Studies/reviews of hypnotherapy for IBS
(Irritable Bowel Syndrome) and related subjects

1982

1984

The Lancet December 1984, Volume 324, Issue 8414, Pages 1232–1234
Controlled trial of hypnotherapy in the treatment of severe refractory irritable-bowel syne drom
Whorwell PJ; Prior A; Faragher EB
Department of Medicine, University Hospital of South Manchester, Manchester M20 8LR, United Kingdom
ABSTRACT
Thirty 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.

1987

1989

1990

1992

1994

1996

Aliment Pharmacol Ther, – 1996 Feb, 10:1, 91-5.
Symptomatology, quality of life and economic features of irritable bowel syndrome—the effect of hypnotherapy
L. A. Houghton, D. J. Heynab, P. J. Whorwell

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.

1997

Postgraduate Medical Journal 73(855), 1-7
The irritable bowel syndromee
Francis CY & Whorwell PJ.
Department of Medicine, University Hospital of South Manchester, UK.
ABSTRACT & LINK
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Irritable bowel syndrome is a common disorder varying in severity from trivial to incapacitating. The pathophysiology and epidemiology are gradually being unravelled and it is now becoming apparent just how poor the quality of life of some of these patients can be. It is no longer acceptable practice to diagnose the condition and discharge the patient on a high fibre diet, particularly as the latter can often make the situation worse. Although hard to treat, worthwhile responses can be achieved by careful targeting of therapy to the many different facets of the disorder..

Gastroenterology 1997;112:A764
Hypnoanalgesia in the irritable bowel syndrome
Koutsomanis D.
Please Note: Currently unable to locate details of this French study of a dozen IBS patients. Other listings however reports reductions in analgesic medication and less abdominal pain experienced following a course of 6-8 analgesia-oriented hypnosis sessions followed by four sessions of autogenic training.

1998

Applied Psychophysiology & Biofeedback - Volume 23, Number 4 (1998), 219-232,
The Treatment of irritable bowel syndrome with hypnotherapy
Tara E. Galovski and Edward B. Blanchard
ABSTRACT
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.

1999

Scandinavian Journal of Gastroenterology, Vol 34, Supplement 230, 7 September 1999 , pp. 49-51(3)
Hypnotherapy in the treatment of irritable bowel syndrome: Methods and results in Amsterdam
Vidakovic-Vukic, M..
ABSTRACT:
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 succesful 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.

2000

Gut – 2000 November; 47(Suppl 2): ii1–ii19.
British Society of Gastroenterology guidelines for the management of the irritable bowel syndrome
J Jones, J Boorman, P Cann, A Forbes, J Gomborone, K Heaton, P Hungin, D Kumar, G Libby, R Spiller, N Read, D Silk, and P Whorwell.
LINK
Recommendations made by the British Society of Gastroenterology's Clinical Services Committee (UK) aimed at identifying key decisons to be made in the management of patients thought to have functional diseases of the gastrointestinal tract (functional dyspepsia and irritable bowel syndrome) are presented in this supplement.
The guidelines were compiled by a multidisciplinary group at the request of the chairman of the British Society of Gastroenterology's Clinical Services Committee.
The prime targets for these guidelines are consultant gastroenterologists, specialist registrars in training, and general practitioners. The purpose is to identify and inform the key decisions to be made in the management of patients thought to have functional diseases of the gut.
As these comprise the commonest conditions seen by gastroenterologists, the working party represented a wide spectrum of practitioners in gastroenterology, including gastroenterologists from both district general hospitals and tertiary referral centres, as well as primary care practitioners, psychiatrists, psychologists, and dietitians.
The aetiology, clinical features, diagnosis and management (both psychological and drug therapy) of irritable bowel syndrome were discussed.
The multidisciplinary group's report included the recommendation – "Those patients with prominent psychiatric morbidity may respond to psychotherapy or cognitive behavioural therapy or require conventional psychiatric treatment, while those with less psychopathology may respond well to hypnotherapy."

2001

2002

Gut – 2002;51:701-704 doi:10.1136/gut.51.5.701
Visceral sensation and emotion: a study using hypnosis
L A Houghton, E L Calvert, N A Jackson, P Cooper, P J Whorwell.
Department of Medicine, University Hospital of South Manchester, Manchester M20 2LR, UK
ABSTRACT & LINK
Background and objectives:
We have previously shown that hypnosis can be used to study the effect of different emotions on the motility of the gastrointestinal tract. These studies demonstrated that both anger and excitement increased colonic motility while happiness led to a reduction. The purpose of this study was to investigate the effect of hypnotically induced emotion on the visceral sensitivity of the gut.
Methods:
Sensory responses to balloon distension of the rectum and compliance were assessed in 20 patients with irritable bowel syndrome (IBS) (aged 17–64 years; 17 female) diagnosed by the Rome I criteria. Patients were studied on four separate occasions in random order either awake (control) or in hypnosis, during which anger, happiness, or relaxation (neutral emotion) were induced.
Results:
Hypnotic relaxation increased the distension volume required to induce discomfort (p=0.05) while anger reduced this threshold compared with relaxation (p<0.05), happiness (p<0.01), and awake conditions (p<0.001). Happiness did not further alter sensitivity from that observed during relaxation. There were no associated changes in rectal compliance or wall tension.
Conclusions:
Further to our previous observations on motility, this study shows that emotion can also affect an IBS patient’s perception of rectal distension and demonstrates the critical role of the mind in modulating gastrointestinal physiology. These results emphasise how awareness of the emotional state of the patient is important when either measuring visceral sensitivity or treating IBS.

Gastroenterology – Vol 123, Issue 6 , (2132-2135), December 2002
The growing case for hypnosis as adjunctive therapy for functional gastrointestinal disorders
Olafur S. Palsson, William E. Whiteheadl
Center for Functional Gastrointestinal & Motility Disorders, University of North Carolina, Chapel Hill, North Carolina

Editorial in the in Gastroenterology concluded that though some studies on hypnotherapy for functional gastrointestinal disorders had been small and lacking methodological rigour "the cumulative and consistent evidence for efficacy of hypnotherapy for these disorders seems to warrant serious consideration of its use as a regular adjunct in primary care and gastroenterology treatment of patients with FD and IBS."

American Journal of Gastroenterology – 2002;97:954-961
Hypnotherapy in Irritable Bowel Syndrome: A Large-Scale Audit of a Clinical Service With Examination of Factors Influencing Responsiveness
Wendy M. Gonsalkorale, Ph.D., Lesley A. Houghton, Ph.D., and Peter J. Whorwell, MD., F.R.C.P.
Department of Medicine, University Hospital of South Manchester, Manchester M20 2LR, UK
OBJECTIVES:
Hypnotherapy has been shown to be effective in the treatment of irritable bowel syndrome in a number of previous research studies. This has led to the establishment of the first unit in the United Kingdom staffed by six therapists that provides this treatment as a clinical service.
This study presents an audit on the first 250 unselected patients treated, and these large numbers have also allowed analysis of data in terms of a variety of other factors, such as gender and bowel habit type, that might affect outcome.
METHODS:
Patients underwent 12 sessions of hypnotherapy over a 3-month period and were required to practice techniques in between sessions. At the beginning and end of the course of treatment, patients completed questionnaires to score bowel and extracolonic symptoms, quality of life, and anxiety and depression, allowing comparisons to be made.
RESULTS:
Marked improvement was seen in all symptom measures, quality of life, and anxiety and depression (all ps < 0.00l), in keeping with previous studies. All sub-groups of patients appeared to do equally well, with the notable exception of males with diarrhea, who improved far less than other patients (p < 0.001). No factors, such as anxiety and depression or other prehypnotherapy variables, could explain this lack of improvement.
CONCLUSIONS:
This study clearly demonstrates that hypnotherapy remains an extremely effective treatment for irrita ble bowel syndrome and should prove more cost-effective as new, more expensive drugs come on to the market. It may be less useful in males with diarrhea-predominant bowel habit. a finding that may have pathophysiological implications.

2003

Alimentary Pharmacology & Therapeutics - Vol 17, Issue 5, pages 635–642, March 2003
Gut-focused hypnotherapy normalises disordered rectal sensitivity in patients with irritable bowel syndrome
Lea, L. A. Houghton, E. L. Calvert, S. Larder, W. M. Gonsalkorale, V. Whelan, J. Randles, P. Cooper, P. Cruickshanks, V. Miller, P. J. Whorwell
FULL REPORT AVAILABLE HERE

Summary
Background : We have previously shown that hypnotherapy alters rectal sensitivity in some patients with irritable bowel syndrome. However, this previous study used incremental volume distension of a latex balloon, which might be susceptible to subject response bias and might compromise the assessment of compliance. In addition, the study group was symptomatically rather than physiologically defined.
Aim : To assess the effect of hypnotherapy on rectal sensitivity in hypersensitive, hyposensitive and normally sensitive irritable bowel syndrome patients using a distension technique (barostat) that addresses these technical issues.
Methods : Twenty-three irritable bowel syndrome (Rome I) patients (aged 24–72 years) were assessed before and after 12 weeks of hypnotherapy in terms of rectal sensitivity, symptomatology, anxiety and depression. Normal values for sensitivity were established in 17 healthy volunteers (aged 20–55 years).
Results : Compared with controls, 10 patients were hypersensitive, seven hyposensitive and six normally sensitive before treatment. Following hypnotherapy, the mean pain sensory threshold increased in the hypersensitive group (P = 0.04) and decreased in the hyposensitive group, although the latter failed to reach statistical significance (P = 0.19). Normal sensory perception was unchanged. Sensory improvement in the hypersensitive patients tended to correlate with a reduction in abdominal pain (r = 0.714, P = 0.07).
Conclusion : Hypnotherapy improves abnormal sensory perception in irritable bowel syndrome, leaving normal sensation unchanged.

2004

Journal of Psychosomatic Research - Vol 56, Issue 3, March 2004, Pages 271–2780
Cognitive change in patients undergoing hypnotherapy for irritablebowelsyndrome
Wendy M Gonsalkorale, (a), , Brenda B Toner (b), Peter J Whorwel (a)
Gastroenterology and Hepatology, Department of Internal Medicine, Sahlgrenska University Hospital, S-41345, Göteborg, Sweden.

Objective
Impaired quality of life and psychological distress are common in irritablebowelsyndrome (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 IBSpatients 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.

2005

European Journal of Gastroenterology and Hepatology - January 2005 - Vol 17 - Issue 1 - pp 15-20
Hypnotherapy in the treatment of irritable bowel syndrome
Gonsalkorale, Wendy M; Whorwell, Peter J
ABSTRACT:
There is accumulating and compelling evidence that hypnotherapy is an effective treatment for irritable bowel syndrome. Recently, studies have shown that hypnotherapy has beneficial effects that are long lasting, with most patients maintaining improvement, and with decreased consultation and medication needs in the long term. The particular gut directed approach used, which is aimed at normalizing and controlling gut function, is also described. While the mechanisms of how hypnotherapy brings about its therapeutic effect are not fully known, changes in colonic motility and rectal sensitivity have been demonstrated, although changes in central processing and psychological effects may also play a role.

2006

International Journal of Clinical & Experimental Hypnosis – 2006 Jan;54(1):7-20.
Hypnosis for irritable bowel syndrome: the empirical evidence of therapeutic effects
Whitehead WE..
University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA.
ABSTRACT & LINK
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.

International Journal of Clinical & Experimental Hypnosis – 2006 Jan;54(1):85-99
Hypnosis home treatment for irritable bowel syndrome: a pilot study
Palsson OS, Turner MJ, Whitehead WE.
Division of Digestive Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
ABSTRACT & LINK
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.

2007

Digestive and Liver Disease - Vol 39, Issue 3, March 2007, Pages 201–215
New insights into the pathogenesis and pathophysiology of irritablebowelsyndrome
L. Öhman, M. Simrén,
Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
ABSTRACT & DOWNLOADABLE PDF
The pathogenesis and pathophysiology of irritable bowel syndrome is complex and still incompletely known. Potential pathogenetic factors include genes, infectious events, psychological symptoms and other loosely defined environmental factors. Both alterations at the central and peripheral level are thought to contribute to the symptoms of irritable bowel syndrome, including psychosocial factors, abnormal gastrointestinal motility and secretion, and visceral hypersensitivity. Today irritable bowe lsyndrome is viewed upon as a disorder of dysregulation of the so-called brain–gut axis, involving abnormal function in the enteric, autonomic and/or central nervous systems, with peripheral abnormalities probably dominating in some patients and disturbed central processing of signals from the periphery in others. Lines of evidence also suggest that inflammation within the gastrointestinal tract may be of great importance in at least subgroups of irritable bowel syndrome patients.
The paper includes the observation: "Further support for the critical role of the mind in modulating visceral sensitivity comes from studies using hypnosis, where different emotions induced during hypnosis affected rectal sensitivity in different ways and gut-directed hypnotherapy per se also affects colorectal sensitivity"

2008

Report commissioned by National Institute for Health & Clinical Excellence (NICE) – 28 Feb 2008
Irritable bowel syndrome in adults: diagnosis and management of irritable bowel syndrome in primary care
National Collaborating Centre for Nursing and Supportive Care
ABSTRACT:
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This guideline was developed by the National Collaborating Centre for Nursing and Supportive Care (NCCNSC) on behalf of the National Institute for Health and Clinical Excellence (NICE). It was commissioned and funded by NICE and developed in accordance with NICE processes and methodologies.
Among it recommendations was that hypnotherapy be considered for refractory IBS while it also included a 17-page chapter on hypnotherapy for IBS followed by a five-page section on indirect comparisons of psychological interventions plus two pages of evidence on the inquiry’s recommendations for psychotherapy, CBT and hypnotherapy.
For commentary on the report by a hypnotherapist and its possible implications for gut-directed hypnotherapy CLICK HERE

World Journal of Gastroenterology – 2008 November 7; 14(41): .
Hypnosis and upper digestive function and disease
Giuseppe Chiarioni, Olafur S Palsson, and William E Whitehead
ABSTRACT & LINK TO FULL REPORT
Hypnosis is a therapeutic technique that primarily involves attentive receptive concentration. Even though a small number of health professionals are trained in hypnosis and lingering myths and misconceptions associated with this method have hampered its widespread use to treat medical conditions, hypnotherapy has gained relevance as an effective treatment for irritable bowel syndrome not responsive to standard care. More recently, a few studies have addressed the potential influence of hypnosis on upper digestive function and disease. This paper reviews the efficacy of hypnosis in the modulation of upper digestive motor and secretory function. The present evidence of the effectiveness of hypnotherapy as a treatment for functional and organic diseases of the upper bowel is also summarized, coupled with a discussion of potential mechanisms of its therapeutic action.
CONCLUSION:
Hypnosis is an altered state of consciousness characterised by highly focused attention and heightened compliance with suggestion. Clinical hypnosis can be used to treat a range of complex psychological or somatic diseases, but this generally requires a structured form of hypnotherapy intervention consisting of several sessions. Hypnosis has a long history of applications in medicine, and is now formally recognised as a valuable aid for various medical problems. However, a limited number of health professionals offer hypnotherapy for medical problems, and it has traditionally been hampered by misconceptions shrouding this psychological intervention. Yet, sufficient evidence has amassed over the years to firmly support the effectiveness of hypnotherapy for various pain problems, as well as to treat IBS, a complex and prevalent functional disorder of the lower bowel. Recently, a few studies have addressed the potential influence of both single-session hypnosis and a course of hypnotherapy on upper digestive function and diseases with encouraging results.
Hypnosis delivered on a single session by an expert therapist has been shown capable of modulating gastric secretion and accelerating gastric emptying in healthy volunteers. In addition, hypnosis has improved gastric emptying and epigastric sensations in severe functional dyspepsia. Small bowel transit may also be influenced by hypnosis.
In the past, hypnotherapy has been used with a successful outcome to decrease the relapsing rate of peptic ulcer disease. More recently, two randomised controlled trials have shown hypnotherapy to be a highly effective treatment for functional dyspepsia and functional chest pain of presumed esophageal origin unresponsive to standard care. In both of these upper gastrointestinal diseases, clinical benefits were well maintained at long-term follow-ups. However, both of these studies were carried out by the same research team -- the Manchester group in England. Additional well designed studies from independent investigators are eagerly awaited to substantiate the efficacy of hypnotherapy in this domain.

2009

Cochrane Database Syst Review – 2009 Jan 21;(1):CD006442. .
Psychological treatments for the management of irritable bowel syndrome
(Hypnotherapy for Irritable Bowel Syndrome - a Systematic Review)
J. Hefner, A. Rilk, B. M. Herbert, S. Zipfel, P. Enck, U. MartensZijdenbos IL, de Wit NJ, van der Heijden GJ, Rubin G, Quartero AO.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Stratenum 6.131, P.O. Box 85500, Utrecht, Netherlands, 3508
ABSTRACT:
BACKGROUND:
No consensus exists on the optimal treatment for irritable bowel syndrome (IBS). Psychological treatments are increasingly advocated but their effectiveness is unclear.
OBJECTIVES:
To evaluate the efficacy of psychological interventions for the treatment of irritable bowel syndrome.
SEARCH STRATEGY:
A computer assisted search of MEDLINE, EMBASE, PsychInfo, CINAHL, Web of Science, The Cochrane Library and Google Scholar was performed for the years 1966-2008. Local databases were searched in Europe.
SELECTION CRITERIA:
Randomised trials comparing single psychological interventions with either usual care or mock interventions in patients over 16 years of age. No language criterion was applied.
DATA COLLECTION AND ANALYSIS:
The search identified 25 studies that fulfilled the inclusion criteria. The relative risk (RR), risk difference (RD), number needed to treat (NNT) and standardized mean difference (SMD) along with 95% confidence intervals were calculated using a random effects model for each outcome.
MAIN RESULTS:
Psychological interventions as a group The SMD for symptom score improvement at 2 and 3 months was 0.97 (95% CI 0.29 to 1.65) and 0.62 (95% CI 0.45 to 0.79) respectively compared to usual care. Against placebo, the SMDs were 0.71 (95% CI 0.08 to 1.33) and -0.17 (95% CI -0.45 to 0.11) respectively. For improvement of abdominal pain, the SMDs at 2 and 3 months were 0.54 (95%CI 0.10 to 0.98) and 0.26 (95% CI 0.07 to 0.45) compared to usual care. The SMD from placebo at 3 months was 0.31 (95% CI -0.16 to 0.79). For improvement in quality of life, the SMD from usual care at 2 and 3 months was 0.47 (95%CI 0.11 to 0.84) and 0.31 (95%CI -0.16 to 0.77) respectively. Cognitive behavioural therapy The SMD for symptom score improvement at 2 and 3 months was 0.75 (95% CI -0.20 to 1.70) and 0.58 (95% CI 0.36 to 0.79) respectively compared to usual care. Against placebo, the SMDs were 0.68 (95% CI -0.01 to 1.36) and -0.17 (95% CI -0.45 to 0.11) respectively. For improvement of abdominal pain, the SMDs at 2 and 3 months were 0.45 (95% CI 0.00 to 0.91) and 0.22 (95% CI -0.04 to -0.49) compared to usual care. Against placebo the SMD at 3 months was 0.33 (95% CI -0.16 to 0.82). For improvement in quality of life, the SMDs at 2 and 3 months compared to usual care were 0.44 (95% CI 0.04 to 0.85) and 0.92 (95% CI 0.07 to 1.77) respectively.Interpersonal psychotherapy The RR for adequate relief of symptoms was 2.02 (95% CI 1.13 to 3.62), RD 0.30 (95% CI 0.13 to 0.46), NNT 4 for comparison with care as usual. The SMD for improvement of symptom score was 0.35 (95% CI -0.75 to 0.05) compared with usual care. Relaxation/Stress management The SMD in symptom score improvement at 2 months was 0.50 (95%CI 0.02 to 0.98) compared with usual care. The SMD in improvement of abdominal pain at 3 months was 0.02 (95%CI -0.56 to 0.61) compared with usual care. Long term results Very few long term follow-up results were available. There was no convincing evidence that treatment effects were sustained following completion of treatment for any treatment modality.
AUTHORS' CONCLUSIONS:
Psychological interventions may be slightly superior to usual care or waiting list control conditions at the end of treatment although the clinical significance of this is debatable. Except for a single study, these therapies are not superior to placebo and the sustainability of their effect is questionable. The meta-analysis was significantly limited by issues of validity, heterogeneity, small sample size and outcome definition. Future research should adhere to current recommendations for IBS treatment trials and should focus on the long-term effects of treatment.

2010

Gastroenterology & Hepatology (N Y). 2010 November; 6(11): 705–711
Complementary and alternative medicine modalities for the treatment of irritable bowel syndrome: Facts or myths?
Justin C. Y. Wu, Dr. Wu
Dept of Medicine & Therapeutics & Institute of Digestive Disease, Chinese University of Hong Kong and Prince of Wales Hospital, Shatin, Hong Kong
ABSTRACT & LINK
Due to unsatisfactory results from conventional treatment of irritable bowel syndrome (IBS), complementary and alternative medicine (CAM) modalities are increasingly popular treatment alternatives. Unfortunately, most CAM clinical trials have been of poor quality, and the efficacies of these therapies have not been adequately elucidated, even through systematic reviews or meta-analyses. There is also a general lack of understanding of their mechanisms of action. Currently, insufficient evidence exists to support the use of traditional Chinese medicine, acupuncture, meditation, and reflexology for treatment of IBS. However, there is some evidence supporting the use of peppermint oil and gut-directed hypnotherapy for IBS treatment. Due to mounting evidence of the microbiologic and immunologic basis of IBS, probiotics and exclusion diets are also becoming promising treatment modalities. This paper will review the current literature on various CAM practices for IBS treatment and appraise their advantages and disadvantages in clinical practice.

2012

American Journal of Gastroenterology – 2012 Feb;107(2):276-85
Effects of gut-directed hypnotherapy on IBS in different clinical settings-results from two randomized, controlled trials
Lindfors P, Unge P, Arvidsson P, Nyhlin H, Björnsson E, Abrahamsson H, Simrén M.
ABSTRACT:
OBJECTIVES:
Gut-directed hypnotherapy has been found to be effective in irritable bowel syndrome (IBS). However, randomised, controlled studies are rare and few have been performed outside highly specialised research centres. The objective of this study was to study the effect of gut-directed hypnotherapy in IBS in different clinical settings outside the traditional research units.
METHODS:
The study population included IBS patients refractory to standard management. In study 1, patients were randomised to receive gut-directed hypnotherapy (12 sessions, 1 h/week) in psychology private practices or supportive therapy, whereas patients were randomised to receive gut-directed hypnotherapy in a small county hospital or to serve as waiting list controls in study 2. Gastrointestinal symptom severity and quality of life were evaluated at baseline, at 3 months follow-up and after 1 year.
RESULTS:
We randomised 138 IBS patients refractory to standard management, 90 in study 1 and 48 in study 2. In both the studies, IBS-related symptoms were improved at 3 months in the gut-directed hypnotherapy groups (P<0.05), but not in the control groups (ns). In study 1, a significantly greater improvement of IBS-related symptom severity could be detected in the gut-directed hypnotherapy group than in the control group (P<0.05), and a trend in the same direction was seen in study 2 (P=0.17). The results seen at 3 months were sustained up to 1 year.
CONCLUSIONS:
Gut-directed hypnotherapy is an effective treatment alternative for patients with refractory IBS, but the effectiveness is lower when the therapy is given outside the highly specialised research centres.

Scandinavian Journal of Gastroenterology [2012, 47(4):414-20]
Long-term effects of hypnotherapy in patients with refractory irritable bowel syndrome
Lindfors P, Unge P, Nyhlin H, Ljótsson B, Björnsson ES, Abrahamsson H, Simrén M
Dept of Internal medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
ABSTRACT:
OBJECTIVES:
Gut-directed hypnotherapy is considered to be an effective treatment in irritable bowel syndrome (IBS) but few studies report the long-term effects. This retrospective study aims to evaluate the long-term perceived efficacy of gut-directed hypnotherapy given outside highly specialized hypnotherapy centers.
METHODS:
208 patients, who all had received gut-directed hypnotherapy, were retrospectively evaluated. The Subjective Assessment Questionnaire (SAQ) was used to measure changes in IBS symptoms, and patients were classified as responders and non-responders. Patients were also asked to report changes in health-care seeking, use of drugs for IBS symptoms, use of alternative non-pharmacological treatments, and if they still actively used hypnotherapy.
RESULTS:
Immediately after hypnotherapy, 103 of 208 patients (49%) were responders and 75 of these (73%) had improved further at the follow-up 2-7 years after hypnotherapy (mean 4 years). A majority of the responders still used hypnotherapy on a regular basis at follow-up (73%), and the responders reported a greater reduction in health-care seeking than non-responders. A total of 87% of all patients reported that they considered gut-directed hypnotherapy to be worthwhile, and this differed between responders and non-responders (100% vs. 74%; p < 0.0001).
CONCLUSION:
This long-term follow-up study indicates that gut-directed hypnotherapy in refractory IBS is an effective treatment option with long-lasting effects, also when given outside highly specialized hypnotherapy centers. Apart from the clinical benefits, the reduction in health-care utilization has the potential to reduce the health-care costs.

Current Gastroenterology Reports [2012]
Meditation over Medication for Irritable Bowel Syndrome? On Exercise and Alternative Treatments for Irritable Bowel Syndrome
Asare F, Störsrud S, Simrén M
Dept of Internal Medicine and clinical nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 41345, Sweden
ABSTRACT:
Complimentary alternative treatment regimens are widely used in irritable bowel syndrome (IBS), but the evidence supporting their use varies. For psychological treatment options, such as cognitive behavioral therapy, mindfulness, gut-directed hypnotherapy, and psychodynamic therapy, the evidence supporting their use in IBS patients is strong, but the availability limits their use in clinical practice. Dietary interventions are commonly included in the management of IBS patients, but these are primarily based on studies assessing physiological function in relation to dietary components, and to a lesser degree upon research examining the role of dietary components in the therapeutic management of IBS. Several probiotic products improve a range of symptoms in IBS patients. Physical activity is of benefit for health in general and recent data implicates its usefulness also for IBS patients. Acupuncture does not seem to have an effect beyond placebo in IBS. A beneficial effect of some herbal treatments has been reported.

2013

American Journal of Gastroenterology – 107, 627-631 (19 February 2013)
Long-Term Success of GUT-Directed Group Hypnosis for Patients With Refractory Irritable Bowel Syndrome: A Randomized Controlled Trial
Gabriele Moser MD1, Silja Trägner MD1, Ewelina Elwira Gajowniczek MD1, Andrea Mikulits MD1, Maria Michalski MD1, Lili Kazemi-Shirazi MD1, Stefanie Kulnigg-Dabsch MD1, Martina Führer MD2, Elisabeth Ponocny-Seliger PhD3, Clemens Dejaco MD1 and Wolfgang Miehsler MD1
1Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
2Anton Proksch Institute (Psychiatry), Vienna, Austria
3Sigmund Freud Private University, Vienna, Austria
ABSTRACT:
Objectives:
Gut-directed hypnotherapy (GHT) in individual sessions is highly effective in the treatment of irritable bowel syndrome (IBS). This study aimed to assess the long-term effect of GHT in group sessions for refractory IBS.
Methods:
A total of 164 patients with IBS (Rome-III-criteria) were screened, and 100 refractory to usual treatment were randomized 1:1 either to supportive talks with medical treatment (SMT) or to SMT with GHT (10 weekly sessions within 12 weeks). The primary end point was a clinically important improvement on several dimensions of daily life (assessed by IBS impact scale) after treatment and 12-month follow-up. The secondary end point was improvement in general quality of life (QOL; Medical Outcome Study Short-Form-36), psychological status (Hospital Anxiety Depression Scale) and reduction of single IBS symptoms. Analysis was by intention to treat.
Results:
A total of 90 patients received allocated intervention. After treatment, 28 (60.8%) out of 46 GHT patients and 18 (40.9%) out of 44 SMTs improved (absolute difference 20.0%; 95% confidence interval (CI): 0–40.2%; P=0.046); over 15 months, 54.3% of GHT patients and 25.0% of controls improved (absolute difference 29.4%; 95% CI 10.1–48.6%; P=0.004). GHT with SMT improved physical and psychological well being significantly more than SMT alone (P<0.001). Gender, age, disease duration and IBS type did not have an influence on the long-term success of GHT.
Conclusions:
GHT improves IBS-related QOL, is superior to SMT alone, and shows a long-term effect even in refractory IBS.

Background
Gut-directed hypnotherapy can reduce IBS symptoms, but the mechanisms underlying this therapeutic effect remain unknown.
Aim
To determine the effect of hypnotherapy and educational intervention on brain responses to cued rectal distensions in IBS patients.
Methods
Forty-four women with moderate-to-severe IBS and 20 healthy controls (HCs) were included. Blood oxygen level dependent (BOLD) signals were measured by functional Magnetic Resonance Imaging (fMRI) during expectation and delivery of high- (45 mmHg) and low-intensity (15 mmHg) rectal distensions. Twenty-five patients were assigned to hypnotherapy (HYP) and 16 to educational intervention (EDU). Thirty-one patients completed treatments and posttreatment fMRI.

Results
Similar symptom reduction was achieved in both groups. Clinically successful treatment (all responders) was associated with significant BOLD attenuation during high-intensity distension in the dorsal and ventral anterior insula (cluster size 142, P = 0.006, and cluster size 101, P = 0.005 respectively). Moreover HYP responders demonstrated a pre–post treatment BOLD attenuation in posterior insula (cluster sizes 59, P = 0.05) while EDU responders had a BOLD attenuation in prefrontal cortex (cluster size 60, P = 0.05). Pre–post differences for expectation conditions were almost exclusively seen in the HYP group. Following treatment, the brain response to distension was similar to that observed in HCs, suggesting that the treatment had a normalising effect on the central processing abnormality of visceral signals in IBS.

Conclusions
The abnormal processing and enhanced perception of visceral stimuli in IBS can be normalised by psychological interventions. Symptom improvement in the treatment groups may be mediated by different brain mechanisms.

BMC Pediatrics June 2014
Gut-directed hypnotherapy in children with irritable bowel syndrome or functional abdominal pain (syndrome): a randomized controlled trial on self exercises at home using CD versus individual therapy by qualified therapists
Juliette MTM RuttenEmail author, Arine M Vlieger, Carla Frankenhuis, Elvira K George, Michael Groeneweg, Obbe F Norbruis, Walther Tjon a Ten, Herbert Van Wering, Marcel GW Dijkgraaf, Maruschka P Merkus and Marc A Benninga
Link to full report
ABSTRACT:
Background
Irritable bowel syndrome (IBS) and functional abdominal pain (syndrome) (FAP(S)) are common pediatric disorders, characterized by chronic or recurrent abdominal pain. Treatment is challenging, especially in children with persisting symptoms. Gut-directed hypnotherapy (HT) performed by a therapist has been shown to be effective in these children, but is still unavailable to many children due to costs, a lack of qualified child-hypnotherapists and because it requires a significant investment of time by child and parent(s). Home-based hypnotherapy by means of exercises on CD has been shown effective as well, and has potential benefits, such as lower costs and less time investment. The aim of this randomized controlled trial (RCT) is to compare cost-effectiveness of individual HT performed by a qualified therapist with HT by means of CD recorded self-exercises at home in children with IBS or FAP(S).

Methods/Design
260 children, aged 8-18 years with IBS or FAP(S) according to Rome III criteria are included in this currently conducted RCT with a follow-up period of one year. Children are randomized to either 6 sessions of individual HT given by a qualified therapist over a 3-month period or HT through self-exercises at home with CD for 3 months.

The primary outcome is the proportion of patients in which treatment is successful at the end of treatment and after one year follow-up. Treatment success is defined as at least 50% reduction in both abdominal pain frequency and intensity scores. Secondary outcomes include adequate relief, cost-effectiveness and effects of both therapies on depression and anxiety scores, somatization scores, QoL, pain beliefs and coping strategies.

Discussion
If the effectiveness of home-based HT with CD is comparable to, or only slightly lower, than HT by a therapist, this treatment may become an attractive form of therapy in children with IBS or FAP(S), because of its low costs and direct availability.

Methods:
Studies were identified by a literature search of the databases Allied and Complementary Medicine Database, Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, PubMed, PsycINFO, and Scopus (from inception to June 30, 2013). Primary outcomes were adequate symptom relief, global gastrointestinal score, and safety. Summary relative risks (RRs) with number needed to treat (NNT) and standardized mean differences (SMDs) with 95% confidence intervals (95% CIs) were calculated using random-effects models.

Results:
Eight randomized controlled trials with a total of 464 patients and a median of 8.5 (7–12) hypnosis sessions over a median of 12 (5–12) weeks were included into the analysis. At the end of therapy, hypnosis was superior to control conditions in producing adequate symptom relief (RR, 1.69 [95% CI = 1.14–2.51]; NNT, 5 [3–10]) and in reducing global gastrointestinal score (SMD, 0.32 [95% CI = −0.56 to −0.08]). At long-term follow-up, hypnosis was superior to controls in adequate symptom relief (RR, 2.17 [95% CI = 1.22–3.87]; NNT, 3 [2–10]), but not in reducing global gastrointestinal score (SMD, −0.57 [−1.40 to 0.26]). One (0.4%) of 238 patients in the hypnosis group dropped out due to an adverse event (panic attack).

Conclusion:
This meta-analysis demonstrated that hypnosis was safe and provided long-term adequate symptom relief in 54% of patients with irritable bowel syndrome refractory to conventional therapy.

Methods
A literature search was performed using MEDLINE (PubMed), Embase, PsycINFO and the Cochrane Central Register of Controlled Trials (CENTRAL database). Only randomized controlled trials that compared hypnotherapy with any other conventional treatment or no treatment in patients with IBS were included. Studies had to report outcomes as IBS symptom score or quality of life. The mean change in outcome score was used to pool these outcomes for the meta-analysis. Data were synthesized using the standardized mean difference for continuous data.

Results
Seven randomized controlled trials (6 papers) involving 374 patients with IBS were identified. Performance bias was high in all trials because it was impossible to blind participants and therapists in this type of intervention. The outcomes in this meta-analysis were evaluated at 3 months for short-term effects and at 1 year for long-term effects. The change in abdominal pain score at 3 months was significant in the hypnotherapy group (standardized mean difference, -0.83; 95% CI, -1.65 to -0.01). Three of the 4 trials showed greater improvement in overall gastrointestinal symptoms in the hypnotherapy group.

Conclusions
This study provides clearer evidence that hypnotherapy has beneficial short-term effects in improving gastrointestinal symptoms of patients with IBS.

Alimentary Pharmacology & Therapeutics

Review article: gut-directed hypnotherapy in the management of irritable bowel syndrome and inflammatory bowel disease

S. L. Peters, J. G. Muir, P. R. Gibson
First published: 10 April 2015 https://doi.org/10.1111/apt.13202Citations: 63
This uncommissioned review article was subject to full peer-review.

Background
Gut-directed hypnotherapy is being increasingly applied to patients with irritable bowel syndrome (IBS) and to a lesser extent, inflammatory bowel disease (IBD).
Aim
To review the technique, mechanisms of action and evidence for efficacy, and to identify gaps in the understanding of gut-directed hypnotherapy as a treatment for IBS and IBD.

Methods
A review of published literature and a systematic review of clinical trials in its application to patients with IBS and IBD were performed.

Results
Gut-directed hypnotherapy is a clearly described technique. Its potential mechanisms of action on the brain-gut axis are multiple with evidence spanning psychological effects through to physiological gastrointestinal modifications. Six of seven randomised IBS studies reported a significant reduction (all P < 0.05) in overall gastrointestinal symptoms following treatment usually compared to supportive therapy only. Response rates amongst those who received gut-directed hypnotherapy ranged between 24% and 73%. Efficacy was maintained long-term in four of five studies. A therapeutic effect was also observed in the maintenance of clinical remission in patients with ulcerative colitis. Uncontrolled trials supported the efficacy and durability of gut-directed hypnotherapy in IBS. Gaps in understanding included to whom and when it should be applied, the paucity of adequately trained hypnotherapists, and the difficulties in designing well controlled-trials.

Conclusions
Gut-directed hypnotherapy has durable efficacy in patients with IBS and possibly ulcerative colitis. Whether it sits in the therapeutic arsenal as a primary and/or adjunctive therapy cannot be ascertained on the current evidence base. Further research into efficacy, mechanisms of action and predictors of response is required.
Psychological treatments
Hypnotherapy and CBT are the most extensively studied psychological treatments within IBS and IBD populations. Other promising treatments include psycho-education, acceptance and commitment therapy and various forms of biofeedback. The application of hypnosis for the treatment of IBS was first described by Whorwell and colleagues at the University Hospital of South Manchester in the 1980s and is known commonly today as ‘gut-directed hypnotherapy’.17 While initially used for IBS, gut-directed hypnotherapy has recently been applied to patients with IBD.
Hypnotherapy
The therapeutic technique
Hypnotherapy refers to the use of hypnosis as a therapeutic technique. Typically, hypnosis involves an introduction where suggestions for imaginative experiences are presented. A hypnotic induction will then follow, with the aim of allowing the subject to enter an altered consciousness or trance state. Once in the trance state, suggestions for changes in subjective experience, alterations in perception, sensation, emotion, thought or behaviour are presented. In gut-directed, as opposed to standard hypnotherapy, suggestions are made for the control and normalisation of gastrointestinal function (normally on a repetitive basis) and metaphors are used for bringing about improvement, as outlined in Table 1. This differs from other forms of psychological treatment where therapy is provided to patients in a conscious state.

Conclusions
Despite the limitations of study design, evidence is mounting that gut-directed hypnotherapy has durable efficacy in patients with IBS and possibly IBD without apparent safety issues. Where it might sit in the therapeutic arsenal alongside dietary, pharmacological and other therapies, as a primary therapy and/or an adjunct to conventional therapy, cannot be ascertained on the current evidence-base. Further research into efficacy, predictors of response and mechanisms of action are imperative.

Authorship
Guarantor of the article: Peter R. Gibson.
Author contributions: Writing of the manuscript: Simone L. Peters and Peter R. Gibson. All authors approved the final version of the manuscript.

Alimentary Pharmacology & Therapeutics
Randomised clinical trial: the efficacy of gut-directed hypnotherapy is similar to that of the low FODMAP diet for the treatment of irritable bowel syndrome

S. L. Peters, C. K. Yao, H. Philpott, G. W. Yelland, J. G. Muir, P. R. Gibson

First published: 11 July 2016 https://doi.org/10.1111/apt.13706Citations: 87
The Handling Editor for this article was Professor Alex Ford, and it was accepted for publication after full peer-review.

Background
A low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet is effective in treating irritable bowel syndrome (IBS).

Aim
To compare the effects of gut-directed hypnotherapy to the low FODMAP diet on gastrointestinal symptoms and psychological indices, and assess additive effects.

Methods
Irritable bowel syndrome patients were randomised (computer-generated list), to receive hypnotherapy, diet or a combination. Primary end-point: change in overall gastrointestinal symptoms across the three groups from baseline to week 6. Secondary end-points: changes in psychological indices, and the durability of effects opublication after full peer-review.

Results
Of 74 participants, 25 received hypnotherapy, 24 diet and 25 combination. There were no demographic differences at baseline across groups. Improvements in overall symptoms were observed from baseline to week 6 for hypnotherapy [mean difference (95% CI): −33 (−41 to −25)], diet [−30 (−42 to −19)] and combination [−36 (−45 to −27)] with no difference across groups (P = 0.67). This represented ≥20 mm improvement on visual analogue scale in 72%, 71% and 72%, respectively. This improvement relative to baseline symptoms was maintained 6 months post-treatment in 74%, 82% and 54%. Individual gastrointestinal symptoms similarly improved. Hypnotherapy resulted in superior improvements on psychological indices with mean change from baseline to 6 months in State Trait Personality Inventory trait anxiety of −4(95% CI −6 to −2) P < 0.0001; −1(−3 to 0.3) P = ns; and 0.3(−2 to 2) P = ns, and in trait depression of −3(−5 to −0.7) P = 0.011; −0.8(−2 to 0.2) P = ns; and 0.6(−2 to 3) P = ns, respectively. Groups improved similarly for QOL (all p ≤ 0.001).

Conclusions
Durable effects of gut-directed hypnotherapy are similar to those of the low FODMAP diet for relief of gastrointestinal symptoms. Hypnotherapy has superior efficacy to the diet on psychological indices. No additive effects were observed.

Conclusions
Durable effects of gut-directed hypnotherapy are similar to those of the low FODMAP diet for relief of gastrointestinal symptoms. Hypnotherapy has superior efficacy to the diet on psychological indices. No additive effects were observed.

Gut-directed hypnotherapy
Those randomised to receive gut-directed hypnotherapy underwent 1-h hypnosis sessions weekly for 6 weeks. The sessions were based on the well-established Manchester model.14 The sessions were scripted (i.e. the same for each participant) and were conducted with an appropriately trained and experienced clinical hypnotherapist (SLP). Participants were provided with a pre-recorded compact disc that was identical to the first session's script and were asked to listen to it daily during the 6-week intervention period. After the gut-directed hypnotherapy intervention was completed, the participants kept the compact disc and were able to listen to it at their choosing. Continued use of the compact disc in the follow-up period was not a requirement of the study. Adherence to gut-directed hypnotherapy was measured according to the attendance at scheduled sessions and to daily use of the compact disc during the intervention phase. Adherence was arbitrarily defined as attending all sessions and no more than two missed days of listening to the compact disc per week over the 6-week study period, as recorded by SLP at each hypnosis session.

JAMA Pediatr. 2017;171(5):470-477. doi:10.1001/jamapediatrics.2017.0091
Home-based hypnotherapy self-exercises vs Individual hypnotherapy with a therapist for treatment of pediatric Irritable Bowel Syndrome, Functional Abdominal Pain, or Functional Abdominal Pain Syndrome: A randomized Clinical Trial
TJuliette M. T. M. Rutten, MD, PhD; Arine M. Vlieger, PhD; Carla Frankenhuis; et al
Department of Pediatric Gastroenterology, Emma Children’s Hospital and Academic Medical Center, Amsterdam, the Netherlands
Key Points:
Question:  What is the effectiveness of home-based hypnotherapy exercises compared with individual hypnotherapy performed by qualified therapists in children with functional abdominal pain?
Findings:  This noninferiority randomized clinical trial of 250 analyzed children found that the effectiveness of home-based treatment with hypnosis was noninferior to individual hypnotherapy performed by therapists 1 year after the end of treatment.
Meaning:  Hypnotherapy is a highly valuable treatment in children with functional abdominal pain and should be incorporated in national guidelines and reimbursed by health insurance companies. This study provides a rationale for the implementation of an easy-to-use home-based treatment in daily practice.
Abstract
Importance  Individual gut-directed hypnotherapy (HT) is effective in pediatric irritable bowel syndrome (IBS) and functional abdominal pain or functional abdominal pain syndrome (FAP[S]). It is, however, unavailable to many children.
Objective:  To compare the effectiveness of HT by means of home-based self-exercises using a CD with that of individual HT (iHT) performed by qualified therapists.
Design, Setting, and Participants  This noninferiority randomized clinical trial with a follow-up of 1 year after the end of treatment was conducted from July 15, 2011, through June 24, 2013, at 9 secondary and tertiary care centers throughout the Netherlands. A total of 303 children were eligible to participate. Of those, 260 children (aged 8-18 years) with IBS or FAP(S) were included in this study. Children were randomized (1:1 ratio) to home-based HT with a CD (CD group) or iHT performed by qualified therapists (iHT group). No children withdrew from the study because of adverse effects.
Interventions  The CD group was instructed to perform exercises 5 times per week or more for 3 months. The iHT group consisted of 6 sessions during 3 months.
Main Outcomes and Measures  Primary outcomes were treatment success directly after treatment and after 1-year follow-up. Treatment success was defined as a 50% or greater reduction in pain frequency and intensity scores. The noninferiority limit was set at 50% treatment success in the CD group, with a maximum of 25% difference in treatment success with the iHT group after 1-year follow-up. Modified intention-to-treat analyses were performed.
Results  A total of 132 children were assigned to the CD group and 128 to the iHT group; 250 children were analyzed (126 in the CD group and 124 in the iHT group) (mean [SD] age, 13.4 [2.9] years in the CD group and 13.3 [2.8] years in the iHT group; 94 female [74.6%] in the CD group and 85 [68.5%] in the iHT group). Directly after treatment, 46 children (36.8%) in the CD group and 62 (50.1%) in the iHT group were successfully treated. After 1-year follow-up, the 62.1% treatment success in the CD group was noninferior to the 71.0% in the iHT group (difference, −8.9%; 90% CI, −18.9% to 0.7%; P = .002).
Conclusions and Relevance  Long-term effectiveness of home-based HT with a CD is noninferior to iHT performed by therapists in pediatric IBS or FAP(S). Treatment with hypnosis using a CD provides an attractive treatment option for these children,

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