Irritable Bowel Syndrome and Hypnosis
by Melissa J. Roth, CHt., PhD
Irritable Bowel Syndrome, also known as spastic colon, colitis or nervous stomach is a baffling and complex set of gastrointestinal symptoms that affects 15% to 20% of the population(approximately 20 million people). It is characterized by intermittent abdominal cramping, constipation, diarrhea, a combination of both constipation and diarrhea, pain and bloating. Some IBS patients report having both constipation and diarrhea in the same day. Two thirds of the patients are women. It is the second most cited reason for missed work days. It accounts for approximately half of all visits to gastroenterologists.
The causes of IBS are unknown. A diagnosis of IBS is actually a diagnosis of exclusion--you rule out everything else. Since IBS symptoms overlap a number of other, potentially life threatening conditions, it is imperative that the person sees his/her physician or a gastroenterologist, to receive a proper diagnosis. While it is not clear what causes it, we know that people with IBS have changes in the way sensations are perceived in the colon. There are anatomical changes in the lining of the colon and to the nervous system of the colon. What causes these changes is unknown. Symptoms range in severity from an occasional mild episode to debilitating, life-altering illness which prevents the individual form working or from functioning normally. The symptoms are exacerbated by stress, changes in diet and changes in routine, among a host of other things. Some people are so sensitive they must eat virtually the same foods, in the same proportions, at the same times each day or suffer the consequences. Until recently, IBS was thought to be simply a 'nervous' disorder and was not taken as seriously as it deserved. While IBS will not kill you, it is far more than just a nuisance.
Traditional treatment consists of fiber therapy, antispasmodic medications and antidepressants. Fiber is added to the diet both through the use of bulking type laxatives and a high fiber diet. These are just as important for those people who chief complaint is diarrhea as it is for constipation. Antispasmodic medications, such as Bentyl, reduce the spasms in the gut. Antidepressants, in this case, actually function on the nervous system of the gut to reduce its sensitivity to pain and other sensations rather than acting as emotional mood enhancers. However, anyone who has suffered from the symptoms of IBS for any length of time justifiably presents with some degree of depression. It is important to note that only 25% of the people who suffer with IBS symptoms respond to traditional treatments. That means that 75% do not seem to improve with traditional treatments or do not improve enough to actually feel better.However, the evidence is overwhelming that IBS symptoms do respond to hypnosis. Not only do they respond, but they respond dramatically! The research evidence to support this is so dramatic and so overwhelming that Adriane Fugh-Berman, M.D., chair of the National Women's Health Network in Washington, D.C., says that hypnosis should be the treatment of choice for severe cases of IBS. In my practice, so far, 100% of the clients I have treated with hypnosis have shown improvement in their symptoms. 94% have gained greater than a 50% reduction in symptoms and 83% have become symptom free and remained that way long after the sessions have ended. Seven of the first eight clients (the number in the first phase of a three stage research project) became symptom free during the six sessions. While the eighth subject did not become symptom free in the standard six session regime, his symptoms did improve significantly in numbers of episodes and the duration and severity of symptoms in those episodes. He continued his sessions to gain greater relief. All of these clients had refractory (meaning they did not respond to drug and diet therapy) IBS symptoms for greater than four years. Most reported that the symptoms had started in childhood. Clients ranged in age from 35 to 50 years old. Although all of them were taking multiple medications, including steroids, bulking laxatives and on special diets, none of them had gained relief from their symptoms.
For instance, Melinda is a 35 year old special education teacher. When Melinda firs t came to my office she had recently been release from the hospital for a particularly severe episode of uncontrolled diarrhea. She was on high dosages of multiple medications. She reported that the medications had too many side effects and that in spite of them she had not seen much improvement in her symptoms. Whiel she was no longer experiencing fecal incontinence, she still had watery stools several times a day. When asked to rank her symptoms on a scale of zero to ten, with ten being the worst and zero indicating the absence of symptoms, she ranked them as follows: diarrhea, 5; abdominal pain, 7; bloating, 8 and fatigue, 8. At the beginning of the sixth and final session she ranked the same symptoms as follows: diarrhea, 0; abdominal pain, 0; bloating, 'maybe 2"; fatigue, 0. She reported these results in symptom improvement in spite of higher levels of stress caused by the unexpected deaths of two close friends. Working in conjunction with her physician, Melinda is now off medications for her IBS symptoms and remains symptom free.Jackie characterized her symptoms as a 'panic attack of the bowels.' After only two sessions she reported that her symptoms had improved so much that she 'actually got out with her family and went places' for the first time in over four years. She cannot remember when she did not have IBS symptoms. Now, she reports that she 'feels better upon awakening than I have in years.' She no longer has abdominal pain upon awakening. Even though she had one period of diarrhea in a time of unduly high stress, she still had no pain associated with it. Working in conjunction with her physician, Jackie has come off all the drugs she was on prior to starting the program and has not had a return of her symptoms even though her stress levels remain high.
Susan, a financial specialist, during her first visit characterized her symptoms as: pain, 10; gas, 7; bloating, 10; constipation, 10; and diarrhea, 2. By the middle of the program she reported her symptoms as follows: pain, 0; gas, 1; bloating, 0; constipation, 0-1; and diarrhea, 0. By the end of the program she reported zeros in all categories.The common thread among these people is that they had unabated IBS symptoms which interfered with their daily living. None of them actually believed hypnosis would work to alleviate their symptoms. However, they were so desperate for relief they were willing to try anything. They were desperate for hope, for an alternative to 'learning to live with' debilitating symptoms. Now, due to hypnotherapy treatment for their symptoms, they have been able to return to a much more normal lifestyle. The hypnotherapeutic model I used with these people was inspired by the research done by gastroenterologist Peter J. Whorwell, MD, in Manchester, England, and Dr. Olafur Palsson's research done at Eastern Virginia Medical Center. The clients came for six to eight sessions spaced two weeks apart. The hypnosis portion of their session was tape recorded and they were instructed to play the tape for themselves daily between sessions. All suggestions, metaphors and imagery was 'gut specific' and incorporated information on how a normal gastrointestinal system functions. Suggestions were made about the intestines being coated with a special, protective coating to insulate it from irritants, etc. At the last session, subjects were taught self hypnosis techniques and given instructions on how to formulate their own self hypnotic suggestions.
Each session consisted of four distinct parts. Each session consists of an evaluation and management phase in which you rank the client's symptoms for the past two week period. The second phase of the session consists of educating the client concerning their illness and various aspects of good health and nutritional habits. The third phase is the induction in which you induce deep to profound states of relaxation on each session and the fourth phase consists of the actual gut specific metaphors and suggestions. Personally, I give very few direct suggestions and use mainly gut specific metaphors.The numerous studies published in the world's medical literature document that hypnosis is a highly effective treatment for IBS symptoms. Hypnosis represents a brief therapy which is benign, noninvasive and inexpensive. Since IBS symptoms are cyclical in nature, the results of any therapy must be evaluated over a long period of time. The greater the number of hypnosis sessions, the longer lasting the relief the client gets. While many clients will report symptom relief after one or two sessions, unless they come back for multiple sessions spaced over a period of three to four months, they will notice a gradual 'creeping back' of their symptoms. Clients following the multi-session approach have now maintained their symptom improvements for up to five years after the sessions ended--and still counting. In today's insurance climate of managed care, hypnotherpy is being embraced. It is imperative, however, that you work closely with the client's personal physician and that you not accept clients who have not gotten a definitive diagnosis of IBS. Successful IBS clients will build a practice for you.
© Melissa J. Roth, CHt., PhD(c)
Melissa J. Roth, CHt.,PhD(c) has taught these techniques to dozens of hypnotherpaists around the world.