# The Effects of Hypnosis on Gastrointestinal Problems



## eric (Jul 8, 1999)

Olafur S. Palsson, Psy.D.Associate Professor of Medicine, School of Medicine, UNC-Chapel HillHypnosis is a treatment method which still carries an aura of mystery that,unfortunately, continues to be promoted by misrepresentations in movies and stageshows for entertainment. In reality, there is little mysterious about hypnosisanymore. It is a well-researched clinical technique which was formally accepted as atreatment method by the American Medical Association and the AmericanPsychological Association over thirty years ago. Clinical hypnosis is currently usedby thousands of clinicians in the U.S. to treat both psychological and medicalproblems.Until recently, the possibility of using hypnosis to treat gastrointestinal problems hadreceived little attention. In the last 15 years, however, research has shown thathypnosis can influence gastrointestinal functioning in powerful ways, and that it isparticularly effective in helping patients with irritable bowel syndrome (IBS) and tocontrol nausea and vomiting.How Hypnosis WorksHypnosis is a special mental state in which a person's focus of attention becomesnarrow and intense like the beam of a bright flashlight in a dark room. This state isusually created with the aid of a hypnotist who guides the person systematically torelax, 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 holdsthe entire attention. Therefore, people tend to experience things they think of,imagine or remember, more vividly and clearly than under usual circumstances. Thisis why people can sometimes recall things from their distant past under hypnosisalthough they are unable to do so in the normal waking state (research has shown,however, that such hypnotically enhanced recall can be highly contaminated by theperson's imagination). The narrow hyperfocus of this mental state is also whytherapists using hypnosis are frequently able to help people make strong positivechanges in their emotions and physical functioning. Hypnosis can work like amagnifying glass on the mind's effects on the body and emotion.Clinical hypnosis relies on suggestion, imagery and relaxation to produce itstherapeutic effects. Hypnotic suggestions are things that the hypnotist verballysuggests may happen while the person is under hypnosis. Due to the focused andreceptive state of the hypnotized person, these suggestions happen almostautomatically and without conscious decision or effort. For example, if you receivethe suggestion under hypnosis that your arm may be getting heavy, you will verylikely feel it becoming heavy, without trying to do anything to make it happen. This"automaticity" -- the feeling of things happening by themselves -- is by someconsidered the hallmark of hypnosis and is often surprising to people experiencinghypnosis for the first time.Hypnotic imagery consists of mentally picturing events or situations or places in away that has a desired positive physical or mental effect. For example, patientsundergoing surgical or dental procedures are sometimes taught to enter a hypnoticstate and go to a pleasant place in their mind. When successfully applied, the persongets completely engrossed in the vivid enjoyable imagery and is therefore happilyunaware of the unpleasantness of the procedure.The hypnotic state is naturally accompanied by relaxation, and the physical relaxingeffects are often deliberately strengthened further by clinicians through suggestionsand relaxing imagery. Some of the benefits that come from hypnosis treatment arelikely to result partly or entirely from the fact that hypnosis is a powerful relaxationmethod.Over decades of research and clinical experience, hypnosis has proven to have manyvaluable therapeutic uses. In psychotherapy, hypnotic techniques can speed thetherapy process in various ways -- for example, by facilitating a patient's selfunderstanding,extinguishing unfortunate habits, uncovering repressed or forgottenmemories, reducing anxiety and phobias, and helping a person to assume a new andmore adaptive outlook. In medicine and health psychology, hypnosis is used toreduce pain and discomfort associated with medical procedures such as childbirth,treatment of burns, and surgery where chemical anesthesia cannot be usedeffectively. It is also used to treat chronic pain and psychosomatic problems and tocounter unhealthy habits that can contribute to illness. In dentistry, hypnoticanalgesia is an effective needle-less alternative to topical anesthetic drugs, reducesbleeding and discomfort in oral surgery, and is used to treat teeth grinding andtemporomandibular disorder.The Effects of Hypnosis on Gastrointestinal FunctioningIn recent years, the effects of gastrointestinal functioning and GI symptoms havebeen studied extensively. The hypnotic state itself, without any particularsuggestions, seems to slow down the gut. Clear-cut and specific changes in GIfunctioning can be induced in individuals by directing thinking or inducing specificemotional states under hypnosis.For example, one study [1] found that when healthy volunteers were hypnotized andsimply instructed to relax, the orocaecal transit time (the time it takes material topass through the GI tract from the mouth to the first part of the colon) waslengthened from 93 to 133 minutes. Another study [2] found that being in a hypnoticstate decreases muscle movements in the stomach. The same study demonstrated thatthe emotional state of happiness, created under hypnosis, suppresses gastric muscleactivity while anger and excitement increase muscle movement in the stomach. Apair of other studies [3] have shown that when volunteers were guided to useimagery of eating a delicious meal while they were under hypnosis, gastric acidsecretion was increased by 89%, and that acid production of the stomach could alsobe deliberately decreased during hypnosis using hypnotic instructions.Close to fifty published studies have reported on the therapeutic effects of hypnosison nausea and vomiting problems related to chemotherapy, after surgery, and duringpregnancy. Overall, this substantial body of literature indicates that hypnosis can bea powerful aid in controlling nausea and vomiting.Hypnosis may also be helpful in preventing gastrointestinal problems from recurringafter they have been treated with medication. One study [4] of thirty patients withrelapsing duodenal ulcers who had been successfully treated with a course ofmedication, found that only 53% of the patients who received preventive hypnosistreatment had a relapse within one year. By contrast, everyone (100%) in acomparison group receiving no hypnosis relapsed in the same period of time.In 1984, researchers in Manchester in England published a study [5] report in thejournal Lancet, showing that hypnosis treatment dramatically improved thesymptoms of IBS patients who had failed to benefit from other treatment. Theresearchers had randomly divided patients with severe IBS problems into twogroups. Fifteen patients were treated with seven hypnosis sessions. Fifteencomparison patients were treated with seven sessions of psychotherapy, and thosepatients also received placebo pills (pills with no medically active ingredients) whichthey were told were a new research medication for IBS symptoms. Every patient inthe hypnosis group improved, and that group showed substantial improvement in allcentral symptoms of IBS. The control group showed only very modest improvementin symptoms.Partly due to these dramatic results with treatment-refractory patients, a dozen otherstudies have followed, including three U.S. studies. The general conclusions frommost of these studies are that hypnosis seems to improve the symptoms of 80% ormore of all treated patients who have well-defined "classic" IBS problems, especiallyif they do not have complicating factors such as psychiatric disorders. Theimprovement is, in many cases, maintained for at least a year after the end oftreatment. What is particularly remarkable is that this high rate of positive treatmentresponse is seen even in studies where all the participating patients had failed toimprove from regular medical care.The dramatic response of IBS patients to hypnosis treatment raises the question ofexactly 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 howhypnosis treatment affects the body of IBS patients. Since it is well known that manypeople with IBS have unusual pain sensitivity in their intestines, which is thought tobe related to the clinical pain they experience, much of the focus of these studies hasbeen on assessing the impact of this kind of treatment on intestinal pain thresholds.The two English studies both measured intestinal pain sensitivity with ballooninflation tests. The second study also measured muscle tone, to see if hypnosisrelaxes the smooth muscles of the GI tract. No overall changes in pain sensitivitywere detected, and gut muscle tension was also unchanged after treatment (except asubgroup of unusually pain-sensitive patients had lessened pain sensitivity in thesecond study) [7].In 1995-1996, during my post-doctoral fellowship in the Division of DigestiveDiseases and Nutrition at UNC-Chapel Hill, we conducted the first U.S. study [8] onhypnosis for IBS under the direction of Dr. William Whitehead. We evaluated theeffects of a highly standardized treatment protocol, delivered verbatim followingwritten scripts, on rectal pain thresholds and muscle tone. Seventeen out of the 18patients treated with hypnosis showed significant improvement in their clinicalsymptoms. However, like the English researchers, we found that gut pain thresholdsand muscle tension were unchanged after treatment. In a second study [9], which Iconducted with co-investigators at the Eastern Virginia Medical School, we used thesame treatment protocol but this time measured autonomic nervous systemfunctioning 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 ifthey would change due to treatment. Again, we found no changes in our physicalmeasures after treatment (with the exception of reduction in sweat gland reactivity)even though 21 out of 24 treated patients were clinically improved. It should benoted, however, that in both of our studies, we found clear improvement in thepsychological well-being of our patients after hypnosis treatment.In summary, it is clear from our work and other research that hypnosis treatmentsubstantially improves all the central symptoms of IBS in the majority of patientswho receive such treatment (see the effects of our two studies on clinical symptomsin the Figure). What happens in the body of these patients to cause suchimprovement, however, remains a mystery.Future ProspectsIn light of the many studies which have shown hypnosis treatment to be effective forsuch problems as IBS and nausea and vomiting, the question may be raised as to whythis kind of treatment is not more widely available or generally offered to patientswith such GI problems.One limitation is the fact that not everybody is equally hypnotizable. Research hasconsistently shown that at least 15% of people are practically non-hypnotizable, andeven those who are able to enter a hypnotic state vary greatly in how well theyrespond. Interestingly, the ability to be hypnotized is a stable mental trait. In otherword, if you are highly hypnotizable now, you will most likely be so also in thirtyyears. Fortunately, the majority of people are sufficiently hypnotizable to have apotential for enjoying at least some of the medical and psychological benefits ofclinical hypnosis.Furthermore, the idea of being hypnotized does not agree with all people. Evenindividuals 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 otherconcerns about the hypnosis experience. Fortunately, other forms of psychologicaltreatment for gastrointestinal problems -- in the case of IBS especially cognitivebehavioraltherapy -- have also been found to be effective and are good alternatives.Finally, an obstacle which has barred many patients from receiving help forgastrointestinal disorders with hypnosis is the fact that in the U.S. the technique ismore commonly used by psychologists and other mental health professionals than byphysicians. Many mental health professionals who use hypnosis are not accustomedto treating gastrointestinal disorders and are, therefore, reluctant to take on treatmentof such problems.As the beneficial effects of hypnosis on gastrointestinal functioning become betterknown both to health professionals and the general public, this benign andcomfortable form of treatment will hopefully become a more popular treatmentoption for GI patients -- especially for those who have not received much relief fromstandard medical management. As far as IBS is concerned, we have been making aneffort in the last two years to encourage clinicians across the country who haveadequate training in hypnosis to provide such treatment for IBS. We have done thisby providing them, free of charge, with the complete standardized treatment protocolwhich has proven effective in our research. To date, more than eighty licensed healthprofessionals, practicing in almost all states, have started using our protocol, makingit a little bit easier for patients in many geographical locations to receive help withhypnosis.References1. 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, 69-723. 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 Hypnotherapyin 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 thetreatment of severe refractory irritable bowel syndrome. Lancet, 2, 1232-1234.6. Prior A., Colgan, S.M., Whorwell P.J. (1990). Changes in rectal sensitivity afterhypnotherapy 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 hypnotherapynormalizes 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 treatmentfor 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 bowelsyndrome: Symptom improvement and autonomic nervous system effects. Gastroenterology,118,(4) A174FOR MORE INFORMATION ABOUT HYPNOSIS AND IBS, VISIT: http://www.ibshypnosis.com/


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## cookies4marilyn (Jun 30, 2000)

Thanks Eric, for the wonderful information on this effective treatment method. Both Eric and I have found relief for IBS symptom reduction using this treatment method through the IBS Audio Program 100 : www.ibsaudioprogram100.com If you are interested in further research in this area, also take a peek at the CBT - Hypnotherapy Forum link below, which not only has research information but also success stories for the use of clinical hypnotherapy for IBS treatment.







Hope you find it helpful!


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