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HYPNOSIS FOR IBS

What is Irritable Bowel Syndrome (IBS)?

IBS is really a diagnosis of exclusion. It is not an inflammatory disease and often does not show up with diagnostic testing. In order to arrive at a diagnosis of Irritable Bowel Syndrome, it is important to rule out ulcerative colitis, Crohn’s disease, and inflammatory bowel syndrome.

Irritable Bowel Syndrome (IBS) is a disorder that leads to abdominal pain and cramping, which is relieved with a bowel movement. It is also associated with a change in frequency and consistency of the stools. For most people, the symptoms of IBS involve cramping, pain, constipation, diarrhea, and bloating. Although the syndrome can cause a great feeling of discomfort, it does not permanently harm the intestines nor does it lead to serious disease. Some people can control the symptoms with certain medications and stress reduction, but there are other people however, for whom the symptoms of IBS can be disabling.

IBS can occur at any age but often begins during the teenage years or in early adulthood. Twice as many women have it as do men. The main symptoms of IBS are abdominal pain, fullness, bloating and gas that have been present for at least three days a week for three months. People with IBS often switch between constipation and diarrhea or mostly have one or the other.

It is not always clear why people develop IBS. One important factor is to understand that the intestines are highly connected to the brain neurologically. Signals go back-and-forth between the bowel and the brain all the time. These signals affect the functioning of the bowel and can heighten the symptoms and awareness of pain and bloating. The nervous system becomes more active when there is stress, causing the intestines to become increasingly sensitive and contract more. People with IBS can be overly responsive to even the slightest conflict or stress. Stress and anxiety can make a person more aware of sensations that arise in the colon. This awareness itself can lead to greater anxiety and discomfort. So the stress and symptom go- back and forth through the nervous system. This is the “gut feeling” taken to the extreme.

Our approach:

• The first step is to encourage physical relaxation and a decrease of stress and anxiety. This is done by an induction into a very calm and relaxed state.
• As the client begins to feel more relaxed, suggestions are made for her to drift down into an even deeper experience of calm and comfort so that she can begin to learn the sensation of deep relaxation without stress or anxiety.
• The next step consists of using Ericksonian metaphors that encourage the client to dissociate from the discomfort that she is experiencing.
• When the client is fully relaxed and in a deep state of comfort and well-being, suggestions are made to encourage changes in the way the G.I. tract functions. This can lead to a decrease in the IBS discomfort and symptoms. Not only do the symptoms of intestinal pain, cramping or bloating diminish, but the client also becomes less aware and less bothered by the symptoms. As the client’s attention moves away from the symptoms, the bowel pains begin to fade away.
• Finally, there are suggestions for increased health and comfort as the intestines become less and less reactive to irritation, stress, anxiety and upsetting events in life.

Hypnosis is a very powerful approach that helps most people who suffer from Irritable Bowel Syndrome (IBS) find greater comfort and relief from pain and discomfort.  The benefits are usually noticed after the 2nd or 3rd session. By the last session, there should be noticeable improvement in the symptoms with long-lasting results.

OVERVIEW OF PUBLISHED RESEARCH INTO HYPNOSIS AND IBS

Lindfors et al. Effects of gut-directed hypnotherapy on IBS in different clinical settings-results from two randomized, controlled trials. Am J Gastroenterol. 2012 Feb;107(2):276-85. This pair of controlled research trials in Sweden investigated the effects of 12 sessions of gut-directed hypnotherapy for IBS in two different clinical settings. In study 1, 90 patients were randomly assigned to receive either hypnotherapy or supportive therapy in psychology private practices, whereas in the second study 48 patients were randomly assigned to either gut-directed hypnotherapy or a waiting list in a small county hospital. Gastrointestinal symptom severity and quality of life were evaluated at baseline, at 3 months follow-up and after 1 year. In both the studies, IBS-related symptoms were improved at 3 months in the hypnosis groups but not in the control groups. In study 1, hypnosis produced a significantly greater improvement in IBS symptom severity than in the control group (P<0.05), and a trend in the same direction was seen in study 2. The benefits from hypnosis treatment seen at 3 months were sustained up to 1 year. 

Lindfors et al. Long-term effects of hypnotherapy in patients with refractory irritable bowel syndrome. Scand J Gastroenterol. 2012 Apr;47(4):414-20. This article reported the findings of a retrospective Swedish survey of 208 IBS patients who completed a course of hypnosis hypnosis treatment. The Subjective Assessment Questionnaire was used to measure changes in IBS symptoms, and patients were classified as either treatment responders and non-responders based on their scores. Patients also reported changes in health-care use, use of medications for IBS symptoms, use of other non-pharmacological treatments, and whether they still actively used hypnosis. Immediately after hypnotherapy 49% of patients were responders, and 73% of these had improved further when they were surveyed at follow-up 2-7 years after hypnotherapy. The majority of the patients reported that they still used hypnotherapy on a regular basis at follow-up. Patients whose symptoms had shown good response to hypnosis used healthcare services less after treatment compared to non-responders. 

Vlieger et al. Long-term follow-up of gut-directed hypnotherapy vs. standard care in children with functional abdominal pain or irritable bowel syndrome. Am J Gastroenterol. 2012 Apr;107(4):627-31. This was a follow-up study to a previously published trial (Vlieger et al. 2007 - see above) testing the use of hypnosis to treat IBS and functional abdominal pain in children. Here the investigators reported the long-term effects of hypnotherapy versus standard medical treatment plus supportive therapy. All 52 patients treated in the previous study were invited to complete a standardized abdominal pain diary after an average period of 4.8 years had passed from the completion of treatment. After all that time, 68% of the patients who received hypnosis treatment versus only 20% of patients in the comparison group were in remission. Pain intensity scores were 2.8 in the hypnotherapy group at that timepoint, compared to 7.3 in the control group, and pain frequency scores averaged 2.3 for the hypnosis group and 7.1 for the control group. The amount of non-gastrointestinal body symptoms was also signficantly lower in the hypnosis group, but the two groups did not differ in quality-of-life scores, doctors' visits, or missed days of school or work in this follow-up assessment. 

Gulewitsch et al. Brief hypnotherapeutic-behavioral intervention for functional abdominal pain and irritable bowel syndrome in childhood: a randomized controlled trial. Eur J Pediatr. 2013 Aug;172(8):1043-51. In this study, 38 children with IBS or functional abdominal pain, ranging in age from 6 to 12 years, were randomly assigned to either a standardized hypnotherapeutic-behavioral treatment (20 children) or to a waiting list condition (18 children). In the hypnosis treatment group, 11 of the 20 children 55.0%) showed clinical remission (defined as 80% or greater improvement), while only one child (5.6%) in the waiting list condition had such degree of improvement. Pain scores and pain-related disability improved significantly more in the hypnosis treatment group than in the the waiting list condition. 

Moser et al. Am J Gastroenterol. Long-term success of gut-directed group hypnosis for patients with refractory irritable bowel syndrome: a randomized controlled trial. 2013 Apr;108(4):602-9. Ninety IBS patients who had failed to show response to usual treatment were randomly assigned to receive one of two types of group treatment: Either supportive talk therapy sessions or gut-directed hypnosis treatment in groups. Both interventions were a series of 10 weekly sessions over 3 months. Significantly more hypnosis patients than supportive group patients were improved after treatment (60.8% vs. 40.9%) and over 15 months the difference became even more significant (54.3% vs. 25.0% improved). The researchers also found that physical and psychological well-being in the hypnosis group participants improved significantly more compared to patients just getting standard medical care. 

Gerson et al. Group hypnotherapy for irritable bowel syndrome with long-term follow-up. Int J Clin Exp Hypn. 2013;61(1):38-54. Seventy-five IBS patients were treated in groups with the standardized North Carolina IBS Hypnosis Protocol and their symptom status and quality of life tested at multiple time points up to 12 months after treatment. Compared to pre-treatment symptom severity there was a significant reduction in IBS symptoms after treatment as well as at 3, 6, and 12 months follow-up. Sixty percent of the treated patients showed clinically significant improvement in IBS. 

Dobbin A, Dobbin J, Ross SC, Graham C, Ford MJ. Randomised controlled trial of brief intervention with biofeedback and hypnotherapy in patients with refractory irritable bowel syndrome. J R Coll Physicians Edinb. 2013;43(1):15-23. This study compared brief interventions with either three sessions of biofeedback or three sessions of hypnotherapy for women with treatment-refractory IBS symptoms. A total of 61 women completed the study. Both hypnosis and biofeedback treatment were found equally effective at improving IBS symptom severity scores, total non-gastrointestinal symptom scores and anxiety and depression ratings during 24 weeks follow-up. It should be noted that the hypnosis treatment used in this study - only three sessions for each patient - is the shortest treatment course (fewest sessions) used in any published study of hypnosis for IBS to date. 

Lowén MB, Mayer EA, Sjöberg M, Tillisch K, Naliboff B, Labus J, Lundberg P, Ström M, Engström M, Walter SA. Effect of hypnotherapy and educational intervention on brain response to visceral stimulus in the irritable bowel syndrome. Aliment Pharmacol Ther. 2013 Jun;37(12):1184-97. The purpose of this study was to examine how the brains of IBS patients respond differently to sensations from their bowels after a course of either hypnotherapy or (for comparison) an educational intervention also designed to treat IBS. Signals indicating the amount of brain activity in different parts of the brain were measured by using functional Magnetic Resonance Imaging (fMRI) while a balloon was inflated in the bowel (rectum) of the subjects. A total of thirty-one female patients completed treatment and testing. IBS symptoms improved similarly and significantly in both treatment groups. Participants whose symptoms improved from either type of treatment showed lessened brain response to intense balloon distension afterwards, and their brains reacted more like normal individuals to the gut sensations produced by those balloon distensions. However, patients in the hypnosis group showed reduction in activity in somewhat different brain centers after treatment (posterior insula) compared to the education group, suggesting that hypnosis treatment may perhaps have some specific or unique therapeautic effects on brain activity in IBS patients. 

Miller V, Carruthers HR, Morris J, Hasan SS, Archbold S, Whorwell PJ. Hypnotherapy for irritable bowel syndrome: an audit of one thousand adult patients. Aliment Pharmacol Ther. 2015 May;41(9):844-55. This article summarized outcome of hypnotherapy for one thousand IBS patients treated in a gastroenterology hypnotherapy unit in Manchester, England. All the patients were treated with 12 sessions of hypnotherapy following the structured treatment approach of the Manchester group. Overall, 76% of the patients improved from the treatment. Success rates were higher for females than males (80% vs. 62%) and slightly higher in patients with anxiety (79% vs 71%). In addition to bowel symptom improvement, non-gastrointestinal symptoms also improved significantly on average after treatment, and hypnotherapy also improved quality of life scores. 

Lövdahl J, Ringström G, Agerforz P, Törnblom H, Simrén M. Nurse-Administered, Gut-Directed Hypnotherapy in IBS: Efficacy and Factors Predicting a Positive Response. Am J Clin Hypn. 2015 Jul;58(1):100-14. This study evaluated the effectiveness of standardized nurse-administered hypnotherapy protocol that was a Swedish-language extended variant of the North Carolina protocol, and aimed to identify factors that predicted good treatment outcome. Eighty-five patients received 12 weekly sessions of individual hypnotherapy by a nurse. The symptoms of 58% of the patients showed improved from the treatment, and of these 82% showed favorable clinical response already half-way through the treatment course (after 6 sessions). Women had a higher response rate than men to the treatment.