Irritable Bowel Syndrome IBS

IBS is among the most clearly proven of applications for hypnosis (see studies below). Hypnosis has been shown to be beneficial to as many as 80% of those participating in studies.  This makes it more effective for managing the symptoms of IBS than any other approach.

We use a format of five to six sessions with IBS client

Long Term Benefits of Hypnosis for IBS

71% of patients initially responded
to therapy. GUT

It has been shown that hypnotherapy can relieve the symptoms of irritable bowel syndrome in the short-term. However, there is data on its long-term benefits.
In this study, physicians from Manchester, England, evaluated 204 patients before, immediately after, and up to 6 years following hypnotherapy.

Patients completed questionnaires which scored symptoms, quality of life, anxiety, and depression. Subjects also retrospectively assessed the effects of the hypnotherapy in order to define their “responder status”.
The physicians found that 71% of patients initially responded to therapy. Of these, 81% maintained their improvement over time.

Symptom scores significantly improved on pre-hypnotherapy levels.

The team did not find any significant differences in the symptom scores between patients assessed at 1, 2, 3, 4, or more than 5 years following treatment.

However, they determined that although quality of life, anxiety and depression scores were improved at follow-up, these showed some deterioration.

In addition, patients reported a reduction in consultation rates and medication use following the completion of hypnotherapy.

Dr Gonsalkorale‘s team concluded, “This study demonstrates that the beneficial effects of hypnotherapy appear to last at least 5 years”.

“Thus it is a viable therapeutic option for the treatment of irritable bowel syndrome”.

Please Visit Gut 2003; 52: 1623-9
24 Oct. 2003

The Following link will take you directly to the studies listed below:

http://www.ibshypnosis.com/IBSresearch.html

Whorwell PJ; Prior A; Faragher EB. Controlled trial of hypnotherapy in the treatment of severe refractory irritable-bowel syndrome.The Lancet 1984, 2: 1232-4. This study is the earliest and perhaps the best study in this research area to date, as it was thoroughly placebo-controlled and showed dramatic contrast in response to hypnosis treatment above the placebo group. Thirty patients with severe symptoms unresponsive to other treatment were randomly chosen to receive 7 sessions of hypnotherapy (15 patients) or 7 sessions of psychotherapy plus placebo pills (15 patients). The psychotherapy group showed a small but significant improvement in abdominal pain and distension, and in general well-being but not bowel activity pattern. The hypnotherapy patients showed a dramatic improvement in all central symptom. The hypnotherapy group showed no relapses during the 3-month follow-up period.

Graph adapted from the above paper, showing group differences in two of the main IBS symptoms:

Whorwell PJ; Prior A; Colgan SM. Hypnotherapy in severe irritable bowel syndrome: further experience. Gut, 1987 Apr, 28:4, 423-5. This report summed up further experience with 35 patients added to the 15 treated with hypnotherapy in the 1984 Lancet study. For the whole 50 patient group, success rate was 95% for classic IBS cases, but substantially less for IBS patients with atypical symptom picture or significant psychological problems. The report also observed that patients over age 50 seemed to have lower success rate from this treatment.

Harvey RF; Hinton RA; Gunary RM; Barry RE. Individual and group hypnotherapy in treatment of refractory irritable bowel syndrome. Lancet, 1989 Feb, 1:8635, 424-5. This study employed a shorter hypnosis treatment course than other studies for IBS, and the success rate was lower, most likely demonstrating that a larger number of sessions is necessary for optimal benefit. Twenty out of 33 patients with refractory irritable bowel syndrome treated with four sessions of hypnotherapy in this study improved. Improvement was maintained at a 3-month treatment.

These researchers further found that hypnosis treatment for IBS in groups of up to 8 patients seems as effective as individual therapy.

Prior A, Colgan SM, Whorwell PJ. Changes in rectal sensitivity after hypnotherapy in patients with irritable bowel syndrome. Gut 1990;31:896. This study found IBS patients to be less sensitive to pain and other sensations induced via balloon inflation in their gut while they were under hypnosis. Sensitivity to some balloon-induced gut sensations (although not pain sensitivity) was reduced following a course of hypnosis treatment.

Houghton LA; Heyman DJ; Whorwell PJ. Symptomatology, quality of life and economic features of irritable bowel syndrome–the effect of
hypnotherapy. Aliment Pharmacol Ther, 1996 Feb, 10:1, 91-5.
 This study compared 25 severe IBS patients treated with hypnosis to 25 patients with similar symptom severity treated with other methods, and demonstrated that in addition to significant improvement in all central IBS symptoms, hypnotherapy recipients had fewer visits to doctors, lost less time from work than the control group and rated their quality of life more improved. Those patients who had been unable to work prior to treatment resumed employment in the hypnotherapy group but not in the control group. The study quantifies the substantial economic benefits and improvement in health-related quality of life which result from hypnotherapy for IBS on top of clinical symptom improvement.

Koutsomanis D. Hypnoanalgesia in the irritable bowel syndrome. Gastroenterology 1997, 112, A764. This French study showed less analgesic medication use required and less abdominal pain experienced by a group of 12 IBS patients after a course of 6-8 analgesia-oriented hypnosis sessions followed by 4 sessions of autogenic training. Patients were evaluated at 6-month and 12-month follow-up.

Houghton LA, Larder S, Lee R, Gonsalcorale WM, Whelan V, Randles J, Cooper P, Cruikshanks P, Miller V, Whorwell PJ. Gut focused hypnotherapy normalises rectal hypersensitivity in patients with irritable bowel syndrome (IBS). 

Gastroenterology 1999; 116: A1009. Twenty-three patients each received 12 sessions of hypnotherapy. Significant improvement was seen in the severity and frequency of abdominal pain, bloating and satisfaction with bowel habit.A subset of the treated patients who were found to be unusually pain-sensitive in their intestines prior to treatment (as evidenced by balloon inflation tests) showed normalization of pain sensitivity, and this change correlated with their pain improvement following treatment. Such pain threshold change was not seen for the treated group as a whole.

Vidakovic Vukic M. Hypnotherapy in the treatment of irritable bowel syndrome: methods and results in Amsterdam. Scand J Gastroenterol Suppl, 1999, 230:49-51.Reports results of treatment of 27patients of gut-directed hypnotherapy tailored to each individual patient. All of the 24 who completed treatment were found to be improve.

Galovski TE; Blanchard EB. Appl Psychophysiol Biofeedback, 1998 Dec, 23:4, 219-32. Eleven patients completed hypnotherapy, with improvement reported for all central IBS symptoms, as well as improvement in anxiety. Six of the patients were a waiting-control group for comparison, and did not show such improvement while waiting for treatment.

Gonsalkorale WM, Houghton LA, Whorwell PJ. Hypnotherapy in irritable bowel syndrome: a large-scale audit of a clinical service with examination of factors influencing responsiveness. Am J Gastroenterol 2002 Apr;97(4):954-61.
This study is notable as the largest case series of IBS patients treated with hypnosis and reported on to date. 250 unselected IBS patients were treated in a clinic in Manchester, England, using 12 sessions of hypnotherapy over a 3-month period plus home practice between sessions. Marked improvement was seen in all IBS symptoms (overall IBS severity was reduced by more than half on the average after treatment), quality of life, and anxiety and depression. All subgroups of patients appeared to do equally well except males with diarrhea, who improved far less than other patients for unknown reason.

Palsson OS, Turner MJ, Johnson DA, Burnett CK, Whitehead WE. Hypnosis treatment for severe irritable bowel syndrome: investigation of mechanism and effects on symptoms. Dig Dis Sci 2002 Nov;47(11):2605-14.
Possible physiological and psychological mechanisms of hypnosis treatment for IBS were investigated in two studies. Patients with severe IBS 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. 17 of 18 patients in study 1 and 21 of 24 patients in study 2 were judged substantially improved Improvement was well-maintained at 10-12 month follow up in study 2.

Lea R, Houghton LA, Calvert EL, Larder S, Gonsalkorale WM, Whelan V, Randles J,
Cooper P, Cruickshanks P, Miller V, Whorwell PJ.Gut-focused hypnotherapy normalizes disordered rectal sensitivity in patients with irritable bowel syndrome.Aliment Pharmacol Ther. 2003 Mar 1;17(5):635-42.
This study evaluated the rectal sensitivity changes in IBS patients who received hypnotherapy, like a previous study by the same group (see Houghton et al’s study above, but using a slightly different methodology. Twenty-three IBS patients were tested before and after 12 weeks of
hypnotherapy. Following the course of hypnotherapy, the mean pain sensory threshold increased in the hypersensitive subgroup and tended to decrease in the hyposensitive group,
although the l. Reduction in gut pain sensitivity was associated with a reduction in abdominal pain. These results suggest that hypnotherapy may work at least partly by normalizing bowel perception in those patients who have abnormal gut sensitivity, while leaving normal sensation unchanged.

Gonsalkorale WM, Toner BB, Whorwell PJ. J Psychosom Res. 2004 Mar;56(3):271-8. Cognitive change in patients undergoing hypnotherapy for irritable bowel syndrome.Cognitive changes were evaluated in 78 IBS patients who completed a 12-session hypnosis treatment course, using the recently developed Cognitive Scale for Functional Bowel Disorders.

Hypnotherapy resulted in improvement of symptoms, quality of life, anxiety and depression. Unhelpful IBS-related cognitions improved significantly, with reduction in the total cognitive score and all component themes related to bowel function. Overall symptom reduction correlated with an improvement on the cognitive scale.

Gonsalkorale WM, Miller V, Afzal A, Whorwell PJ. Long term benefits of hypnotherapy for irritable bowel syndrome. Gut. 2003 Nov;52(11):1623-9. In this study, 204 IBS patients treated with a course of hypnotherapy completed questionnaires scoring symptoms, quality of life, anxiety, and depression before, immediately after, and up to six years following treatment. 71% of patients showed improvement in response to treatment initially, and of those, 81% were still improved years later, while most of the other 19% only reported slight worsening of symptoms. Quality of life and anxiety or depression scores were also still significantly improved at follow-up but showed some deterioration. Patients also reported fewer doctor visits rates and less medication use long-term after hypnosis treatment. These results indicate that for most patients the benefits from hypnotherapy last at least five years.

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