The hypnotherapy group showed no relapses during the 3-month follow-up period.
Graph adapted from the above paper, showing group differences in two of the main IBS symptoms:
Whorwell PJ; Prior A; Colgan SM. Hypnotherapy in severe irritable bowel syndrome: further experience. Gut, 1987 Apr, 28:4, 423-5.
This report summed up further experience with 35 patients added to the 15 treated with hypnotherapy in the 1984 Lancet study. For the whole 50 patient group, success rate was 95% for classic IBS cases, but substantially less for IBS patients with atypical symptom picture or significant psychological problems. The report also observed that patients over age 50 seemed to have lower success rate from this treatment.
Harvey RF; Hinton RA; Gunary RM; Barry RE. Individual and group hypnotherapy in treatment of refractory irritable bowel syndrome. Lancet, 1989 Feb, 1:8635, 424-5.
This study employed a shorter hypnosis treatment course than other studies for IBS, and the success rate was lower, most likely demonstrating that a larger number of sessions is necessary for optimal benefit. Twenty out of 33 patients with refractory irritable bowel syndrome treated with four sessions of hypnotherapy in this study improved. Improvement was maintained at a 3-month treatment. These researchers further found that hypnosis treatment for IBS in groups of up to 8 patients seems as effective as individual therapy
Prior A, Colgan SM, Whorwell PJ. Changes in rectal sensitivity after hypnotherapy in patients with irritable bowel syndrome. Gut 1990;31:896.
This study found IBS patients to be less sensitive to pain and other sensations induced via balloon inflation in their gut while they were under hypnosis. Sensitivity to some balloon-induced gut sensations (although not pain sensitivity) was reduced following a course of hypnosis treatment.
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 Feb, 10:1, 91-5.
This study compared 25 severe IBS patients treated with hypnosis to 25 patients with similar symptom severity treated with other methods, and demonstrated that in addition to significant improvement in all central IBS symptoms, hypnotherapy recipients had fewer visits to doctors, lost less time from work than the control group and rated their quality of life more improved. Those patients who had been unable to work prior to treatment resumed employment in the hypnotherapy group but not in the control group. The study quantifies the substantial economic benefits and improvement in health-related quality of life which result from hypnotherapy for IBS on top of clinical symptom improvement.
Koutsomanis D. Hypnoanalgesia in the irritable bowel syndrome. Gastroenterology 1997, 112, A764.
This French study showed less analgesic medication use required and less abdominal pain experienced by a group of 12 IBS patients after a course of 6-8 analgesia-oriented hypnosis sessions followed by 4 sessions of autogenic training. Patients were evaluated at 6-month and 12-month follow-up.
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). Gastroenterology 1999; 116: A1009.
Twenty-three patients each received 12 sessions of hypnotherapy. Significant improvement was seen in the severity and frequency of abdominal pain, bloating and satisfaction with bowel habit. A subset of the treated patients who were found to be unusually pain-sensitive in their intestines prior to treatment (as evidenced by balloon inflation tests) showed normalization of pain sensitivity, and this change correlated with their pain improvement following treatment. Such pain threshold change was not seen for the treated group as a whole.
Vidakovic Vukic M. Hypnotherapy in the treatment of irritable bowel syndrome: methods and results in Amsterdam. Scand J Gastroenterol Suppl, 1999, 230:49-51.Reports results of treatment of 27patients of gut-directed hypnotherapy tailored to each individual patient. All of the 24 who completed treatment were found to be improve.
Galovski TE; Blanchard EB. Appl Psychophysiol Biofeedback, 1998 Dec, 23:4, 219-32. Eleven patients completed hypnotherapy, with improvement reported for all central IBS symptoms, as well as improvement in anxiety. Six of the patients were a waiting-control group for comparison, and did not show such improvement while waiting for treatment.
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 Apr;97(4):954-61.
This study is notable as the largest case series of IBS patients treated with hypnosis and reported on to date. 250 unselected IBS patients were treated in a clinic in Manchester, England, using 12 sessions of hypnotherapy over a 3-month period plus home practice between sessions. Marked improvement was seen in all IBS symptoms (overall IBS severity was reduced by more than half on the average after treatment), quality of life, and anxiety and depression. All subgroups of patients appeared to do equally well except males with diarrhea, who improved far less than other patients for unknown reason.
Palsson OS, Turner MJ, Johnson DA, Burnett CK, Whitehead WE. Hypnosis treatment for severe irritable bowel syndrome: investigation of mechanism and effects on symptoms. Dig Dis Sci 2002 Nov;47(11):2605-14.
Possible physiological and psychological mechanisms of hypnosis treatment for IBS were investigated in two studies. Patients with severe IBS received seven biweekly hypnosis sessions and used hypnosis audiotapes at home. Rectal pain thresholds and smooth muscle tone were measured with a barostat before and after treatment in 18 patients (study I), and treatment changes in heart rate, blood pressure, skin conductance, finger temperature, and forehead electromyographic activity were assessed in 24 patients (study II). Somatization, anxiety, and depression were also measured. All central IBS symptoms improved substantially from treatment in both studies. Rectal pain thresholds, rectal smooth muscle tone, and autonomic functioning (except sweat gland reactivity) were unaffected by hypnosis treatment. However, somatization and psychological distress showed large decreases. In conclusion, hypnosis improves IBS symptoms through reductions in psychological distress and somatization. Improvements were unrelated to changes in the physiological parameters measured. 17 of 18 patients in study 1 and 21 of 24 patients in study 2 were judged substantially improved Improvement was well-maintained at 10-12 month follow up in study 2.
Lea R, Houghton LA, Calvert EL, Larder S, Gonsalkorale WM, Whelan V, Randles J,
Cooper P, Cruickshanks P, Miller V, Whorwell PJ.Gut-focused hypnotherapy normalizes disordered rectal sensitivity in patients with irritable bowel syndrome.Alimentary Pharmacology& Therapeutics 2003 Mar 1;17(5):635-42.
This study evaluated the rectal sensitivity changes in IBS patients who received hypnotherapy, like a previous study by the same group (see Houghton et al's study above, but using a slightly different methodology. Twenty-three IBS patients were tested before and after 12 weeks of
hypnotherapy. Following the course of hypnotherapy, the mean pain sensory threshold increased in the hypersensitive subgroup and tended to decrease in the hyposensitive group,
although the l. Reduction in gut pain sensitivity was associated with a reduction in abdominal pain. These results suggest that hypnotherapy may work at least partly by normalizing bowel perception in those patients who have abnormal gut sensitivity, while leaving normal sensation unchanged.
Gonsalkorale WM, Miller V, Afzal A, Whorwell PJ. Long term benefits of hypnotherapy for irritable bowel syndrome. Gut. 2003 Nov;52(11):1623-9.
In this study, 204 IBS patients treated with a course of hypnotherapy completed questionnaires scoring symptoms, quality of life, anxiety, and depression before, immediately after, and up to six years following treatment. 71% of patients showed improvement in response to treatment initially, and of those, 81% were still improved years later, while most of the other 19% only reported slight worsening of symptoms. Quality of life and anxiety or depression scores were also still significantly improved at follow-up but showed some deterioration. Patients also reported fewer doctor visits rates and less medication use long-term after hypnosis treatment. These results indicate that for most patients the benefits from hypnotherapy last at least five years.
Gonsalkorale WM, Toner BB, Whorwell PJ. J Psychosom Res. 2004 Mar;56(3):271-8. Cognitive change in patients undergoing hypnotherapy for irritable bowel syndrome.
Cognitive changes were evaluated in 78 IBS patients who completed a 12-session hypnosis treatment course, using the recently developed Cognitive Scale for Functional Bowel Disorders. Hypnotherapy resulted in improvement of symptoms, quality of life, anxiety and depression. Unhelpful IBS-related cognitions improved significantly, with reduction in thetotal cognitive score and all component themes related to bowelfunction. Overall symptom reduction correlated with an improvement on the cognitive scale.
Palsson OS, Turner MJ, Whitehead WE. Hypnosis home treatment for irritable bowel syndrome: a pilot study. Int J Clin Exp Hypn. 2006 Jan;54(1):85-99.
A 3-month home-treatment version of a scripted hypnosis protocol previously shown to improve all central IBS symptoms was completed by 19 IBS patients. Outcomes were compared to those of 57 matched IBS patients from a separate study receiving only standard medical care. Ten of the hypnosis subjects (53%) responded to treatment by 3-month follow-up (response defined as more than 50% reduction in IBS severity) vs. 15 (26%) of controls. Hypnosis subjects improved more in quality of life scores compared to controls. Anxiety predicted poor treatment response. Hypnosis responders remained improved at 6-month follow-up. Although response rate was lower than previously observed in therapist-delivered treatment, hypnosis home treatment may double the proportion of IBS patients improving significantly across 6 months.
Barabasz A, Barabasz M. Effects of tailored and manualized hypnotic inductions for complicated irritable bowel syndrome patients. Int J Clin Exp Hypn. 2006 Jan;54(1):100-12.
This small clinical pilot study provided preliminary data on the effects of hypnotic inductions tailored to an irritable bowel syndrome patient in each session compared to Palsson's fully scripted (standardized) protocol. A total of eight IBS patients previously unresponsive to any treatment were assigned randomly to either the tailored or standardized induction condition. Other than pre-testing for hypnotizability, the procedure followed for the standardized group (four subjects) was exactly as prescribed by O. Palsson (1998). The same scripts were used for the other (tailored) group of four patients except that the inductions were individualized. Patients showed favorable treatment response immediately post-treatment and at 10-month follow-up. Only the tailored group showed no incapacitating pain at post-treatment but greater emotional stress than the standardized group. The tailored group continued to improve and showed better results than the standardized group at 10-month follow-up, and the post-reatment emotional distress had decreased significantly
Smith GD. Effect of nurse-led gut-directed hypnotherapy upon health-related quality of life in patients with irritable bowel syndrome. J Clin Nurs. 2006 Jun;15(6):678-84.
This study conducted in Edinburgh, UK, measured the effects of a nurse-led gut-directed hypnotherapy. Seventy-five patients were treated with 5 to 7 1/2 hours of hypnotherapy, as well as receiving education and support. Diary results showed that the physical symptoms of abdominal pain and bloating improved significantly after treatment. There were also significant statistical improvements in six of the eight health-related quality of life scales and in anxiety scores after treatment.
Vlieger AM, Menko-Frankenhuis C, Wolfkamp SC, Tromp E, Benninga MA. Hypnotherapy for children with functional abdominal pain or irritable bowel syndrome: a randomized controlled trial. Gastroenterology. 2007 Nov;133(5):1430-6.
This randomized controlled trial compared the effectiveness of six sessions of hypnotherapy over 12 weeks with results from standard medical therapy plus six sessions of supportive therapy in children with functional abdominal pain or IBS. Fifty-three children ranging in age from 8 to 18 years, with functional abdominal pain (31patients) or IBS (22 patients), were randomly assigned to either hypnotherapy or the comparison treatment. Pain scores decreased significantly in both groups from baseline to 1 year follow-up, but the hypnotherapy group showed significantly greater reduction in pain compared with the comparison group. At one-year follow-up, treatment was judged successful for 85% of the hypnotherapy group and 25% of the comparison group (p< .001).
Senior Gastroenterologist in the UK and top IBS expert.
Irritable bowel syndrome (IBS) would seem to be a disorder that might be amenable to treatment with hypnosis. There is no structural damage and the various possible underlying mechanisms such as disordered motility and visceral (internal) sensitivity might be susceptible to modulation by the mind. Thus, nearly 20 years ago, we undertook the first controlled trial of hypnotherapy in this disorder. The results were extremely encouraging and eventually led us to developing a hypnotherapy unit dedicated to the provision of this service.
Video: about Hypnosis
<b>Several years ago we published an audit of the first 250 patients treated and found that hypnosis not only helps the symptoms of IBS but also significantly improves quality of life.1 Interestingly, it also relieves the additional symptoms from which so many patients with IBS suffer such as nausea, lethargy, backache, and urinary problems. This is in sharp contrast to the medications currently available for IBS, which often help one or two symptoms if at all.</b>
However, hypnosis should not be regarded as a panacea as up to 30% of patients fail to respond. Even when patients do improve, conventional approaches to treatment should not necessarily be ignored. Therefore it is still important that lifestyle factors such as diet are also taken into account. In addition, some patients may find that an occasional loperamide or laxative, depending on the bowel habit abnormality, maybe required.
Unfortunately, most patients, especially those with severe symptoms, require multiple sessions of treatment. In our unit, we allow up to 12 sessions which therefore results in this being a time consuming and costly approach in the short term. However, as a result of the undoubted sustained benefits of treatment, it has been calculated that it becomes cost effective within 2 years when compared to conventional approaches. As new (and likely expensive) drugs now in development for IBS reach the market, hypnotherapy may become a more viable option from the financial point of view.
Hypnotherapy therefore appears to be a realistic option in the treatment of conditions such as IBS. Our success has been reproduced by others, but the technique has, so far, not been generally adopted. This is probably because of the unfounded suspicion that surrounds the subject coupled with the fact it is not something with which most physicians or gastroenterologists are especially familiar. Hopefully these negative attributes will decline with time, especially if the success of the technique continues to be supported by a strong evidence base.
The hypnosis treatment described in this article was conducted by therapists who were following a rigorous treatment protocol in the treatment of patients diagnosed with IBS. Treatment involves generally seven to twelve sessions with a qualified therapist.
Many individuals practice hypnosis but not all are qualified to treat medical conditions. Care should be taken in finding a qualified hypnotherapist to treat IBS. A list of clinicians in the U.S. who use a treatment protocol standardized by Olafur S. Palsson, Psy.D, et.al., from the Department of Medicine, University of North Carolina, Chapel Hill, may be found at this web site: http://www.ibshypnosis.com/IBSclinicians.html
Effects of Hypnosis on GI Problems
Olafur S. Palsson, Psy.D.
Associate Professor of Medicine, School of Medicine, UNC-Chapel Hill
Hypnosis is a treatment method which still carries an aura of mystery that, unfortunately, continues to be promoted by misrepresentations in movies and stage shows for entertainment. In reality, there is little mysterious about hypnosis anymore. It is a well-researched clinical technique which was formally accepted as a treatment method by the American Medical Association and the American Psychological Association over thirty years ago. Clinical hypnosis is currently used by thousands of clinicians in the U.S. to treat both psychological and medical problems.
Until recently, the possibility of using hypnosis to treat gastrointestinal problems had received little attention. In the last 15 years, however, research has shown that hypnosis can influence gastrointestinal functioning in powerful ways, and that it is particularly effective in helping patients with irritable bowel syndrome (IBS) and to control nausea and vomiting.
IBS - Beyond the Bowel: The Meaning of Co-existing Medical Problems
Olafur S. Palsson, Psy.D. and William E. Whitehead, Ph.D.
UNC Center for Functional GI & Motility Disorders
SYMPTOMS ALL OVER THE BODY IN IBS
Several research reports have established that IBS patients report non-bowel symptoms more frequently than other GI patients and general medical patients. For example, four studies that have asked IBS patients about a wide variety of body symptoms(1-4) all found headaches (reported by 23-45% of IBS patients), back pain (28-81%), and frequent urination (20-56%) to be unusually common in individuals with IBS compared to other people. Fatigue (36-63%) and bad breath or unpleasant taste in the mouth (16-63%) were found in three of these four studies to be more common among IBS patients, as well.
Furthermore, a large number of other symptoms have been reported to occur with unusually high frequency in single studies. In our recent systematic review of the medical literature(5), we found a total 26 different symptoms, that are reported to be more common in IBS patients than comparison groups in at least one study. Non-gastrointestinal symptoms more common in irritable bowel syndrome patients than in comparison groups(5).
3. Heart palpitations or racing heart
4. Back pain
5. Shortness of breath
6. Muscle ache
7. Frequent urinating
8. Difficulty urinating
9. Sensitivity to heat or cold
10. Constant tiredness
11. Pain during intercourse (sex)
12. Trembling hands
13. Sleeping difficulties
14. Bad breath/unpleasant taste in mouth
15. Grinding your teeth
16. Jaw pain
17. Flushing of your face and neck
18. Dry mouth
19. Weak or wobbly legs
20. Scratchy throat
21. Tightness or pressure in chest
22. Low sex drive
23. Poor appetite
24. Eye pain
25. Stiff muscles
26. Eye twitching
IS IT POSSIBLE TO REDUCE NON-GI SYMPTOMS IN IBS?
It is unknown to what degree standard medical treatment for IBS, when successful, also results in improvement in non-GI symptoms. The problem is that most IBS treatment research has not examined how non-IBS symptoms change. Non-IBS symptoms have also not been a focus of standard IBS treatment. An exception to this is psychological treatment trials for IBS, which sometimes have included general physical symptom questionnaires among the measures of treatment effects. <b>We, therefore, know from our two studies of hypnosis treatment for IBS(22) as well as from research in England(23) that hypnosis treatment for IBS regularly improves non-GI symptoms substantially in addition to its beneficial effects on bowel symptoms.</b> Less is known about improvement in non-GI symptoms from cognitive-behavioral therapy (CBT), which is the other widely researched psychological treatment for IBS. However, there is every reason to believe that CBT can reduce the tendency to experience a lot of general physical symptoms, based on a review of over 30 such treatment studies(24). These benefits of psychological treatment for IBS point to extra value of such treatments for the subgroup of IBS patients who have many non-GI symptoms.
Hope this helps, it was one of the best things I have ever done for my severe IBS with a home treatment CD. But it was quite a bit different then the one your doctor gave you.
IBS Forum Moderator
I am not a doctor. All information I present is for educational purposes only and should not be subsituted for the advise of a qualified health care provider.
Please make sure you have your symptoms diagnosed by a medical practitioner or a doctor.