# The Effectiveness of Hypnotherapy in the Management of Irritable Bowel Syndrome



## cookies4marilyn

Clinical studies of gut-directed clinical hypnotherapy for the treatment of IBS by various sources have shown this method to be helpful - however, as this article points out, these processes are hard to come by for most patients - this is why Michael Mahoney developed the IBS Audio Program 100 and recorded it so that anyone could have the benefit of this therapy in the privacy of their own home with less expense than in -person therapy. Michael's clinical hypnotherapy is gut-specific and uses his own process for the protocol, which is the Ongoing Progressive Session Induction Method. Here is some information regarding research in the field:http://www.medscape.com/viewarticle/543563 The Effectiveness of Hypnotherapy in the Management of Irritable Bowel SyndromeS. Wilson; T. Maddison; L. Roberts; S. Greenfield; S. Singh Aliment Pharmacol Ther. 2006;24(5):769-780. ©2006 Blackwell PublishingPosted 10/03/2006 Summary and IntroductionSummaryAim: To systematically review the literature evaluating hypnotherapy in the management of irritable bowel syndrome (IBS).Methods: Electronic databases were searched (Cochrane Library, Medline, CINAHL, AMED, Embase, PsycINFO, CISCOM, TRIP and the Social Science Citation index), bibliographic references scanned and main authors contacted. No restrictions were placed on language or publication year. Eligible studies involved adults with IBS using single-component hypnotherapy. All studies, except single case or expert opinion, were sought and all patient-related outcomes eligible.Results: Out of 299 unique references identified, 20 studies (18 trials of which four were randomized, two controlled and 12 uncontrolled) and two case series were eligible. These tended to demonstrate hypnotherapy as being effective in the management of IBS. Numbers of patients included were small. Only one trial scored more than four out of eight on internal validity.Conclusion: The published evidence suggests that hypnotherapy is effective in the management of IBS. Over half of the trials (10 of 18) indicated a significant benefit. A randomized placebo-controlled trial of high internal validity is necessary to establish the effectiveness of hypnotherapy in the management of IBS. Until such a trial is undertaken, this form of treatment should be restricted to specialist centres caring for the more severe forms of the disorder......Conventional therapy leaves up to 25% of sufferers without relief of symptoms[17] and many patients have been reported to turn to alternative therapies.[18]'Gut-directed hypnotherapy' (GDH), a type of hypnosis, is one of the alternative therapies most frequently reported to have a demonstrable beneficial therapeutic impact on IBS symptoms.[19,20] GDH is based on the use of hypnotic induction, using progressive relaxation and other techniques, followed by imagery directed towards control and normalization of gut function.[20] Therapy also aims to teach autohypnosis, to enable patients to manage their own symptoms without ongoing reliance on primary or secondary care, although occasional refresher sessions may be required.........All of the published work that investigates the efficacy of GDH in the management of IBS suggests a benefit and some of the existing treatment centres have achieved remarkable results.[20,29,40] This therapy appears to have potential in the management of refractory IBS of long duration, particularly where this is having a significant impact on the patient's QOL. ------Mayo Clin Proc. 2005;80:511-524 © 2005 Mayo Foundation for Medical Education and Researchhttp://www.mayoclinicproceedings.com/insid...AID=888&UIDHypnosis in Contemporary MedicineJAMES H. STEWART, MD From the Department of Internal Medicine and Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Jacksonville, Fla.ExcerptGASTROENTEROLOGYHypnosis for irritable bowel syndrome (IBS) has been studied extensively (Table 565-72). A 1984 study in England showed significant benefits from hypnosis.65 Thirty patients with refractory IBS and severe symptoms were randomly assigned to 7 individual sessions of hypnotherapy or psychotherapy plus placebo pills. Although the psychotherapy group showed a small but significant improvement in some characteristics, all patients in the hypnosis group had significant improvements (P<.0001) in well-being, bowel habits, distention symptoms, and pain, with no relapses at 3-month follow-up. A subsequent report added 35 more patients to the hypnosis group of 15 from the earlier study; those with classic symptoms and no psychological problems fared best with hypnosis, as did patients younger than 50 years.66 Direct, specific suggestions for symptom relief were most successful. At 18-month follow-up, the 15 patients in the earlier hypnosis group remained in remission.The positive results with hypnosis for IBS have been confirmed in several other trials.67-70 It was concluded that "in addition to relieving the symptoms of irritable bowel syndrome, hypnotherapy profoundly improves the patients' quality of life and reduces absenteeism from work."69 Use of audiotapes for self-hypnosis at home, used in many IBS studies, was considered important for success.70-73 Other studies and reviews have shown similar results for IBS.72-74


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## cookies4marilyn

Irritable Bowel Syndrome & Hypnotherapyby Michael Mahoney, Founder of UK Register of IBS Therapists – Healingwell.comIrritable Bowel Syndrome (IBS) is a heterogeneous condition with varying severity and symptomology. At least one in four of the general population is affected at some time in their lives (Jones 1992, Harvey 1983, Cook 1987). Despite the condition being classed as ‘non-serious’, it has serious cost implications to the UK National Health Service and Health Insurance Providers throughout the world, due to frequent presentations to general practitioners, hospital physicians and other specialist services (Talley 1995). The diagnosis is often reached by exclusion of diagnosable physical abnormalities and organic disease (Latimer 1983). But according the World Health Organization (1979), “health, which is a state of complete physical, mental and social well being and not merely the absence of disease or infirmity, is a fundamental human right”As a clinical hypnotherapist I have taken great interest in the management of this disorder as I have experienced the distress and frustration this client group feel in the search for relief from symptoms which have a severe impact on their lifestyle. With conventional medical treatment being of little proven benefit (Houghton 1996) there is a need to look beyond treating the symptoms to addressing the cause. In the holistic view of illness, physical disease is only one of several manifestations of basic imbalance of the organism, other manifestations may take the form of psychological and social pathologies (Capra 1983 p131).The fact is that holistic approach to medical and psychological care is required in the management of IBS, but that the psychological aspect is not universally accepted by the medical profession or the client group with clients feeling there is a stigma attached to this aspect of care. As a clinical Hypnotherapist I have an impact on these management issues as facilitator addressing the human response to this disorder, whereas physicians address thetreatment of the disorder.EtiologyIBS is an extremely common digestive disorder accounting for up to 50% of all cases seen by gastroenterologists (Harvey 1983). Of those that present in western society women outnumber men 4:1.PathogenesisIBS is defined as a “functional bowel disorder in which abdominal pain is associated with defecation or change in bowel habit, and with features of disordered defecation and with distention (Thompson et al 1992). However there is multiple symptomology that is associated with this complex disorder which is not always mentioned in standard textbooks. Upper gastroenterology symptoms including nausea, vomiting, early satiety are common (Farthing 1995). Extra bowel manifestations include urological symptoms (Jones 1992), fatigue backache, headache and gynecological symptoms (Longstreth 1995) often precipitating multiple specialist referrals to exclude organic cause. Many women undergo diagnostic laparoscopy or even hysterectomy (Langstreth 1995). Inappropriate surgery in the form of cholecystectomy and appendectomy has also been reported.Many suggestions are made as to onsetting causes of IBS such as stress factors, enteric infection or surgical intervention all of which have been found to increase visceral hypersensitivity. Even antibiotics, or trauma have been suggested as triggers.The Uses of HypnotherapyThe medical profession cannot be sure of the causes, nor have they suitable treatment for the condition, new drugs which may be effective in some individuals are mainly prohibitively expensive for sufferers. Hypnotherapy in the UK and elsewhere has been shown to help in the vast majority of cases of IBS sufferers. The writer is aware of at least one hospital gastroenterology department with its own hypnotherapy team alongside. Hypnotherapy is non intrusive, safe, comfortable and a cost effective and complementary to use along side mainstream medicine, some in the profession would in this case argue ‘alternative’ since the medical profession are generally at a loss with this condition. Having conducted a private medical research project at the invitation of a medical center, and subsequently private patient trails in specifically designed hypnotherapy processes, the IBS Audio Program 100® is now use by sufferers in over 30 countries…As a specialist in this area, the understanding that sufferers have the need for understanding, and an empathetic approach. Sufferers who consider hypnotherapy currently tend to do so as a ‘last resort’ rather than a first approach after diagnosis. The medical profession are becoming more aware of benefits of hypnotherapy from a specialist in the field. As a medical center based practitioner my hypnotherapy practices receives referrals from general practitioners, gastroenterologists and specialist gastro nurses. Just dealing with the symptoms of IBS is not enough, the individual has to learn to rebuild internal energy, many sufferers feel drained emotionally, life issues and responsibilities continue to deplete inner emotional strength, leading in some cases to anxiety or even some forms of depression. Before the sufferer even thinks of working through the IBS, they invariably need an emotional ‘topup’, they need their batteries charged, after perhaps years of pain and discomfort, of being told by various medical professionals that there is nothing that can be done, even though intrusive and sometimes painful examinations have been undergone, many sufferers feel emotionally drained. Work and family relationships can be eroded and strained, social life and love life can be virtually non-existent, concentration and recall, may be almost impossible compared to how it used to be, confidence and self esteem of the individual is often very low, and the ability to see things in perspective is greatlyreduced. Therefore to tell a sufferer that they must do this or that, without preparing for the journey is almost certain failure. Hypnotherapy, when conducted correctly can increase self-esteem, confidence, and allow the sufferer to begin a journey of self improvement and management, by changing their thoughts, changing negative thoughts and feelings for positive ones.. and thereby equip themselves emotionally to move away from the symptoms and thoughts of IBS and begin moving forward, a journey that many sufferers have or are taking at this moment, with positive changes.© 2000 Michael Mahoney www.healingwell.com/library/ibs/mahoney1.asp________________________________________Michael Mahoney is a clinical Hypnotherapist with over 20 years experience in his profession. He is principle trainer of the UK Register of IBS Therapists, and an associate member of the Primary Care Society for Gastroenterology. For more information about hypnotherapy and the IBS Audio Program 100, CDs for hypnotherapy for IBS, visit www.ibs-register.co.uk or www.ibscds.com


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## cookies4marilyn

Informational bump


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## code9

What do you think this means in relation to IBS as a mental illness? I'd be interested in Mahoney's take on that. If simply changing your thought patterns can treat, if not completely eliminate symptoms, what impact does that have on say, the effectiveness of Lotronex?I mean, I had a short discussion with Eric about it, but I'm only directing this to you, and will not respond to Kathleen or Eric, since that discussion apparently will go nowhere. But I am genuinely interested in how this might work, and what Mahoney thinks it means in terms of the pathology of IBS.We know hypnotherapy can't cure cancer. We know it can modify behavior, or at least some believe so. So, in my mind, this is pointing to IBS being a behavior. Not a physical illness that could be directly treated with medication. Does he ever answer questions? I'd love to talk to him about the program.


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## IBD/IBS Author

Hey Code9,I'm hesitant to post a reply to the question you're asking Marilyn and Mike since you've said you won't reply to Kathleen or Eric, but here goes. . . Let me start by saying, I've had IBD (colitis) and IBS for at least 10 years, probably more, but was Dx'd 10 years ago with SEVERE D and weight loss, among other symptoms. I am not going to get 'scientific' about things because I've put a ton of time and energy into changing my diet, lifestyle, and stress levels and just don't want to put any more time into researching this to death. BUT, I will say that part of what helps me to control my IBD and IBS symptoms has been self-hypnosis, meditation, and Reiki (energy healing).For many, these are a little too woo-woo - and when they were all first recommended to me I fell into that category and poo-poo'd them. However, when I was to the point where I weight about 90 lbs. (I'm 5'7"), was pooping blood and mucus up to 30x/day, couldn't work, couldn't even leave my house, and simply wanted to die I was willing to try everything and anything and did. Some things that worked/work for other people haven't worked for me, but other things - like the hypnosis, meditation, and Reiki - have helped me out. I know that my IBS kicks in when I'm stressed, scared, or fearful, and the ability to quiet my mind and thoughts helps me to quiet and control my symptoms. Like I said earlier, I'm not going to get into the 'why' and 'how' of it, at least not right now 'cause I'm too busy feeling well and living my life to dwell too much on it. But, these 'alternative' therapies along with diet changes, a career change, and Rx meds for my colitis have taken my life from one not worth living to one where I do what I want, travel pretty much when and where I want, and live. The only big sacrifice I make in my life at this point is not being able to eat or drink certain foods, and quite honestly it's a small price to pay for having my life back. Hope that helps.Cheers,Elizabeth


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## code9

Well, I won't reply to the aforementioned two, because one thinks I am accusing them of something and the other likes pasting abstracts too much. Especially when I've already read the entire study.Although that doesn't really answer the question, you do feel like stress management and hypnosis were a major part of the recovery process. You mention RX meds, but they are not the point you seem to dwell on. So :1) Do you feel that your IBS/IBD was, or is, a mental illness that needed to be treated by hypnosis and meditation?OR 2) Do you feel that these were just adjuncts to treat acute bouts of stress and anxiety, and did not inherently solve the underlying problems?OR3) Do you feel the RX is unnecessary, and that hypnosis and meditation alone could treat your symptoms and by re-training your brain you could get to a point where the illness was not a problem?-----Thanks for the reply. I'm really not trying to be an ass, although some people are taking it that way. I just want to clarify for people reading this board, and for myself : Is CBT/hypno/meditation/reiki actually treating an organic physiological illness at its base level? Or is it just a tool in controlling acute bouts of stress and anxiety?Some people are billing IBS as a fight or flight response, which apparently occurs 24/7, causing mast cells to release histamine and in turn cause spikes of serotonin near 5-HT3 receptors (see folks, I have read those papers). They are also claiming it can be fixed, or mostly fixed, (I think the figure "98%" was quoted) simply through meditation/will power/CBT.This bothers me on some level, because I feel like it's just a recycled way of saying that this is a mental illness, just calling it "reiki" or "CBT" or "hypnosis" is just a more chic way of saying "mental help." This is the attitude that I'm sure many of us have run into many, many times. I've been called an addict and been told I need psychiatric help by handfuls of GIs. I don't take opiates now, never had a problem with them. Regardless of some of the misinformation I am reading about them here, I've never known anyone who has had a problem tolerating them. Again, a lot of Drossman's theories are based on tests in rats that haven't even been proven in humans. Even the case studies from his own papers talk about long-term opiate users with high tolerance. (Again, I do read the papers, not just the vague abstracts.)I saw a psych, he told me SSRIs would fix all my problems, and if not, I should try CBT. But he had no clue what a 5-HT3 receptor was, or what the enteric nervous system was. SSRIs, SNRIs, trycyclics, benzos... etc do not help my IBS. They do help with acute anxiety, as I'm sure hypnosis/CBT/meditation would as well. But they don't help with the underlying problem of my gut malfunctioning. Some people seem to react strongly to this statement, I don't know why, I think that's something they need to sort out for themselves.But overall, I am curious to know how you view these treatments. I'd hate to see this board telling new comers that the solutions are mental treatments *for a problem that is organic and physiological.* That is like me going to a cancer board and telling them if they get enough mental help, they will get better.... or do you disagree? Not that it might help in a fashion, perhaps help them deal with the problem better, be less anxious, more relaxed, it should have a positive effect, but to call it a treatment is a bit... grandiose? hyperbolic? rude?


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## cookies4marilyn

Hi Code,Elizabeth was gracious enough to help me out and reply first here, as I wanted to give some thought to your comments before I replied. I will also try to briefly address a few of your concerns if I may. Firstly, I read all your posts because I wanted to get a feel for where you are coming from. I note that you are a fellow looking to take Lotronex for your severe long-standing IBS- D, and I also note that Jeff, Eric and Kathleen were very gracious and helpful to you in responding to your posts early on. So I must emphatically state that I take a bit of issue with your comments about Kathleen and Eric, as these two individuals have taken a lot of time and devotion to help those who are suffering on this BB for many years. Granted, you may not agree with all of what they post, or their posting styles, but both of them are well read in the lastest IBS research studies and take pains to present all aspects of the topics they address. I will not enter into further discussion of this, but I wanted my position known that these are two good people. And they would not mislead anyone - ever.... No doubt you are very well read - you have the ability to do a search of any of the topics you present here and find the information you want to find. A cyber space BB, including my own posts, should be taken by the reader as opinion, and anyone with any intelligence knows how to go to respected medical websites, Medscape, Medline, the various Journals, etc. to find what they are looking for. Jeff has provided a forum for such research articles.I am not going to get into medical rhetoric here as it has been awhile since working on my PhD, so I dont wear that hat over here, but you seem to be searching for some answers and some validation as to just what your condition may be defined as.With a bit of verification for you, I have to confirm that the IBS condition is NOT - I repeat - NOT a mental condition or psychological, or all in the mind, etc. Even though termed a functional disorder (the function is faulty, but "nothing is found") there is an abnormality in the way the brain and the gut communicate. I agree with you that IBS is a physiological condition in that there are differences between the IBS patient and the non-patient that can be measured by various tests, CT scans, etc. You can look up those studies easily.In reading your past posts, and the more recent longer ones, I believe that you are searching for some understanding about how a psychological or "mental" approach could possibly address gut issues. IBS isnt something one has or causes by themselves because their thinking is faulty, or they have mental illness of some sort. You are equating your thinking of what you believe is a treatment for mental illness - CBT, HT, etc. which is not the case. So we are in agreement there - IBS is not a mental illness. Nowhere is it stated in the medical criteria that it is so. That does not preclude however, that a person with mental concerns could not have co-morbid IBS. But we are not discussing that here.But I know where you are coming from - because I was there once too. When hypnotherapy was first suggested to me, I felt too that I didnt have a mental problem, why should I consider it, etc. So I do respect your mindset. At first, I too thought about the "mind help" thing. But I also had a bit of that put to me early on in my DX. I was put on every SSRI, tricyclic, off-use med, codeine, valium, belladonna tincture, etc., you name it, I was on it. All with NO help whatsoever, so by the time I got to this BB - upon my GIs recommendation, because he was all out of answers, the hypnotherapy was for me a last resort after over 20 years of suffering. The very last thing my GI said to me, was how about trying Lortronex - to which I said, they are taking it off the market - I knew before he did - so that was the only med I was not on - years before, in 1993, I was asked to be in the clinical trials at Mayo Clinic for Lotronex, but my IBS was so severe, I could not keep going back there for the eating of the barium scrambled eggs pooping in a tophat while they filmed me thing... But I digress - but only to show you that you are where I was back in 2000 when I came to this BB - and there is so much more research now then there was then. I totally get the mental illness, it's in our heads connection that you have to IBS and this type of treatment modality.There is NO cure for IBS to date - hypnotherapy is but one way that has been shown to help the vast majority of people who try it - not all - but the vast majority. And most people try it as a last resort after all the meds.Will ht cure cancer? - NO. Will it mend a broken arm? NO..... Will it change neural pathways in the brain that are faulty that do not communicate properly between the brain and the gut signals - YES. If you heard a loud noise right now, you would jump, your heart rate would increase, you would show physical reactions to an outside stimulus. These are automatic, some responses are learned. You know the Pavlov's dog salivating thing. Pretty basic. Well, at one time or another, you had a D episode or similar and there was a faulty imprint made, a misconnection - for myself, at first, IBS was a here and there thing, once every few months, then every few weeks, to almost every day - for hours on end. A severe D attack could come out of the blue - not thinking about anything stressful, nothing eaten that would do it, etc. After a while, I became fearful of leaving the house, etc. and one negative thought got imbedded over another - chicken or egg thing - fear of D gave me the D, and while not having the D, worried I would get the D. But initially no thought was involved in the random IBS first time I had it. So for myself, I thought that I must have a bowel obstruction, or a tumor, or cancer, and when the verdict was "just" IBS, it became rather disappointing because how could anything not fatal make one feel like they want to die - seriously - that is where I was - just like many of us here on this BB.So IBS is not a behavior, nor is it willed, nor does it mean we did something in our past, or any of those mental, psychological connotations that I believe you are refering to - but I do understand why you are taking issue with the modality - I totally get where you are coming from there. But too, all you need to do is read the research about it - there are plenty of websites out there with the info. Take it or leave it - that is your right.I respect your quest - and I empathize with why you are questioning all of this, but I will say that we are all here to care and support each other - I know you are hurting - big time - and you are frustrated - but I also invite you to investigate this further on your own . I am not here to suggest you try a cognitve modality of treatment - I hope you are able to take the Lotronex and that this can be your treatment of choice. Perhaps if I would have taken it just before they pulled it off the market back when my GI suggested it, I would not have gone onto the BB for help and never would have known about HT - I would have been helped sufficiently enought that I wouldnt be seeking support and answers.But the fact remains that I did come here and found my answer this way - and that many others have as well - they are not mental cases - far from it.As far as Mike goes, I will post an article he has written about all in the head - he talks about the changes in the brain under hypnotherapy, and that is a physiological response. He is with patients all day into the evening hours, and presenting his work to hospitals, medical associations and physicians. If you have a specific question, I can ask him, but he is so busy that he does not have time to entertain long replies. One thing he is adamant about, is not pushing anyone into anything. He became involved in helping folks with IBS when he had a patient with the condition who was referred to him by a gastroenterologist back in 1991 - he approached the professional minds at the time for guidance, and worked diligently to help those that came to him who were suffering so badly - and all of whom had met with no success from meds and other treatment methods. So the science is in fact there.In closing let me say, that I do not consider this a rebuttal, nor do I want to entertain a debate or long ongoing discussion with you. I think it is fair to say that no one on this BB suggests that HT or other cognitive treatments are the way to go for everyone, or that IBS is a mental condition - so actually - on that we can both agree.I sincerely wish you well in your journey to feeling better - no matter which way that takes you - You are obviously very intelligent and pro-active in trying to find what works best to you and looking to understand the condition in the best way that you can. All of our journeys are different but they all want to end up finding some relief, understanding, care and support. No one thing works for everyone - follow your research and do what is best for you. It took me 20 years to find out after years of agony and I can only share my journey.Thank you for sharing yours - all the best.


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## code9

Thanks, that was a really good post, I think you exactly get what I am saying. I think we sound very much alike in onset and everything. As to Eric and Kathleen, their answers to my previous questions are fine. I'm sure they spend a lot of time suggesting things to people, I guess it was the way that HT was being presented that was off putting. The way you lay it out, I feel, is a realistic logical description of how it could be working.I really liked the way you put this "*and one negative thought got imbedded over another - chicken or egg thing - fear of D gave me the D*". That is how I see it, there is a "wind up" of anxiety and it's cyclical, I feel that. But I get the point about the chicken or the egg... same with me, I never felt anxious about the occasional D, until it became unrelenting. I had D long before I ever had a traumatic episode with it, so I feel there is something underlying the anxiety, but I would never say anxiety doesn't play a role in that cyclical cycle. I think the distinction I was trying to make, was how big of a role does the mental state play on what is a physiological illness. In this one, it could go a long way in some people, and not far in other's... which is what I believe you are saying.At any rate, that is a good explanation, and explains to me how HT or CBT may work to a marked degree without necessarily changing the basic malfunction of the ENS. (Which, if it exists in a person, I don't believe it can be changed by HT or CBT). It's been suggested to me, it may be something I look into. I tend to lean towards the side of medicine, especially since Codeine and Zofran have been so very helpful, but your point is very clear and well taken.Thanks


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## eric

Marilyn - Dr Palsson is going to be or was in (march) Chicago to give a key note speach to the American society of clinical hypnosis.Hypnosis has been officially recognized since 1958 by the American Medical Association.Code 9 - you don't have to listen to us, nor has anything we said so far been our personal opinions, but actual research from many experts all over the world are actively studying the physiology of IBS.


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