# The evidence for gut directed hypnotherapy is effective in IBS



## eric (Jul 8, 1999)

FYI"Hypnosis is only one of several approaches to treating irritable bowel syndrome and may not be the most suitable option for all patients click here for discussion of treatment options for IBS. However, hypnosis treatment has some advantages which makes it an attractive option for many IBS sufferers with chronic and severe symptoms:- It is one of the most successful treatment approaches for chronic IBS. The response rate to treatment is 80% and better in most published studies to date. - The treatment often helps individuals who have failed to get improvements with other methods see for example: Whorwell et al., 1984, 1987; Palsson et al., 1997, 2000.- It is a uniquely comfortable form of treatment; relaxing, easy and generally enjoyable.- It utilizes the healing power of the person's own mind, and is generally completely without negative side effects. - The treatment sometimes results in improvement in other symptoms or problems such as migraine or tension headaches, along with the improvement in IBS symptoms.- The beneficial effects of the treatment last long after the end of the course of treatment. According to research, individuals who improve from hypnosis treatment for IBS can generally look forward to years of reduced bowel symptoms. " http://www.ibshypnosis.com/whyhypnosis.html Overview of research on Hypnotherapy for IBS http://www.ibshypnosis.com/IBSresearch.html Hypnosis Treatment of Irritable Bowel Syndrome By: Olafur S. Palsson, Psy.D., Research Associate, Department of Medicine, University of North Carolina at Chapel Hill http://www.aboutibs.org/Publications/HypnosisPalsson.html Hypnotherapy for Functional Gastrointestinal Disorders By: Peter J. Whorwell, M.D., University Hospital of South Manchester, England http://www.aboutibs.org/Publications/hypnosis.html The Effects of Hypnosison Gastrointestinal Problems Olafur S. Palsson, Psy. D.Research Associate, UNC-CHAPEL HillDepartment of MedicinesHypnosis 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. webmdHypnosis for Irritable Bowel http://my.webmd.com/content/article/34/1728_87469 Aliment Pharmacol Ther. 2003 Mar 1;17 5:635-42. Related Articles, Links Gut-focused hypnotherapy normalizes disordered rectal sensitivity in patients with irritable bowel syndrome.Lea R, Houghton LA, Calvert EL, Larder S, Gonsalkorale WM, Whelan V, Randles J, Cooper P, Cruickshanks P, Miller V, Whorwell PJ.Academic Department of Medicine, University Hospital of South Manchester, UK.BACKGROUND: We have previously shown that hypnotherapy alters rectal sensitivity in some patients with irritable bowel syndrome. However, this previous study used incremental volume distension of a latex balloon, which might be susceptible to subject response bias and might compromise the assessment of compliance. In addition, the study group was symptomatically rather than physiologically defined. AIM: To assess the effect of hypnotherapy on rectal sensitivity in hypersensitive, hyposensitive and normally sensitive irritable bowel syndrome patients using a distension technique barostat that addresses these technical issues. METHODS: Twenty-three irritable bowel syndrome Rome I patients aged 24-72 years were assessed before and after 12 weeks of hypnotherapy in terms of rectal sensitivity, symptomatology, anxiety and depression. Normal values for sensitivity were established in 17 healthy volunteers aged 20-55 years. RESULTS: Compared with controls, 10 patients were hypersensitive, seven hyposensitive and six normally sensitive before treatment. Following hypnotherapy, the mean pain sensory threshold increased in the hypersensitive group P = 0.04 and decreased in the hyposensitive group, although the latter failed to reach statistical significance P = 0.19. Normal sensory perception was unchanged. Sensory improvement in the hypersensitive patients tended to correlate with a reduction in abdominal pain r = 0.714, P = 0.07. CONCLUSION: Hypnotherapy improves abnormal sensory perception in irritable bowel syndrome, leaving normal sensation unchanged.PMID: 12641511Am J Clin Hypn. 2002 Jul;45 1:31-7. Related Hypnotherapy and refractory irritable bowel syndrome: a single case study.Galovski TE, Blanchard EB.State University of New York at Albany, USA.The current study describes the successful administration of hypnotherapy with a subject suffering from refractory Irritable Bowel Syndrome IBS and Generalized Anxiety Disorder GAD. The subject had suffered from IBS for 30 years and had unsuccessfully pursued multiple psychological treatments, both traditional and non-traditional. He was referred to the Center for Stress and Anxiety Disorders and commenced hypnotherapy directed primarily at the IBS symptoms. After 6 treatment sessions, his IBS symptomatology had improved 53%. He stopped treatment at that point and continued autohypnosis with the aid of treatment audiotapes provided by his therapist. Follow-up at 6 months indicated continued improvement 70%. A 2-year follow-up revealed an improvement of 38% in IBS symptomatology. Concurrent levels of depression and anxiety had also substantially decreased. Hypnotherapy is shown to be a viable, palatable, and enduring treatment option for an individual who had been refractory to many previous therapies.PMID: 12116613Am J Gastroenterol. 2002 Apr;97 4:954-61. Related Articles, Links Hypnotherapy in irritable bowel syndrome: a large-scale audit of a clinical service with examination of factors influencing responsiveness.Gonsalkorale WM, Houghton LA, Whorwell PJ.Department of Medicine, University Hospital of South Manchester, United Kingdom.OBJECTIVES: Hypnotherapy has been shown to be effective in the treatment of irritable bowel syndrome in a number of previous research studies. This has led to the establishment of the first unit in the United Kingdom staffed by six therapists that provides this treatment as a clinical service. This study presents an audit on the first 250 unselected patients treated, and these large numbers have also allowed analysis of data in terms of a variety of other factors, such as gender and bowel habit type, that might affect outcome. METHODS: Patients underwent 12 sessions of hypnotherapy over a 3-month period and were required to practice techniques in between sessions. At the beginning and end of the course of treatment, patients completed questionnaires to score bowel and extracolonic symptoms, quality of life, and anxiety and depression, allowing comparisons to be made. RESULTS: Marked improvement was seen in all symptom measures, quality of life, and anxiety and depression all ps < 0.001, in keeping with previous studies. All subgroups of patients appeared to do equally well, with the notable exception of males with diarrhea, who improved far less than other patients p < 0.001. No factors, such as anxiety and depression or other prehypnotherapy variables, could explain this lack of improvement. CONCLUSIONS: This study clearly demonstrates that hypnotherapy remains an extremely effective treatment for irritable bowel syndrome and should prove more cost-effective as new, more expensive drugs come on to the market. It may be less useful in males with diarrhea-predominant bowel habit, a finding that may have pathophysiological implications.PMID: 12003432Dig Dis Sci. 2002 Nov;47 11:2605-14. Related Articles, Links Hypnosis treatment for severe irritable bowel syndrome: investigation of mechanism and effects on symptoms.Palsson OS, Turner MJ, Johnson DA, Burnelt CK, Whitehead WE.University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7080 USA.Hypnosis improves irritable bowel syndrome IBS, but the mechanism is unknown. Possible physiological and psychological mechanisms were investigated in two studies. Patients with severe irritable bowel syndrome received seven biweekly hypnosis sessions and used hypnosis audiotapes at home. Rectal pain thresholds and smooth muscle tone were measured with a barostat before and after treatment in 18 patients study I, and treatment changes in heart rate, blood pressure, skin conductance, finger temperature, and forehead electromyographic activity were assessed in 24 patients study II. Somatization, anxiety, and depression were also measured. All central IBS symptoms improved substantially from treatment in both studies. Rectal pain thresholds, rectal smooth muscle tone, and autonomic functioning except sweat gland reactivity were unaffected by hypnosis treatment. However, somatization and psychological distress showed large decreases. In conclusion, hypnosis improves IBS symptoms through reductions in psychological distress and somatization. Improvements were unrelated to changes in the physiological parameters measured.Publication Types: Clinical Trial Randomized Controlled Trial PMID: 12452403Appl Psychophysiol Biofeedback. 1998 Dec;234:219-32. Related Articles, Links 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 TrialPMID: 10457813 Z Gastroenterol 2003 May;41 5:405-12 Hypnosis in gastroenterologyArticle in GermanHauser W.Medizinische Klinik I, Klinikum Saarbrucken gGmbH, Saarbrucken. w.haeuser###klinikum-saarbruecken.deHypnosis is one of the oldest remedies against physical diseases and mental disorders of mankind. The term hypnosis is used for the description of a technique as well as for the description of an altered state of consciousness which is induced by this technique. Hypnosis is a scientific tool in psychophysiological studies of gastrointestinal functions secretion, motility, visceral sensitivity and their processing in the central nervous system. Hypnosis is an empirically validated treatment of the irritable bowel syndrome even refractory to medical treatment which is recommended by international expert groups Rome II and the British Society of Gastroenterology. In diagnostic upper gastrointestinal endoscopy the relevance of hypnosis as an alternative of intravenous sedation needs to be clarified. Hypnosis cannot be recommended as an alternative for intravenous analgosedation in painful endoscopic therapeutic procedures of the gastrointestinal tract.PMID: 12772053Gastroenterology. 2002 Dec;123 6:1778-85. Related Articles, Links Comment in: Gastroenterology. 2002 Dec;123 6:2132-5.Long-term improvement in functional dyspepsia using hypnotherapy.Calvert EL, Houghton LA, Cooper P, Morris J, Whorwell PJ.Department of Medicine, Wythenshawe Hospital, Southmoor Road, Manchester, United Kingdom.BACKGROUND & AIMS: We have shown hypnotherapy HT to be effective in irritable bowel syndrome, with long-term improvements in symptomatology and quality of life QOL. This study aimed to assess the efficacy of HT in functional dyspepsia FD. METHODS: A total of 126 FD patients were randomized to HT, supportive therapy plus placebo medication, or medical treatment for 16 weeks. Percentage change in symptomatology from baseline was assessed after the 16-week treatment phase short-term and after 56 weeks long-term with 26 HT, 24 supportive therapy, and 29 medical treatment patients completing all phases of the study. QOL was measured as a secondary outcome. RESULTS: Short-term symptom scores improved more in the HT group median, 59% than in the supportive 41%; P = 0.01 or medical treatment 33%; P = 0.057 groups. HT also benefited QOL 42% compared with either supportive therapy 10% P < 0.001 or medical treatment 11% P < 0.001. Long-term, HT significantly improved symptoms 73% compared with supportive therapy 34% P < 0.02 or medical treatment 43% P < 0.01. QOL improved significantly more with HT 44% than with medical treatment 20% P < 0.001. QOL did improve in the supportive therapy 43% group, but 5 of these patients commenced taking antidepressants during follow-up. A total of 90% of the patients in the medical treatment group and 82% of the patients in the supportive therapy group commenced medication during follow-up, whereas none in the HT group did so P < 0.001. Those in the HT group visited their general practitioner or gastroenterologist significantly less median, 1 than did those in the supportive therapy median, 4 and medical treatment median, 4 groups during follow-up P < 0.001. CONCLUSIONS: HT is highly effective in the long-term management of FD. Furthermore, the dramatic reduction in medication use and consultation rate provide major economic advantages.Publication Types: Clinical Trial Randomized Controlled Trial PMID: 12454833


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## BQ (May 22, 2000)

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## cookies4marilyn (Jun 30, 2000)

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