# Hypnotherapy for IBS by Dr Whorwell



## Darlene D

Thanks, Eric!







You know, I have been going back and forth on whether to invest in Mike's tapes. I have finally decided to go ahead and order them. I am fed up with trying to control this on my own. Does it help depression also?


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## carolauren

Eric,I first learned about hypnosis for IBS from Dr Whorwell's work. I saw an ad in, of all places, Parade magazine about treatments for IBS and I ordered the tape. It was done by Dr. Whorwell! I wonder how the approach he uses differs from Mike's.


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## eric

Yes Dr Whorewell started the studies on this, and there are basically three major people in regards to it at the moment, Dr Whorewell, Dr palsson and Mike all who have been doing this a long time. Mike's hypnotherapy is a refine gut directed HT process, called gut specific and is not the same gut directed HT over and over, but the sessions progress with the patient as they change. Mike will be back soon and I will have him comment more. The HT has to be for the IBS to be of superior benefit to IBS then just HT, thats very important.Darlene, I am personally glad your going to try it and we of course will help on our forum as much as humanly possible of course to answer questions and guide you through. It has been shown to ease depression and anxiety as side effects of doing it. I have a lot of information on all this iff you would like to see it.Gasgirl are you doing Mike's or Dr Whorewells?


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## JeanG

Thanks for posting this, Eric!Darlene, I'm glad to hear you'll be doing the tapes.







They are very enjoyable, as well as helpful. Pop on over to the hypnotherapy forum and join us with any questions you have.JeanG


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## eric

FYI http://www.aboutibs.org/Publications/hypnosis.html


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## eric

Gasgirl, here is some info for you.The IBS Audio Program was developed through ten years of ongoing IBS research by Michael Mahoney, one of the United Kingdomï¿½s leading clinical hypnotherapists. Mahoney has over 13 years experience as a hypnotherapist, now specializes in treating IBS patients, and is regularly referred patients by gastroenterologists and family care physicians.[13] He is an associate member of the Primary Care Society for Gastroenterology, a worldwide organization. The IBS hypnotherapy program follows a scheduled 100 day treatment period and is conducted on your own time in your own home. The program is successful for over 80% of the patients who use it, and the reduction in symptoms and their severity averages 80-90% for these users. Itï¿½s interesting to note the significant difference in success rates for the IBS-specific hypnotherapy tapes versus general hypnotherapy tapes. In contrast to Mahoneyï¿½s 80-90% success rate, general hypnotherapy tapes featuring standard relaxation techniques and visualization exercises have only produced an average 57% improvement rate for IBS patients.[14] While any improvement is certainly better than none at all, itï¿½s clear that the benefits are far greater from a hypnotherapy program specifically developed for and aimed at IBS. Most impressively, Mahoneyï¿½s statistics arise from studies with patients who were given no relief whatsoever from conventional medical therapy ï¿½ people who were, in fact, referred by gastroenterologists who had exhausted all other potential avenues of help. The incomparable success rates for the tapes are likely due to Mahoneyï¿½s in-depth study and understanding of both IBS and hypnotherapy, which results in reducing anxiety, stress and fears directly related to IBS attacks, and increasing patient confidence, self esteem, and management of IBS-specific symptoms. The IBS method of hypnotherapy developed by Mahoney is gut-specific, and termed ï¿½on-going progressive session induction.ï¿½ This method was created upon the basis that as a patient responds and improves, something new must continue to happen in therapy to help the patient achieve further results. Experience has shown that if the process remains the same, the patient is more likely to become stalled at some stage of the treatment. Particularly, the sounds and words used in therapy initially, when IBS symptoms are present, can become associated with this negative state of health and mind. These same sounds and words should not continue to be used throughout the therapy because the negative associations can then become anchored onto the healing methods, which will eventually limit the progress of the patient. The IBS method of hypnotherapy allows the patient to continue to progress throughout the entire course of treatment, and beyond. As patients learn new ways of thinking, they have more internal resources available to use in overwriting their previous negative beliefs. This then leads to further progress, more free mental resources, more progress, and the resultant reduction of IBS symptoms. Hypnotherapy works on the basis that everyone is continuously developing in one way or another, as every day involves learning, making decisions, experiencing emotions, etc. The IBS method of treatment takes advantage of this development and encourages it by changing the sessions and mental suggestions in ways that help carry the patient continuously forward. This approach is based on the belief that everyone throughout their lives has to keep looking for ways of moving forward, and that continuous personal development should be second nature to us all. As change is a natural part of life, we should view it as an opportunity and not a threat. The IBS method reduces the subconscious negative perceptions of change, allowing the embrace of new thoughts and beliefs, with the resultant improvement in IBS symptoms. Typically patients begin to feel much better as a result of changes in the way they think, their outlook on life, and its events, though rarely can someone pinpoint the precise moment improvements begin. These results stem from the subconscious mind, which controls the digestive system, very gently beginning to  realize that the thought patterns of IBS are no longer needed. The subconscious reminds the individual as a whole that they existed very well, thank you, without IBS, and can do so again. The audio program is complex in its make up, but quite seamless and simple for the patient as the learning process is made easy through the use of enjoyable imagery and suggestions. The therapy itself allows changes, both physical and emotional, to occur without difficulty. Mahoney believes that just dealing with the symptoms of IBS is not enough, that the individual must learn to rebuild internal energy. Many people with IBS feel drained emotionally by the stress of living with the disorder, and the resultant crises and responsibilities in their lives continually deplete their inner emotional strength and reserves, often leading to anxiety or even depression. Before a patient can begin the process of working through their IBS, they frequently need an emotional ï¿½top-upï¿½ of these inner reserves. In essence, they need their emotional batteries charged, as they have likely endured years of unstoppable pain and discomfort, of being told by various medical professionals that there is nothing that can be done, and intrusive or painful examinations and tests. In addition, family and work relationships may have been strained or eroded by living with an incurable illness, social and love lives may have dwindled to non-existence, and confidence and self-esteem may be at low ebb. With all of these additional stress factors the ability to put IBS in perspective is drastically reduced. If a patient begins therapy at this point, they will be completely unprepared for the process and unable to act upon the instructions, and failure is likely if not certain. Mahoneyï¿½s program takes these IBS-specific circumstances into account, and tailors the hypnotherapy tapes to increase confidence and self-esteem first, in order to allow the patient to begin a journey of physical and emotional improvement and management. Then begins the change in their thoughts, the exchange of negative beliefs and feelings for positive ones, and the ability to move away from the symptoms and thoughts of IBS and forward towards a life without the disorder. Mahoney believes that this IBS-specific method of hypnotherapy is the best, and his patient trial results support this. The IBS Audio Program itself is structured over a 100 day period, with a listening schedule for each day (including 20 days off). The program consists of 3 double-sided audio cassettes or CDs, which contain an introduction and five different hypnotherapy sessions, each building on the preceding one. Sessions vary in duration but average 25-35 minutes. The program also includes a progress log/symptom check list. All that is required for participation is to find a set time each day when you can listen quietly and be undisturbed. Simply fit your listening time into your daily schedule at your own convenience. The introductory and five discrete sessions are as follows:  Introduction * Provides detailed information about hypnotherapy, the specific process being used for the audio treatments, and information about IBS. * Acknowledges the physical and psychological combination that characterizes IBS pathology, triggers, and symptoms. * Aims to treat both IBS and the problems in a personï¿½s life that have resulted from IBS, including anxiety, social fears, depression, fatigue, worry. * Sets a stopping point for the emotional drain of IBS; from this point on IBS symptoms will not worsen but will improve. Subconscious begins to be affected and physical changes will follow. * Emphasis on the safe, gentle, non-invasive aspects of therapy and its record as a safe form of treatment for many conditions for many years. First Session * The foundation session. Allows listeners to take the time to reduce their stresses and apprehensions, to become familiar with the hypnotherapy process, and to learn that they are in control at all times. * Offers a gentle introductions to reduce anxieties and emphasize calming thoughts, thus reducing the negative thought patterns which trigger IBS physical responses. * Helps manage IBS symptoms and let users begin to understand the benefits of allowing both mind and body to work together towards the goal. Second Session * Begins to address the subconscious and conscious thoughts which can trigger IBS symptoms. * Teaches users, through creative imagery, to exercise control over these thoughts. * Uses the power of suggestion to enable listeners to learn to control the speed of peristaltic waves of the GI tract, leading to normal bowel movements. * Uses the mind to regulate the body. Third Session * Uses visualization to control the entire digestive process, from start to finish. * Begins to allow user to take control and mentally search for areas within the GI tract where there is IBS pain or discomfort, and then reduce these symptoms while continuing to use positive thoughts. * Negative thoughts should be decreasing and replaced by positive thoughts, which will help develop new coping strategies. Fourth Session * Uses metaphor to help view the journey through IBS as a trip that is nearing an end. * Acknowledges struggles of the past, the many steps the journey has required, and that while there may be a step back occasionally the progression forward will remain. * Acknowledges old thought patterns and allows them to be released; enhances positive thought patterns to achieve continued improvement. * Emphasizes that while memories of old thought patterns may remain, we donï¿½t live in the past. We live in the moment. From this moment on IBS will steadily improve, a sense of order has been reached, and progress will now continue on its own. Fifth Session * Encapsulates positive moments from the five previous sections. * Reaffirms the effects of the program. * Listeners are encouraged to review this session occasionally after the program ends to optimize their positive changes. Of the five sessions, some are listened to once while others are repeated a dozen times. Content and order are both important. The program gives people the structure necessary to allow a progression to the end of IBS in their lives, with the final result of the reintroduction of both previously forbidden foods and stressful activities. These factors are meant to be reintroduced into patientsï¿½ lives in a controlled and structured way, with a subconscious and conscious mindset that prevents the suffering of physical problems from these formerly attack-inducing elements. After the program is concluded, patients are encouraged to listen to the final tape for an additional period of time to ensure the learned processes are embedded into their subconscious.


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## trbell

eric, since you threw the ad in here I have to ask whether Mike's tapes were part of the recent UK study or is there something better?tom


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## eric

Tom, I was answering gasgirls question about Mike's tapes. Mike is a member of the brain gut research group, the primary society for the UK gastroenterology and a member of the British Hypnotherapy society and more.He has been doing this for quite a while and is very experienced.No this was not part of the study your refering to, although Mike has done his own in house studies they have not been published yet. On my end at the research center we are working on doing a real clinical study on them.He is stilll away for a while and I am sure will be back to answer questions in time.A part of all this is in the experience of the Hypnotherapist and Mike has over ten years experience and is extremely professional and runs the UK Register of IBS therapist who he trains in IBS. He is also involved in the UK in other aspects of IBS and Hypnotherapy on the national level as a consultant. I cannot comment more on that aspect at this time.


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## Guest

Eric.... excuse my naiveness on this subject please........ but just what exactly is the mechanism by which hypnotherapy is imposed? There are people who cannot be hypnotized. Why is this? And for those of us who do not wish to be hypnotized...... what other avenues are available to us for dealing with physiological illness?


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## eric

Artspirt, hypnotherapy is a natural state of the human body. While its true not everyone can be hypnotized, most people can. Another effective form of treatment for IBS on a concious level isCBT for one, but a lot of the relaxation techniques like meditation also helps some of the physiology of the relaxation responce and hence would help IBS. With HT there is a little more going on though.This is not information on hypnosis and IBS, but more general on hypnosis.These article's are a little bit old and more has been learned on it since it they were written. http://www.sciam.com/2001/0701issue/0701nash.html http://www.howstuffworks.com/hypnosis.htm


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## JeanG

Bump up for gasgirl.







JeanG


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## carolauren

Eric,I am doing Mike's tapes, and I read everything on them on this board and at his site before I ordered them. Thanks for the review, though.The tape that I referred to that was Dr. Whorwell's is a videotape where he explains what they do at his clinic and the various approaches used, and it struck me that the centerpiece of this was hypnotherapy. There were patients on the tape who also spoke about what had been helpful for them. There was a little part of a hypnotherapy session shown, and the therapist was using imagery that was explicitly guiding the patient through relaxing the colon, which was somewhat different from the way Mike has structured his sessions. It seemed more direct. I don't know if they do the same thing every session or not. I was just curious about different approaches to IBS/gut-directed hypno.I don't know if anybody on this board has been treated at his clinic; I've never seen it come up.Before I heard about Mike's tapes I searched alot of hypnotherapy sites to try and find someone in the U.S. who does medical hypno and specifically for IBS. There were only a couple and only one in my state, too far away. That's why I was so pleased to find out about Mike's work.Seems that hypnotherapy in this country is primarily used for addictions, pain relief, preparation for surgery and the like. And, of course, lots of past-life regression types of stuff, which I was not interested in the least!


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## trbell

eric, I wasn't attackeing you so relax. I was only suggesting that if you are going to promote one product the appropriate place to discuss this might be the product forum?I happen to be an advocate for HT and Mike's tapes in particular but wouldn't pose as an expert and say they are the only option. I think that maybe you forget that you have become an expert here and what you say influences a lot of people.I'm curious to know what you think about what was said here about the Whorwell tape? it sounds pretty gut directed to me.tom


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## Guest

Thank you again. I already participate in the CBT, and just today asked my therapist (via email) about possible HT. She is going to think about it and get back to me. She does perform it on some patients but wants to make sure she knows exactly what we are targeting. I suggested my anxiety response.


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## eric

Gasgirl, it sounds to me like you might have seen a promotion video for his unit at the hospital, they do Hypnosis in person and send tapes home with the person. It is a unit inside a gastroentestinal unit of a hospital. They have been doing it longer in the UK and have set that up. ON this they seem to be more progressive then in the US so far, but that will change soon. There the differences in the HT methods and Mike's changes as the person changes (while still gut directed), Dr Whorwell uses a gut directed approach. The major thing in HT for IBS is that its for IBS. For more depth on all this Mike will have to answer this he is the expert.Tom, I am relaxed. Again I was replying to Gasgirl and her question and the difference in tapes. One (Dr Whorwells is gut directed a good thing) , 2 Mike's is gut specific, a good thing) and I was explaining Mike's tapes to her. She is already doing them I see now so maybe what I posted may also reinforces the aspects of what they are doing. A good thing. On the differences DR whorwell does most in person and his staff and I believe it uses mostly the same gut directed HT repeatedly, Mike's is a gut specific Ongoing Progressive Session Induction Methods (OPSIM). There is a difference in the HT methods, both are for IBS. Mike' is still away I am sure he will explain this more for you in depth.This is part of it."The principle of the Program is that we are not born with negative feelings and destructive behaviours; we learn them. Thus we should be able to learn new positive ones. The OPSIM processes harness this natural ability to learn and to change through absorbing information from experiences, thoughts and feelings."


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## trbell

now we're on the same page, eric. I think the information on gut specific and gut directed would be of interest to people here. there's not really enough evidence for me or Whorwell or Mike or Paulson to make the claim yet but it shouldn't stop you.tom


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## eric

Tom, I have seen the results of all three's work. I am not making any claims the results from all three professionals speak for themselves in IBS. They all know what they are doing.


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## carolauren

IS there a difference between gut-specific and gut-directed, or is that just semantics?Eric, I didn't take your post as an ad, just informational. I think you just forgot who I am!







I don't know if Dr. Whorwell's tape was promotional or not, but I got alot of good information off it and it was instrumental in my pointing me in the direction of hypnotherapy--I had never heard about it before for IBS. I was impressed by his soft-spoken manner and compassion; I think he and Mike are cut out of the same cloth. I don't know anything about this Paulson guy.


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## trbell

sorry, eric, what I meant by a claim wasn't necessarily bad. it's just that the standard of proof scientifically is higher than publication on a web page or in a newspaper or even in a journal.please let me know bc if there's anything else i need to apologize for - i think perhaps others are tiring of these constant put-downs.tom


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## eric

Gasgirl, mainly semantics. Mike's aprroach is to have the sessions grow with the patient. Some use the same methods over again. Everyone mentioned here uses HT directed to the gut and to the symptoms of IBS.Paulson, is someone I have talked to a few times personally. On time on the phone to for forty minutes on IBS and HT.







He is at the UNC and is the hypnotherapist for IBS there, although he is also a Dr Studying other very important IBS issues. He is also really nice so these guys must all be from the same cut.







Mike is one of the nicest people it has been my pleasure to meet personally and is very compasionate. Paulson has a public website for IBS.www.ibshypnosis.comand also worte this. http://www.med.unc.edu/medicine/fgidc/hypnosis.htm Hope that helps Gasgirl and later I will have Mike help explain it to you better then I can. I don't want the message that it is effecitve for most to get lost in the semantics.


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## carolauren

Eric,Oh, yeah Palsson at UNC! I had the spelling wrong. I had looked at the UNC site and his site a long time ago!







Don't worry about the message being lost; if people take the time to do some reading on it, the evidence of its effectiveness is more abundant than anything else I've seen for IBS.


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## eric

Tom, I am done being petty with you, this is just childish games. Its been going on too long now. I would rather do more constructive things with my time. I suggest you do also.If you have a problem with me email me or Jeff and take it off the bb, don't pretend to play games pretending to learn if you don't want to hear what I have to say, then don't ask me questions, you already know enough about all this, its a joke, and its at the expence of others trying to learn and perhaps even try it. I would also imagine an insult to Mike as a professional in IBS when he reads this, or any of the professional hypnotherapists who maybe reading this thread at any given time.This bb is about compassion to help people suffering a complex problem, I would rather myself spend my time in that reagrds and not bickering with you. Because I don't see you honestly here trying to learn, just complain and say they don't know, they know a lot.


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## trbell

eric, this is not petty to me either personally or professionally. tom


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## eric

You don't seem to be acting to professional with your comments." Hypnotherapy significantly improves symptoms in IBS patients Hypnotherapy significantly improves quality of life in irritable bowel syndrome patients, both in the short- and long-term, claim British researchers reporting to the BSG conference. Two research teams investigated the impact of hypnotherapy on quality of life in patients suffering from irritable bowel syndrome (IBS). They presented their findings at the British Society of Gastroenterology Annual Meeting in Birmingham, England. In the first study, investigators from the Western General Hospital in Edinburgh, Scotland, evaluated the impact of gut-directed hypnotherapy upon health-related quality of life (HRQoL) status in IBS patients. A total of 75 IBS patients (55 females, median age 37 years) were enrolled in the trial. The predominant symptoms among the patients were abdominal pain in 46 (61%), altered bowel habit in 24 (32%), and abdominal bloating in 5 (7%). Hospital Anxiety and Depression Scales, and an IBS disease-specific quality of life tool (IBSQoL) were used to measure outcomes. The researchers took measurements at baseline (pre-treatment) and at 3 months post-treatment. There were found to be statistical improvements in all domains of the IBSQoL (emotional, mental, and physical health, sleep, energy, diet, and social and physical role) after treatment. Improvements were most marked in female patients, particularly those with predominant abdominal pain. Furthermore, significant improvements were seen in both males and females for anxiety and depression. Dr G. D. Smith commented that gut-directed hypnotherapy had a very positive impact upon psychological well being and HRQoL in IBS. This appeared most effective in patients with a predominant symptom of abdominal pain and bloating. The authors recommended that a randomized, controlled study of hypnotherapy in IBS should be conducted. In the second study, a team from the University Hospital of South Manchester, England, conducted a long-term follow-up of IBS patients treated with hypnotherapy. A total of 239 IBS patients, who had undergone hypnotherapy between 1 and 5 years previously, were contacted and asked to complete 3 separate questionnaires. Of these, 178 patients responded. In a Subjective Assessment Questionnaire (assessing effects of hypnotherapy, medication use, and consultation rates) 86% of patients were found to have improved at the end of hypnotherapy (62% of whom rated symptoms as very much better). Of the patients that improved, 83% reported that, since finishing hypnotherapy, symptoms had remained the same as at the end of hypnotherapy, or had continued to improve. However, 17% had some deterioration. In addition, 59% of patients did not require any medication. Of those who did, 40% took it less often than previously. Three quarters of the patients consulted their GP and/or hospital consultant less often about IBS symptoms, and 49% less about other symptoms. All IBS measures in an IBS Questionnaire (rating severity of symptoms and QOL) remained significantly better at follow-up than before hypnotherapy. These included pain severity and frequency, bloating, bowel habit dissatisfaction, and life interference. There was only slight deterioration in some of the measures at follow-up, compared with post-hypnotherapy. Extra-colonic symptoms, QOL, and Hospital Anxiety and Depression scores all remained improved at follow-up. Author W. M. Gonsalkorale said on behalf of the group, "This study confirms the long-term benefit of hypnotherapy." "In addition, the substantial reduction of medication and consultation rates highlights the significant economic advantages of this form of treatment," it was concluded. BSG 19 March 2002 http://www.gastrohep.com/news/news.asp?id=1158 "Hypnosis for Irritable Bowel Can Relieve Painful Symptoms, Some Say By Mark Moran , MPH WebMD Medical News Reviewed By Dr. Jacqueline Brooks Aug. 23, 2001 -- Relax, you're getting sleepy ... very sleepy. That may sound like a Hollywood clichï¿½ -- the glassy-eyed subject lulled by a swinging watch -- but some researchers believe the peaceful state achieved in hypnosis can help people suffering from irritable bowel syndrome. At a meeting this week of the World Congress of Psychosomatic Medicine, gastroenterologist Peter Whorwell, MD, will discuss more than 20 years of research showing that hypnosis can not only improve symptoms of irritable bowel syndrome, or IBS, but can even alter the underlying physical problems that cause the symptoms. The movie version of hypnosis is not much like the real thing. Instead, says Whorwell, in his practice it is more like meditation, yoga, or guided imagery. For treating IBS, a hypnotherapist guides a patient in relaxation exercises and helps him focus on the muscles of the stomach that are so critical in IBS. "It's a concentrated form of relaxation where the therapist is teaching the patient to control systems of their body they can't normally control," Whorwell tells WebMD. IBS is a common disorder of the digestive system that leads to cramps and pain, gassiness, bloating, and changes in bowel habits. Some people with IBS have constipation, others have diarrhea, and some have both. And many doctors believe there is a psychological component to IBS, in which stress, depression, or other mental states can lead to physical symptoms in the gut. Such symptoms are called "psychosomatic," and Whorwell says they are not confined to IBS. "Every disease has a psychological component," he says. With IBS it's important for patients to have better control of the contractions of their stomach muscles and the sensitivity of their stomach to stress and other influences. That's where hypnosis can help, Whorwell says. But it doesn't happen overnight. "It's a skill the patient has to take the time to learn," he says. "Just as it took time to learn to control bowels as an infant, it takes time to train your body to control your gut." At the Hypnosis Unit of University Hospitals of South Manchester, in England, where Whorwell practices, patients typically receive twelve half-hour sessions of hypnotherapy, he says. Hypnotherapy can be used in combination with drugs that ease the pain of stomach contractions, or with changes in diet. But Whorwell believes that for some patients hypnosis can be superior. "The beauty of hypnotherapy is that once patients are better, they stay better," he says. "Once a person stops using drugs, the symptoms can come back." Whorwell acknowledges that finding a hypnotherapist who knows what he is doing and -- more important -- knows about IBS, can be difficult. And hypnotherapy remains somewhat outside the mainstream, he believes. Still, a 1996 statement by the American Gastroenterological Association suggests that hypnotherapy is generally accepted as a treatment for IBS. "Several psychological treatments have been studied in patients with IBS, including psychotherapy, ... hypnosis, relaxation, and biofeedback," according to the statement. "These seem to be effective at reducing abdominal pain and diarrhea but not constipation, and they also reduce anxiety and other psychological symptoms." "I'm a believer," says gastroenterologist Cynthia M. Yoshida, MD, director of the Women's GI Clinic at the Digestive Health Center of Excellence at the University of Virginia, Charlottesville. "Most people in the field will tell you it's not just medicine that does it [for IBS]." At the Women's Clinic, people with IBS may receive a range of "alternative" treatments similar to hypnosis, including guided imagery and relaxation techniques, possibly in addition to drugs and dietary changes. "It's very individualized depending on what is going on in the patient's life and whether stress is a big part of their symptoms," she tells WebMD. "There is no cookbook for treating IBS." http://my.webmd.com/content/article/1728.87469 With permission"Using Relaxation Coping with Functional Gastrointestinal Disorders Kenneth R. Jones, Ph.D. Research Assistant Professor of Medicine/Clinical Psychologist Steve Heymen, MS Instructor of Medicine/Certified Biofeedback Therapist Ten Relaxing Behaviors Relaxation training is a integral component of behavioral therapies for managing chronic pain, promoting health, and helping patients cope with life-threatening illness such as breast cancer. Relaxation can also assist in managing functional GI disorders. How can Relaxation Help? Research has shown that relaxation provides several health benefits including: decreasing excess arousal produced by worry or anxiety, managing insomnia, buffering the adverse physiological responses to stress, and increasing pain tolerance while decreasing some of the symptoms associated with chronic pain. Relaxation training is also a vital part of any stress management program and is a component of many cognitive-behavioral treatment programs for problems such as headache, depression, anxiety, and phobias. Many researchers and health professionals believe that relaxation provides two important functions: (1) as a coping skill that can be used immediately when a person is stressed, overly aroused, or in pain, and (2) by preventing some of the damaging effects of stress. Daily practice of relaxation lowers arousal that is associated with wear and tear on the body. Regular use of relaxation enables one to calm the body before beginning stressful activities and has been associated with improvements in the immune system as well as improved survival of cancer patients. Thus, daily practice of relaxation makes a person generally more relaxed, better prepared to manage daily demands, and better able to buffer the long-term effects of stress, while also providing a tool to use when things get out of hand. For individuals with functional GI disorders, relaxation appears to help by dampening the pain, managing the arousal naturally associated with physical distress, empowering the patient with self-help skills, and managing irritability which is a very common consequence of chronic pain. What is Relaxation? The skill of achieving a deep state of relaxation has been pursued throughout much of recorded history and is a key element in many religious, cultural, and philosophical traditions. Contemporary health scientists have attempted to specify what relaxation is and identify how to teach people to relax effectively. It is helpful to view relaxation from the perspective of three integrated systems in the body: the brain, the skeletal muscle system, and the autonomic nervous system. The Brain/Cognition: During and following relaxation, individuals typically report experiencing less rapid thinking and an increased ability to focus thoughts and maintain concentration. The quality of thought is also reported to be calm and restful in nature. Herbert Benson, MD, an accomplished researcher of the healthy effects of relaxation, describes the thinking state of relaxation as a "passive attitude," perceived as a peaceful willingness to just let thoughts flow in a natural, non-directed or non-controlled manner. Relaxation produces a particular pattern of bioelectrical brain activity as recorded in the electroencephalogram (EEG). The EEG of non-relaxed individuals shows relatively low voltage high frequency brain activity that is not synchronized. When deeply relaxed, the dominant frequency of brain nerve firings slows, portions of the brain appear to fire in a synchronized fashion, and a high voltage slow frequency pattern can be recorded. We refer to this EEG pattern as alpha activity. Everyone produces some alpha activity prior to falling asleep. Difficulty producing alpha activity is associated with sleep onset insomnia. Because we can record alpha and give people feedback on how well they are producing alpha states, we can use alpha feedback as one way to teach relaxation skills (see biofeedback, below). The Muscles: When relaxed, there are two changes in muscular activity. First, relaxed people are very still. If they move at all, they do so slowly and gently. Second, muscle tone is greatly diminished when people relax. Muscle tone is the background level of muscle tightness in between overt muscle movements. Many of us get sore, aching muscles in our lower backs and shoulders or develop muscle tension headaches when muscle tone is too high for too long. The Autonomic Nervous System: The third system that changes with relaxation is the autonomic nervous system. This is the part of the nervous system outside of our brain and spinal cord that controls digestion, blood circulation, and other our basic biological processes. The Latin-based word "autonomic," literally translates in English to "automatic." This nervous system controls parts of our body that we do not normally have to attend to, like when our heart beats or the level of activity of our gastrointestinal system. This autonomic nervous system has two branches, the sympathetic nervous system and the parasympathetic nervous system. The sympathetic and parasympathetic systems activate different parts of the body in different ways, but they tend to act like the two sides of an old-fashioned scale -- when the sympathetic system is activated, the parasympathetic system is less activated and vice-versa. Generally, the sympathetic nervous system is activated when you are challenged, stressed, or faced with a dangerous situation. When we are anxious, frightened, or in pain, we know that our heart beats more forcefully and races, our palms sweat, and we suddenly feel very awake and alert. By contrast, we tend to be more parasympathetically activated when out of danger and environmental demands are low. Under parasympathetic activation, the organs take care of "vegetative" or housekeeping functions such as digesting meals, converting blood sugars for long-term storage, and moving nutrients to cells while moving waste away. Breathing is an interesting physiological process as it is controlled voluntarily and by the autonomic nervous system, such as when we sleep, lose consciousness, or do not need to voluntarily regulate our breathing for activities such as speaking. Research studies suggest that many parts of the autonomic nervous system tend to follow the activity of breathing. Under sympathetic activation, breathing tends to be rapid, shallow, and less rhythmic. During relaxation and parasympathetic activation, breathing is slow, deep, and has a regular rhythm. Because one can voluntarily change breathing patterns and because the autonomic nervous system tends to mimic what is going on with breathing, a relaxed breathing pattern can be a successful way to gain control over automatic physiological processes. These three systems, the brain/cognition, the muscles, and the autonomic nervous system, are integrated by brain centers including: the limbic system (governing emotions), the hypothalamus (controlling basic biological/behavioral processes), and the reticular activating system (regulating arousal). The three systems tend to work in a coordinated fashion. When an individual changes the pattern of responding in one system, this affects the other systems. Thus, if one becomes very still and reduces muscle tone, there is a tendency for the brain and autonomic nervous system to generally reflect relaxation. Methods of producing relaxation tend to focus on one system, combinations of these systems, or all three. Key Elements in Learning to Relax: Like any skilled act, relaxation skills are developed through practice. For a patient to show any lasting benefit from relaxation training, research has indicated that a minimum of four training/therapy sessions is critical. Researchers have found that patients will continue to show skill development over the first 10 relaxation training sessions, but generally, patients do not show additional benefit from more than 10 sessions. Regular practice of relaxation appears to be critical in learning how to become deeply relaxed and producing health benefits from relaxation. If one has difficulty in becoming relaxed, special coaching or individual tailoring of a relaxation technique may be required (see Seeking Professional Assistance, below). Which Method is Best for Me? There are subtle differences produced by various methods of teaching relaxation. Nevertheless, researchers have repeatedly found that any systematic program of relaxation appears to produce positive changes in physiologic and psychological states for most people. Thus, one should choose a relaxation training program that feels comfortable to them. Various training programs are available through college continuing education programs such as yoga, transcendental mediation, or self-hypnosis. Many self-help books, guided relaxation tapes, or music-based relaxation recordings are also available. Biofeedback can also be a very powerful relaxation technique. Biofeedback is a psychological self-regulation technique using feedback from one's body reflected through a computer. Several studies have also shown that hypnosis is helpful to irritable bowel syndrome patients. Hypnosis therapies for functional GI disorders include both relaxation and suggestions for how to cope with functional GI problems. The Basics: Roger Poppen has done a good deal of research attempting to identify in the most basic way, what one has to do to produce relaxation. He has broken this down into10 basic behaviors that you may want to try (see box). Seeking Professional Assistance: Health psychologists and other behavioral medicine specialists regularly teach relaxation skills to help individuals cope with medical problems or reduce health risks. A health psychologist can also assist those who have difficulty learning to relax when a more individualized relaxation program is required. If you have difficulty finding a health psychologist, ask your health care providers for a referral, call your state psychological association, or contact a behavioral pain management program. Ten Relaxing Behaviors: Most individuals prefer practicing relaxation in a recliner chair in a quiet room (TV off). Head: The head is motionless and well supported by a pillow or recliner chair, and the head is centered with the midline of the body. Eyes: Eyelids are lightly closed with smooth appearance and there is no motion of the eyes (one may want to focus on an object low and distant in the room before closing the eyes). Mouth: The lips are parted at the center of the mouth and the front teeth are slightly  parted. Throat: There is an absence of motion and the neck centered with midline. Shoulders: Shoulders are rounded (dropped) and symmetric. Body: The body is still. The torso, hips and legs are symmetric in regard to midline. The muscles are still and the body is fully supported by the chair. Hands: The hands should rest on chair arms or lap. The fingers are still and should be gently curved. Feet: The feet and toes are still. The toes are pointed away from each other such that the feet form a V. Quiet: You should make no vocalizations or loud respiratory sounds. Breathing: Breathing pattern should be slower than when aroused, deep, and regular in rhythm. After getting into a relaxed state, just simply remain still and enjoy this state for 10-20 minutes. If you feel yourself becoming more tense, review the list of relaxed behaviors. If you have trouble with worrisome thoughts, try focusing on your breathing and thinking about breathing out tension and breathing in deeper relaxation. Adapted from Poppen, R (1988), Behavioral Relaxation Training & Assessment, New York: Pergamon Press."


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with permissionThe Effects of Hypnosis On Gastrointestinal Problems Olafur S. Palsson, Psy. D. Research Associate, UNC-CHAPEL Hill Department of Medicines 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 possibilities 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 in particular, it is effective in helping patients with irritable bowel syndrome and to control nausea and vomiting. How Hypnosis Works: Hypnosis is a special mental state in which a person's focus of attention becomes narrow and intense like the beam of a bright flashlight in a dark room. This state is usually created with the aid of a hypnotist,who guides the person systematically to relax, focus only on one thing, and to allow things to happen by themselves. Whatever the mind focuses on while in this special mental state of hypnosis holds the entire attention. Therefore, people tend to experience things they think of, imagine or remember, more vividly and clearly than under usual circumstances. This is why people can sometimes recall things from their distant past under hypnosis even though unable to do so in the normal waking state (research has shown, however, that such hypnotically enhanced recall can be highly contaminated by the person's imagination). The narrow hyperfocus of this mental state is also why therapists using hypnosis are frequently able to help people make strong positive changes in their emotions and physical functioning. Hypnosis can work like a magnifying glass on the mind's effects on the body and emotion. Clinical hypnosis relies on suggestions, imagery, and relaxation to produce its therapeutic effects. Hypnotic suggestions are things that the hypnotist verbally suggests may happen while the person is under hypnosis. Due to the focused and receptive state of the hypnotized person, these suggestions happen almost automatically and without conscious decision or effort. If you, for example, receive the suggestion under hypnosis that your arm may be getting heavy, you will very likely feel it becoming heavy, without trying to do anything to make it happen. This "automaticity", the feeling of things happening by themselves, is by some considered the hallmark of hypnosis, and is often surprising to people experiencing hypnosis for the first time. Hypnotic imagery consists of picturing mentally events or situation or place in a way that has a desired positive physical or mental effect. For example, patients undergoing surgical or dental procedures are sometimes taught to enter a hypnotic state and go to a pleasant place in their mind. When successfully applied, the person gets completely engrossed in the vivid enjoyable imagery and is therefore happily unaware of the unpleasantness of the procedure. The hypnotic state is naturally accompanied by relaxation, and the physical relaxing effects are often deliberately strengthened further by clinicians through suggestions and relaxing imagery. Some of the benefits that come from hypnosis treatment are likely to result partly or  entirely from the fact that hypnosis is a powerful relaxation method. Over decades of research and clinical experience, hypnosis has proven to have many valuable therapeutic uses. In psychotherapy, hypnotic techniques can speed the therapy process in various ways - for example by facilitating patients' self-understanding, extinguishing unfortunate habits, uncovering repressed or forgotten memories, reducing anxiety and phobias, and helping people to adopt a new and more adaptive outlook. In medicine and health psychology, hypnosis is used to reduce pain and discomfort associated with medical procedures such as childbirth, treatment of burns, and surgery where chemical anesthesia cannot be used effectively. It is also used to treat chronic pain and psychosomatic problems and counter unhealthy habits that contribute to illness. In dentistry, hypnotic analgesia is an effective needle-less alternative to topical anesthetic drugs, reduces bleeding and discomfort in oral surgery, and is used to treat teeth grinding and temporomandibular disorder. In recent years, the effects of gastrointestinal functioning and GI symptoms have been studied extensively. The Effects of Hypnosis on Gastrointestinal Functioning: The hypnotic state itself, without any particular suggestions, seems to slow down the gut, and clear-cut and specific changes in GI functioning can be induced in individuals by directing thinking or inducing specific emotional states under hypnosis. For example, one study(1) found that when healthy volunteers were hypnotized and simply instructed to relax, the orocaecal transit time (the time it takes material to pass through the GI tract from the mouth to the first part of the colon) was lengthened from 93 to 133 minutes. Another study(2) found that being in a hypnotic state decreases muscle movements in the stomach. The same study demonstrated that the emotional state of happiness, created under hypnosis, suppresses gastric muscle activity but anger and excitement increase muscle movement in the stomach . A pair of other studies(3) showed that when volunteers were guided to use imagery of eating a delicious meal while they were under hypnosis, gastric acid secretion was increased by 89%, and that acid production of the stomach could also be deliberately decreased during hypnosis using hypnotic instructions. Close to fifty published studies have reported on the therapeutic effects of hypnosis on nausea and vomiting problems related to chemotherapy, after surgery, and during pregnancy. Overall, this substantial body of literature indicates that hypnosis can be a powerful aid in controlling nausea and vomiting. Hypnosis may also be helpful in preventing gastrointestinal problems from recurring after they have been treated with medication: One study(4) of thirty patients with relapsing duodenal ulcers who had been successfully treated with a course of medication, found that only 53% of the patients who received preventive hypnosis treatment had a relapse within one year. In contrast everybody (100%) in a comparison group receiving no hypnosis relapsed in the same period of time. In 1984, researchers in Manchester in England published a study(5 )report in the journal Lancet, showing that hypnosis treatment dramatically improved the symptoms of IBS patients who had failed to benefit from other treatment. The researchers had randomly divided patients with severe IBS problems into two groups. Fifteen patients were treated with seven hypnosis sessions. Fifteen comparison patients were treated with seven sessions of psychotherapy, and those patients also received placebo pills (pills with no medically active ingredients) which they were told were a new research medication for IBS symptoms. Every patient in the hypnosis group improved, and that group showed substantial improvement in all central symptoms of IBS. The control group showed only very modest improvement in symptoms. Partly due to these dramatic results with treatment-refractory patients, a dozen other studies have followed, including three U.S. studies. The general conclusions from most of these studies are that hypnosis seems to improve the symptoms of 80% or more of all treated patients who have well-defined "classic" IBS problems, especially if they do not have complicating factors such as psychiatric disorders. The improvement is in many cases maintained at least for a year after the end of treatment. What is particularly remarkable is that this high rate of positive treatment response is seen even in studies where the participating patients all have failed to improve from regular medical care. The dramatic response of IBS patients to hypnosis treatment raises the question of exactly how this kind of treatment influences the symptoms in such a beneficial way. Four studies to date, two in England and two in the U.S., have tried to discover how hypnosis treatment affects the body of IBS patients. Since it is well known that many people with IBS have unusual pain sensitivity in their intestines, which is thought to be related to the clinical pain they experience, much of the focus of these studies has been on assessing the impact of this kind of treatment on intestinal pain thresholds. The two English studies both measured intestinal pain sensitivity with balloon inflation tests. The second study also measured muscle tone, to see if hypnosis relaxes the smooth muscles of the GI tract. No overall changes in pain sensitivity were detected, and gut muscle tension was also unchanged after treatment (except a subgroup of unusually pain-sensitive patients had lessened pain sensitivity in the second study(7). . In 1995-1996, during my post-doctoral fellowship in the Division of Digestive Diseases and Nutrition at UNC-Chapel Hill, we conducted the first U.S. study(8) on hypnosis for IBS under the direction of Dr. Whitehead. We evaluated the effects of a highly standardized treatment protocol, delivered verbatim following written scripts, on rectal pain thresholds and muscle tone. Seventeen out of the 18 patients we treated with hypnosis showed significant improvement in their clinical symptoms. However, we found, like the English researchers, that gut pain thresholds and muscle tension were unchanged after treatment. In a second study(9,) which I conducted with co-investigators at the Eastern Virginia Medical School, we used the same treatment protocol but this time measured autonomic nervous system functioning and blood levels of a gut hormone called vasoactive intestinal peptide. These are regulators of GI functioning in the human body, and the aim was to see if they would change due to treatment. Again, we found no changes in our physical measures after treatment (with the exception of reduction in sweat gland reactivity) even though 21 out of 24 treated patients were clinically improved. It should be noted, though, that in both our studies, we found clear improvement in the psychological well-being of our patients after treatment. In summary, it is clear from our work and other research that hypnosis treatment substantially improves all the central symptoms of IBS in the majority of patients who receive such treatment (see the effects of our two studies on clinical symptoms in the Figure). What happens in the body of these patients to cause such improvement, however, remains a mystery. Future prospects: In light of the many studies which have shown hypnosis treatment to be effective for such problems as IBS and nausea and vomiting, the question may be raised why this kind of treatment is not more widely available or generally offered to patients with such GI problems. One limitation is the fact that not everybody is equally hypnotizable. Research has consistently shown that at least 15% of people are practically non-hypnotizable, and even those who are able to enter a hypnotic state vary greatly in how well they respond. Interestingly, the ability to be hypnotized is a stable mental trait. In other word, if you are highly hypnotizable now, you will most likely be so also in thirty years. Fortunately, the majority of people are sufficiently hypnotizable to have a potential for enjoying at least some of the medical and psychological benefits of clinical hypnosis. Furthermore, the idea of being hypnotized does not agree with all people. Even individuals who are sufficiently hypnotizable, may not like the idea of "letting go", may have difficulty trusting a therapist to guide them in hypnosis, or may have other concerns about the hypnosis experience. Fortunately, other forms of psychological treatment for gastrointestinal problems - in the case of IBS especially cognitive-behavioral therapy -- have also been found to be effective and are good alternatives. Finally, an obstacle which has barred many patients from receiving help for gastrointestinal disorders with hypnosis is the fact that in the U.S. the technique is more commonly used by psychologists and other mental health professionals than by physicians. Many mental health professionals who use hypnosis are not accustomed to treating gastrointestinal disorders, and therefore reluctant to take on treatment of such problems. As the reliably beneficial effects of hypnosis on gastrointestinal functioning become better known both to health professionals and the general public, this benign and comfortable form of treatment will hopefully become a more popular treatment option for GI patients - especially for those who have not received much relief from standard medical management. As far as IBS is concerned, we have been making an effort in the last two years to encourage clinicians across the country who have adequate training in hypnosis to provide such treatment for IBS. We have done this by providing them, free of charge, with the complete standardized treatment protocol which has proven effective in our research. To date, more than eighty licensed health professionals, practicing in almost all states, are started using our protocol, making it a little bit easier for patients in many geographical locations to receive help with hypnosis. References 1. Beaugerie, L., Burger A.J, Cadranel J.F, Lamy, P., Gendre J.P., & Le Quintrec, F. (1991). Modulation of orocaecal transit time by hypnosis. Gut, 32, 393-394. 2. Whorwell PJ; Houghton LA; Taylor EE; Maxton DG. Physiological effects of emotion: assessment via hypnosis. (1992). Lancet, 340, 69-72 3. Klein K.B., & Spiegel, D. (1989). Modulation of gastric acid secretion by hypnosis. Gastroenterology, 96, 1383-1387. 4. Colgan, S. M. , Faragher, E. B. , & Whorwell, P. J. (1988). Controlled Trial of Hypnotherapy in Relapse Prevention of Duodenal Ulceration. The Lancet, 1(8598), 1299-300. 5. Whorwell, P.J., Prior, A., & Faragher, E.B. (1984). Controlled trial of hypnotherapy in the treatment of severe refractory irritable bowel syndrome. Lancet, 2, 1232-1234. 6. Prior A., Colgan, S.M., Whorwell P.J. (1990). Changes in rectal sensitivity after hypnotherapy in patients with irritable bowel syndrome. Gut, 31, 896-898. 7. Houghton, L.A., Larder, S., Lee, R., Gonsalkorale, W.M., Whelan, V, Randles, J., Cooper, P., Cruikshanks, P., Miller, V., & Whorwell, P.J. (1999) Gut focused hypnotherapy normalises rectal hypersensitivity in patients with irritable bowel syndrome (IBS). Gastroenterology,116: A1009. 8. Palsson, O.S., Burnett, C.K., Meyer, K., and Whitehead, W.E. (1997). Hypnosis treatment for irritable bowel syndrome. Effects on symptoms, pain threshold and muscle tone. Gastroenterology, 112, A803. 9.Palsson, O.S., Turner, M.J., & Johnson, D.A. (2000). Hypnotherapy for irritable bowel syndrome: Symptom improvement and autonomic nervous system effects. Gastroenterology, 118,(4) A174.


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Irritable Bowel Syndrome & Hypnotherapy by Michael Mahoney, UK Register of IBS Therapists Irritable 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 ï¿½non-seriousï¿½, 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), ï¿½health, 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 rightï¿½ 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 the treatment of the disorder. Etiology IBS 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. Pathogenesis IBS is defined as a ï¿½functional 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 Hypnotherapy The 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 ï¿½alternativeï¿½ 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 6 countries, our web site visited by surfers in over 25 different 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 ï¿½last resortï¿½ 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 ï¿½topupï¿½, 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 erroded and strained, social life and love life can be virtually non-existant, 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 abilty to see things in perspective is greatly reduced. 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. http://www.healingwell.com/library/ibs/mahoney1.asp


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Washington postTREATMENT OF CHOICE Drugs and Other Options for Pain in the Gut By Judy Packer-Tursman Special to The Washington Post Tuesday, May 30, 2000; Page Z23 Q. I am a 43-year-old woman with irritable bowel syndrome. My doctor wants to put me on medication, but I want to know whether it's safe to manage my condition without drugs. An estimated 25 million Americans suffer from a chronic disorder of the lower gastrointestinal tract known as irritable bowel syndrome, or IBS. Many of them suffer more than necessary, either because they don't realize they've got a chronic condition or because they're too embarrassed to talk about its symptoms. These vary widely and may include abdominal cramping or pain, gas, bloating and constipation. Another common sign is diarrhea, which can be mild or severe enough to send a person dashing for a bathroom a dozen times a day, unable to handle school, work or social situations. Usually the person gets an episode of pain, which goes away after a bowel movement. But it happens again and again, often after a meal or during periods of stress. A person who has experienced abdominal discomfort or pain continuously or intermittently, for at least 12 weeks during the past year may be suffering from IBS, which is sometimes called "spastic colon" or "irritable colon." That diagnosis is more likely if pain or discomfort is linked to at least two of these circumstances: the discomfort is relieved after a bowel movement; it is accompanied by a change in the frequency of bowel movements; or it is accompanied by stools that are softer or harder than usual. "It's not the kind of thing that would take you immediately to the emergency room or the doctor's office . . . at least initially," explains Joanne Wilson, associate chief of gastroenterology at Duke University Medical Center in Durham, N.C. For unknown reasons, Wilson says, IBS is twice as common in women as in men. As many as 20 percent of adults in the United States are thought to experience the disorder at some point in their lives, but most don't see a physician about it. Wilson and others are working with the American Digestive Health Foundation (800-668-5237, www.adhf.org) on a campaign to educate the public--and physicians--about ways to manage IBS symptoms. Because its cause is unknown, there is no reliable, standard therapy for IBS. There is, however, good news for those who might worry that their symptoms are signs of life-threatening conditions: IBS hasn't been shown to lead to serious, organic illnesses, such as Crohn's disease, ulcerative colitis or colon cancer. IBS is a functional disorder, which means that no specific anatomical or biochemical abnormalities or infections can be detected to explain symptoms. "IBS is not in your head, and that is so important to realize," says clinical psychologist Olafur S. Palsson, assistant professor of psychiatry and family medicine at Eastern Virginia Medical School in Norfolk. "The intestinal tract is not working right, but there's nothing structurally wrong. You can't find it under a microscope." IBS usually is diagnosed after a physician has excluded other medical conditions as causes of the symptoms. The doctor's evaluation typically includes a medical history, a physical examination and laboratory tests. The doctor looks for red flags, such as weight loss, blood in the stool, a high fever or a family history of inflammatory bowel disease or colon cancer. Initially, IBS was thought to arise from stress or anxiety. While these factors may worsen symptoms, researchers have since found that people with IBS have colon muscles that begin to spasm after mild stimulation: The waves of synchronized muscle contractions that push food down the intestinal tract during digestion become irregular. The colons of people with IBS are also more sensitive and respond strongly to stimuli--such as food, hormonal changes, medication and stress--that wouldn't bother most people. The seven in 10 patients with mild symptoms usually respond to education and reassurance on how to handle the problem and to simple treatments not requiring medication, such as adding fiber to diets, eating smaller meals, restricting dairy products or making lifestyle changes to reduce stress. Even regular exercise is helpful for some people. Typically, IBS patients with moderate or severe symptoms are treated along one of two lines of medication therapy, explains Ray E. Clouse, professor of medicine and psychiatry at Washington University School of Medicine in St. Louis. Some medicines target the gut, such as antispasmodic medications, while other drugs target the brain, such as antidepressants given in low dosages. New drugs also are being developed, called "gut serotonin receptor modulators," to lessen sensations from the gut to the brain. What Works If Drugs Don't? Clouse offers simple advice for people with IBS who are considering alternatives: "Don't get carried away." A person may get relief from unconventional remedies because of the wide-ranging symptoms of IBS, he says, but seemingly harmless self-help treatments could have detrimental effects. For example, he says, people who routinely take calcium supplements run the risk of developing kidney stones. "People can play with the whole spectrum of complementary medicines--but they shouldn't let themselves get way out of whack," Clouse says. Before taking extreme measures, he says, it's wiser to return to conventional care. The difficulty of treating all aspects of IBS with drugs has led to studies, many outside the United States, on alternatives including traditional Chinese medicine and peppermint oil, a smooth-muscle relaxant that may relieve intestinal spasms but can cause acid reflux and anal irritation or burning. Researchers are also finding that, because IBS can be aggravated by stress, relaxing the mind may have positive effects on the body. Douglas Drossman, a gastroenterologist at the University of North Carolina, Chapel Hill, says various types of treatment give patients "a better sense of control." His research team has a $4 million grant from the National Institutes of Health to explore the use of cognitive behavioral therapy for people with moderate to severe IBS symptoms. This psychological technique tries to change how people react to their symptoms--for example, teaching them to become less upset by flare-ups and to accept them as temporary. At last week's annual meeting of the American Gastroenterological Association in San Diego, Palsson reported that hypnosis treatment seems to relax the autonomic nervous system, which controls movement in the digestive tract. "We're not just making people believe they're better," Palsson says. "Stool consistency is better, so something is happening to the digestive tract . . . and abdominal pain is much lessened. Bowel movement frequency was also reduced by the treatment."


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Hypnotherapy Helps Irritable Bowel Syndrome Symptoms SAN DIEGO, May 22 (Reuters Health) - Hypnotherapy improves irritable bowel syndrome (IBS) symptoms, according to a report presented here at the Digestive Disease Week meetings. IBS is an inflammatory digestive disorder. Its symptoms include abdominal pain, alternating constipation and diarrhea, bloating and depression. The disease, which appears to be aggravated by stress, affects mostly women, with the onset usually occurring between ages 20 to 30. Dr. Olafur S. Palsson and colleagues at the Eastern Virginia Medical School in Norfolk, Virginia provided 24 IBS patients, 15 women and 9 men, with seven sessions of hypnosis treatment. In addition, the patients used hypnosis audiotapes at home. At the end of the 14-week study period, 21 of the 24 patients "rated themselves improved in all central IBS symptoms after treatment," the researchers report. Significant improvement was found in abdominal pain, bloating, stool consistency and bowel movement frequency. Palsson's group also measured the autonomic nervous system, which regulates the digestive system and other involuntary body activities. After the course of hypnotherapy, the autonomic nervous system was less easily stimulated. The researchers propose that this calming effect "may plausibly contribute to the symptom improvement." http://mentalhealth.about.com/library/arch...+bowel+syndrome


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Am J Med 1999 Nov 8;107(5A):27S-32S Related Articles, Books, LinkOut Therapeutic approach to the patient with irritable bowel syndrome. Camilleri M. Department of Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA. This article reviews briefly the evidence to support current therapies in irritable bowel syndrome (IBS) and the novel therapeutic approaches on the threshold of clinical application. Fiber is indicated at a dose of at least 12 grams per day in patients with constipation-predominant IBS. Loperamide (and probably other opioid agonists) are of proven benefit in diarrhea-predominant IBS; loperamide may also aid continence by enhancing resting anal tone, but there is no evidence that it results in pain relief. In general, smooth muscle relaxants are best used sparingly, on an as-needed basis, because their overall efficacy is unclear. The 5-HT3 antagonist, alosetron, results in adequate relief of pain and improvements in bowel function in female nonconstipated patients with IBS. Psychotropic agents are important in relieving depression and are of proven benefit for pain and diarrhea in patients with depression associated with IBS. Further trials with selective serotonin reuptake inhibitors are awaited. Psychological treatments including hypnotherapy are less widely available but may play an important role in the relief of pain. In summary, current therapies targeted on the predominant symptoms in IBS are moderately successful. As the bowel sensorimotor and limbic system disturbances of IBS are more clearly understood, we should anticipate other pharmacologic approaches in the near future, including alpha-adrenergic agonists and 5-HT4 agonists. New therapies directed at treatment of the syndrome, rather than relief of symptoms, are needed. Publication Types: Review Review, Tutorial PMID: 10588170


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Appl Psychophysiol Biofeedback 1998 Dec;23(4):219-32 Related Articles, Books, LinkOut The treatment of irritable bowel syndrome with hypnotherapy. Galovski TE, Blanchard EB. University of Albany, State University of New York, New York, USA. Previous research from the United Kingdom has shown hypnotherapy to be effective in the treatment of irritable bowel syndrome (IBS). The current study provides a systematic replication of this work in the United States. Six matched pairs of IBS patients were randomly assigned to either a gut-directed hypnotherapy (n = 6) or to a symptom monitoring wait-list control condition (n = 6) in a multiple baseline across subjects design. Those assigned to the control condition were later crossed over to the treatment condition. Subjects were matched on concurrent psychiatric diagnoses, susceptibility to hypnosis, and various demographic features. On a composite measure of primary IBS symptoms, treatment was superior (p = .016) to symptom monitoring. Results from the entire treated sample (n = 11; one subject was removed from analysis) indicate that the individual symptoms of abdominal pain, constipation, and flatulence improved significantly. State and trait anxiety scores were also seen to decrease significantly. Results at the 2-month follow-up point indicated good maintenance of treatment gains. No significant correlation was found between initial susceptibility to hypnosis and treatment gain. A positive relationship was found between the incidence of psychiatric diagnosis and overall level of improvement. Publication Types: Clinical Trial


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## eric

Medical Hypnosis in the Hospital by Gï¿½rard V. Sunnen, M.D. BACK TO HOME Hypnosis has many applications for relieving distress in hospitalized patients. Gï¿½rard V. Sunnen, M.D., a psychiatrist and hypnotherapist, describes the ways in which hypnotic techniques can help patients undergo medical procedures, surgery, and rehabilitation therapy and cope with life-threatening illness. Sunnen cites evidence from the research literature of the benefits of hypnosis for hospitalized patients with medical conditions and presents several case illustrations.--Editor, Journal of the Institute for the Advancement of Health Hospitalization, even with all available medical technology, remains a trying experience. The same concerns, apprehensions, and fears exist today as they did centuries ago in the face of dangers to well-being and sometimes to life itself. The psychological well-being of hospitalized patients is, therefore, not only for humane considerations but also for reasons connected to health and recovery: patients may do better when undergoing procedures, recovering from operations, or surmounting the side effects of treatments if they are relaxed, rested, and feeling hopeful. Hypnosis is a process by which an individual is guided from his or her usual state of consciousness to a condition that is marked by psychological and physical relaxation; altered perceptions such as the slowing down of time or a change in one's body image; and a shift from analytic to synesthetic thinking, that is, the mind shows less dependence on logic and a greater receptivity to sensations and feelings. The resulting change in perception and thinking is known as a trance. The nature of the trance state varies from one individual to another. The ability of hypnosis to induce deep multilevel relaxation, to quell anticipatory anxiety, to increase tolerance to adverse stimuli, and to intensify affirmative imagery can be adapted to the hospital setting for maximizing the mind's contribution to healing. Hypnosis has recently seen a resurgence in its medical applications, with increasing sophistication in the ways it has been used for many clinical problems, in and out of the hospital.(1) Equally important, modern hypnotists, in contrast to earlier ones who tended to be authoritarian in their approach, encourage patients to determine the nature of their own experiences, that is, to develop their unique potential in their trance. They are also mindful of psychodynamic considerations. Thus, they use permissive and often frankly meditative methods and function as a guide to point the way to conditions of consciousness that are conducive to psychological adjustment and growth.(2) Hypnosis in Special Procedures Procedures performed under local anesthesia with or without sedation are often anticipated by the patient with the same apprehension as those requiring general anesthesia. The idea of being conscious during a procedure may be reassuring in one respect and unsettling in another. On one hand, the patient's sense of control is maintained; on the other hand, the patient may feel uncertain as to how he or she will deal with the experience. Even a simple procedure, like a spinal tap, can be approached with dramatic imagery: the mental picture of a needle may be much larger than the actual size of the needle. Similar distortions may also occur with regard to other procedures, such as cardiac catheterization, bone marrow biopsy, or sigmoidoscopy. The anticipatory anxiety generated by the patient's fantasies about a procedure should not be neglected. It can turn a routine stay in the hospital into a nightmarish experience and negatively sensitize the patient to future hospitalizations. The following case history illustrates some of the principles of hypnosis when used in the hospital with certain medical procedures: A 52-year old woman who had never been hospitalized was admitted for workup of a lung shadow. She was to undergo a bronchoscopic examination the following day. When she became agitated and highly anxious, a consultation was requested. Hurriedly wiping away some traces of tears to appear more presentable, she looked distraught and restless in her bed. Anticipation of the procedure, which had been explained to her in a cursory and hurried fashion, had left her in a state of panic. She imagined a large, cold, straight metallic tube being pushed into her throat and saw herself in the agonies of choking. Yet, on another level, she spoke amazingly candidly and rationally: "Doctor, I've been a smoker for many years. I think tomorrow they will find that I have cancer. But I think I can come to terms with it." The procedure was explained once more to her. The tube was described--a picture of it was even drawn--as flexible and as leaving plenty of space for air to pass. She was told that the more relaxed she would be, the more easily air could pass. The benefits of deep, autonomic nervous system relaxation were evident to her, and she heartily agreed to attempt a hypnotic experience. Because of her high level of anxiety, an approach more directive than normally used for outpatient office procedures was invoked. With her permission, her wrist was taken; gently and slowly her arm was brought straight out in front of her. She was presented with images of heaviness and relaxation, and her arm slowly waved itself downward, the hand gently releasing itself until it came to rest on the bed. With her eyes closed, all muscle tightness disappeared; her respiration adopted a slow, tempered rhythm; her face appeared serene and seemed to communicate a profound peacefulness. Once the hypnotic induction had taken place, the goal centered on achieving the most profound relaxation possible. Then, the patient was encouraged to dispel the fear-laden images and to replace them with images that would be more consonant with her well-being. "You will feel the tube," he said, "but at the same time your throat and all your air passages can be relaxed, and it need not bother you. You will have plenty of air and with each breath you can feel more and more relaxation sweeping through you. You may in fact be so relaxed that the whole experience will seem to be occurring some distance from you, far away. Until then, you may find yourself thinking very little about the procedure, if at all, leaving time for you to rest fully." The next day the patient underwent the bronchoscopy. The procedure was completed in just a few minutes; the patient was remarkably calm throughout. The tube met so little resistance and there were so few bronchial secretions that the surgeon called the hypnotherapist to gain a better understanding of this phenomenon. When asked about the experience, the hypnotherapist described how, conscious of the whole procedure and feeling peaceful, the patient had felt the tube inside her chest, as from a distance, and had mused to herself making a game of it, imagining it was a little train coursing through some tunnels. Hypnosis in Surgery The hypnotic phenomenon that perhaps inspires the most awe involves the patient who undergoes major surgery without chemical anesthesia.(3) According to Moll,(4) the first surgical operations on "magnetized" subjects were those performed by Recamier in 1821. (At that time, hypnotic phenomena were thought to be produced by the influence of magnetized objects.) Jules Cloquet followed him in 1829, Dr. John Elliotson in England, Dr. Albert Wheeler in the United States, and the well-known Dr. James Esdaile in India in 1840. It is postulated that in certain individuals through hypnotic mechanisms, a sufficient level of endogenous agents--that is, those agents that occur naturally in the body--may be produced to block all perceptions of pain.(5) However, many author(6)(13) point out that pain is a sensation intimately intertwined with fear and that surgical procedures performed with hypnotic anesthesia may owe their success to the modulation of anxiety as much as to the neutralization of pain. Since 1950, interest in hypnoanesthesia has rekindled. Suppressed by the discovery of chloroform, ether, and nitrous oxide for more than a century, this renewed interest has been fueled not only by the growing sophistication in understanding hypnosis, but by new philosophies of patient care, such as the belief that patients should have access to any treatment modality capable of easing the stress of illness and its treatment. It is estimated by some investigators(7) that 10 percent of the population could undergo major procedures with hypnoanesthesia. Others(8) estimate the figure to he far lower. Patient selection appears to be very important. Adequate studies are lacking, but good candidates for hypnoanesthesia are likely to be highly hypnotizable and especially adept at altering the processing of painful stimuli. While probably only a small percentage of patients can negotiate major surgery using the hypnotic trance as the sole anesthetic, a far more important percentage can benefit from the "softer" or more subtle therapeutic influence of hypnosis, as it is applied in an integrated fashion through the continuum of the hospitalization sequence. As such, hypnotic intervention can begin in the preoperative period, can be continued during the operation itself, and can be maintained through the postoperative stage to assist the patient through all phases of psychological and physical adjustment. As is the case with hypnosis preceding medical procedures, preoperative hypnotic preparations center on exploring the patient's fantasies about the operation, neutralizing the mental set of anxious anticipation, and correcting the nefarious effects of destructive imagined scenarios. The patient is introduced to the idea of deep relaxation, taken through the steps of experiencing the hypnotic trance, and presented with affirmative images and statements relating to the sequence of events likely to be encountered in the operative procedure. If the medical hypnotherapist intends to be present during the operation, this fact is mentioned before surgery so that hypnotic contact may be more easily reestablished while the patient is anesthetized. It has been assumed for decades that a patient in the deeper or even moderate levels of chemical anesthesia was in a state of other-worldliness and had shed all semblance of consciousness. However, some clinicians and researchers have reported patients who have remembered events that occurred during surgery when they were presumed to be unconscious. Crile(9) reported the case of a patient receiving nitrous oxide (as well as his own case in his autobiography) where some awareness of the environment was preserved. While nay-sayers have attributed these reports to insufficient levels of anesthesia, reports of more occurrences of partial awareness in documented deep anesthesia prompted studies to investigate this phenomenon. In one study, Wilson and Turner questioned 150 postcesarean patients.(10) They found three patients who accurately recalled actual events and 46 who retained some dreamlike remembrances of the operation. More recent studies have focused on the hypnotic recollection of the operative experience, that is, asking the hypnotized patient to recall an operation. Consciously, some patients may have little or no recall, but others--especially those who are highly hypnotizable--are able, in the context of trance, to reexperience important events within the operative procedure. It has been reasonably well established that such patients are attuned, in such situations, to meaningful communications by the personnel who are present in the operating room, especially surgeons and anesthesiologists. It is therefore possible that surgical patients may be aware of negative comments on their progress by surgical personnel, to which patients may react.(11) If, for example, a surgeon says, "There's a lot of blood loss here," the patient may respond with a rise in blood pressure and increased heart and respiratory rate, making cardiovascular instability more likely, Hypnotherapists, in anticipation of this phenomenon, may add preoperative suggestions such as, "You will remain calm, deeply relaxed, peaceful, totally undisturbed by any conversation around you. Your mind centers on feelings of well-being throughout the operation." As far as the hypnotherapist is concerned, the clinical implication of the retention of some awareness during anesthesia is that some degree of hypnotic contact and rapport may be established--or reestablished, if the groundwork has previously been done--during the course of the operation, for purposes of assisting the patient adjust to its vicissitudes. It is well known, for example, that if the patient's abdominal muscles are tight, the surgeon may order more anesthesia. This may not be necessary if the hypnotherapist gently whispers suggestions to the deeply anesthetized patient to relax his or her muscles. Postoperatively, the patient who has already experienced the trance state can easily be given suggestions for dealing with all aspects of the recovery process, including rest, comfort, and return to harmonious biological rhythms (that is, normal appetite and sleep). Rehabilitation Medicine People who have suffered catastrophic illnesses or accidents usually have a long journey to recovery, and may require global adjustments in life goals, family dynamics, and self-image. Stroke victims, amputees, and individuals with spinal cord injuries, for example, need multi-level support to help them cope with their shattered world. Rehabilitation. therefore, is both a physical and a psychosocial process, aimed at assisting destabilized patients to regain optimal physical competency and psychological integrity. In the face of cataclysmic loss (of bodily function--as in hemiparesis (paralysis of one side of the body), aphasia (impairment or loss of speech), or quadriplegia (paralysis of both arms and legs)--the patient often questions his or her will to live. Other traumatic though less debilitating injuries, such as the loss of a finger, can engender severe depression, withdrawal from others, self-destructive thoughts, and a loss of self-esteem. It is clear that adaptations to such tragedies may have as much to do with their symbolic representations as with their objective realities. The heartening advances of rehabilitation medicine are tied not only to technology but also to an appreciation of the complex psychological needs of patients. Staff members know how important their self-generated enthusiasm is in mobilizing their patients' optimism and how loss of motivation can stunt progress or foster regression. The following case history illustrates the application of hypnosis to the difficult process of rehabilitation. A 35-year-old executive returning late from a company meeting was injured while driving on a rainy highway. His only memory of his accident was of being carried on a stretcher from a ditch, with the lights of ambulances flashing. He remembered the slow realization that he could not move his arms or legs; even worse, that the feelings in his limbs and torso had been snuffed out. He could only move his head from side to side and sink into his quadriplegic nightmare. A consultation with a hypnotherapist was requested three weeks into his rehabilitation, because he was not progressing satisfactorily. He did poorly on the tilt table, which is used for physical therapy, and he was not eating well. This highly intelligent man talked lucidly to the hypnotherapist about his visions of his future: he would no longer be able to work, his already shaky marriage would crumble, and he would most likely need a full-time caretaker. With all this against him, he asked, how could he find a reason to live? Such questions are difficult to counter rationally. Given the premises, he had drawn his own conclusions. To tap into his motivational reservoir, his intellectualizing network would have to be bypassed. This man agreed to undergo hypnosis and responded to hypnotic induction. Whereas before the accident his analytical mind may have posed a defensive barrier to induction, his despair and wish to be helped facilitated the process. The therapist placed his thumb in the middle of the patient's forehead, providing a sensory focus for centering awareness. With the patient's eyes closed and with his focus turned internally toward the contact point, a count was started. In synchrony with the patient's breathing, each number symbolized a progression into a relaxed mindfulness, toward a state of mind freed from the incessant pressure of thinking . During the ensuing ten treatments, hypnotic therapy was aimed at different dimensions of his condition. Aside from suggestions of physical comfort, efforts were made to extend the range and intensity of the patient's sensory awareness. The boundaries of his sensitivity to touch were determined, and suggestions were given to expand them farther into his torso, as far as he could each time, and progressively he regained some, albeit minute, sensory ground. The therapist also guided him to experience feelings of peace and to contemplate acceptance mixed with a willingness to try his very best to improve. Finally, the patient was asked to dissolve all negative future scripts created by his imagination. For the moment, he would have to attend fully to his rehabilitation therapy. To this end, he began to apply himself diligently. He graduated from the tilt table, grew stronger, and was eventually sent home with outpatient support services. For hospitalized patients with catastrophic illnesses, hypnotic treatment does not stop after the first consultation. A series of treatments over time is generally effective, as in the above example, since the goals are approached in small steps over the course of weeks or months. In such cases, it is advantageous to teach patients the skill of self-hypnosis so that they will he able to surmount periods of private distress, regain autonomy, and participate in their own recovery. Hypnotic Approaches to Cancer Treatment Cancer affects a person on many levels, from the cellular to the psychological. While the baffling varieties of its manifestations continue to he elucidated, there is an evolving awareness of its complex psychological dimensions. Cancer patients are likely to experience intense distress and pain--pain from the disease itself, from its treatments, and from the deep psychological and social changes the disease and its treatments induce. Recently there has been a growing appreciation of the needs of cancer patients for support, open communication, understanding, and for the sensitivity and professionalism with which life-threatening illnesses need to be approached. Hypnosis is used at several levels of cancer care.(5)(6)(12-14) First, it is useful as a means of dealing with the symptoms of the disease itself: pain and symptoms associated with specific or organ systems; and nonspecific symptoms such as fatigue, malaise, irritability, and insomnia. Second, hypnosis may be helpful in the management of the side effects of cancer treatments. This is very important because the side effects of chemotherapy and radiation--such as nausea and vomiting--are often so unpalatable that they may cause the patient to drop out of therapy. Third, cancer patients are faced with major psychological adjustments. Many view their diagnosis with nihilism and are forced to grapple with profound existential issues. Lastly, and still somewhat controversially, hypnosis has been aimed at modifying the course of the disease process itself through the medium of mental images.(15)(16) The individual in deep hypnotic trance may experience any one of a variety of shifts in body image. The perception of oneself in space including, if appropriate, the presence of pain, can then be modulated by the influence of hypnosis on cognitive processes and self-perception. "I"--the core of the experiencing self--can be asked, in hypnosis, to modify its relationship to the feeling of pain. When contemplated, pain may take on qualities that were not immediately appreciated. It may he perceived as sharp, diffuse, warm or cold, as having volume, shape, color, and even sound. Painful stimuli are recognized consciously and then elaborated into complex variegated sensations.(17) The mind can alter or neutralize the perception of painful stimuli. The wounded soldier continuing to engage in battle is one example of the mind's influence on pain and, by extension, all perception. In a hypnotic trance, the field of consciousness has the potential of having more direct access to pain, to its associative networks in the central nervous system, and to the mechanisms underlying its processing. Thus, "hot" pain may be made to feel cool; pain that is perceived to be large and looming may be made smaller in volume; pain that seems oppressively close can be made to seem farther away; and, under certain conditions, pain can be abolished altogether. In altering or removing pain, care must be taken not to block its warning function. In the early stages of an illness, a new sensation of pain or discomfort may be an important indicator for revising the therapeutic strategy. In more advanced cases, this is not as relevant. The following case history demonstrates some principles of hypnotic alleviation of symptoms due to cancer. A 55-year-old man with carcinoma of the left colon that had been diagnosed two years previously was referred by his oncologist for hypnotic treatment of pelvic pain. A recent checkup had revealed metastatic liver nodules, and a bone scan showed a solitary lesion in the pelvic bone. He had started taking aspirin, propoxyphene, and occasionally codeine. This highly educated man was able to appraise the complexities of his situation with composure and open-mindedness. He did not wish to discuss death at any length. He said that he had come to terms with death. He stated succinctly, however, that he did not wish to squander his precious time and that he wanted to be with his family, have time to take care of certain business matters, and be as free of discomforts as possible. His intermittent pelvic pain interfered with walking and sexuality. Because he was very ambivalent about plans for chemotherapy and radiation, he opted for more time to make decisions about these matters. This patient successfully learned to experience a medium level of trance--a perfectly workable depth of hypnotic relaxation--which was induced using an arm levitation technique. The hypnotherapist then helped the patient achieve glove anesthesia--a phenomenon marked by a sensor void in an area of the body, in this case a hand--was achieved. The patient perceived a prick of a skinfold near the thumb as a faraway flicker of touch. By way of the same mechanism and progressive extension, he was taught to induce numbness to other parts of his body. The hypnotherapist moved the patient's numbed hand to the patient's pelvis and told him: "Imagine the numbness and coolness in your hand, seeping through your skin, extending into your thigh, spreading. Like rings of water on the smooth surface of a pond, concentric rings of numbness flow as deeply as you can imagine." The learning process, extended to self-hypnosis gave him variable relief. Sometimes he could dispel the pain completely. At other times, especially when his mood was low, he could obtain only partial relief. But overall, he felt more relaxed and consequently had more energy and was more active. In the last few years, we have witnessed an interest in exploring the uses of mental techniques not only to guide cancer patients to a better frame of mind, but also to influence the disease process itself.(15)(18) Techniques span a wide array of approaches, most of which confine themselves to visualization in the context of hypnosis and/or meditation. Reports of positive results using these techniques are largely anecdotal. In spite of mounting evidence of links between the mind and the neurohumoral, immunological, and autonomic nervous system mechanisms,(18-24) the efficacy of mental techniques such as imagery, with or without the use of hypnosis, has not been demonstrated scientifically to affect the course of cancer. There is a need for more systematized investigations of these methods. Summary and Future Directions In the evolving philosophy of patient care, not only traditional and state-of-the-art therapies, but all modalities capable of enhancing comfort and well-being are approached with a willingness for evaluation, with a special awareness given to the importance of psychological factors in the healing, convalescent, and rehabilitative processes. Today, hospitalized patients, faced with an alien environment, time constraints, and a panoply of novel procedures, are apt to need therapeutic approaches that attend to their psychological needs and to the human dimensions of their experience. Medical hypnosis, a clinical science has undergone extensive conceptual evolution and technical sophistication in recent years, is increasingly understood as a treatment modality with the capacity to be applied, in selected situations, to a wide range of problems encountered in the hospital milieu.(25) Of the phenomena potentially manifested during trance, multi-level (psychophysiological) relaxation, the modulation of painful sensations, the alleviation of drug side effects and nonspecific symptoms such as malaise and insomnia, the reduction of anticipatory anxiety, and the strengthening of motivation for recovery find the most usefulness. Lastly, and still somewhat controversially, is the application of hypnotic imaginal techniques in an attempt to influence the neurohumoral and immunological components of healing. As the healing process becomes more acutely appreciated as a multidimensional, dynamic phenomenon, and as therapeutic trance states become more accepted as valuable gateways to the enhanced communication between mind and body, medical hypnosis will increasingly solidify its role as an agent capable of assisting the individual toward achieving global health and well-being. Gï¿½rard V. Sunnen, M.D., is Associate Clinical Professor of Psychiatry at the New York University Bellevue Hospital Medical Center. He is in private practice of psychiatry and clinical hypnosis in New York City. References 1.Fromm E. Significant developments in clinical hypnosis during the past 26 years. Int J Clin & Exp Hyp 1987;35(4):215-30. 2.Baker EL. The state of the art of clinical hypnosis. Int J Clin & Exp Hyp 1987;35(4):203-14. 3.Gravitz MA. Early uses of hypnosis as surgical anesthesia. Am J Clin Hyp 1988;30(3);201-8. 4.Moll A. Hypnotism. London: Walter Scott Publishing, 1909. 5.Hilgard ER, Hilgard JR. Hypnosis in the relief of pain, 2nd ed. Los Altos, CA: Kaufman, 1983. http://www.triroc.com/sunnen/topics/hypnohosp.htm


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## eric

Int J Clin Exp Hypn 2000 Apr;48(2):138-53 Related Articles, Books, LinkOut A meta-analysis of hypnotically induced analgesia: how effective is hypnosis? Montgomery GH, DuHamel KN, Redd WH. Cancer Prevention and Control Program, Mount Sinai School of Medicine, New York, NY 10029-6574, USA. guy.montgomery###mssm.edu Over the past two decades, hypnoanalgesia has been widely studied; however, no systematic attempts have been made to determine the average size of hypnoanalgesic effects or establish the generalizability of these effects from the laboratory to the clinic. This study examines the effectiveness of hypnosis in pain management, compares studies that evaluated hypnotic pain reduction in healthy volunteers vs. those using patient samples, compares hypnoanalgesic effects and participants' hypnotic suggestibility, and determines the effectiveness of hypnotic suggestion for pain relief relative to other nonhypnotic psychological interventions. Meta-analysis of 18 studies revealed a moderate to large hypnoanalgesic effect, supporting the efficacy of hypnotic techniques for pain management. The results also indicated that hypnotic suggestion was equally effective in reducing both clinical and experimental pain. The overall results suggest broader application of hypnoanalgesic techniques with pain patients. Publication Types: Meta-Analysis PMID: 10769981


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## trbell

great information, eric.can you please leave the personal attacks to bc/tom


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## eric

Anesthesiology 2000 May;92(5):1257-67 Related Articles, Books, LinkOut Neural mechanisms of antinociceptive effects of hypnosis. Faymonville ME, Laureys S, Degueldre C, DelFiore G, Luxen A, Franck G, Lamy M, Maquet P. Departments of Anesthesiology and Intensive Care Medicine and Neurology, and the Cyclotron Research Centre, University Hospital of Liege, Liege, Belgium. anesrea###ulg.ac.be BACKGROUND: The neural mechanisms underlying the modulation of pain perception by hypnosis remain obscure. In this study, we used positron emission tomography in 11 healthy volunteers to identify the brain areas in which hypnosis modulates cerebral responses to a noxious stimulus. METHODS: The protocol used a factorial design with two factors: state (hypnotic state, resting state, mental imagery) and stimulation (warm non-noxious vs. hot noxious stimuli applied to right thenar eminence). Two cerebral blood flow scans were obtained with the 15O-water technique during each condition. After each scan, the subject was asked to rate pain sensation and unpleasantness. Statistical parametric mapping was used to determine the main effects of noxious stimulation and hypnotic state as well as state-by-stimulation interactions (i.e., brain areas that would be more or less activated in hypnosis than in control conditions, under noxious stimulation). RESULTS: Hypnosis decreased both pain sensation and the unpleasantness of noxious stimuli. Noxious stimulation caused an increase in regional cerebral blood flow in the thalamic nuclei and anterior cingulate and insular cortices. The hypnotic state induced a significant activation of a right-sided extrastriate area and the anterior cingulate cortex. The interaction analysis showed that the activity in the anterior (mid-)cingulate cortex was related to pain perception and unpleasantness differently in the hypnotic state than in control situations. CONCLUSIONS: Both intensity and unpleasantness of the noxious stimuli are reduced during the hypnotic state. In addition, hypnotic modulation of pain is mediated by the anterior cingulate cortex. Publication Types: Clinical Trial Controlled Clinical Trial PMID: 10781270


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## eric

Some doctors and patients believe hypnosis can help ease the pain of surgery. (ABCNEWS.com) Power Over the Pain Hypnosis Can Ease Pain of Childbirth, Surgery May 7 ï¿½ Tania Lapointe is the happy mother of three young children. But when she recalls giving birth to her two boys, 5-year-old Guille and 2-year-old Philip, she is not exactly overcome by a warm, maternal glow of remembrance. ï¿½ Premium Video: See the Hypnotized GMA Audience "I was in extreme pain ï¿½ the kind of pain where I was almost convulsing, screaming 'give me drugs, give me drugs,'" Lapointe said. For her baby Chole, born one month ago, Lapointe was determined it was going to be different, and it was. During labor, without any medication at all, she was calm, quiet, and peaceful, surrounded by her husband, her mid-wife and Maureen Saba, the woman who taught her how to perform self-hypnosis. Saba, a hypno-birthing practitioner, has taught Lapointe and dozens of other women how to be self-hypnotized during birthing. The women use positive images and relaxation exercises to ease the pain of childbirth, and for many, the results have been outstanding, advocates say. Summoning Serenity During Labor "They are so focused, they are in such control. It's incredible," Saba said. Though self-hypnosis is not a new idea, it is a rising trend in natural childbirth. Many people think a hypnotist as someone waving a pocket watch in front of a person's eyes to make them do things they would not normally do. But when it comes to clinical applications, hypnosis is nothing like what you may have seen on stage, or in movies. Women are encouraged to think of birth pains as surges or pressure rather than "contractions." They are asked to picture themselves in a serene location, such as the beach. The hypno-birthing practitioner encourages them to feel waves of relaxation moving through their body. Some 1,000 instructors are certified through the HypnoBirthing Institute, based in Epsom, N.H. ï¿½ and the demand for the instructors certainly exists. Lapointe cannot imagine giving birth without one. "This was like heaven compared to the other two," Lapointe said. Pregnant mothers or patients who choose to learn self-hypnosis as a way to ease pain during pregnancy or surgical procedures use a combination of techniques to achieve a state of hypnosis. "Some of the basics are learning how to breathe properly how to let the muscles completely relax," Saba said. "It really must be practiced at home, self-hypnosis gets better with practice," she said. Saba has her students attend five classes of self-hypnosis instruction. When they're done with the classes, they continue to practice at home using tapes and the techniques they learned in class. Breezing Through Kidney Operation Hypnosis is not just for the labor room. Robert Scott used hypnosis when he had his second kidney removed at Boston's Beth Israel Deaconess Medical Center. His doctor, Elivira Lang, says hypnosis reduces the need for pain medication, which often leaves the patient confused and weakened. It worked for Scott, who said that with just a tiny bit of medication and hypnosis, his second kidney removal was a breeze compared to the last. "This one I'm much more alert afterwards, much more awake," Scott said. His experience is not unusual. Dr. Lang has published the results of a study with 241 patients who have undergone hypnosis while having radiological procedures. "We found three things: the procedures are more comfortable, safer and faster," Lang said. " I think it's just a state of focused concentration like you're watching TV, you're reading a book." Doctors in other disciplines also believe in the power of focused concentration. Taking Sting Out of Burns Toronto dentist Dr. Victor Rausch uses hypnosis in his practice, and when had his own molar extracted by a colleague, he hypnotized himself, and used no anesthesia. Clinicians have also used hypnosis to help patients through one of the most painful procedures in all of medicine ï¿½ removing the bandages from a burn victim. David Patterson, a professor of rehabilitation medicine at the University of Washington, used hypnosis to help electrical technician Ladd Richter, who suffered burns over 20 percent of his body after an electrical explosion. The process helped Richter through the twice-a-day ordeal of treating his wounds, and he felt energized when the hypnosis was done. "I feel like a million bucks," Richter said. "When you get up, you feel like you just slept. Like you had a good power nap. Full of energy." And whether it's a devastating experience like burns, or a joyous experience like giving birth, the benefits of hypnosis continue into recovery. "The huge difference was my recovery," Lapointe said. "I was alert after the birth ï¿½ and this time I was on my feet, right after the birth I was on my feet." http://more.abcnews.go.com/sections/gma/go...s_and_pain.html


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## JeanG

Hi Eric:That's a lot of great information!!! I'll have to print it out to read little by little.Thanks.







JeanG


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## ohnometo

Hey Tom







Are you getting in trouble again


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## trbell

Donna, yeah, thanks for the thought.The article on Whorwell's research is finally up and I hesitate to post it as these abstracts can lead to confusion but it's also one of the few good research studies on HT.I hope this doesn't degenerate into one of those things but from my reading it suggests (not proves) that the kind of HT used worked for all except males with IBS-D. From what eric has seen on the bb here Mike's tapes do seem to help males with IBS-D. This would seem to be either something in the research or the type of HT. I'd be interested in any thoughts people might have. http://www.ncbi.nlm.nih.gov/entrez/query.f...2&dopt=Abstract tom


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## ohnometo

TomI can see where you would have questions about this expecially being a male with IBS..You need to learn all the information you can and with your knowledge share what you have learned..It just might help one other person..and that makes a big difference...Take care


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## JeanG

Bump! Lots of good info here.JeanG


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## eric

Something, I am curious about is what if the males in the study had additional sessions? And what was their total global responce to all their symptoms, not just the d? I need to see the full study.


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