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Filed under: IBS

Hypnotherapy as an Adjunctive Treatment for IBS Patients

The patients stricken by inflammatory bowel disease (IBD) commonly report that stress intensifies their symptoms. Those who are in remission report that stress precedes repeated bouts with the disease, which is a combination of Crohn’s disease and ulcerative colitis. Primary symptoms of this condition are diarrhea accompanied by bleeding, abdominal pain and lesser symptoms such as weight loss, anemia and fever. In addition to inflammation of the gastrointestinal tract, it can include mouth ulcers, erythema nodosum, sclerosing cholangitis, arthralgia and iritis.  The disease can range from moderately severe to incapacitating. The combination of Crohn’s disease and ulcerative colitis known as inflammatory bowel disease can be fatal. The cause or causes are only hypothesized at this time. Studies (Bamias, Nyce, De La Rue, & Cominelli, 2005; Wen & Fiocchi, 2004; Young & Abreu, 2006) conclude that an immune function disorder is most likely the cause. Treatment is with medication (anti-inflammatory or immunomodulatory). Patients who do not respond to treatment may require surgical intervention.

Hypnotherapy has been successful at treating other stress-related diseases, both physical and mental. Theoretically, it may have a beneficial effect on severe cases of IBS. When other treatments fail, it might be a last resort effort to avoid surgery. Gruzelier (2002) studied the effects of hypnosis on stress and psychological aspects of disease. Indications are that it does allow the patient to influence their own physiology favorably and therefore, may be a viable adjunctive treatment option for IBS patients.

Hypnotherapy in conjunction with gastroenterology has been researched for two decades. The method of “gut-focused hypnosis” was (for purposes of this study) given weekly for 12 weeks. An audio recording was given to each of the 15 participants and they were urged to practice at home between the one-week intervals.

The fifteen patients who were not experiencing a good outcome with the use of medications alone were studied to assess how hypnotherapy affected them. The subjects numbered 15 total, of which 12 had ulcerative colitis and 3 had Crohn’s disease. None were improving with usual treatment. Those in the ulcerative colitis group each had one-third of their colon affected by the disease. The Crohn’s disease group was classified as the ileocolic variety. The severity scale used included a rating of mild, moderate, severe or very severe. Before the study, all subjects were classified as severe or very severe.

At the end of 12 weeks, 14 of the subjects reported their symptoms as being mild or moderate. Four subjects with ulcerative colitis experienced remission, 6 ulcerative colitis subjects were classified as mild and one ulcerative colitis subject was moderate. One patient with ulcerative colitis did not respond to hypnotherapy for IBS and required surgery. One patient with Crohn’s disease had a relapse during the follow-up and required surgery at a later time.

The results of the studied compared favorably to classification prior to hypnotherapy when 5 subjects reported very poor quality of life (33.3%), 6 reported poor (40%), 3 reported moderate (20%) and one reported good (6.7%). Following hypnotherapy, 12 subjects (79.9%) considered quality of life excellent (4 subjects) or good (8 subjects). One reported moderate and, as mentioned, 2 required surgical intervention.

Although it is not proposed that hypnotherapy can replace medication in treating IBS, it is considered a viable complementary treatment. Hypnotherapy improved response to medication and quality of life in the majority of subjects studied. New research into adding hypnotherapy to conventional treatment for IBS patients is strongly indicated. A single-blind study with a control group is likely to yield valuable data.

References

Bamias, G., Nyce, M. R., De La Rue, S. A., & Cominelli, F. (2005). New concepts in the pathophysiology of inflammatory bowel disease. Annals of Internal Medicine, 143, 895–904.

Gruzelier, J. H. (2002). A review of the impact of hypnosis, relaxation, guided imagery and individual differences on aspects of immunity and health. Stress, 5, 147–163. Wen, Z., & Fiocchi, C. (2004). Inflammatory bowel disease: Autoimmune or immunemediated pathogenesis? Clinical Developments in Immunology, 11(3–4), 195–204.

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Leave a Comment February 19, 2011

Hypnosis for IBS – A review study

IBS or Irritable Bowel Syndrome affects approximately 10 to 15% of the population and is one of the most common complaints seen by gastroenterologists. IBS symptoms can range widely and can encompass severe abdominal pain, constipation to non-colonic symptoms such as back pain, lethargy and nausea. It is said that IBS is multifactorial in nature and the following are thought to contribute to its incidence: Dietary factors, psychological factors, inheritance, inflammation, motility, visceral sensitivity and central processing. Common treatment for IBS includes medication, but overall unsatisfactory results let this research team from the University of Manchester study hypnotherapy as a treatment option for this condition.

This team in the early 1980’s developed a gut focused hypnotic technique that depended on the patient having some knowledge of the gut and bowel. Once the patient was educated on its processes, they were given an introduction session of hypnosis that simply focused on relaxation – this so that they could simply get used to the hypnotic phenomenon. In subsequent sessions, patients were given direct and indirect suggestions on how they were in fact, in control of their gut function. Guided imagery was the basis for many of these suggestions. Each session lasted from half an hour to an hour and were quite repetitive in nature. Sessions were repeated on a weekly basis for up to three months.

In this first study that looked at the efficacy of this treatment 30 IBS patients were randomized into either seven half hour hypnotic sessions using this gut focused technique or into a supportive therapy that used placebo medication. The study found that patients receiving the hypnosis showed a statistically significant improvement in abdominal bloating, pain, bowel dysfunction and general well being than the control group.

In the team’s latest study into this area, twenty six patients were given twelve sessions of hypnosis at intervals of a week and twenty four patients received supportive treatment plus the placebo for the same period of time. Twenty nine patients were also randomized into a conventional medical treatment. The study found that after 12 weeks, 60% of the IBS patients in the hypnotherapy group improved compared with 41% that received medical treatment and 34% that received supportive therapy. One year after the study, patients in the hypnotherapy group continued to improve with respect to their IBS symptoms unlike the medical group and supportive group whose results remained unchanged. Not one patient of the hypnotherapy group switched groups to receive medical treatment, whereas 82% and 90% of patients in the supportive and medical group required medication for their IBS condition.

The review found that its quite speculative as to how hypnosis serves the purpose of reducing symptoms but it is seen as a being a mechanism or at least, or a means of having an effect on both psychological and physiological processes aiding condition relief.

The review found in its conclusion that patients undergoing hypnosis for IBS had a 60% to 70% chance of improvement with respect to their IBS symptoms. The hypnotherapy was shown to improve in these patients a variety of physiological processes that are typically considered abnormal with the condition of IBS. The study found that these patients were more likely to go back to work, take less medication, and seek medical care less frequently. The study found that hypnosis and hypnotherapy form a valuable treatment that should be included in any conventional approaches to treat the condition of IBS.

References
Miller, V., & Whorwell, P. (2009). Hypnotherapy for Functional Gastrointestinal Disorders: A Review. International Journal of Clinical and Experimental Hypnosis, 57(3), 279-292. Retrieved from EBSCOhost.

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Leave a Comment January 28, 2011


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