# IBS and hypnotherapy an effective treatment



## eric (Jul 8, 1999)

FYI on the effectivenes of hypnotherapy on IBS.Lancet 1984 Dec 1;2(8414):1232-4 Related Articles, Books, LinkOut Controlled trial of hypnotherapy in the treatment of severe refractory irritable-bowel syndrome. Whorwell PJ, Prior A, Faragher EB 30 patients with severe refractory irritable-bowel syndrome were randomly allocated to treatment with either hypnotherapy or psychotherapy and placebo. The psychotherapy patients showed a small but significant improvement in abdominal pain, abdominal distension, and general well-being but not in bowel habit. The hypnotherapy patients showed a dramatic improvement in all features, the difference between the two groups being highly significant. In the hypnotherapy group no relapses were recorded during the 3-month follow-up period, and no substitution symptoms were observed. Publication Types: Clinical trial Randomized controlled trial PMID: 6150275, UI: 85059903 Gut 1987 Apr;28(4):423-5 Related Articles, Books, LinkOut Hypnotherapy in severe irritable bowel syndrome: further experience. Whorwell PJ, Prior A, Colgan SM Fifteen patients with severe intractable irritable bowel syndrome previously reported as successfully treated with hypnotherapy, have now been followed up for a mean duration of 18 months. All patients remain in remission although two have experienced a single relapse overcome by an additional session of hypnotherapy. Experience with a further 35 patients is reported giving a total group of 50. This group was divided into classical cases, atypical cases and cases exhibiting significant psychopathology. The response rates were 95%, 43%, and 60% respectively. Patients over the age of 50 years responded very poorly (25%) whereas those below the age of 50 with classical irritable bowel syndrome exhibited a 100% response rate. This study confirms the successful effect of hypnotherapy in a larger series of patients with irritable bowel syndrome and defines some subgroup variations.  PMID: 3583070, UI: 87220014 J R Soc Med 1988 Dec;81(12):718-20 Related Articles, Books, LinkOut The irritable bowel: a pathological or a psychological syndrome? Waxman D The irritable bowel syndrome is discussed together with some of its theories, methods of investigation and various treatment regimens. Eight case histories are reported. In each patient, symptoms appeared to be precipitated by situations interpreted by that patient as stressful. A programme of prospective desensitization using hypnosis is described. Where symptoms of depression were additionally present, antidepressant medication was prescribed. This was subsequently phased out as and when indicated. Where patients had been taking antidiarrhoeal or antispasmodic drugs, various stool bulking agents or benzodiazepines, these were also slowly discontinued as treatment progressed. Cases were followed up from 3 months to 12 years. In 2 cases recurrence of symptoms was again successfully treated. There was no recurrence of any of the bowel symptoms in any other patient. The results support the view that the irritable bowel syndrome is psychogenic in origin. PMID: 3065500, UI: 89125527 Lancet 1989 Feb 25;1(8635):424-5 Related Articles, Books, LinkOut Individual and group hypnotherapy in treatment of refractory irritable bowel syndrome. Harvey RF, Hinton RA, Gunary RM, Barry RE Gastroenterology Unit, Frenchay Hospital, Bristol. 33 patients with refractory irritable bowel syndrome were treated with four 40-minute sessions of hypnotherapy over 7 weeks. 20 improved, 11 of whom lost almost all their symptoms. Short-term improvement was maintained for 3 months without further formal treatment. Hypnotherapy in groups of up to 8 patients was as effective as individual therapy. Publication Types: Clinical trial Randomized controlled trial PMID: 2563797, UI: 89142812 Gut 1990 Aug;31(8):896-8 Related Articles, Books, LinkOut Changes in rectal sensitivity after hypnotherapy in patients with irritable bowel syndrome. Prior A, Colgan SM, Whorwell PJ Department of Medicine, University Hospital of South Manchester. Fifteen patients with the irritable bowel syndrome were studied to assess the effect of hypnotherapy on anorectal physiology. In comparison with a control group of 15 patients who received no hypnotherapy significant changes in rectal sensitivity were found in patients with diarrhoea-predominant irritable bowel syndrome both after a course of hypnotherapy and during a session of hypnosis (p less than 0.05). Although patient numbers were small, a trend towards normalisation of rectal sensitivity was also observed in patients with constipation-predominant irritable bowel syndrome. No changes in rectal compliance or distension-induced motor activity occurred in either subgroup nor were any changes in somatic pain thresholds observed. The results suggest that symptomatic improvement in irritable bowel syndrome after hypnotherapy may in part be due to changes in visceral sensitivity. PMID: 2387513, UI: 90353800 Br J Hosp Med 1991 Jan;45(1):27-9  Related Articles, Books, LinkOut Use of hypnotherapy in gastrointestinal disease. Whorwell PJ University Hospital of South Manchester, West Didsbury. Recent controlled studies in the field of gastroenterology have shown that hypnotherapy is unequivocally beneficial in conditions such as irritable bowel syndrome and peptic ulceration. There is also some evidence for influence on certain physiological functions. Further research should help to define more clearly the role of this controversial form of therapy. Publication Types: Clinical trial Randomized controlled trial PMID: 2009436, UI: 91183314 ------------------ http://www.ibshealth.com/ www.ibsaudioprogram.com


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## eric (Jul 8, 1999)

Gastroenterol Clin North Am 1991 Jun;20(2):249-67 Related Articles, Books, LinkOut Psychologic considerations in the irritable bowel syndrome. Whitehead WE, Crowell MD Johns Hopkins University School of Medicine, Baltimore, Maryland. Among medical clinic patients consulting for IBS, symptoms of psychologic distress are common, and more than half of these patients are found to have a psychiatric diagnosis in addition to bowel dysfunction. Many investigators have therefore concluded that IBS is a psychophysiologic disorder and proposed that patients with IBS be treated with psychologic techniques. However, recent studies suggest that this association may be spurious; persons in the community who have symptoms of IBS but do not consult a doctor have no more psychologic symptoms than persons without bowel symptoms. This indicates that psychologic symptoms do not cause bowel symptoms, but, instead, influence which persons with bowel symptoms will consult a physician. The bowel symptoms and the psychologic symptoms that coexist in most patients with IBS may be best thought of as comorbid conditions. Neither causes the other, but both may be serious enough to warrant treatment. Moreover, in some patients whose bowel symptoms consist of vague complaints of abdominal pain not specifically related to defecation or to changes in the frequency or consistency of bowel habits, the psychologic disorder may be primary. Psychologic stress may exacerbate IBS whether or not the patient has a psychiatric disorder, and psychologic stress may trigger acute episodes of symptoms similar to those of IBS even in persons without IBS. However, the magnitude of this correlation is modest, suggesting that only about 10% of the variation in bowel symptoms is attributable to stress. Psychologically oriented treatments have a role in the management of IBS. Most patients who consult internists about bowel symptoms have significant levels of depression and anxiety, and they tend to notice and to worry about somatic complaints more when they experience these dysphoric affects. Psychologic treatments that reduce the level of their psychologic distress also frequently reduce the frequency and severity of complaints about bowel symptoms. Tricyclic antidepressants may be tried as a first line of treatment; they have been shown to be superior to placebo for the management of abdominal pain and diarrhea but not constipation. In patients who do not show an adequate response to antidepressants, brief psychotherapy focusing on better ways of coping with current problems, hypnosis, or behavior therapy emphasizing methods of controlling reactions to stress are recommended. Controlled trials show these treatment approaches to be superior to medical management alone. It may appear paradoxical that psychologic treatments aimed at the management of emotions are so frequently found to reduce bowel symptoms, because the motility disorder responsible for the bowel symptoms may be unrelated to the psychologic symptoms that influence the patient to seek treatment.+4 Publication Types: Review Review, tutorial PMID: 2066151, UI: 91293860 Lancet 1992 Jul 11;340(8811):69-72 Related Articles, Books, LinkOut Physiological effects of emotion: assessment via hypnosis. Whorwell PJ, Houghton LA, Taylor EE, Maxton DG Department of Medicine, University Hospital of South Manchester, UK. Assessment of the physiological effects of physical and emotional stress has been hampered by a lack of suitable laboratory techniques. Since hypnosis can be used safely to induce specific emotional states of considerable intensity, we studied the effect on distal colonic motility of three hypnotically induced emotions (excitement, anger, and happiness) in 18 patients aged 20-48 years with irritable bowel syndrome. Colonic motility index was reduced by hypnosis on its own (mean change 19.1; 95% CI 0.8, 37.3; p less than 0.05) and this change was accompanied by decreases in both pulse (12; 8, 15) and respiration (6; 4, 8) rates (p less than 0.001 for both). Anger and excitement increased the colonic motility index (50.8; 29.4, 72.2; and 30.4; 8.9, 51.9, respectively; p less than 0.01 for both), pulse rate (26; 22, 30; and 28; 24, 32; p less than 0.001 for both), and respiration rate (14; 12, 16; and 12; 10, 14; p less than 0.001 for both). Happiness further reduced colonic motility although not significantly from that observed during hypnosis alone. Changes in motility were mainly due to alterations in rate than in amplitude of contractions. Our results indicate that hypnosis may help in the investigation of the effects of emotion on physiological functions; this approach could be useful outside the gastrointestinal system. Our observation that hypnosis strikingly reduces fasting colonic motility may partly explain the beneficial effects of this form of therapy in functional bowel disorders. Publication Types: Clinical trial Randomized controlled trial Comments: Comment in: Lancet 1992 Aug 15;340(8816):434 PMID: 1352012, UI: 92310038 Aliment Pharmacol Ther 1996 Feb;10(1):91-5 Related Articles, Books, LinkOut Symptomatology, quality of life and economic features of irritable bowel syndrome--the effect of hypnotherapy. Houghton LA, Heyman DJ, Whorwell PJ  Department of Medicine, University Hospital of South Manchester, UK. AIMS: The purposes of this study were to quantify the effects of severe irritable bowel syndrome on quality of life and economic functioning, and to assess the impact of hypnotherapy on these features. METHODS: A validated quality of life questionnaire including questions on symptoms, employment and health seeking behaviour was administered to 25 patients treated with hypnotherapy (aged 25-55 years; four male) and to 25 control irritable bowel syndrome patients of comparable severity (aged 21-58 years; two male). Visual analogue scales were used and scores derived to assess the patients' symptoms and satisfaction with each aspect of life. RESULTS: Patients treated with hypnotherapy reported less severe abdominal pain (P < 0.0001), bloating (P < 0.02), bowel habit (P < 0.0001), nausea (P < 0.05), flatulence (P < 0.05), urinary symptoms (P < 0.01), lethargy (P < 0.01), backache (P = 0.05) and dyspareunia (P = 0.05) compared with control patients. Quality of life, such as psychic well being (P < 0.0001), mood (P < 0.001), locus of control (P < 0.05), physical well being (P < 0.001) and work attitude (P < 0.001) were also favourably influenced by hypnotherapy. For those patients in employment, more of the controls were likely to take time off work (79% vs. 32%; p = 0.02) and visit their general practitioner ( 58% vs. 21%; P = 0.056) than those treated with hypnotherapy. Three of four hypnotherapy patients out of work prior to treatment resumed employment compared with none of the six in the control group. CONCLUSION: This study has shown that in addition to relieving the symptoms of irritable bowel syndrome, hypnotherapy profoundly improves the patients' quality of life and reduces absenteeism from work. It therefore appears that, despite being relatively expensive to provide, it could well be a good long-term investment. PMID: 8871448, UI: 97025225 : Eur J Gastroenterol Hepatol 1996 Jun;8(6):525-9 Related Articles, Books, LinkOut Use of hypnotherapy in gastrointestinal disorders. Francis CY, Houghton LA Department of Medicine, University Hospital of South Manchester, UK. Medical history is full of anecdotal reports on the use of hypnosis in the treatment of gastrointestinal and other disorders. Unfortunately, much of the work published to date consists mainly of short case reports or involves small numbers of patients. They have, however, all broadly given the same message: that patients symptoms improve and they cope better with their condition after hypnotherapy. More recently, controlled trials have shown that patients with severe refractory irritable bowel syndrome or relapsing duodenal ulcer disease respond well to hypnotherapy. This article aims to give an overview of the areas in gastroenterology where hypnotherapy has been applied, discussing in particular what progress has been made in the area of irritable bowel syndrome. Publication Types: Review Review, tutorial PMID: 8823562, UI: 96420865 Can J Psychiatry 1997 Oct;42(8):835-40 Related Articles, Books, LinkOut A biopsychosocial understanding of the irritable bowel syndrome: a review. Goldberg J, Davidson P Department of Psychiatry, McMaster University, Hamilton, Ontario. OBJECTIVES: To review and examine the clinical and research literature on irritable bowel syndrome (IBS) with a view to establishing the role that psychiatric factors play in the pathogenesis and treatment of this syndrome. RESULTS: Comorbid psychiatric illness is common with IBS, yet only a small proportion of these patients seek medical attention. Many patients are either satisfied by reassurance or experience symptom relief from medical treatment directed at target symptoms. A small group of patients do not experience much relief, and it is largely this group who come to the psychiatrist's attention. Psychotropic medication is helpful when clinically indicated, and tricyclic antidepressants in small doses (for example, 50 mg) may be helpful for those patients with a pain-predominant pattern of IBS. Psychotherapy (including cognitive, behavioural, relaxation, thermal-biofeedback, insight-oriented therapy, and hypnosis) has been shown to provide relief, although it has often been difficult to differentiate this improvement from a placebo response. CONCLUSIONS: The group of patients with "refractory IBS" used a large amount of health care resources in an attempt to find relief to their distress. Further study is needed to gain a better understanding of which component of psychotherapy is most cost-effective and which patients are most likely to benefit. The large group of those who admit to symptoms compatible with IBS but who do not seek medical attention has to a large extent been excluded from most studies. Exploring this group may provide further insight into this perplexing  syndrome. Publication Types: Review Review, tutorial PMID: 9356771, UI: 98019618 ------------------ http://www.ibshealth.com/ www.ibsaudioprogram.com


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## eric (Jul 8, 1999)

Aliment Pharmacol Ther 1999 May;13 Suppl 2:48-53 Related Articles, Books, LinkOut Review article: clinical evidence to support current therapies of irritable bowel syndrome. Camilleri M Mayo Clinic, Rochester, Minnesota 55905, USA. camilleri.michael###mayo.edu This review summarizes the clinical evidence to support current therapies in irritable bowel syndrome (IBS). Fibre is indicated at a dose of at least 12 g per day in patients with constipation-predominant IBS. Loperamide (and probably other opioid agonists) are of proven benefit in diarrhoea-predominant IBS; loperamide may also aid continence by enhancing resting anal tone. In general, smooth muscle relaxants are best used sparingly, on an 'as needed' basis, as their overall efficacy is unclear. Psychotropic agents are important in relieving depression and of proven benefit for pain and diarrhoea in patients with depression associated with IBS. Further trials with selective serotonin reuptake inhibitors (SSRIs) are awaited. Psychological treatments including hypnotherapy are less widely available, but may play an important role in relief of pain. In summary, current therapies targeted on the predominant symptoms in IBS are moderately successful. New therapies are needed to more effectively relieve this syndrome, not just symptoms. Publication Types: Review Review, tutorial PMID: 10429740, UI: 99358371 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 PMID: 10457813, UI: 99386263 Scand J Gastroenterol Suppl 1999;230:49-51 Related Articles, Books, LinkOut Hypnotherapy in the treatment of irritable bowel syndrome: methods and results in Amsterdam. Vidakovic-Vukic M Sint Lucas Andreas Ziekenhuis, Dept. of Internal Medicine, Amsterdam, The Netherlands. BACKGROUND: Irritable bowel syndrome (IBS) is frequently observed, but its etiology and pathogenesis are still unknown. However, it is clear that individual perception plays an important part in pathogenesis (hypersensitive, hyperreactive gut). There is no easy medical treatment of IBS. However, in recent years, hypnotherapy (HT) has been shown to be successful in the treatment of IBS. METHODS: Recently we started treating IBS patients using hypnotherapy. All our patients remained symptomatic, despite medical therapy. We applied the gut-targeted method, adding to it the view that the therapy should be tailored to the individual, in accordance with each person's unique representational style. RESULTS: So far, 27 patients have been treated, with good results, comparable to results elsewhere. Of these patients two stopped the therapy prematurely, and one remained symptomatic. All other patients experienced clear improvement: pain and flatulence was reduced or completely disappeared, and bowel habits normalized. CONCLUSION: Based on data from the literature and supported by our own experience, we conclude that hypnotherapy is a valuable addition to the conventional treatment of IBS. To improve our knowledge of sensitivity to hypnotherapy, further research is necessary to recognize cases with more hypersensitivity and those dominated by hypervigilance. More generally, we need a theoretical model of hypnotherapy as applied to treating physiological disorders. PMID: 10499462, UI: 99427808 Baillieres Best Pract Res Clin Gastroenterol 1999 Oct;13(3):473-87 Related Articles, Books, LinkOut Harnessing the patient's powers of recovery: the role of the psychotherapies in the irritable bowel syndrome. Read NW Centre for Human Nutrition, University of Sheffield, Northern General Hospital, UK. The aim of this chapter is to provide a clear and balanced account of the role of the various forms of psychotherapy in the irritable bowel syndrome (IBS). It commences with an account of the philosophical basis for psychotherapy, attempting to integrate the concepts of autonomic arousal, repression, conversion and a developmental disorder of thinking and emotional expression. These concepts are used to explain why separation and loss can lead to the development of IBS and how the gut is such an important vehicle for emotional expression. Against this background the role and philosophy of relaxation therapy, hypnotherapy, biofeedback, cognitive behavioural therapy and analytical psychotherapy are discussed. These therapies describe a philosophical approach that is quite different from biomedical treatments in that it attempts to harness the patient's own powers for recovery. For that reason the efficacy of psychotherapies cannot be evaluated by randomized controlled trials. Psychotherapies rely on the relationship between therapist and patient and vary according to whether the locus of responsibility lies mainly with the therapist or mainly with the patient. Different patients may well require different therapies. Publication Types: Review Review, tutorial PMID: 10580923, UI: 20045408 Biomed Pharmacother 1986;40(1):4-5 Related Articles, Books, LinkOut Management of irritable bowel syndrome. Prior A, Whorwell PJ Few drugs are of proven efficacy in irritable bowel syndrome. Bulking agents probably relieve constipation, spasmolytics may alleviate pain and antidiarrhoeals help control urgency and diarrhoea. With a combination of reassurance and therapeutic intervention up to 75% of patients can be expected to improve. For the 25% who do not, alternative therapies such as stress management, psychotherapy or hypnotherapy may prove effective. PMID: 3011142, UI: 86216545 Harefuah 1999 Aug;137(3-4):105-7, 175 Related Articles, Books, LinkOut [Biofeedback treatment of irritable bowel syndrome]. [Article in Hebrew] Barak N, Ishai R, Lev-Ran E Biofeedback Unit, Sheba Medical Center, Tel Hashomer. Irritable bowel syndrome is a group of heterogenic complaints of functional bowel disorder in the absence of organic pathology. The pathophysiology is unclear. In most cases treatment includes symptomatic remedies, antidepressants, psychotherapy and hypnotherapy. Biofeedback has recently been introduced as a therapeutic modality. Treatment also includes relaxation techniques and guided imagery, together with computer-assisted monitoring of sympathetic arousal. Biofeedback requires active participation of patients in their healing progress and leads to symptom reduction in 2/3. PMID: 10959294, UI: 20415196 Treatment of choice The Washington Post: http://www.washingtonpost.com/wp-dyn/artic...-2000May30.html ------------------ http://www.ibshealth.com/ www.ibsaudioprogram.com


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## eric (Jul 8, 1999)

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 a 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." Gastroenterology, Vol 96, 1383-1387, Copyright ï¿½ 1989 by AmericanGastroenterological Association Modulation of gastric acid secretion byhypnosisKB Klein and D Spiegel School of Medicine, University of North Carolina, Chapel Hill. The ability of hypnosis to both stimulate and inhibit gastric acid secretion in highly hypnotizablehealthy volunteers was examined in two studies. In the first, after basal acid secretion was measured,subjects were hypnotized and instructed to imagine all aspects of eating a series of delicious meals.Acid output rose from a basal mean of 3.60 +/- 0.48 to a mean of 6.80 +/- 0.02 mmol H+/h withhypnosis, an increase of 89% (p = 0.0007). In a second study, subjects underwent two sessions ofgastric analysis in random order, once with no hypnosis and once under a hypnotic instruction toexperience deep relaxation and remove their thoughts from hunger. When compared to theno-hypnosis session, with hypnosis there was a 39% reduction in basal acid output (4.29 +/- 0.93 vs.2.60 +/- 0.44 mmol H+/h, p less than 0.05) and an 11% reduction in pentagastrin-stimulated peak acidoutput (28.69 +/- 2.34 vs. 25.43 +/- 2.98 mmol H+/h, p less than 0.05). We have shown that differentcognitive states induced by hypnosis can promote or inhibit gastric acid production, processes clearlycontrolled by the central nervous system. Hypnosis offers promise as a safe and simple method forstudying the mechanisms of such central control. Hawaii Med J 1999 Dec;58(12):344-7 Related Articles, Books Clinical applications of hypnotherapy in a medical setting. Simon EP, James LC Department of Psychology, Tripler Regional Medical Center, Honolulu, Hawaii, USA. Since 1958, hypnosis has been recognized by the American Medical Association as a legitimate form of medical treatment when administered by an appropriately trained practitioner. With the prevalence of certification societies and international organizations, the specialty has increased its level of professionalism and clinical applications. However, in spite of increased exposure and utilization of this unique clinical application, its use within medical settings varies considerably. The purpose of this article is to provide an understanding of clinical hypnosis and offer clinical applications, with the goal of increasing its exposure and utilization within medical settings. PMID: 10666949, UI: 20131601 ClinicalBehavioral therapy improves management of irritable bowel syndromeWESTPORT, May 01 (Reuters Health) - Patients with (IBS) benefit from multi-component behavioraltherapy in addition to standard medical treatment, researchers in Germany report.Dr. Ingeborg Heymann-Monnikes, of Humboldt University, Berlin, Germany, and colleaguescompared the benefits of multi-component behavioral therapy and standard medical treatment withstandard medical treatment alone. Twenty-four outpatients with IBS were randomly selected to receivestandardized multi-component behavioral therapy plus standard medical treatment or standard medicaltreatment alone.According to the researchers, "standardized multi-component behavioral therapy included IBSinformation and education, progressive muscle relaxation, training in illness-related cognitive copingstrategies, problem-solving and assertiveness training in 10 sessions over 10 weeks."Evaluations of the patients were conducted over 14 weeks with follow-up evaluations at 3 months andfor the multi-component behavioral therapy group again at 6 months, according to the report in theApril issue of The American Journal of Gastroenterology.Subjects kept a daily IBS diary in which they were asked to note "intensity, frequency, duration,unendurability and impact on daily life activities of each of 20 IBS-related symptoms." The researchersalso gave the participants a battery of six psychological tests.The investigators found that there was a significant reduction in IBS symptoms "as measured by dailysymptom diaries" for the standardized multi-component behavioral therapy group compared with thestandard medical treatment group. In addition, "overall well-being significantly improved in thestandardized multi-component behavioral therapy group but remained unchanged in the standardmedical treatment group."Also, patients in the standardized multi-component behavioral therapy group "felt significantly more incontrol of their health." Reported quality of life also significantly improved for this group whileremaining unchanged for the standard medical treatment group.Am J Gastroenterol 2000;95:981-994.-Westport Newsroom 203 319 2700------------------ http://www.ibshealth.com/ www.ibsaudioprogram.com


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## eric (Jul 8, 1999)

Medical Hypnosis in the Hospital by Gerard V. Sunnen, M.D. BACK TO HOME Hypnosis has many applications for relieving distress in hospitalized patients. Gerard 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. Gerard 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. 6.Kroger WS. Clinical and experimental hypnosis in medicine, dentistry, and psychology, 2nd ed. Philadelphia: Lippincott, 1977. 7.Lederman EI, Fordyce CY, Stacy TE. Hypnosis as an adjunct to anesthesiology. Md ------------------ http://www.ibshealth.com/ www.ibsaudioprogram.com


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## eric (Jul 8, 1999)

Int J Clin Exp Hypn 2000 Apr;48(2):138-53 Related Articles, Books 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, UI: 20232846 : 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 PMID: 10781270, UI: 20243229 FromMedical Tribune Audiotape Hypnotherapy TreatsIrritable Bowel[Medical Tribune 40(11):13, 1999. ï¿½]ORLANDO, FL-A three-month course of self-administeredaudiotape hypnotherapy improved symptoms in 57 perhaps ofpatients who were being treated for irritable bowel syndrome (IBS),according to a study presented here at the Digestive Disease Weekmeeting last month. In-person hypnotherapy improved symptoms67 percent.Alastair Forbes, M.D., and his colleagues at St. Mark's Hospital inLondon, England, tested audiotaped or in-person hypnotherapysessions on 52 IBS patients who had not been helped by dietary ordrug therapies. The researchers wanted to see if audiotapehypnotherapy is a realistic alternative to in-person therapy, which ismore expensive. In this study improved symptoms in 67 percent ofthe patients.Twenty-seven of the patients were treated with audiotapes and 25received in-person hypnotherapy. Patients using the audiotapeswere told to listen to them daily. They met with a clinician after sixweeks of treatment and at the end of the three-month course.The audiotapes were 30 minutes long and included standardrelaxation techniques and visualization exercises.The team found that the tapes worked nearly as well as individualhypnotherapy sessions. After three months, symptoms improved in67 percent of in-person hypnotherapy patients and 57 percent ofthose hypnotized by audiotape.The patients' average age was 37. The duration of their symptomsranged from eight months to 40 years.Another group at the meeting, led by Wendy Gonsalkorale, M.D.,reported a 25 percent improvement in symptoms in 75 percent ofpatients given hypnotherapy. Dr. Gonsalkorale is the manager ofthe hypnotherapy unit at the University Hospital of SouthManchester. "Our groups are arriving at very similar results" she said."Hypnotherapy is clearly very useful in patients who aren't beinghelped by more conventional treatments." Dr Doug Drossman, real audio lecture four one from the bottom of the page. http://healthwatch.medscape.com/medscape/p...udioarchive.asp ------------------ http://www.ibshealth.com/ www.ibsaudioprogram.com [This message has been edited by eric (edited 10-10-2000).]


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## cookies4marilyn (Jun 30, 2000)

Thanks, Eric!







As always, a fantastic job gathering data for us!!!! These articles are very much appreciated..Thank goodness I finally got my printer repaired!!! Thanks again for sharing this with all of us!







------------------Marilyn


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## JeanG (Oct 20, 1999)

Thanks for all the info, Eric.







Hypnosis is #1 in my book, too.JeanG


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## wanderingstar (Dec 1, 1999)

Thanks for doing this eric. I think it will help a lot of people in deciding whether hypnosis is for them, and for dispelling any preconceptions. Thanks again,Susan


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## eric (Jul 8, 1999)

I hope so Susan it is looking better and better for this as a safe treatment.------------------ http://www.ibshealth.com/ www.ibsaudioprogram.com


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## eric (Jul 8, 1999)

Bump







------------------ http://www.ibshealth.com/ www.ibsaudioprogram.com


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## Brandi Guidry (Jul 9, 2000)

Eric,Thanks for posting these most interesting articles. I love to read any news concerning anything that is GI related. Hypnotherapy is definetly a great treatment for pts. with IBS. I just wish that more people knew about it. Now if only I could make myself get into hypnosis.... Different subject... Brandi







[This message has been edited by Brandi Guidry (edited 11-27-2000).]


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## Guest (Dec 13, 2000)

If you want an eye-opening approach to yourintestinal problems read The Fungus Linkby Dough Kaufmann. He offers somethingmany doctors are ignorant of for diagnosing and treatment. It's an easier, morepractical, more effective and cheaperapproach to getting satisfaction andeven a cure. Give it a try and you'll have a more positive outlook for your health.


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