Introduction

Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder characterized by chronic abdominal pain or cramps, and altered bowel functioning (diarrhea and/or obstipation). Other gastrointestinal symptoms include bloating and gas. Most of those suffering IBS have mild symptoms, but there is still a substantial number of patients with severe symptoms with considerable impairment of functioning in daily life, and loss of work and school days.

What is the cause of Irritable Bowel Syndrome?

The cause of IBS is unknown and to date no specific abnormality has been found in IBS patients. Although the pathophysiology is unclear, IBS may be explained by a combination of  both physiological and psychological factors. Some of the factors involve the smooth muscles that contract to move food through the intestines, and others involve abnormalities in the nervous system regulating the digestion, such as an overreaction to the stretches of the gut caused by gas or stool. There are several psychological factors that predict whether somebody will get IBS or not: Anxiety, depression, high levels of psychological distress, and sleep problems are risk factors for IBS.

Therapy of Irritable Bowel Syndrome

Partially because the precise cause of irritable bowel syndrome is not known, conventional treatment has proven difficult. Usually the initial therapy starts with education of the patient about the nature of IBS, reassurance that IBS is a benign condition, advice about diet (e.g. exclusion of gas-producing foods) and physical activity.

Medications target symptoms such as pain, bloating, diarrhea, and constipation but show little evidence of effectiveness for IBS therapy.

Psychological treatments have proven a promising alternative therapy compared to standard medical care for severe irritable bowel syndrome. Of all the tested psychological therapies, cognitive-behavioural therapy and hypnotherapy have been best backed by scientific evidence.

Click here for more information on symptoms, cause and therapy of IBS.

Clinical hypnosis and irritable bowel syndrome

The first trial on hypnosis and IBS was done by Dr Whorwell and colleagues in 1984. Thirty patients with severe IBS refractory to standard medical treatment were allocated to either a group that received seven sessions of hypnotherapy, or a group who received psychotherapy plus placebo pills. Overall changes in abdominal pain, bowel habits, abdominal distension, and general well-being were significantly greater in the hypnotherapy group.

A recent meta-analysis of 8 randomized controlled trials showed that hypnotherapy for irritable bowel syndrome is superior to control conditions (e.g. usual medical care, supportive therapy, waiting list), provides adequate symptom relief, and is safe and well tolerated.

How is hypnosis treatment for IBS conducted?

How long does hypnotherapy for IBS take?

Typically a hypnotherapy programme for IBS consists of 7-12 individual sessions over a period of 3 months. From our experience, clients see improvements in their symptoms already after a few sessions. To keep long-term results, clients are usually advised to complete the full hypnotherapy programme.

How is the hypnotherapy programme for IBS designed?

Usually a treatment session starts with an induction and deepening consisting of suggestions for muscle relaxation and imagery of a favourite place of relaxation, followed by suggestions for ego-strengthening, general well-being, and mental calm. Further sessions also include so-called gut-directed techniques aiming at normalizing and controlling gut function. One of the latter techniques involves moving one hand onto the abdomen and inducing a feeling of warmth and comfort. Metaphors are often used during the treatment sessions: In the case of IBS with diarrhea, the instestine may be thought of as a river, which could be fast and turbulent; the patient could then be imagining it moving slowly and smoothly. Between therapy sessions, patients are asked to practice self-hypnosis at home on a daily basis in order to improve the effectiveness of the treatment.

The hypnotherapeutic treatment strategy depends on the patient’s needs, and several other techniques are available. If there are reasons to use analytical techniques to look for the root cause of the problem, regression and dissociative techniques may be used. Feared or avoided situations (e.g. patients avoiding travelling because of the fear that there might not be a bathroom nearby) can be rehearsed in imagination using pseudoorientation in time. Glove analgesia is a good alternative in the control of abdominal pain in IBS.

How effective is hypnosis for IBS?

More than half of the refractory patients will benefit

Early studies by Whorwell and colleagues showed that – at a follow-up after 18 months – 84% of all patients improved (and the sucess rate for patients with classical symptoms was even better with 95%). A recent audit of 1000 patients reported a significant reduction of severity of IBS symptoms in 76% of participants in a gut-directed hypnotherapy programme.

Treatment benefits usually last for several years

Studies by Gonsalkorale and colleagues found that 81% of patients retained the therapeutic improvements long term (for up to 5 years after treatment).

There are „positive side-effects“: Improvements of psychological symptoms and quality of life

Hypnotic therapy of IBS is associated with improvements of quality of life, psychological well-being, self-efficacy, and with a reduction of symptoms of anxiety, depression, and somatization.

How do emotions such as anger and happiness affect our digestion?

Can we actually measure the effects of physiological and psychological stress on the body?

Using hypnosis is a safe and highly reproducible way to induce specific emotions.
Emotions such as excitement and anger increase the contractions of the intestine, and happiness has a calming effect on our digestive system (a reduction of the contraction rate). This might explain some everyday experiences such as abdominal cramps or more frequent defection during especially stressful events in our life, and also help to understand why hypnosis is effective in the treatment of irritable bowel syndrome.

Hypnosis is effective in the treatment of irritable bowel syndrome

• 7 – 12 sessions over a 2-3 months period are sufficient for marked symptom improvements
• All of the central symptoms of IBS improve substantially
  • Pain
  • Constipation / diarrhea
  • Bloating /distension
• Compared to medications, hypnosis has lots of “positive side effects”: There are improvements of
  • Quality of life, psychological well-being, self-efficacy
  • symptoms of anxiety, depression, somatization
  • Long-term improvements retained for years in majority of patients who respond to hypnotherapy

What are the indications to use psychotherapy and clinical hypnosis in IBS?

• Psychotherapeutic methods (gut-directed hypnotherapy, cognitive-behavioral therapy, psychodynamic therapy) are effective in the treatment of IBS and should be integrated into the therapy concept (German Society for Gastroenterology, DGVS).
• Referral for psychological interventions (cognitive behavioural therapy [CBT], hypnotherapy and/or psychological therapy) should be considered for people with IBS who do not respond to pharmacological treatments after 12 months and who develop a continuing symptom profile (UK NICE [National Institute for Health and Care Excellence] guidelines).

Literature:

Olafur S. Palsson (2015) Hypnosis Treatment of Gastrointestinal Disorders: A Comprehensive Review of the Empirical Evidence, American Journal of Clinical Hypnosis, 58:2, 134-158.