Irritable Bowel Syndrome/Crohn's Disease/Colitis

The research abstracts below indicate that hypnotherapy is highly effective for the treatment of IBS, with a response rate of 87%. In-person hypnotherapy sessions are considered to be more valuable than approaches limited to self-hypnosis/home treatment and the use of audio tapes, although these approaches are more economical for the client. Attitude, stress and anxiety have shown to be associated with IBS flareups and treatment response, so a holistic hypnotherapeutic approach would include working on these issues.

Integr. Med.. 2000 Mar 21;2(2):127-131.
Hypnotherapy for crohn's disease. A promising complementary/alternative therapy.
Abela MB.
American Institute of Hypnotherapy,., Irvine, CA, USA

Crohn's disease is a nonspecific chronic syndrome of unknown origin for which, to date, no conventional (i.e., medical or surgical) cure exists. However, recent clinical case studies and anecdotal reports have shown that the use of different forms of hypnotherapy for the treatment of Crohn's have actually resulted in cures. This report reviews and compares the effectiveness of hypnotherapy in the treatment of Crohn's disease vis-a-vis current medical and surgical therapies, in addition to reviewing evidence of the modulation of immune function parameters by hypnosis, while providing support for current etiological hypotheses of Crohn's disease as an autoimmune disorder.

Int J Clin Exp Hypn. 2006 Jan;54(1):85-99.
Hypnosis home treatment for irritable bowel syndrome: a pilot study.
Palsson OS, Turner MJ, Whitehead WE. opalsson@med.unc.edu
Division of Digestive Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

Hypnosis treatment often improves irritable bowel syndrome (IBS), but the costs and reliance on specialized therapists limit its availability. A 3-month home-treatment version of a scripted hypnosis protocol previously shown to improve all central IBS symptoms was completed by 19 IBS patients. Outcomes were compared to those of 57 matched IBS patients from a separate study receiving only standard medical care. Ten of the hypnosis subjects (53%) responded to treatment by 3-month follow-up (response defined as more than 50% reduction in IBS severity) vs. 15 (26%) of controls. Hypnosis subjects improved more in quality of life scores compared to controls. Anxiety predicted poor treatment response. Hypnosis responders remained improved at 6-month follow-up. Although response rate was lower than previously observed in therapist-delivered treatment, hypnosis home treatment may double the proportion of IBS patients improving significantly across 6 months.

Int J Clin Exp Hypn. 2006 Jan;54(1):65-84.
Hypnosis for irritable bowel syndrome: the quest for the mechanism of action.
Simren M. magnus.simren@medicine.gu.se
Dept of Internal Medicine, Sahlgrenska University Hospital, Goteborg, Sweden.

Irritable bowel syndrome (IBS) is a very common condition in the Western part of the world, and it accounts for a large proportion of the workload of a gastroenterologist. Unfortunately, the pathogenesis and pathophysiology of the syndrome are incompletely understood, and the treatment options are limited. However, hypnotherapy is one treatment option that has proven to be very useful in IBS. The mechanisms of action explaining why hypnosis is effective for IBS are not altogether known, but recent studies have shed some light on this issue. These studies, and what can be learned from them about how hypnosis impacts IBS, are reviewed in this article. Hypnosis may affect IBS partly through changes in colorectal sensitivity and improvement in psychological factors. The effects on GI motility and the autonomic nervous system are less clear and need further evaluation.

Int J Clin Exp Hypn. 2006 Jan;54(1):7-20.
Hypnosis for irritable bowel syndrome: the empirical evidence of therapeutic effects.
Whitehead WE. William_Whitehead@med.unc.edu
University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA.

Irritable bowel syndrome (IBS) is a complex and prevalent functional gastrointestinal disorder that is treated with limited effectiveness by standard medical care. Hypnosis treatment is, along with cognitive-behavioral therapy, the psychological therapy best researched as an intervention for IBS. Eleven studies, including 5 controlled studies, have assessed the therapeutic effects of hypnosis for IBS. Although this literature has significant limitations, such as small sample sizes and lack of parallel comparisons with other treatments, this body of research consistently shows hypnosis to have a substantial therapeutic impact on IBS, even for patients unresponsive to standard medical interventions. The median response rate to hypnosis treatment is 87%, bowel symptoms can generally be expected to improve by about half, psychological symptoms and life functioning improve after treatment, and therapeutic gains are well maintained for most patients for years after the end of treatment.

Am J Clin Hypn. 2005 Jan;47(3):161-78.
Hypnosis and irritable bowel syndrome: a review of efficacy and mechanism of action.
Tan G, Hammond DC, Joseph G. Michael E. DeBakey tan.gabriel@med.va.gov
VA Medical Center, Baylor College of Medicine, Houston, TX 77030, USA.

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by abdominal pain, distension, and an altered bowel habit for which no cause can be found. Despite its prevalence, there remains a significant lack of efficacious medical treatments for IBS to date. In this paper we reviewed a total of 14 published studies (N=644) on the efficacy of hypnosis in treating IBS (8 with no control group and 6 with a control group). We concluded that hypnosis consistently produces significant results and improves the cardinal symptoms of IBS in the majority of patients, as well as positively affecting non-colonic symptoms. When evaluated according to the efficacy guidelines of the Clinical Psychology Division of American Psychological Association, the use of hypnosis with IBS qualifies for the highest level of acceptance as being both efficacious and specific. In reviewing the research on the mechanism of action as to how hypnosis works to reduce symptoms of IBS, some evidence was found to support both physiological and psychological mechanisms of action.

BMC Fam Pract. 2004 Oct 13;5:22.
General practitioners believe that hypnotherapy could be a useful treatment for irritable bowel syndrome in primary care.
Cox S, de Lusignan S, Chan T. stephen.cox@gp-h82615.nhs.uk
Gillets Surgery, Deanland Road, Balcome, West Sussex, RH17 6PH, UK.

BACKGROUND: Irritable bowel syndrome is a common condition in general practice. It occurs in 10 to 20% of the population, but less than half seek medical assistance with the complaint. METHODS: A questionnaire was sent to the 406 GPs listed on the West Sussex Health Authority Medical List to investigate their views of this condition and whether they felt hypnotherapy had a place in its management RESULTS: 38% of general practitioners responded. The achieved sample shared the characteristics of target sample.Nearly half thought that irritable bowel syndrome (IBS) was a "nervous complaint" and used a combination of "the placebo effect of personal care," therapeutic, and dietary advice. There is considerable divergence in the perceived effectiveness of current approaches. Over 70% thought that hypnotherapy may have a role in the management of patients with IBS; though the majority (68%) felt that this should not be offered by general practitioners. 84% felt that this should be offered by qualified hypnotherapist, with 40% feeling that this should be offered outside the health service. CONCLUSIONS: General practitioners vary in their perceptions of what constitutes effective therapy in IBS. They are willing to consider referral to a qualified hypnotherapist.

J Psychosom Res. 2004 Mar;56(3):271-8.
Cognitive change in patients undergoing hypnotherapy for irritable bowel syndrome.
Gonsalkorale WM, Toner BB, Whorwell PJ. wgonsalkorale@compuserve.com
Department of Medicine, University Hospital of South Manchester, Manchester, UK.

OBJECTIVE: Impaired quality of life and psychological distress are common in irritable bowel syndrome (IBS) and may be associated with unhelpful cognitions. Hypnotherapy (HT) is effective in improving both symptoms and quality of life in patients with IBS, and this study was designed to determine whether this improvement is reflected in cognitive change using a validated scale recently developed for use in such patients. METHOD: A total of 78 IBS patients completed a validated symptom-scoring questionnaire, the Hospital Anxiety and Depression (HAD) Scale and the Cognitive Scale for Functional Bowel Disorders (FBDs), before and after 12 sessions of gut-focused HT. RESULTS: HT resulted in improvement of symptoms, quality of life and scores for anxiety and depression (all P's<.001). IBS-related cognitions also improved, with reduction in the total cognitive score (TCS; P<.001) and all component themes related to bowel function (all P<.001). Cognitions were related to symptom severity because the most abnormal cognitive scores were observed in patients with the highest symptom scores (P<.001). Furthermore, a reduction in symptom score following treatment correlated with an improvement in the cognitive score (P<.001). Regression analysis confirmed that the cognitive score had independence from the other scores and did not serve solely as a proxy for symptom improvement. CONCLUSION: This study shows that symptom improvement in IBS with HT is associated with cognitive change. It also represents an initial step in unravelling the many possible mechanisms by which treatments such as HT might bring about improvement.

Psychosom Med. 2004 Mar-Apr;66(2):233-8.
Treatment with hypnotherapy reduces the sensory and motor component of the gastrocolonic response in irritable bowel syndrome.
Simren M, Ringstrom G, Bjornsson ES, Abrahamsson H. magnus.simren@medicine.gu.se
Department of Internal Medicine, Sahlgrenska University Hospital, Goteborg, Sweden.

OBJECTIVE: Postprandial symptoms in irritable bowel syndrome are common and relate to an exaggerated motor and sensory component of the gastrocolonic response. We investigated whether this response can be affected by hypnotherapy. METHODS: We included 28 patients with irritable bowel syndrome refractory to other treatments. They were randomized to receive gut-directed hypnotherapy 1 hour per week for 12 weeks (N = 14) or were provided with supportive therapy (control group; N = 14). Before randomization and after 3 months, all patients underwent a colonic distension trial before and after a 1-hour duodenal lipid infusion. Colonic sensory thresholds and tonic and phasic motor activity were assessed. RESULTS: Before randomization, reduced thresholds after vs. before lipid infusion were seen in both groups for all studied sensations. At 3 months, the colonic sensitivity before duodenal lipids did not differ between groups. Controls reduced their thresholds after duodenal lipids for gas (22 +/- 1.7 mm Hg vs. 16 +/- 1.6 mm Hg, p <.01), discomfort (29 +/- 2.9 mm Hg vs. 22 +/- 2.6 mm Hg, p <.01), and pain (33 +/- 2.7 mm Hg vs. 26 +/- 3.3 mm Hg, p <.01), whereas the hypnotherapy group reduced their thresholds after lipids only for pain (35 +/- 4.0 mm Hg vs. 29 +/- 4.7 mm Hg, p <.01). The colonic balloon volumes and tone response at randomization were similar in both groups. At 3 months, baseline balloon volumes were lower in the hypnotherapy group than in controls (83 +/- 14 ml vs. 141 +/- 15 ml, p <.01). In the control group, reduced balloon volumes during lipid infusion were seen (141 +/- 15 ml vs. 111 +/- 19 ml, p <.05), but not after hypnotherapy (83 +/- 14 ml vs. 80 +/- 16 ml, p >.20). CONCLUSION: Hypnotherapy reduces the sensory and motor component of the gastrocolonic response in patients with irritable bowel syndrome. These effects may be involved in the clinical efficacy of hypnotherapy in IBS.

Dig Dis Sci. 2002 Nov;47(11):2605-14.
Hypnosis treatment for severe irritable bowel syndrome: investigation of mechanism and effects on symptoms.
Palsson OS, Turner MJ, Johnson DA, Burnelt CK, Whitehead WE.
University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7080 USA.

Hypnosis improves irritable bowel syndrome (IBS), but the mechanism is unknown. Possible physiological and psychological mechanisms were investigated in two studies. Patients with severe irritable bowel syndrome received seven biweekly hypnosis sessions and used hypnosis audiotapes at home. Rectal pain thresholds and smooth muscle tone were measured with a barostat before and after treatment in 18 patients (study I), and treatment changes in heart rate, blood pressure, skin conductance, finger temperature, and forehead electromyographic activity were assessed in 24 patients (study II). Somatization, anxiety, and depression were also measured. All central IBS symptoms improved substantially from treatment in both studies. Rectal pain thresholds, rectal smooth muscle tone, and autonomic functioning (except sweat gland reactivity) were unaffected by hypnosis treatment. However, somatization and psychological distress showed large decreases. In conclusion, hypnosis improves IBS symptoms through reductions in psychological distress and somatization. Improvements were unrelated to changes in the physiological parameters measured.

Am J Clin Hypn. 2002 Jul;45(1):31-7.
Hypnotherapy and refractory irritable bowel syndrome: a single case study.
Galovski TE, Blanchard EB.
State University of New York at Albany, USA.

The current study describes the successful administration of hypnotherapy with a subject suffering from refractory Irritable Bowel Syndrome (IBS) and Generalized Anxiety Disorder (GAD). The subject had suffered from IBS for 30 years and had unsuccessfully pursued multiple psychological treatments, both traditional and non-traditional. He was referred to the Center for Stress and Anxiety Disorders and commenced hypnotherapy directed primarily at the IBS symptoms. After 6 treatment sessions, his IBS symptomatology had improved 53%. He stopped treatment at that point and continued autohypnosis with the aid of treatment audiotapes provided by his therapist. Follow-up at 6 months indicated continued improvement (70%). A 2-year follow-up revealed an improvement of 38% in IBS symptomatology. Concurrent levels of depression and anxiety had also substantially decreased. Hypnotherapy is shown to be a viable, palatable, and enduring treatment option for an individual who had been refractory to many previous therapies.

Int J Colorectal Dis. 2000 Nov;15(5-6):328-34.
Hypnotherapy and therapeutic audiotape: effective in previously unsuccessfully treated irritable bowel syndrome?
Forbes A, MacAuley S, Chiotakakou-Faliakou E. alastair.forbes@ic.ac.uk
St Mark's Hospital, Watford Road, Harrow HA1 3UJ, UK.

Irritable bowel syndrome (IBS) is not always readily responsive to conventional therapy. Hypnotherapy is effective but time consuming and labour intensive. Preliminary data suggested equivalent value from a specially devised audiotape. Tape use is now compared with gut-directed hyponotherapy in a randomised controlled trial. Consenting patients (n = 52; 37 women) with established IBS were recruited to a 12-week study. All had failed dietary and pharmacological therapy. The median age was 37 years (range 19-71); median symptom duration was 60 months (8-480). Randomisation was to six sessions of individual hypnotherapy, or to the tape, with stratification according to predominant symptom. Symptom scores and validated psychological questionnaires were utilised. Twenty-five patients (18 women) received hypnotherapy, 27 the tape. Successful trance was induced in all hypnotherapy patients. By intention to treat, symptom scores improved in 76% of hypnotherapy patients and in 59% of tape patients (not significant). Amongst 45 patients providing a full set of symptom scores there was advantage to hypnotherapy, with a reduction in median score from 14 to 8.5 compared to an unchanged score of 13 in audiotape patients (P < 0.05). The assessor considered 52% in each group to have improved. Those with greater initial anxiety tended to be more compliant and more likely to respond. Gut-directed hypnotherapy and audiotapes appear valuable in resistant IBS. Although probably inferior to hypnotherapy, the ease and economy of tape use may be considered sufficient to recommend it as a second-line option in IBS, reserving hypnotherapy for failures.

Scand J Gastroenterol Suppl. 1999;230:49-51.
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.

Appl Psychophysiol Biofeedback. 1998 Dec;23(4):219-32.
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.

Semin Gastrointest Dis. 1999 Jan;10(1):14-9.
Stress and mind-body impact on the course of inflammatory bowel diseases.
Anton PA.
UCLA Department of Medicine, Los Angeles, CA, USA.

At present, the medical management of inflammatory bowel diseases (IBD) including Crohn's disease and ulcerative colitis, are focused on topical, locally active antiinflammatories and systemic immunosuppressives, which are thought to exert their targeted effects in the gastrointestinal mucosa. There is a paucity of controlled trials assessing the impact of mind, central nervous system (CNS), and neuromodulation on the overly active immune response in the intestinal mucosa. Patients and their physicians have long been aware of a strong association between attitude, stress, and flares of their IBD. Although reports to date remain mostly anecdotal, the degree to which mind-body influences and stress impact levels of local inflammation deserves closer attention with the aim of identifying contributing mechanisms, which may highlight new therapeutic interventions, as well as assist in identifying particular subsets of patients that may respond to novel forms of adjunctive treatments for IBD, including hypnosis, meditation, neuropeptide receptor modulation, and cortisol-releasing factor (CRF) modulation.

Am J Clin Hypn. 1997 Oct;40(2):111-7.
Hypnosis and the treatment of ulcerative colitis and Crohn's disease.
Schafer DW.
University of California, Irvine, USA.

Ulcerative colitis and Crohn's Disease can be cured if they are treated as autoimmune diseases with a special understanding of the personality conflicts in the patient. The author hypothesizes that all autoimmune diseases are characterized by a high normal amount of the aggressive instinctual drives and ambivalence about their realization. Each patient's personality causes the ambivalence to be somaticized into specific autoimmune bodies that aggressively are overproduced and then attack specific tissues. Hypnosis helps in gaining insight, reinforcing interpretations, handling stress, visualizing normal intestinal areas, and controlling of the autoimmune antibodies to the normal level. This paper deals specifically with these 2 diseases.

J Adv Nurs. 1986 Sep;11(5):561-7.
A stress management programme for inflammatory bowel disease patients.
Milne B, Joachim G, Niedhardt J.

This randomized controlled trial was designed to determine whether practising stress management techniques would decrease activity and promote psychosocial functioning in inflammatory bowel disease patients. Eighty ambulatory adults received a pre-intervention interview, at which time baseline data about disease activity and psychosocial functioning were collected. They were then randomly assigned to either the intervention or control group. The intervention group received six classes on stress management which included autogenics, personal planning skills and communication techniques. All 80 subjects were followed up at 4-month intervals for 1 year by interviewers who were blind to group designation. The data collection instruments, which were used at all assessment points, comprised three questionnaires: the Crohn's Disease Activity Index (CDAI) and the Inflammatory Bowel Disease (IBD) Stress Index. These instruments produced scores which decreased with improvement in physical and psychosocial well-being. At all assessment points, both the CDAI and IBD Stress Index scores dropped significantly (P less than 0.05) from baseline in the treatment group. However, there was no significant change in the scores of the control group throughout the study year. There were no significant changes in medications at any assessment point in either group that could account for changes in the scores. The results of this study indicate that stress management techniques may have therapeutic benefits for IBD patients.