Clinical research studies on hypnotherapy for Irritable Bowel Syndrome

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

NOTE TO RESEARCHERS AND THERAPISTS

The list is in chronological order of publication rather than in alphabetical order of authors as one of its aims is to provide an indication of the development of research over the years. Text below which set in green indicates links or a downloadable pdf.

Time and effort has been given to trying to ensure information about papers and other publications listed here is accurate and as comprehensive as possible. Therefore if you notice errors – or are aware of additional studies which could be appropriately included within this page – please contact us by emailing
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The information on this page cataloguing research studies in the use of hypnotherapy for IBS can be downloaded as a 17-page PDF file by clicking the logo to the right
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This page was last updated   16th January 2016

1982

Scandinavian Journal of Gastroenterology Supplement –. 1982;79:16-9.
Symptoms in irritable bowel syndrome
Dotevall G, Svedlund J, Sjödin I.
Department of Medicine, University Hospital of South Manchester, Manchester M20 8LR, United Kingdom

ABSTRACT
In a consecutive study of 101 patients with IBS and at least one year of complaints, the presence of somatic and mental symptoms were measured. By definition all patients had abdominal pain and/or disturbed bowel function in the absence of organic disease. The most prominent symptom of indigestion was abdominal distension. Many patients also had complaints of food intolerance and avoided bulk forming agents such as fruits and vegetables. Symptoms associated with the upper gastrointestinal tract such as burning sensations in the epigastrium nausea and acid regurgitation were seen in a majority of the patients.
Mental symptoms were seen in almost all patients. A majority had complaints of inner tension, worrying over trifles, autonomic disturbances and muscular tension. Symptoms referred to the neurasthenic syndrome were also frequently seen, such as fatiguability and irritable and hostile feelings. Common depression symptoms were sadness and feelings of helplessness. Other mental symptoms of importance were phobias, sleep disturbances, reduced sexual interest, loss of appetite and obsessive-compulsive symptoms. Our conclusion is that patients with IBS frequently have upper gastrointestinal and mental symptoms which should be taken into account searching for more rational methods of treatment.

1984

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

Gut 1987;28:423-425 doi:10.1136/gut.28.4.423
Hypnotherapy in severe irritable bowel syndrome: further experience.
P J Whorwell, A Prior, S M Colgan
ABSTRACT
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Fifteen patients with severe intractable irritable bowel syndrome previously reported as successfully treated with hypnotherapy, have now been followed up for a mean duration of 18 months. All patients remain in remission although two have experienced a single relapse overcome by an additional session of hypnotherapy. Experience with a further 35 patients is reported giving a total group of 50. This group was divided into classical cases, atypical cases and cases exhibiting significant psychopathology. The response rates were 95%, 43%, and 60% respectively. Patients over the age of 50 years responded very poorly (25%) whereas those below the age of 50 with classical irritable bowel syndrome exhibited a 100% response rate. This study confirms the successful effect of hypnotherapy in a larger series of patients with irritable bowel syndrome and defines some subgroup variations.


1989

The Lancet - Vol 333, Issue 8635, 25 February 1989, Pages 424–425
Individual and Group Hypnotherapy in treatment of refractory irritable bowel syndrome
R.F. Harvey, R.M. Gunary, R.A. Hinton, R.E. Barry
a Gastroenterology Unit, Frenchay Hospital, Bristol;, United Kingdom
b Reproductive Medicine Clinic, Bristol General Hospital;, United Kingdom
c Department of Clinical Psychology, Southmead Hospital, Bristol;, United Kingdom

d and University Department of Medicine, Bristol Royal Infirmary, United Kingdom
ABSTRACT
Thirty-three patients with refractoryirritablebowelsyndrome were treated with four 40-minute sessions of hypnotherapy over seven weeks. 20 improved, 11 of whom lost almost all their symptoms. Short-term improvement was maintained for three months without further formal treatment. Hypnotherapy in groups of up to eight patients was as effective as individual therapy.

Gastroenterology – Vol 96, Issue 6, 1989, Pages 1383-1387
Modulation of gastric acid secretion by hypnosis
Klein, K.B., Spiegel, D
School of Medicine, University of North Carolina, Chapell Hill, NC, USA

ABSTRACT
The ability of hypnosis to both stimulate and inhibit gastric acid secretion in highly hypnotizable healthy volunteers was examined in two studies. In the first, after basal acid secretion was measured, subjects were hypnotized and instructed to imagine all aspects of eating a series of delicious meals. Acid output rose from a basal mean of 3.60 ± 0.48 to a mean of 6.80 ± 0.02 mmol H+/h with hypnosis, an increase of 89% (p = 0.0007). In a second study, subjects underwent two sessions of gastric analysis in random order, once with no hypnosis and once under a hypnotic instruction to experience deep relaxation and remove their thoughts from hunger. When compared to the no-hypnosis session, with hypnosis there was a 39% reduction in basal acid output (4.29 ± 0.93 vs. 2.60 ± 0.44 mmol H+/h, p < 0.05) and an 11% reduction in pentagastrin-stimulated peak acid output (28.69 ± 2.34 vs. 25.43 ± 2.98 mmol H+/h, p < 0.05).
We have shown that different cognitive states induced by hypnosis can promote or inhibit gastric acid production, processes clearly controlled by the central nervous system. Hypnosis offers promise as a safe and simple method for studying the mechanisms of such central control.

1990

Gut – 1990;31:896-898 doi:10.1136/gut.31.8.896
Changes in rectal sensitivity after hypnotherapy in patients with irritable bowel syndrome.
A Prior, S M Colgan, P J Whorwell
Department of Medicine, University Hospital of South Manchester
.
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Fifteen patients with the irritable bowel syndrome were studied to assess the effect of hypnotherapy on anorectal physiology. In comparison with a control group of 15 patients who received no hypnotherapy significant changes in rectal sensitivity were found in patients with diarrhoea-predominant irritable bowel syndrome both after a course of hypnotherapy and during a session of hypnosis (p less than 0.05). Although patient numbers were small, a trend towards normalisation of rectal sensitivity was also observed in patients with constipation-predominant irritable bowel syndrome. No changes in rectal compliance or distension-induced motor activity occurred in either subgroup nor were any changes in somatic pain thresholds observed. The results suggest that symptomatic improvement in irritable bowel syndrome after hypnotherapy may in part be due to changes in visceral sensitivity.


1992

Lancet. – 1992 Jul 11;340(8811):69-72
Physiological effects of emotion: assessment via hypnosis.
Whorwell PJ, Houghton LA, Taylor EE, Maxton DG.l
Department of Medicine, University Hospital of South Manchester.

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Assessment of the physiological effects of physical and emotional stress has been hampered by a lack of suitable laboratory techniques. Since hypnosis can be used safely to induce specific emotional states of considerable intensity, we studied the effect on distal colonic motility of three hypnotically induced emotions (excitement, anger, and happiness) in 18 patients aged 20-48 years with irritable bowel syndrome. Colonic motility index was reduced by hypnosis on its own (mean change 19.1; 95% CI 0.8, 37.3; p less than 0.05) and this change was accompanied by decreases in both pulse (12; 8, 15) and respiration (6; 4, 8) rates (p less than 0.001 for both). Anger and excitement increased the colonic motility index (50.8; 29.4, 72.2; and 30.4; 8.9, 51.9, respectively; p less than 0.01 for both), pulse rate (26; 22, 30; and 28; 24, 32; p less than 0.001 for both), and respiration rate (14; 12, 16; and 12; 10, 14; p less than 0.001 for both). Happiness further reduced colonic motility although not significantly from that observed during hypnosis alone. Changes in motility were mainly due to alterations in rate than in amplitude of contractions. Our results indicate that hypnosis may help in the investigation of the effects of emotion on physiological functions; this approach could be useful outside the gastrointestinal system. Our observation that hypnosis strikingly reduces fasting colonic motility may partly explain the beneficial effects of this form of therapy in functional bowel disorders.

1994

British Medical Journal – 1994 December 17; 309(6969): 1647–1648..
Irritable bowel or irritable mind? Psychological treatment is essential for some.
Francis Creed.
Department of Psychiatry, Manchester Royal Infirmary, UK
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Strong evidence exists that the irritable bowel syndrome has an important psychological component. Firstly, about half of patients with the irritable bowel syndrome in a hospital clinic have psychiatric disorder when assessed by research criteria. This is two or three times greater than the prevalence among patients with organic gastrointestinal conditions such as peptic ulcers or inflammatory bowel disturbance and healthy controls (<20%),' suggesting a strong association between the irritable bowel syndrome and psychological disorder. Although anxiety, depression, and sexual problems might be the consequence of persistent abdominal symptoms, they are not found to the same extent in patients with organic diseases that also lead to persistent abdominal symptoms. The anxiety and depression might explain attendance at the hospital rather than the occurrence of the symptoms, but people attending hospital also have much worse intestinal symptoms than people with the irritable bowel syndrome in the community, and the anxiety almost certainly exacerbates the pain and bowel dysfunction.

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
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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.


American Journal of Gastroenterology – Spring 1996
Hypnotherapy and functional bowel disorders.
Wendy M,  Gonsalkorale, Peter J Whorwell
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Although the symptoms of irritable bowel syndrome (IBS) are very prevalent in the general population, only the minority with IBS who seek treatment tend to be somewhat psychologically distressed. Four different classes of psychological treatment (brief psychodynamic psychotherapy, hypnotherapy, multicomponent cognitive-behavioral treatment regimens, and cognitive therapy) have each been shown to be superior to symptom monitoring or routine clinical medical care. Results with cognitive therapy and hypnotherapy have been replicated and have been found to be superior to attention-placebo control conditions. Benefits from psychological treatment have been maintained at up to 4 years. Close collaboration between psychologists and gastroenterologists is urged in the assessment and management of this patient population.

Professional Psychology: Research and Practice, Vol 27(3), Jun 1996, 241-244.
Psychological treatment of irritable bowel syndrome.
Blanchard, Edward B.; Malamood, Howard S.
ABSTRACT & LINK
Although the symptoms of irritable bowel syndrome (IBS) are very prevalent in the general population, only the minority with IBS who seek treatment tend to be somewhat psychologically distressed. Four different classes of psychological treatment (brief psychodynamic psychotherapy, hypnotherapy, multicomponent cognitive-behavioral treatment regimens, and cognitive therapy) have each been shown to be superior to symptom monitoring or routine clinical medical care. Results with cognitive therapy and hypnotherapy have been replicated and have been found to be superior to attention-placebo control conditions. Benefits from psychological treatment have been maintained at up to 4 years. Close collaboration between psychologists and gastroenterologists is urged in the assessment and management of this patient population.

American Journal of Gastroenterology – 1996 Feb;91(2):277-83.
Psychological treatments for irritable bowel syndrome: a critique of controlled treatment trials
Talley NJ, Owen BK, Boyce P, Paterson K.
University of Sydney, Australia.
ABSTRACT & LINK
OBJECTIVE:
We aimed to determine the efficacy of psychological treatments in irritable bowel syndrome.
METHODS:
A systematic review of the literature on psychological treatments of IBS was performed using Medline (1966-1994) and Psychlit (1974-1994) and secondary references. Fully published studies in English were selected if they compared any type of "psychological" treatment of irritable bowel syndrome with a control group. Studies without any comparable control group, studies in which the subject group was not confined to irritable bowel syndrome sufferers, and those in which irritable bowel syndrome symptoms were not the primary outcome measures were excluded. Each study was reviewed using a structured format to examine methodological issues. A quality algorithm was developed a priori based on eight key requirements.
RESULTS:
Eight studies (57%) reported that a psychological treatment was superior to control therapy; five failed to detect a significant effect, and one did not report if psychological treatment was superior. By the quality algorithm, only one study (a hypnotherapy trial) exceeded the preset cutoff score of 6, but this study was poorly generalizable due to sample selection.
CONCLUSION:
The efficacy of psychological treatment for irritable bowel syndrome has not been established because of methodological inadequacies; future trials need to address these design limitations.

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.
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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.


Alimentary Pharmacology and Therapeutics June 1997
Patient-perceived severity of irritable bowel syndrome in relation to symptoms, health resource utilization and quality of life
B. A. Hahn, L. J. Kirchdoerfer, S. Fullerton, E. Mayer
.
ABSTRACT:
Aim:
In this study of patients with irritable bowel syndrome (IBS), we evaluated the relationship between patient-rated severity of IBS and patients' physical and psychological symptoms, health care resource use and quality of life.
Methods:
One hundred and twenty-six patients diagnosed with IBS were administered a series of questionnaires, including the Bowel Symptom Checklist, the Symptom Checklist-90 R (a psychological symptom checklist), the IBSQOL (a disease-specific quality of life instrument), the SF-36 (a general health status instrument), and a health resource utilization assessment that measured health care use, time loss from work, impact on productivity, and days worked with symptoms.
Results:
No relationship was found between IBS severity and gastrointestinal symptoms, except for a feeling of unpassed stool. IBS severity was also not related to psychological symptom severity. Direct traditional indicators of resource use (e.g. physician visits, hospital admissions and emergency room visits) were not significantly associated by severity level; however, indirect measures of resource use (e.g. number of days with pain, productivity and number of bed days) were related to severity. Quality of life was clearly associated with perceived IBS severity. Patients who rated themselves as very severe reported the lowest scores and had the poorest health for all quality of life dimensions measured.
Conclusions:
These findings suggest that perceived IBS severity is defined by the limitations the disease imposes, rather than by the symptoms. Patients with reduced productivity and decreased functioning for most of the quality of life indicators were those who rated their IBS as very severe. trials.
 

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 & LINK
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.


Gastroenterology – Vol 115, Issue 5, November 1998, Pages 1263–1271
Is rectal pain sensitivity a biological marker for irritable bowel syndrome: Psychological influences on pain perception
William E. Whitehead1, Olafur S. Palsson2

1
Division of Digestive Diseases and Nutrition and UNC Functional Gastrointestinal Disorders Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
2
Departments of Psychiatry and Family and Community Medicine, Eastern Virginia Medical School, Norfolk, Virginia
ABSTRACT & LINK
Background & Aims:
Rectal pain sensitivity has been called a biological marker for irritable bowel syndrome, but this conclusion may be premature. This article is a critical review of the evidence for psychological influences on perception.
Methods:
The world literature accessible through Index Medicus from 1973 to 1997 was systematically reviewed.
Results:
Evidence favoring a biological basis for pain sensitivity is that two thirds of patients report pain at abnormally low thresholds of rectal distention despite normal somatic pain thresholds. Pain thresholds are not correlated with anxiety or depression. Evidence favoring psychological influences on perception is that patients with the irritable bowel syndrome rate even sham distentions as more painful, and when perception tests that minimize psychological influences are used, they have normal sensory thresholds. Also, stress alters sensory thresholds. Sensitization by repeated distention has been cited as evidence of a biological basis for hyperalgesia, but it is not unique to patients with irritable bowel. Brain imaging shows that different regions are activated by painful distention in patients with irritable bowel syndrome, but this is consistent with psychological influences on perception.
Conclusions:
Psychological factors influence pain thresholds in patients with the irritable bowel syndrome. Two cognitive traits, selective attention to gastrointestinal sensations and disease attribution, may account for increased pain sensitivity

Gastroenterology International – Vol 11 No 1 pp 36-44 1998
Physiological and psychological aspects of irritable bowel syndrome and the role of hypnosis
W. M. Gonsalkorale, L.A Houghton, P. J. Whorwell
Department of Medicine, University Hospital of South Manchester, Manchester M20 2LR, UK
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Over the years, irritable bowel syndrome has largety been considered as either a psychological or motility disorder. More recently, the concept that visceral sensitivity may be abnormal has become fashionable although there is still much debate over whether this is manifested at the gut level or located more centrally in the nervous system. Obviously, until the pathogenesis of irritable bowel syndrome is better understood, the rational development of appropriate pharmacological approaches to treatment is going to be hampered. Approximately 15_years ago, we formulated the hypothesis that as long as irritable bowel syndrome results from a potentially reversible rather than irreversible dysfunction of physiological control mechanisms, then it may respond favorably to an approach aimed at encouraging the body to restore itself to normal. Hypnotherapy is such an approach and has the advantage of not being necessarily dependent on a complete understanding of the pathophysiological mechanisms involved.
This paper reviews some of our work in this field and how we have tried to also examine the effect of hypnosis on various pathogenetic mechanisms as they have become topical.

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

Gastroenterolgy – 2002;123:1778–1785
Long-term improvement in functional dyspepsia using hypnotherapy
Emma Louise Calvert, Lesley Anne Houghton, Patricia Cooper, Julie Morris, Peter James Whorwell
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Hypnotherapy was provided by a qualified therapist with patients given a tutorial that included basic pathophysiologic concepts of Functional Dyspepsia and how hypnotherapy might be used to treat the condition.
Hypnosis was induced using eye fixation and closure, followed by progressive muscular relaxation and standard deepening procedures. Suggestions of disease improvement were made using both tactile and imagery techniques. Patients were asked to place hand on abdomen and imagine a reduction of all symptoms. Suggestions of positive changes in motor activity, sensitivity, and secretion of acid and mucus were also introduced. All of these concepts of improvement were reinforced by any appropriate visualisation processes with which the patient felt comfortable.
Outcome:
The results, taken in conjunction with those obtained for IBS confirmed the efficacy of hypnotherapy in a group of functional disorders that are especially difficult to treat. They also warrant the evaluation of this form of treatment in other functional problems not necessarily confined to the gastrointestinal tract.

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.
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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."


International Journal of Colorectal DiseaseVol 15, Numbers 5-6 (2000)
Hypnotherapy and therapeutic audiotape: effective in previously unsuccessfully treated irritable bowel syndrome?
Alastair Forbes, Susan MacAuley & Efterpi Chiotakakou-Faliakou.
ABSTRACT AND LINK
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 hypnotherapy 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.

2001

World Journal Gastroenterol 2001; June 7(3):313-316
Non-pharmacological treatments in the irritable bowel syndrome
A Leahy and O Epstein
Centre for Gastroenterology, Royal Free and University College Medical School, London, UK
ABSTRACT:
Over the past two decades, there have been various attempts to treat IBS using non-pharmacological approaches. As evidence has accumulated to support a role for these interventions, both patients and gastroenterologists have shown increasing interest in exploring this approach to IBS treatment. In this review the authors considered the evidence for psychopathology in IBS and the efficacy of non-pharmacological interventions.
Hypnotherapy in IBS
Hypnotherapy is a state of unusual concentration on the suggestions of the therapist and a willingness to follow their instructions Whorwell et al have reported well constructed controlled trials of hypnotherapy in IBS. The technique is focused around a specific “gut directed” hypnosis protocol where the patient is taught to assert control over gut function and imagery whilst in an hypnotic state. Patients are given a simple account of intestinal smooth muscle physiology and hypnotised in a standard manner. The patient is then requested to place their hand on the abdomen and to sense both a positive feeling of abdominal warmth and increased control over gut function. During hypnosis, visualisation is also employed, using the analogy of a gently flowing river and a gently flowing bowel to reinforce a positive bowel image.
Whorwell’s initial study randomised thirty refractory IBS patients to seven sessions of either hypnotherapy or psychotherapy. When compared to psychotherapy, hypnotherapy was found to have a greater impact on abdominal pain, bowel habit, abdominal distension and general well-being. It should be noted, however, that the response rate in the psychotherapy group was much lower than those reported from other centres. Further experience of gut directed hypnotherapy has been reported in 250 IBS patients indicating an overall response rate of approximately 80%. Factors predicting a less satisfactory response to hypnosis includes atypical symptoms, older age and more profound psychological disturbance.
Two other independent groups have obtained similar results using gut directed hypnotherapy. Both these studies were uncontrolled but do appear to support the value of hypnotherapy in IBS. In addition, it has been reported that hypnotherapy in groups of up to eight patients is as effective as individual therapy. Further support for the effectiveness of hypnotherapy in IBS derives from studies on the effect of hypnotherapy on gut function. In two separate studies, hypnotherapy has been reported to reduce rectal sensitivity and colonic motility.
SUMMARY
Over the last two decades evidence has mounted to suggest that non-pharmacological therapies may be helpful in IBS. Like IBS trials of pharmacological therapies, the studies are often small and poorly controlled. The trials designed to account for a high placebo response rate have either compared non-pharmacological strategies with conventional treatment, or selected only patients who were placebo non-responders. There is broad agreement from the few adequately controlled trials that psychotherapy offers a clear additional therapeutic benefit over and above medical treatments. Hypnotherapy appears to be particularly potent, and, in expert hands, produces consistently impressive therapeutic results even in patients refractory to conventional IBS treatment.
Most IBS patients respond to standard medical treatments. Psychological strategies are time consuming, labour intensive and generally unavailable to the relatively large numbers of patients who might benefit. Consequently, these therapies are best reserved for selected patients who fail to respond to reassurance and education, dietary manipulation, antispasmodics and low dose amitriptyline. Increasingly, patients are expressing a preference for non-pharmacological treatment strategies. Where resources allow, it is not unreasonable to offer these patients a psychodynamic approach as first-line therapy. Ideally, the gastroenterologist should have access to a range of treatment strategies including diet, drugs, psychotherapy, hypnotherapy, relaxation therapy and biofeedback. New approaches such as gut directed, computer-aided biofeedback are particularly attractive as, unlike the interpersonal therapies, this mode of biofeedback does not require highly trained therapists and can be self-administered. Whatever the choice of non-pharmacological therapy, there is evidence that both the doctor and patient can expect symptom improvement, especially when conventional medical measures have failed.

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
LINK TO PDF VERSION
This was an editorial in the in Gastroenterology.
It 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
DOWNLOADABLE PDF
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.


Digestive Diseases and Sciences Volume 47, Number 11 (2002),
Hypnosis treatment for severe irritable bowel syndrome: Investigation of mechanism & effects on symptoms
Olafur S. Palsson, Marsha J. Turner, David A. Johnson, Charles K. Burnett and William E. Whitehead.
Department of Medicine and of Medical Statistics, Education and Research Centre, Wythenshawe Hospital, Southmoor Road, Manchester, United Kingdom
ABSTRACT & LINK
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.

Gastroenterolgy – 2002;123:1778–1785
Long-term improvement in functional dyspepsia using hypnotherapy
Emma Louise Calvert, Lesley Anne Houghton, Patricia Cooper, Julie Morris, Peter James Whorwell
LINK TO FULL REPORT
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Hypnotherapy was provided by a qualified therapist with patients given a tutorial that included basic pathophysiologic concepts of Functional Dyspepsia and how hypnotherapy might be used to treat the condition.
Hypnosis was induced using eye fixation and closure, followed by progressive muscular relaxation and standard deepening procedures. Suggestions of disease improvement were made using both tactile and imagery techniques. Patients were asked to place hand on abdomen and imagine a reduction of all symptoms. Suggestions of positive changes in motor activity, sensitivity, and secretion of acid and mucus were also introduced. All of these concepts of improvement were reinforced by any appropriate visualisation processes with which the patient felt comfortable.
Outcome:
The results, taken in conjunction with those obtained for IBS confirmed the efficacy of hypnotherapy in a group of functional disorders that are especially difficult to treat. They also warrant the evaluation of this form of treatment in other functional problems not necessarily confined to the gastrointestinal tract.

American Journal of Clinical Hypnosis – Vol 45, Issue 1, 2002 pp 31-37
Hypnotherapy and refractory irritable bowel syndrome: A single case study
Tara E. Galovski Ph.D. & Edward B. Blanchard
SUMMARY:
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 two-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.

 

American Journal of Gastroenterology (2002) 97, 954–961; doi:10.1111/j.1572-0241.2002.05615.x
Hypnotherapy in irritable bowel syndrome: a large-scale audit of a clinical service with examination of factors influencing responsiveness
Wendy M Gonsalkorale PhD, Lesley A Houghton PhD and Peter J Whorwell MD FRCP
Department of Medicine, University Hospital of South Manchester, Manchester, United Kingdom
ABSTRACT:
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 < 0.001), in keeping with previous studies. All subgroups 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 irritable 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
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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.


Alimentary Pharmacology & Therapeutics - Vol 22 Issue 11-12, 2003
Review article: the history of hypnotherapy and its role in the irritable bowel syndrome
Peter J Whorwel
Department of Medicine, University Hospital of South Manchester, Manchester, UK
SUMMARY & LINK
Hypnosis is a technique by which an individual can gain a degree of control over physiological as well as psychological function.This paper reviews the history of the phenomenon as well as the accumulating evidence that it is effective in relieving the symptoms of irritable bowel syndrome and improving the quality of life of sufferers. The physiological effects of hypnosis are also discussed coupled with an outline of how a hypnotherapy service might be provided.
Conclusion
Hypnotherapy undoubtedly helps a sizeable proportion of patients with severe IBS and functional dyspepsia and the mechanisms involved are beginning to be understood. The effects of treatment are sustained with cost benefits in terms of reduced medication needs and less absenteeism from work.
With the advent of new techniques of assessing brain activity such as functional magnetic resonance imaging, it seems likely that scientific interest in the phenomenon of hypnosis will continue to grow and that mechanistic research into the subject will flourish. However, its clinical application continues to be inhibited by a variety of prejudices that will probably be more difficult to overcome.

 

JAMA Internal Medicine February 10, 2003
A Systematic Review of Alternative Therapies in the Irritable Bowel Syndrome
Jennifer A. Spanier, BS; Colin W. Howden, MD; Michael P. Jones, MD

Abstract
The irritable bowel syndrome is a common disorder associated with a significant burden of illness, poor quality of life, high rates of absenteeism, and high health care utilization. Management can be difficult and treatment unrewarding; these facts have led physicians and patients toward alternative therapies. We explored a variety of treatments that exist beyond the scope of commonly used therapies for irritable bowel syndrome. Guarded optimism exists for traditional Chinese medicine and psychological therapies, but further well-designed trials are needed. Oral cromolyn sodium may be useful in chronic unexplained diarrhea and appears as effective as and safer than elimination diets. The roles of lactose and fructose intolerance remain poorly understood. Alterations of enteric flora may play a role in irritable bowel syndrome, but supporting evidence for bacterial overgrowth or probiotic therapy is lacking.

The irritable bowel syndrome (IBS) is a common disorder, with a prevalence of 14% to 24% in women and 5% to 19% in men.1 Although most individuals meeting diagnostic criteria for IBS will not seek care, it accounts for 12% of visits to primary care physicians and 28% of visits to gastroenterologists.2,3 In addition, IBS is associated with significant impairment in quality of life, high rates of absenteeism, and significantly increased health care costs.4- 7
Effective therapies are lacking. More than a decade ago, Klein8 commented that "not a single study has been published that provides compelling evidence that any therapeutic agent is efficacious in the global treatment of IBS." Little has changed. Attempts to introduce agents acting via serotonergic receptors have met with concerns about safety and efficacy.9,10 In addition, managed-care pressures have limited the time physicians can spend with patients. This is highly detrimental, as the physician-patient relationship is a critical determinant of treatment success.
The lack of efficacious therapies and diminution of the physician-patient relationship have been accompanied by increased use of complementary and alternative therapies.11 Between 11% and 43% of patients with gastrointestinal disorders use alternative or complementary techniques, and many consider them beneficial.12,13 Unfortunately, physicians are generally not well acquainted with these therapies, and there is a scarcity of reasonable data with which to become acquainted. This article reviews the available literature for alternative or complementary treatments of IBS.

Psychological therapies
Psychological therapies can be broadly classified as psychotherapy, behavior therapy, hypnotherapy, and multicomponent therapy. For purposes of analysis, each category is reviewed separately.
Hypnotherapy
Three of 6 articles were excluded because they were uncontrolled.72- 74 All 3 studies noted improvement with "gut-directed hypnotherapy" and reported response rates of 55%, 84%, and 93%.
Included studies also demonstrated benefits. Prior and colleagues75 reported improved tolerance to rectal balloon distention in diarrhea-predominant but not constipation-predominant IBS. No changes in rectal sensation were seen in a control group of 15 patients with IBS who did not receive hypnotherapy. Thirteen of 15 hypnotherapy-treated patients considered themselves improved. Whorwell et al,76 in their initial published trial of gut-directed hypnotherapy, reported hypnotherapy superior to placebo. Thirty subjects were randomized after a 2-week washout period. As placebo, a physician without specific training provided counseling focused on discussion of symptoms and exploration of emotional and stress factors contributing to symptoms. After a 3-month treatment period that included 7 therapy sessions, both groups showed significant improvement in scores for abdominal pain, distention, and well-being. No significant improvement was seen in the control group for bowel habit. Hypnotherapy was superior to control treatment in all measures. Galovski and Blanchard77 compared hypnotherapy with a symptom-monitoring wait-list condition in 6 matched pairs of patients with IBS. Hypnotherapy-treated patients had significant improvements in a composite score measuring symptoms of abdominal pain, diarrhea, constipation, bloating, flatulence, belching, and nausea. Individually, symptoms of pain, constipation, and flatulence showed significant improvement. No significant change was seen in depression scores, but significant improvement was seen in anxiety.


 
Gut 2003;52:1623-1629 doi:10.1136/gut.52.11.1623
Long term benefits of hypnotherapy for irritable bowel syndrome
W M Gonsalkorale, V Miller, A Afzal, P J Whorwell
Department of Medicine, University Hospital of South Manchester, Manchester, UK
ABSTRACT & LINK
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Background and aims:
There is now good evidence from several sources that hypnotherapy can relieve the symptoms of irritable bowel syndrome in the short term. However, there is no long term data on its benefits and this information is essential before the technique can be widely recommended. This study aimed to answer this question.
Patients and methods:
204 patients prospectively completed questionnaires scoring symptoms, quality of life, anxiety, and depression before, immediately after, and up to six years following hypnotherapy. All subjects also subjectively assessed the effects of hypnotherapy retrospectively in order to define their “responder status”.
Results:
71% of patients initially responded to therapy. Of these, 81% maintained their improvement over time while the majority of the remaining 19% claimed that deterioration of symptoms had only been slight. With respect to symptom scores, all items at follow up were significantly improved on pre-hypnotherapy levels (p<0.001) and showed little change from post-hypnotherapy values. There were no significant differences in the symptom scores between patients assessed at 1, 2, 3, 4, or 5+ years following treatment. Quality of life and anxiety or depression scores were similarly still significantly improved at follow up (p<0.001) but did show some deterioration. Patients also reported a reduction in consultation rates and medication use following the completion of hypnotherapy.
Conclusion:
This study demonstrates that the beneficial effects of hypnotherapy appear to last at least five years. Thus it is a viable therapeutic option for the treatment of irritable bowel syndrome.

The Lancet - Vol 324, Issue 8414, 1 December 1984, Pages 1232–1234
Controlled trial of hypnotherapy in treatment of severe refractory irritable bowel syndrome
P.J. Whorwell, Alison Prior, E.B. Faragher
Department of Medicine, University Hospital of South Manchester, Manchester, UK

ABSTRACT:
30 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.

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.
ABSTRACT:
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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.


Psychosomatic Medicine – March/April 2004 vol. 66 no. 2
Treatment with hypnotherapy reduces the sensory & motor component of the gastrocolonic response in IBS
Magnus Simrén, MD, PhD, Gisela Ringström, RN, Einar S. Björnsson, MD, PhD and Hasse Abrahamsson, MD, PhD
LINK TO FULL PDF VERSION
alternatively
ABSTRACT:
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.

Journal of Consulting and Clinical Psycholog –2004 Dec;72(6):1100-13.
Psychological treatments for irritable bowel syndrome: a systematic review and meta-analysis
Lackner JM, Mesmer C, Morley S, Dowzer C, Hamilton S.
Dept of Medicine, School of Medicine & Biomedical Sciences, University at Buffalo, State University of New York, NY 14215, USA
ABSTRACT:
This study conducted a systematic review to assess the quality of existing literature on psychological treatments for irritable bowel syndrome and to quantify the evidence for their efficacy. Three independent reviewers (two from England, one from the United States) coded the quality of 32 studies, 17 of which provided data suitable for meta-analysis.
Meta-analysis of efficacy data (50% reduction of symptoms) gave an odds ratio of 12 (95% confidence interval = 5.56-25.96) and a number needed to treat of 2. Psychological treatments are, as a class of interventions, effective in reducing symptoms compared with a pooled group of control conditions. Questions regarding the relative superiority of specific psychological treatments and influence of active versus nonspecific treatment effects remain unanswered.

Gastroenterology & Hepatology - Vol 20 Issue 11-12
Meta-analysis: the treatment of irritable bowel syndrome
D. Lesbros-Pantoflickova, P. Michetti, M. Fried, C. Beglinger, A. L. Blum
LINK TO FULL REPORT
Summary
The stated purpose of this study was to evaluate therapies available for the treatment of irritable bowel syndrome, and provide consensus recommendations for their use, a total of 51 double-blind clinical trials using bulking agents, prokinetics, antispasmodics, alosetron, tegaserod and antidepressants were selected. The quality of studies was assessed using 5-point scale. Meta-analyses were performed on all studies, and on ‘high-quality studies.
NB The authors were critical of the quality of many of the trials, including psychotherapy, Their report on psychotherapy for instance stated:
1. Mechanism of action:  Psychological factors such as stressful or traumatic life events are reported by up to 60% of IBS patients, and are associated with the first onset of symptoms or with symptom exacerbation. Harmful events such as abuse, neglect or loss of a parent have been described in IBS patients and, to a certain degree, also in animals models.The aggregation of IBS in families of patients with IBS might also be due to learned responses which are transmitted in early childhood.3 These responses may imply a tendency towards anxiety, depression and somatization.
Thus, it has been suggested that reducing the severity of psychological distress by will alleviate the symptoms of IBS. Psychotherapy, such as cognitive-behavioural therapy,dynamic/interpersonal psychotherapy, hypnotherapy, and stress management may reduce autonomic arousal and anxiety and thus reduce the frequency and severity of symptoms.
There are a number of pathophysiological studies directly evaluating the effect of psychotherapy on GI motility or visceral sensitivity. Most of these studies are related to hypnotherapy. Some controlled studies with IBS patients reported reductions in fasting colonic motility or improvements in abnormal sensory perception in IBS patients with hypnotherapy compared with no treatment or supportive psychotherapy. However, others failed to find such an effect and attributed the improvement of IBS symptoms to reduction in psychological distress and somatization by psychotherapy.
2. Clinical evidence:  There have been numerous trials of psychological treatment in IBS. Many suffer of methodological inadequacies. The main problem of these studies are the absence of a true control group and lack of adequate blinding, leading to a bias assessment.
For example, hypnotherapy was reported to improve IBS symptoms compared with supportive psychotherapy, symptom-monitoring wait-list condition or no treatment. However, some measures such as the therapist contact time or degree of attention to symptoms are lower with these therapeutic procedures than with hypnotherapy. Thus, given the generous placebo response that accompanies trials of functional bowel disorders, the absence of adequate control groups may account for the favourable effect obtained with psychotherapy. Accordingly, in a adequately controlled trial in IBS subjects comparing cognitive behaviour and relaxation therapy to standard care alone showed a reduction in anxiety, depression, social functioning scale and bowel symptoms, with, however, no difference between the three approaches. In addition, similar therapies have been successfully used in organic disorders such as breast cancer. Thus, this type of therapy might simply modify illness behaviour, thus improving the handling of the disorder by the patient. Moreover, while some therapies such as cognitive behaviour therapy, appear efficacious in IBS patients, they are not cost-effective.212 In conclusion, the role for psychotherapy in IBS has not been established.

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:
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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.


American Journal of Clinical Hypnosis Vol 47, Issue 3, 2005
Hypnosis and Irritable Bowel Syndrome: A Review of Efficacy and Mechanism of Action
Gabriel Tan PhD , D. Corydon Hammondb & Joseph Gurrala
ABSTRACT:
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.

Journal of Pediatric Gastroenterology & Nutrition – September 2005 - Volume 41 - Issue - pp S49-S50
Hypnotherapy for Irritable Bowel Syndrome: A Role in Pediatric Practice?
Agrawal, A; Whorwell, P J
CONCLUSIONS & DOWNLOADABLE PDF
Hypnotherapy is very time consuming to provide and is therefore not really suitable for the busy physician to
undertake on a personal basis. We have shown that it can be readily provided by a team of qualified, non-medical
therapists, under the supervision of a specialist gastroenterologist who can provide the necessary medical back-up. The response rate is impressive and it has recently been suggested that “it is becoming increasingly hard to ignore the notion that the skills of the hypnotherapist should be made routinely available to patients with functional GI disorders”. This is
probably not yet practical but certainly the technique is worthy of consideration by departments specialising in
functional gastrointestinal disorders.
The provision of such a service leads to a large number of referrals and because it only has a finite response rate, it is important 'to have a contingency for caring for patients who do not respond. In our department we achieve this goal by having a nurse counsellor to provide continuing support for these individuals.
There has been very little research into the use of hypnotherapy for functional gastrointestinal disorders in the pediatric setting. However, the technique has utility down to at least the age of six years’ old and therefore its use in pediatric gastroenterology is certainly worthy of further exploration.

Alimentary Pharmacology & Therapeutics Vol ume 22, Issue 11-12, pages 1061–1067, December 2005
Review article: the history of hypnotherapy and its role in the irritable bowel syndrome
Whorwell, P J
SUMMARY & LINKS TO PAPER
Alternatively
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This paper reviews the history of hypnotherapy as well as the accumulating evidence that it is effective in relieving the symptoms of irritable bowel syndrome and improving the quality of life of sufferers. The physiological effects of hypnosis are also discussed coupled with an outline of how a hypnotherapy service might be provided.
Conclusion:
Hypnotherapy undoubtedly helps a sizeable proportion of patients with severe IBS and functional dyspepsia and the mechanisms involved are beginning to be understood. The effects of treatment are sustained with cost benefits in terms of reduced medication needs and less absenteeism from work.
With the advent of new techniques of assessing brain activity such as functional magnetic resonance imaging, it seems likely that scientific interest in the phenomenon of hypnosis will continue to grow and that mechanistic research into the subject will flourish. However, its clinical application continues to be inhibited by a variety of prejudices that will probably be more difficult to overcome.

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):27-50.
Gut-directed hypnotherapy: the Manchester approach for treatment of irritable bowel syndrome.
Gonsalkorale WM.
Department of Medicine, University Hospital of South Manchester, Manchester, UK.

ABSTRACT & LINK
This article describes the particular approach of using hypnosis as an adjunct to treating irritable bowel syndrome, developed within the Department of Medicine at the University Hospital of South Manchester, UK, since the 1980s. Patients receive up to 12 sessions over a 3-month period, and the majority of patients achieve marked improvement in symptoms and quality of life, an effect that is usually sustained. The therapy has a "gut-directed" framework that aims to teach patients the necessary hypnotic skills to control gut function and reduce symptoms, such as hand warmth on the abdomen and imagery. Other interventions based on particular lifestyle and psychological factors commonly found to influence symptoms are also included as appropriate for the individual patient.

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.


International Journal of Clinical & Experimental Hypnosis – 2006 Jan;54(1):100-12.
Effects of tailored and manualized hypnotic inductions for complicated irritable bowel syndrome patients
Barabasz A, Barabasz M..
Washington State University, Pullman, Washington 99164, USA.

ABSTRACT:
This modest clinical pilot study was intended to provide preliminary data on the effects of hypnotic inductions tailored to an irritable bowel syndrome patient at each session compared to Palsson's manualized protocol. Patients (N = 8) who had not previously responded to any form of treatment were assigned randomly to either a tailored or manualized induction condition. Other than pretesting for hypnotizability, the procedure followed for the manualized group (n = 4) was exactly as prescribed by O. Palsson (1998). The identical procedure was used for the other 4 patients except that the inductions were individualized. All 8 patients showed favorable responses to treatment immediately posttreatment and at 10-month follow-up. Only the tailored group showed no incapacitating pain at posttreatment but greater emotional stress than the manualized group. The tailored group continued to improve and showed better results than the manualized group at 10 months, and the posttreatment emotional distress was significantly attenuated.

British Journal of General Practice2006 February 1; 56(523): 115–121
Gut-directed hypnotherapy for irritable bowel syndrome: piloting a primary care-based randomised controlled trial
Lesley Roberts, PhD, Sue Wilson, Sukhdev Singh, Andrea Roalfe,
ABSTRACT:
Background
In western populations irritable bowel syndrome (IBS) affects between 10% and 30% of the population and has a significant effect on quality of life. It generates a substantial workload in both primary and secondary care and has significant cost implications. Gut-directed hypnotherapy has been demonstrated to alleviate symptoms and improve quality of life but has not been assessed outside of secondary and tertiary referral centres.
Aim
To assess the effectiveness of gut-directed hypnotherapy as a complementary therapy in the management of IBS.
Design of study
Randomised controlled trial.
Setting
Primary care patients aged 18–65 years inclusive, with a diagnosis of IBS of greater than 6 weeks' duration and having failed conventional management, located in South Staffordshire and North Birmingham, UK.
Method
Intervention patients received five sessions of hypnotherapy in addition to their usual management. Control patients received usual management alone. Data regarding symptoms and quality of life were collected at baseline and again 3, 6, and 12 months post-randomisation.
Results
Both groups demonstrated a significant improvement in all symptom dimensions and quality of life over 12 months. At 3 months the intervention group had significantly greater improvements in pain, diarrhoea and overall symptom scores (P<0.05). No significant differences between groups in quality of life were identified. No differences were maintained over time. Intervention patients, however, were significantly less likely to require medication, and the majority described an improvement in their condition.
Conclusions
Gut-directed hypnotherapy benefits patients via symptom reduction and reduced medication usage, although the lack of significant difference between groups beyond 3 months prohibits its general introduction without additional evidence. A large trial incorporating robust economic analysis is, therefore, urgently recommended.

International Journal of Clinical & Experimental Hypnosis – Vol 54, Issue 1, 2006
Effective management of irritable bowel syndrome—the Manchester model
Peter J. Whorwell..
Department of Medicine, University Hospital of South Manchester, Manchester, UK.

ABSTRACT:
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Over the years, researchers have shown that hypnotherapy can be exceptionally helpful in the management of refractory irritable bowel syndrome. However, it is a labor-intensive modality with a finite success rate and is not suitable for everyone. It is therefore best incorporated into a program of graduated care that has a contingency plan for dealing with individuals who do not respond to this particular form of treatment. This paper describes how hypnotherapy has been successfully integrated into the functional gastroenterology service in Manchester.
 
International Journal of Clinical & Experimental Hypnosis – Vol 54, Issue 1, 2006
Effective management of irritable bowel syndrome—the Manchester model
Peter J. Whorwell..
Department of Medicine, University Hospital of South Manchester, Manchester, UK.

ABSTRACT:
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Over the years, researchers have shown that hypnotherapy can be exceptionally helpful in the management of refractory irritable bowel syndrome. However, it is a labor-intensive modality with a finite success rate and is not suitable for everyone. It is therefore best incorporated into a program of graduated care that has a contingency plan for dealing with individuals who do not respond to this particular form of treatment. This paper describes how hypnotherapy has been successfully integrated into the functional gastroenterology service in Manchester.

British Medical Journal 2006 February 4; 332(7536): 280–283.
Irritable bowel syndrome: diagnosis and management
A Agrawal, & P J Whorwell,
LINK TO FULL TRAINING ARTICLE
Short Abstract
Irritable bowel syndrome is often dismissed as just being a nuisance rather than anything more serious, but its symptoms can seriously diminish a patient's quality of life. When the disease is better understood and treatment is tailored to the individual patient, it can often be rewarding to manage
Summary points
1) Irritable bowel syndrome is often regarded as a trivial, largely psychological disorder that is impossible to treat
2) Patients with severe disease have a range of symptoms that can seriously erode quality of life
3) Abdominal pain can sometimes be devastating, and the bowel dysfunction is not infrequently accompanied by incontinence
4) Better understanding of the pathophysiology, and tailoring treatment to the individual, can make irritable bowel syndrome a surprisingly rewarding condition to manage
Conclusion
IBS is an extremely challenging condition to manage. Effective treatment involves understanding the whole situation and tailoring the treatment to the individual. It is difficult, but not impossible, to offer at least some help to most patients with the condition.

Journal of Clinical Nursing – 2006 Jun;15(6):678-84.
Effect of nurse-led gut-directed hypnotherapy upon health-related quality of life in patients with irritable bowel syndrome
Smith GD.
School of Health in Social Science, University of Edinburgh, Old Medical School, Edinburgh
SUMMARY & LINK
AIMS AND OBJECTIVES:
This study quantified health-related quality of life in a group of irritable bowel syndrome patients and measures changes following a treatment programme of nurse-led gut-directed hypnotherapy.
BACKGROUND:
It is well recognized that health-related quality of life can be severely impaired in patients suffering form the irritable bowel syndrome. Current conventional treatment for irritable bowel syndrome is often unsatisfactory. In contrast it has been shown that gut-directed hypnotherapy is an effective treatment of irritable bowel syndrome with up to three-quarters of patients reporting symptomatic improvement.
DESIGN/METHOD:
Seventy-five patients (55 females/20 males, median age 37.1 years, age range 18-64) comprised the study group. Physical symptoms of irritable bowel syndrome were recorded using seven-day diary cards. On presentation the predominant symptoms were abdominal pain (61%), altered bowel habit (32.5%), and abdominal distension/bloating (6.5%) in the patient group. An irritable bowel syndrome quality of life questionnaire was used to define health-related quality of life. Psychological well-being was measured using the Hospital Anxiety and Depression Scale. Data analysis was carried out using MINITAB, Release 12 for Windows.
RESULTS:
Physical symptoms statistically improved after hypnotherapy. There were also significant statistical improvements (P < 0.001) in six of the eight health-related quality of life domains measured (emotional, mental health, sleep, physical function, energy and social role). These improvements were most marked in female patients who reported abdominal pain as their predominant physical symptom. Anxiety and depression improved following treatment.
CONCLUSION:
Gut-directed hypnotherapy has a very positive impact on health-related quality of life with improvements in psychological well-being and physical symptoms. It appears most effective in patients with abdominal pain and distension. Relevance to clinical practice. This study demonstrates that by integrating complementary therapies into conventional care that gastrointestinal nurses have a potential role in the management of irritable bowel syndrome.

Gastroenterology & Hepatology - Vol 23 Issue 8
Prokinetic effect of gut-oriented hypnosis on gastric emptying
G. Chiarioni, I Vantini, F. de Iorio, L Benini
SUMMARY & LINK TO FULL REPORT
Background 
No data are available on the effect of hypnosis on gastric emptying.
Aim 
To determine the effect of a hypnosis session on gastric emptying and dyspeptic symptoms.
Methods 
We studied emptying by ultrasonography and epigastric sensations in 11 healthy subjects and in 15 patients affected by functional dyspepsia under three conditions according to a fixed schedule: (a) basal, (b) after cisapride and (c) during a 90 min hypnotic trance. Eight healthy subjects repeated an emptying study listening to relaxing music. Statistical analysis was performed using the Friedman test or RM-anova.
Results 
In dyspeptics, the postprandial increase in the antral area was significantly smaller during the hypnosis trance than under the basal and the cisapride conditions. For the patients gastric emptying was significantly shortened by cisapride, and even more by hypnosis (basal 274 ± 16.8 min; cisapride 227 ± 13.2; hypnosis 150 ± 9.7) whereas for healthy subjects it was shortened only by hypnosis. The repeated study in healthy subjects listening to relaxing music showed no significant difference compared with the basal. Epigastric sensations were improved in dyspeptics by hypnosis, but not by cisapride.
Conclusions 
Gut-oriented hypnosis is effective in shortening gastric emptying both in dyspeptic and in healthy subjects.

Gastroenterology & Hepatology - Vol 24 Issue 5
Systematic review: the effectiveness of hypnotherapy in the management of irritable bowel syndrome
S Wilson, T Maddion, L Roberts, S Greenfield, S Singh
SUMMARY & LINK TO FULL REPORT
Aim
To systematically review the literature evaluating hypnotherapy in the management of irritable bowel syndrome (IBS).
Methods
Electronic databases were searched (Cochrane Library, Medline, CINAHL, AMED, Embase, PsycINFO, CISCOM, TRIP and the Social Science Citation index), bibliographic references scanned and main authors contacted. No restrictions were placed on language or publication year. Eligible studies involved adults with IBS using single-component hypnotherapy. All studies, except single case or expert opinion, were sought and all patient-related outcomes eligible.
Results
Out of 299 unique references identified, 20 studies (18 trials of which four were randomized, two controlled and 12 uncontrolled) and two case series were eligible. These tended to demonstrate hypnotherapy as being effective in the management of IBS. Numbers of patients included were small. Only one trial scored more than four out of eight on internal validity.
Conclusion
The published evidence suggests that hypnotherapy is effective in the management of IBS. Over half of the trials (10 of 18) indicated a significant benefit. A randomized placebo-controlled trial of high internal validity is necessary to establish the effectiveness of hypnotherapy in the management of IBS. Until such a trial is undertaken, this form of treatment should be restricted to specialist centres caring for the more severe forms of the disorder.

Journal of Alternative and Complementary Medicine – July/August 2006, 12(6): 517-527.
Where does hypnotherapy stand in the management of iIrritable bowel syndrome? A systematic review
Ali Gholamrezaei, Samaneh Khanpour Ardestani, and Mohammad Hasan Emami
Clinical Hypnotherapy Research Group, Medical Student Research Committee, Isfahan University of Medical Sciences / Poursina Hakim Research Institute, Isfahan, Iran.
ABSTRACT & LINK
Background:
Irritable bowel syndrome (IBS) is a gastrointestinal disorder characterized by chronic abdominal pain and altered bowel habits in the absence of any organic cause. Despite its prevalence, there remains a significant lack of efficient medical treatment for IBS to date. However, according to some previous research studies, hypnosis has been shown to be effective in the treatment of IBS.
Aim:
To determine the definite efficacy of hypnosis in the treatment of irritable bowel syndrome.
Methods: A systematic review of the literature on hypnosis in the treatment of IBS from 1970 to 2005 was performed using MEDLINE®. Full studies published in English were identified and selected for inclusion. We excluded case studies and those studies in which IBS symptoms were not in the list of outcome measures. All studies were reviewed on the basis of the Rome Working Team recommendations for design of IBS trials.
Results:
From a total of 22 studies, seven were excluded. The results of the reviewed studies showed improved status of all major symptoms of IBS, extracolonic symptoms, quality of life, anxiety, and depression. Furthermore these improvements lasted 2–5 years.
Conclusions:
Although there are some methodologic inadequacies, all studies show that hypnotherapy is highly effective for patients with refractory IBS, but definite efficacy of hypnosis in the treatment of IBS remains unclear due to lack of controlled trials supporting this finding.

International Journal of Clinical and Experimental Hypnosis – Vol 54, Issue 1, 2006
Hypnosis for irritable bowel syndrome: The quest for the mechanism of action
Magnus Simrén
ABSTRACT:
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.

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"


Eastern Mediterranean Health Journal - 2007 Mar-Apr;13(2):301-8.
Hypnotherapy for irritable bowel syndrome in Saudi Arabian patients
Al Sughayir MA.
Department of Psychiatry, College of Medicine, King Saud University, Riyadh, Saudi Arabia
ABSTRACT:
This study investigated whether hypnotherapy provides a significant therapeutic effect in Saudi Arabian patients with irritable bowel syndrome. Patients (n=26) were consecutively recruited at a psychiatry outpatient clinic after diagnosis by a gastroenterologist and a medical evaluation for irritable bowel syndrome. Each patient had 12 sessions of hypnotherapy over a period of 12 weeks (1 session per week). Patients completed a scale measuring symptom severity before and 3 months after the trial. Hypnotherapy significantly enhanced a feeling of better quality of life more in male than in female patients, and bowel habit dissatisfaction was reduced more in female than in male patients.

International Journal of Clinical and Experimental Hypnosis – Vol 55, Issue 3, 2007
The Efficacy of Hypnotherapy in the Treatment of Psychosomatic Disorders: Meta-analytical Evidence
Erich Flammer & Assen Alladin
Constance University, Konstanz, Germany / University of Calgary, Calgary, Alberta, Canada
ABSTRACT:
Hypnotherapy is claimed to be effective in treatment of psychosomatic disorders. A meta-analysis was conducted with 21 randomized, controlled clinical studies to evaluate efficacy of hypnosis in psychosomatic disorders. Studies compared patients exclusively treated with hypnotherapy to untreated controls. Studies providing adjunctive standard medical care in either treatment condition were also admitted. Hypnotherapy was categorized into classic (n = 9), mixed form (n = 5), and modern (n = 3). Results showed the weighted mean effect size for 21 studies was d+ = .61 (p = .0000). ANOVA revealed significant differences between classic, mixed, and modern hypnosis. Regression of outcome on treatment dose failed to show a significant relationship. Numerical values for correlation between suggestibility and outcome were only reported in three studies (mean r = .31). The meta-analysis clearly indicates hypnotherapy is highly effective in treatment of psychosomatic disorders.

Gastroenterology Clinics Of North America – (2007)
Irritable bowel syndrome: current approach to symptoms, evaluation, and treatment
Elizabeth J Videlock, Lin Chang
SUMMARY:
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There are frequent advances in knowledge about the clinical presentation, pathophysiology, and treatment of irritable bowel syndrome. It is important for clinicians to be aware of available therapies and the supporting evidence for those therapies to increase patient satisfaction. This is best achieved with a collaborative and long-term clinician-patient relationship and mutual commitment to modify therapy and try new modalities until the greatest relief of symptoms and improvement in health-related quality of life is achieved. This article reviews symptoms, comorbidities, gender differences, and measure of severity in irritable bowel syndrome and current and evidence-based approaches to evaluation and treatment, and the new symptom-based Rome III diagnostic criteria are reviewed and explained.

International Journal of Clinical and Experimental Hypnosis - Vol 55, Issue 4, 2007
Feasibility and acceptability of gut-directed hypnosis on inflammatory bowel disease: A brief communication
Laurie Keefer & Ali Keshavarzian
ABSTRACT & LINK
Hypnotically assisted treatments have been used to reduce stress, improve gastrointestinal motility, strengthen immune function, and potentially reduce inflammation. Such treatments may also help reduce disease flares and improve quality of life in inflammatory bowel diseases (IBD). The authors report the results of a case series of eight white female patients with inactive IBD. All participants initiated and completed treatment, supporting the general acceptability of hypnotically assisted treatment among IBD patients. There was a significant improvement in IBD-quality of life scores for the group posttreatment, t(7) = −3.38, p = .01, with a mean improvement in quality of life of 29 points with significant changes in all 4 subscales. No negative effects of treatment were found.

Gastroenterology Volume 133, Issue 5 , Pages 1430-1436, November 2007
Hypnotherapy for children with functional abdominal pain or irritable bowel syndrome: A randomized controlled trial
Arine M. Vlieger, Carla Menko–Frankenhuis, Simone C.S. Wolfkamp, Ellen Tromp, Marc A. Benninga
Department of Pediatrics, St. Antonius Hospital, Nieuwegein, The Netherlands
ABSTRACT:
The purpose of this study, conducted in the Netherlands, was to examine the effectiveness of hypnotherapy compared to standard medical care in a pediatric population with functional abdominal pain (FAP) or irritable bowel syndrome (IBS)
Background & Aims:
Functional abdominal pain (FAP) and irritable bowel syndrome (IBS) are highly prevalent in childhood. A substantial proportion of patients continues to experience long-lasting symptoms. Gut-directed hypnotherapy (HT) has been shown to be highly effective in the treatment of adult IBS patients. We undertook a randomized controlled trial and compared clinical effectiveness of HT with standard medical therapy (SMT) in children with FAP or IBS. Methods:
Fifty-three pediatric patients, age 8–18 years, with FAP (n = 31) or IBS (n = 22), were randomized to either HT or SMT. Hypnotherapy consisted of 6 sessions over a 3-month period. Patients in the Standard Medical Therapy group received standard medical care and 6 sessions of supportive therapy. Pain intensity, pain frequency, and associated symptoms were scored in weekly standardized abdominal pain diaries at baseline, during therapy, and 6 and 12 months after therapy.
Results:
Pain scores decreased significantly in both groups: from baseline to 1 year follow-up, pain intensity scores decreased in the HT group from 13.5 to 1.3 and in the SMT group from 14.1 to 8.0. Pain frequency scores decreased from 13.5 to 1.1 in the HT group and from 14.4 to 9.3 in the SMT group. Hypnotherapy was highly superior, with a significantly greater reduction in pain scores compared with SMT (P < .001). At 1 year follow-up, successful treatment was accomplished in 85% of the HT group and 25% of the SMT group (P < .001).
Conclusions:
Gut-directed hypnotherapy is highly effective in the treatment of children with longstanding FAP or IBS.

Canadian Journal of Gastroenterology – 2007 April; 21(Suppl B): 3B–22B
Recommendations on chronic constipation (including constipation associated with irritable bowel syndrome) treatment
Pierre Paré, Ronald Bridges, Malcolm C Champion, Subhas C Ganguli, James R Gray E Jan Irvine, Victor Plourde, Pierre Poitras, Geoffrey K Turnbull, Paul Moayyedi, Nigel Flook, MD CCFP FCFP,11 and Stephen M Collins,
ABSTRACT:
While chronic constipation has a high prevalence in primary care, there are no existing treatment recommendations to guide health care professionals. To address this, a consensus group of 10 gastroenterologists was formed to develop treatment recommendations. Although constipation may occur as a result of organic disease, the paper addressed only the management of primary CC or constipation associated with irritable bowel syndrome. The final consensus group was assembled and the recommendations were created following the exact process outlined by the Canadian Association of Gastroenterology for the following areas: epidemiology, quality of life and threshold for treatment; definitions and diagnostic criteria; lifestyle changes; bulking agents and stool softeners; osmotic agents; prokinetics; stimulant laxatives; suppositories; enemas; other drugs; biofeedback and behavioural approaches; surgery; and probiotics. The paper includes consideration of hypnotherapy and the quality of previous studies.

British Medi al Journal –. 2007 May 26; 334(7603): 1105–1109.
Psychological approach to managing irritable bowel syndrome
Bu'Hussain Hayee & Ian Forgacs
Department of Gastroenterology, Kings College Hospital, London SE5 9RS UK
LINK TO FULL REPORT
The medical management of patients with irritable bowel syndrome is often unsatisfactory. Doctors are still taught that irritable bowel syndrome is a diagnosis of exclusion, and patients readily sense that they are being told that nothing is really wrong with them. Many people soon come to appreciate that the range of medical treatments available is limited in both scope and efficacy. The mood of negativity, once established, is difficult to dispel.
Summary points:
1) Irritable bowel syndrome is believed to result from a variety of biological and psychosocial factors
Irritable bowel syndrome is not a diagnosis of exclusion; a positive diagnosis can usually be made
2) The usual medical treatment is often highly unsatisfactory; if psychological factors seem important, these should be dealt with
3) Tricyclic antidepressants and some selective serotonin reuptake inhibitors are of value in improving symptoms
4) Cognitive behaviour therapy has a strong evidence base for its effectiveness
5) Gut directed hypnotherapy is an effective treatment and is especially suitable for more severely affected patients who might be prepared to travel to specialist centres
.

Contemprary Hypnosis – 133, Issue 5 , Vol 24 Issue 4
Irritable bowel syndrome: symptomatic treatment versus integrative psychotherapy
Tom Kraft, David Kraft
ABSTRACT & LINK
Irritable bowel syndrome (IBS) is a functional gastrointestinal (GI) disorder thought to affect 10% to 20% of the population worldwide. Essentially the paper is in two parts. The first part of the paper investigates the world literature and a variety of up to date treatment approaches which, with the exception of cognitive-behavioural therapy (CBT) which also has beneficial effects on patients' overall mood and bloating, are designed to manage individual symptoms of IBS. The review examines the efficacy of pharmaceutical agents (antispasmodics, antidepressants, antidiarrhoeals and the new serotonergic modifying agonists/antagonists), dietary control (fibre, lactose free products, partially hydrolyzed guar gum, peppermint oil, prebiotics and probiotics), CBT (with or without the use of an audiotape) and the standard gut-directed hypnotherapy approach of the Manchester Model.
In the second half, in sharp contrast to the symptomatic treatments, the authors give a detailed account of a 54-year-old female patient with refractory IBS in a setting of a phobic anxiety state. The treatment approach – a combination of psychotherapy and hypnosis – was designed to effect a complete recovery rather than to manage individual symptoms. This case study exemplifies the complex nature of IBS symptoms in relation to the patient's emotions. It was necessary for her to work through these emotional problems so that she did not need to express her intense hostility through her bowels. These problems were expressed both in the psychotherapy sessions as well as in the hypnotherapy. The patient made a full recovery and this was maintained at the follow-up a year later.

Cochrane Database Syst Rev. 2007 Oct 17;(4):CD005110.
Hypnotherapy for treatment of irritable bowel syndrome
Webb AN, Kukuruzovic RH, Catto-Smith AG, Sawyer SM.
ABSTRACT & LINK
Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder of unknown aetiology. Current pharmacological treatments have limited value. Hypnotherapy has been reported to have beneficial effects for IBS symptoms.
OBJECTIVES:
To evaluate the efficacy of hypnotherapy for the treatment of irritable bowel syndrome.
SEARCH STRATEGY:
Published and unpublished randomised clinical trials and quasi-randomised clinical trials were identified through structured searches of MEDLINE (1966 to March 2006), EMBASE (1980 to March 2006), PsycINFO (1806 to March 2006), CINAHL (Cumulative Index to Nursing and Allied Health Literature, 1982 to March 2006), AMED (Allied and Complementary Medicine Database, 1985 to March 2006) and The Cochrane Central Register of Controlled trials. Conference proceedings from Digestive Disease Week (1980 to 2005) were also searched.
SELECTION CRITERIA:
Eligible studies included all randomised and quasi-randomised clinical studies comparing hypnotherapy for the treatment of irritable bowel syndrome with no treatment or another therapeutic intervention.
DATA COLLECTION AND ANALYSIS:
All studies were evaluated for eligibility for inclusion. Included studies were assessed for quality and data were extracted independently by four authors. The primary outcome measure of interest was the overall bowel symptom severity score which combines abdominal pain, diarrhoea or constipation and bloating. Secondary outcomes included abdominal pain, diarrhoea, constipation, bloating, quality of life, patient's overall assessment of well-being, psychological measures as per validated questionnaires, and adverse events.
MAIN RESULTS:
Four studies including a total of 147 patients met the inclusion criteria. Only one study compared hypnotherapy to an alternative therapy (psychotherapy and placebo pill), two studies compared hypnotherapy with waiting-list controls and the final study compared hypnotherapy to usual medical management. Data were not pooled for meta-analysis due to differences in outcome measures and study design. The therapeutic effect of hypnotherapy was found to be superior to that of a waiting list control or usual medical management, for abdominal pain and composite primary IBS symptoms, in the short term in patients who fail standard medical therapy. Harmful side-effects were not reported in any of the trials. However, the results of these studies should be interpreted with caution due to poor methodological quality and small size.
AUTHORS' CONCLUSIONS:
The quality of the included trials was inadequate to allow any conclusion about the efficacy of hypnotherapy for irritable bowel syndrome. More research with high quality trials is needed.

Gut. 2007 December; 56(12): 1770–1798.
Guidelines on the irritable bowel syndrome: mechanisms and practical management
R Spiller, Q Aziz, F Creed, A Emmanuel, L Houghton, P Hungin, R Jones, D Kumar, G Rubin, N Trudgill, and P Whorwell
ABSTRACT:
Background:
IBS affects 5–11% of the population of most countries. Prevalence peaks in the third and fourth decades, with a female predominance.
Aim:
To provide a guide for the assessment and management of adult patients with irritable bowel syndrome.
Methods:
Members of the Clinical Services Committee of The British Society of Gastroenterology were allocated particular areas to produce review documents. Literature searching included systematic searches using electronic databases such as Pubmed, EMBASE, MEDLINE, Web of Science, and Cochrane databases and extensive personal reference databases.
Results:
Patients can usefully be classified by predominant bowel habit. Few investigations are needed except when diarrhoea is a prominent feature. Alarm features may warrant further investigation. Adverse psychological features and somatisation are often present. Ascertaining the patients' concerns and explaining symptoms in simple terms improves outcome. IBS is a heterogeneous condition with a range of treatments, each of which benefits a small proportion of patients. Treatment of associated anxiety and depression often improves bowel and other symptoms. Randomised placebo controlled trials show benefit as follows: cognitive behavioural therapy and psychodynamic interpersonal therapy improve coping; hypnotherapy benefits global symptoms in otherwise refractory patients; antispasmodics and tricyclic antidepressants improve pain; ispaghula improves pain and bowel habit; 5-HT3 antagonists improve global symptoms, diarrhoea, and pain but may rarely cause unexplained colitis; 5-HT4 agonists improve global symptoms, constipation, and bloating; selective serotonin reuptake inhibitors improve global symptoms.
Conclusions:
Better ways of identifying which patients will respond to specific treatments are urgently needed.

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


Nature Clinical Practice Gastroenterology & Hepatology (2008) 5, 624-636 .
Complementary and alternative medicine for IBS in adults: mind–body interventions
David J Kearney & Janelle Brown-Chang
University of Washington School of Medicine, Gastroenterology Section, Seattle VAMC 111GI, USA
SUMMARY & LINK TO FULL REPORT
Standard treatment for IBS focuses on the management or alleviation of the predominant gastrointestinal presenting symptoms, such as diarrhea or constipation, often using pharmacological therapy. For many patients, this approach is unsatisfactory, and patients frequently seek the advice of complementary and alternative medicine (CAM) practitioners in order to explore other treatment options. CAM practices include a broad range of modalities, and mind–body interventions hold particular promise as treatment modalities for IBS because psychological factors could have an important role in IBS symptomatology and quality of life. Psychological stressors are postulated to result in gastrointestinal symptoms through alteration of intestinal function mediated by the autonomic nervous system, hypothalamic–pituitary–adrenal axis and immune system. Hypnotherapy has the strongest supportive evidence as a beneficial mind–body intervention for IBS. Clinical studies of hypnotherapy have uniformly shown improvement of gastrointestinal symptoms, anxiety, depression and quality of life in patients with IBS. Mindfulness meditation remains unstudied for IBS, but is theoretically attractive as a stress-reduction technique. There is a suggestion that relaxation therapy or multimodal therapy (a combination of relaxation therapy, education and psychotherapy) is beneficial for IBS. The most generally accepted psychological mind–body intervention is cognitive behavioral therapy, and clinical trials support the beneficial effects of cognitive behavioral therapy in patients with IBS.
CONCLUSIONS INCLUDE:
Hypnotherapy is the most evidence-based mind–body intervention for IBS. There have been several well-designed clinical studies of hypnotherapy for IBS, including randomized, controlled trials, which uniformly show improvement of gastrointestinal symptoms, anxiety, depression, quality of life, disability and excess health-care costs. The major obstacle to the clinical use of hypnotherapy is its limited availability outside of centers with a special interest in hypnotherapy for IBS. Further study of group hypnotherapy as well as home hypnotherapy (by CD or other audioguides) is needed to expand the availability of this promising intervention.

Evidence-Based Complementary and Alternative Medicine – Vol 5 (2008), Issue 1, Pages 41-506 .
Mind/Body Psychological Treatments for Irritable Bowel Syndrome
Bruce D. Naliboff,1,2,3 Michael P. Fresé,1,2,3 and Lobsang Rapgay2
1 UCLA Center for Neurovisceral Sciences and Women's Health, VAGLAHS, Bldg. 115, Rm. 223, 11301 Wilshire Boulevard, Los Angeles, CA 90073, USA
2 Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
3 Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, CA, USA
ABSTRACT & LINK
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Currently, the goal of treatment for those with irritable bowel syndrome (IBS) is to improve the quality of life through a reduction in symptoms. While the majority of treatment approaches involve the use of traditional medicine, more and more patients seek out a non-drug approach to managing their symptoms. Current forms of non-drug psychologic or mind/body treatment for IBS include hypnotherapy, cognitive behavioral therapy and brief psychodynamic psychotherapy, all of which have been proven efficacious in clinical trials. We propose that incorporating the constructs of mindfulness and acceptance into a mind/body psychologic treatment of IBS may be of added benefit due to the focus on changing awareness and acceptance of one's own state which is a strong component of traditional and Eastern healing philosophies.

Journal of Psychosomatic Research Vol 64, Issue 6, June 2008, Pages 621–623 .
Hypnotherapy for irritable bowel syndrome: The response of colonic and noncolonic symptomse
Peter J. Whorwell
University of Manchester, Manchester, United Kingdom
ABSTRACT & LINK
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There is now good evidence that hypnotherapy benefits a substantial proportion of patients with irritablebowel syndrome and that improvement is maintained for many years. Most patients seen in secondary care with this condition also suffer from a wide range of noncolonicsymptoms such as backache and lethargy, as well as a number of musculoskeletal, urological, and gynaecological problems. These features do not typically respond well to conventional medical treatment approaches, but fortunately, their intensity is often reduced by hypnosis. The mechanisms by which hypnosis mediates its benefit are not entirely clear, but there is evidence that, in addition to its psychological effects, it can modulate gastrointestinal physiology, alter the central processing of noxious stimuli, and even influence immune function.

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.


International Journal of Clinical and Experimental Hypnosis – Vol 56, Issue 3, 2008
Treatment of Inflammatory Bowel Disease: A Role for Hypnotherapy?
Vivien Miller & Peter J. Whorwelll
University of Manchester, Manchester, United Kingdom
ABSTRACT & LINK
Fifteen patients with severe or very severe inflammatory bowel disease on corticosteroids but not responding to medication received 12 sessions of “gut-focused hypnotherapy” and were followed up for a mean duration of 5.4 years with disease severity being graded as remission, mild, moderate, severe, or very severe. Two patients (13.4%) failed to respond and required surgery. At follow-up for the remaining 13 patients, 4 (26.6%) were in complete remission, 8 (53.3%) had mild severity, and 1 (6.7%) was moderately severe. Quality of life became good or excellent in 12 (79.9%). Corticosteroid requirements dramatically declined with 60% of patients stopping them completely and not requiring any during follow-up. Hypnotherapy appears to be a promising adjunctive treatment for inflammatory bowel disease and has steroid sparing effects. Controlled trials to clearly define its role in this disease area are justified.

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.


Gastroenterol – 2009; 47(11): 1153-1159 .
Hypnotherapeutische Interventionen beim Reizdarmsyndrom - eine systematische Übersicht
(Hypnotherapy for Irritable Bowel Syndrome - a Systematic Review)
J. Hefner, A. Rilk, B. M. Herbert, S. Zipfel, P. Enck, U. Martens
Abteilung Innere Medizin VI, Psychosomatische Medizin und Psychotherapie, Universität Tübingen
ABSTRACT:
The Irritable bowel syndrome (IBS) is a highly prevalent functional disorder with a remarkable clinical and economic impact. Several pathogenetic factors of IBS are discussed and summarised within a bio-psycho-social model. Data from published hypnotherapeutic interventions with approximately 800 patients show long-lasting symptom relief. The underlying mechanisms of action are not well understood. Nine mechanism studies show influences of hypnosis on colorectal sensitivity, colorectal motility and mental strain (anxiety, depression, maladaptive cognitions). Results are often contradictory and effects of hypnosis on several of the proposed pathogenetic factors are not examined at all. This paper reviews previous studies on hypnotherapy in IBS patients with a focus on symptom relief and mechanisms of action.

Canadian Family Physician – February 2009 vol. 55 no. 2 .
Complementary and alternative medicine for treatment of irritable bowel syndrome
Yi-Hao A. Shen & Richard Nahas, MD CCFP
Dr Nahas, Seekers Centre for Integrative Medicine, 6 Deakin St, Ottawa, ON K2E 1B3
ABSTRACT:
OBJECTIVE
To review the evidence supporting selected complementary and alternative medicine approaches used in the treatment of irritable bowel syndrome (IBS).
QUALITY OF EVIDENCE
MEDLINE (from January 1966), EMBASE (from January 1980), and the Cochrane Database of Systematic Reviews were searched until March 2008, combining the terms irritable bowel syndrome or irritable colon with complementary therapies, alternative medicine, acupuncture, fiber, peppermint oil, herbal, traditional, yoga, massage, meditation, mind, relaxation, probiotic, hypnotherapy, psychotherapy, cognitive therapy, or behavior therapy. Results were screened to include only clinical trials, systematic reviews, and meta-analyses. Level I evidence was available for most interventions.
MAIN MESSAGE
Soluble fibre improves constipation and global IBS symptoms. Peppermint oil alleviates IBS symptoms, including abdominal pain. Probiotic trials show overall benefit for IBS but there is little evidence supporting the use of any specific strain. Hypnotherapy and cognitive-behavioural therapy are also effective therapeutic options for appropriate patients. Certain herbal formulas are supported by limited evidence, but safety is a potential concern. All interventions are supported by systematic reviews or meta-analyses.
CONCLUSION
Several complementary and alternative therapies can be recommended as part of an evidence-based approach to the treatment of IBS; these might provide patients.

International Journal of Clinical and Experimental Hypnosis – Vol 57, Issue 3, 20091 pp. 279-292(14)
Hypnotherapy for functional gastrointestinal disorders: A review
Vivien Miller and Peter J. Whorwell
ABSTRACT & LINK
Patients with functional gastrointestinal disorders, such as irritable bowel syndrome, functional dyspepsia, and noncardiac chest pain, can suffer from a range of severe symptoms that often substantially erode quality of life. Unfortunately, these conditions are notoriously difficult to treat, with many patients failing to improve despite being prescribed a wide variety of conventional medications. As a consequence, the potential benefits of hypnotherapy have been explored with evidence that this approach not only relieves symptoms but also appears to restore many of the putative psychological and physiological abnormalities associated with these conditions toward normal. These observations suggest that this form of treatment has considerable potential in aiding the management of functional gastrointestinal disorders and should be integrated into the ongoing medical care that these patients are receiving.

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.


American Journal of Gastroenterology – 2010; 105:213–218
No Change in Rectal Sensitivity After Gut-Directed Hypnotherapy in Children With Functional Abdominal Pain or Irritable Bowel Syndrome
A M Vlieger MD, PhD1, M M van den Berg MD, PhD2, C Menko-Frankenhuis2, M E J Bongers MD, PhD2, E Tromp PhD3 and M A Benninga MD, PhD2
J. Hefner, A. Rilk, B. M. Herbert, S. Zipfel, P. Enck, U. Martens
1Department of Pediatrics, St. Antonius Hospital, Nieuwegein, The Netherlands
2Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital Academic Medical Centre, Amsterdam, The Netherlands
3Department of Statistics, St Antonius Hospital, Nieuwegein, The Netherlands
Correspondence: A.M. Vlieger, MD, PhD, Department of Pediatrics, St Antonius Hospital, P.O. Box 2500, Nieuwegein 3430 EM, The Netherlands
ABSTRACT AND LINK
OBJECTIVES:
Gut-directed hypnotherapy (HT) has recently been shown to be highly effective in treating children with functional abdominal pain (FAP) and irritable bowel syndrome (IBS). This study was conducted to determine the extent to which this treatment success is because of an improvement in rectal sensitivity.
METHODS:
A total of 46 patients (aged 8–18 years) with FAP (n=28) or IBS (n=18) were randomized to either 12 weeks of standard medical therapy (SMT) or HT. To assess rectal sensitivity, a pressure-controlled intermittent distension protocol (barostat) was performed before and after the therapy.
RESULTS:
Rectal sensitivity scores changed in SMT patients from 15.1±7.3 mm Hg at baseline to 18.6±8.5 mm Hg after 12 weeks of treatment (P=0.09) and in HT patients from 17.0±9.2 mm Hg to 22.5±10.1 mm Hg (P=0.09). The number of patients with rectal hypersensitivity decreased from 6 of 18 to 0 of 18 in the HT group (P=0.04) vs. 6 of 20 to 4 of 20 in the SMT group (P=0.67). No relationship was established between treatment success and rectal pain thresholds. Rectal sensitivity scores at baseline were not correlated with intensity, frequency, or duration of abdominal pain.
CONCLUSIONS:
Clinical success achieved with HT cannot be explained by improvement in rectal sensitivity. Furthermore, no association could be found between rectal barostat findings and clinical symptoms in children with FAP or IBS. Further studies are necessary to shed more light on both the role of rectal sensitivity in pediatric FAP and IBS and the mechanisms by which hypnotherapy results in improvement of clinical symptoms.

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.


American Journal of Gastroenterology 107, 276-285 (February 2012)
Effects of gut-directed hypnotherapy on IBS in different clinical settings—Results from two randomized, controlled trials
Perjohan Lindfors, Peter Unge, Patrik Arvidsson, Henry Nyhlin, Einar Björnsson, Hasse Abrahamsson and Magnus Simrén
Dept of Medicine & Therapeutics & Institute of Digestive Disease, Chinese University of Hong Kong and Prince of Wales Hospital, Shatin, Hong Kong

ABSTRACT:
OBJECTIVES:
Gut-directed hypnotherapy has been found to be effective in irritable bowel syndrome (IBS). However, randomized, controlled studies are rare and few have been performed outside highly specialized research centers. 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 randomized to receive gut-directed hypnotherapy (12 sessions, 1 h/week) in psychology private practices or supportive therapy, whereas patients were randomized 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 randomized 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 specialized research centers.

American Journal of Gastroenterology – 107, 627-631 (April 2012)
Long-term follow-up of gut-directed hypnotherapy vs. standard care in children with functional abdominal pain
Arine M Vlieger, Juliette M T M Rutten, Anita M A P Govers, Carla Frankenhuis and Marc A Benninga
ABSTRACT:
Objectives:
We previously showed that gut-directed hypnotherapy (HT) is highly effective in the treatment of children with functional abdominal pain (FAP) and irritable bowel syndrome (IBS). Aim of this follow-up study was to investigate the long-term effects of HT vs. standard medical treatment plus supportive therapy (SMT).
Methods:
All 52 participants of our previous randomized controlled trial (RCT) were invited to complete a standardized abdominal pain diary, on which pain frequency and pain intensity were scored. Furthermore, the Children's Somatization Inventory (CSI) and a general quality of life (QOL) questionnaire were filled out. Clinical remission was defined as >80% improvement in pain scores compared with baseline.
Results:
All 27 HT patients and 22 out of 25 SMT patients participated in this study. Two patients of the SMT group were lost to follow-up and one refused to participate. After a mean duration of 4.8 years follow-up (3.4–6.7), HT was still highly superior to conventional therapy with 68 vs. 20% of the patients in remission after treatment (P=0.005). Pain intensity and pain frequency scores at follow-up were 2.8 and 2.3, respectively, in the HT group compared with 7.3 and 7.1 in the SMT group (P<0.01). Also, somatization scores were lower in the HT group (15.2 vs. 22.8; P=0.04). No differences were found in QOL, doctors' visits, and missed days of school or work between the two groups.
Conclusions:
The beneficial effects of gut-directed HT are long lasting in children with FAP or IBS with two thirds still in remission almost 5 years after treatment, making it a highly valuable therapeutic option.

 

Biological Research for Nursing [2012, 14(1):71-7]
The potential role of a self-management intervention for ulcerative colitis: a brief report from the ulcerative colitis hypnotherapy trial
Keefer L, Kiebles JL, Kwiatek MA, Palsson O, Taft TH, Martinovich Z, Barrett TA
Center for Psychosocial Research in GI, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
ABSTRACT:
Inflammatory bowel diseases (IBD) are chronic inflammatory illnesses marked by unpredictable disease flares, which occur spontaneously and/or in response to external triggers, especially personal health behaviors. Behavioral triggers of flare may be responsive to disease self-management programs.
We report on interim findings of a randomized controlled trial of gut-directed hypnotherapy (HYP, n = 19) versus active attention control (CON, n = 17) for quiescent ulcerative colitis (UC). To date, 43 participants have enrolled; after 5 discontinuations (1 in HYP) and 2 exclusions due to excessive missing data, 36 were included in this preliminary analysis. Aim 1 was to determine the feasibility and acceptability of HYP in UC. This was achieved, demonstrated by a reasonable recruitment rate at our outpatient tertiary care clinic (20%), high retention rate (88% total), and our representative IBD sample, which is reflected by an equal distribution of gender, an age range between 21 and 69, recruitment of ethnic minorities (?20%), and disease duration ranging from 1.5 to 35 years. Aim 2 was to estimate effect sizes on key clinical outcomes for use in future trials. Effect sizes (group × time at 20 weeks) were small to medium for IBD self-efficacy (.34), Inflammatory Bowel Disease Questionnaire (IBDQ) total score (.41), IBDQ bowel (.50), and systemic health (.48). Between-group effects were observed for the IBDQ bowel health subscale (HYP > CON; p =.05) at 20 weeks and the Short Form 12 Health Survey Version 2 (SF-12v2) physical component (HYP > CON; p <.05) at posttreatment and 20 weeks.
This study supports future clinical trials testing gut-directed hypnotherapy as a relapse prevention tool for iInflammatory bowel diseases

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.


Procedia - Social and Behavioral Sciences  Vol 33, 2012, Pages 75–79
The use of Ericksonian hypnosis in somatic disorders
Irina Holdevici & Barbara Cr?ciun
Faculty of Psychology, Titu Maiorescu University, Calea V?c?re?ti nr.187, sector 4, Bucharest, 040051, Romania
Faculty of Psychology and Educational Sciences, Bucharest University, ?os. Panduri nr. 90, sector 5, Bucharest,050656,
ABSTRACT:
Hypnotic techniques play an important role in treating psychosomatic disorders. The connection between psyche and soma represents the basis on which hypnosis works, stimulating the subject to find in his own subconscious the healing resources. The present study has as main objective to evaluate the efficiency of a psychotherapy program based on Ericksonian hypnosis techniques of reducing pain and symptoms in psychosomatic disorders. The main disorders that have been treated by hypnotic techniques are migraines, asthma and gastrointestinal disorders. The results have shown a significant decrease of pain level and symptom relief for these patients.

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.


 
Alimentary Pharmacology and Therapeutics April 2013; 108:602–609; doi:10.1038/ajg.2013.19;3
Effect of hypnotherapy and educational intervention on brain response to visceral stimulus in the irritable bowel syndrome
M. B. O. Lowén, E. A. Mayer, M. Sjöberg, K. Tillisch, B. Naliboff, J. Labus, P. Lundberg, M. Ström, M. Engström, S. A. Walterr
Department of Clinical and Experimental Medicine/Gastroenterology, Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden

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
.

 
American Journal of Gastroenterol 2013; 108:602–609; doi:10.1038/ajg.2013.19;3
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
Correspondence: Gabriele Moser, MD, Universität Klinik für Innere Medizin III, Abteilung für Gastroenterologie und Hepatologie, Währinger Gürtel 18-20, WienA-1090, Austria. E-mail: gabriele.moser@meduniwien.ac.at

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.

European Journal of Pediatrics – 9 April 2013
Brief hypnotherapeutic–behavioral intervention for functional abdominal pain and irritable bowel syndrome in childhood: a randomized controlled trial
Marco Daniel Gulewitsch, Judith Müller, Martin Hautzinger, Angelika Anita Schlarb
Department of Psychology, Clinical Psychology and Psychotherapy, University of Tübingen, Schleichstraße 4, 72076, Tübingen, Germany
ABSTRACT:
Objectives:
Functional abdominal pain and irritable bowel syndrome are two prevalent disorders in childhood which are associated with recurrent or chronic abdominal pain, disabilities in daily functioning, and reduced quality of life. This study aimed to evaluate a brief hypnotherapeutic-behavioral intervention program in a prospective randomized controlled design.
Methods:
Thirty-eight children, 6 to 12 years of age, and their parents were randomly assigned to a standardized hypnotherapeutic–behavioral treatment (n = 20) or to a waiting list condition (n = 18). Both groups were reassessed 3 months after beginning. Primary outcome variables were child-completed pain measures and pain-related disability. Secondary outcome variables were parent-completed measures of their children's pain and pain-related disability. Health-related quality of life from both perspectives also served as a secondary outcome. In the treatment group, 11 of 20 children (55.0 %) showed clinical remission (>80 % improvement), whereas only one child (5.6 %) in the waiting list condition was classified as responder.
Results:
Children in the treatment group reported a significantly greater reduction of pain scores and pain-related disability than children of the waiting list condition. Parental ratings also showed a greater reduction of children's abdominal pain and pain-related disability. Health-related quality of life did not increase significantly
Conclusions: :
Hypnotherapeutic and behavioral interventions are effective in treating children with long-standing AP. Treatment success of this brief program should be further evaluated against active interventions with a longer follow-up.

Archive of Disease in Children – 2013;98:252-257
Gut-directed hypnotherapy for functional abdominal pain or irritable bowel syndrome in children: a systematic review
Juliette M T M Rutten1, Johannes B Reitsma2, Arine M Vlieger3, Marc A Benninga1
Correspondence to
Dr Juliette M T M Rutten, Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Centre room C2-312, PO Box 22700, Amsterdam 1100 DD, The Netherlands; j.m.rutten@amc.nl.,

ABSTRACT:
Objectives
Gut directed hypnotherapy (HT) is shown to be effective in adult functional abdominal pain (FAP) and irritable bowel syndrome (IBS) patients. We performed a systematic review to assess efficacy of HT in paediatric FAP/IBS patients.
Methods
We searched Medline, Embase, PsychINFO, Cumulative Index to Nursing and Allied Health Literature databases and Cochrane Central Register of Controlled Trials for randomised controlled trials (RCT) in children with FAP or IBS, investigating efficacy of HT on the following outcomes: abdominal pain scores, quality of life, costs and school absenteeism.
Objectives
Gut directed hypnotherapy (HT) is shown to be effective in adult functional abdominal pain (FAP) and irritable bowel syndrome (IBS) patients. We performed a systematic review to assess efficacy of HT in paediatric FAP/IBS patients.
Methods
We searched Medline, Embase, PsychINFO, Cumulative Index to Nursing and Allied Health Literature databases and Cochrane Central Register of Controlled Trials for randomised controlled trials (RCT) in children with FAP or IBS, investigating efficacy of HT on the following outcomes: abdominal pain scores, quality of life, costs and school absenteeism.
Results
Three RCT comparing HT to a control treatment were included with sample sizes ranging from 22 to 52 children. We refrained from statistical pooling because of low number of studies and many differences in design and outcomes. Two studies examined HT performed by a therapist, one examined HT through self-exercises on audio CD. All trials showed statistically significantly greater improvement in abdominal pain scores among children receiving HT. One trial reported beneficial effects sustained after 1 year of follow-up. One trial reported statistically significant improvement in quality of life in the HT group. Two trials reported significant reductions in school absenteeism after HT.
Conclusions
Therapeutic effects of HT seem superior to standard medical care in children with FAP or IBS. It remains difficult to quantify exact benefits. The need for more high quality research is evident.

Alimentary Pharmacology & Therapeutics Volume 38, Issue 7, pages 761–771, October 2013
Gut-directed hypnotherapy improved remission maintenance for UC
L. Keefer, T. H. Taft, J. L. Kiebles, Z. Martinovich, T. A. Barrett1 andO. S. Palsson
ABSTRACT
Background
Psychotherapy is not routinely recommended for in ulcerative colitis (UC). Gut-directed hypnotherapy (HYP) has been linked to improved function in the gastrointestinal tract and may operate through immune-mediated pathways in chronic diseases.
Aims
To determine the feasibility and acceptability of HYP and estimate the impact of HYP on clinical remission status over a 1-year period in patients with an historical flare rate of 1.3 times per year.
Methods
A total of 54 patients were randomised at a single site to seven sessions of gut-directed HYP (n = 26) or attention control (CON; n = 29) and followed for 1 year. The primary outcome was the proportion of participants in each condition that had remained clinically asymptomatic (clinical remission) through 52 weeks post treatment.
Results
One-way analysis of variance comparing HYP and CON subjects on number of days to clinical relapse favoured the HYP condition [F = 4.8 (1, 48), P = 0.03] by 78 days. Chi-squared analysis comparing the groups on proportion maintaining remission at 1 year was also significant [χ2(1) = 3.9, P = 0.04], with 68% of HYP and 40% of CON patients maintaining remission for 1 year. There were no significant differences between groups over time in quality of life, medication adherence, perceived stress or psychological factors.
Conclusion
This is the first prospective study that has demonstrated a significant effect of a psychological intervention on prolonging clinical remission in patients with quiescent ulcerative colitis (Clinical Trial # NCT00798642).

2014

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.


Am J Gastroenterol 2014; 109:1350–1365; doi:10.1038/ajg.2014.148; published online 17 June 2014
Effect of Antidepressants and Psychological Therapies, Including Hypnotherapy, in Irritable Bowel Syndrome: Systematic Review and Meta-Analysis therapists
Alexander C Ford MBChB, MD1,2, Eamonn M M Quigley MD, FRCP, FACP, FACG, FRCPI3, Brian E Lacy MD, PhD4, Anthony J Lembo5, Yuri A Saito6, Lawrence R Schiller MD, MSHS, RFF, FACG, AGAF7, Edy E Soffer8, Brennan M R Spiegel MD, MSHS, RFF, FACG, AGAF9 and Paul Moayyedi MBChB, PhD, MPH, FACG10
. 1Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK
. 2Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
. 3Division of Gastroenterology and Hepatology, Department of Medicine, Houston Methodist Hospital, Houston, Texas, USA
. 4Dartmouth-Hitchcock Medical Center, Gastroenterology, Lebanon, New Hampshire, USA
. 5The Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
. 6Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
. 7Digestive Health Associates of Texas, Baylor University Medical Center, Dallas, Texas, USA
. 8Division of Gastroenterology at Cedars-Sinai, University of Southern California, Los Angeles, Califoria, USA
. 9Department of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
. 10Division of Gastroenterology, McMaster University, Health Sciences Center, Hamilton, Ontario, Canada

ABSTRACT:
OBJECTIVES: 
Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal
disorder. Evidence relating to the treatment of this condition with antidepressants and psychological therapies continues to accumulate.
METHODS: We performed an updated systematic review and meta-analysis of randomized controlled trials (RCTs). MEDLINE, EMBASE, and the Cochrane Controlled Trials Register were searched (up to December 2013). Trials recruiting adults with IBS, which compared antidepressants with placebo, or psychological therapies with control therapy or “usual management,” were eligible. Dichotomous symptom data were pooled to obtain a relative risk (RR) of remaining symptomatic after therapy, with a 95% confidence interval (CI).
RESULTS: 
The search strategy identified 3,788 citations. Forty-eight RCTs were eligible for inclusion: thirty-one compared psychological therapies with control therapy or “usual management,” sixteen compared antidepressants with placebo, and one compared both psychological therapy and antidepressants with placebo. Ten of the trials of psychological therapies, and four of the RCTs of antidepressants, had been published since our previous meta-analysis. The RR of IBS symptom not improving with antidepressants vs. placebo was 0.67 (95% CI=0.58–0.77), with similar treatment effects for both tricyclic antidepressants and selective serotonin reuptake inhibitors. The RR of symptoms not improving with psychological therapies was 0.68 (95% CI=0.61–0.76). Cognitive behavioral therapy, hypnotherapy, multicomponent psychological therapy, and dynamic psychotherapy were all beneficial.
CONCLUSIONS: 
Antidepressants and some psychological therapies are effective treatments for IBS. Despite the considerable number of studies published in the intervening 5 years since we last examined this issue, the overall summary estimates of treatment effect have remained remarkably stable.

Journal of Gastroenterology Aug 2014, Volume 49, Issue 8, pp 1193–1205
Treatment of abdominal pain in irritable bowel syndrome
Tim Vanuytsel, Jan  F. Tack, Guy E. 
Boeckxstaens,Translational Research Cebtre for Gastrointestinal Disorders, Leuven, Louvain, Belgium

ABSTRACT:
Functional abdominal pain in the context of irritable bowel syndrome (IBS) is a challenging problem for primary care physicians, gastroenterologists and pain specialists. We review the evidence for the current and future non-pharmacological and pharmacological treatment options targeting the central nervous system and the gastrointestinal tract.
Cognitive interventions such as cognitive behavioral therapy and hypnotherapy have demonstrated excellent results in IBS patients, but the limited availability and labor-intensive nature limit their routine use in daily practice.
In patients who are refractory to first-line therapy, tricyclic antidepressants (TCA) and selective serotonin reuptake inhibitors are both effective to obtain symptomatic relief, but only TCAs have been shown to improve abdominal pain in meta-analyses. A diet low in fermentable carbohydrates and polyols (FODMAP) seems effective in subgroups of patients to reduce abdominal pain, bloating, and to improve the stool pattern. The evidence for fiber is limited and only isphagula may be somewhat beneficial. The efficacy of probiotics is difficult to interpret since several strains in different quantities have been used across studies. Antispasmodics, including peppermint oil, are still considered the first-line treatment for abdominal pain in IBS. Second-line therapies for diarrhea-predominant IBS include the non-absorbable antibiotic rifaximin and the 5HT3 antagonists alosetron and ramosetron, although the use of the former is restricted because of the rare risk of ischemic colitis. In laxative-resistant, constipation-predominant IBS, the chloride-secretion stimulating drugs lubiprostone and linaclotide, a guanylate cyclase C agonist that also has direct analgesic effects, reduce abdominal pain and improve the stool pattern.

Psychosomatic Medicine: June 2014 - Volume 76 - Issue 5 - p 389–398
Efficacy, Tolerability, and Safety of Hypnosis in Adult Irritable Bowel Syndrome: Systematic Review and Meta-Analysis
Schaefert, Rainer MD; Klose, Petra PhD; Moser, Gabriele MD; Häuser, Winfried MD

Department of General Internal Medicine and Psychosomatics (R.S.), University of Heidelberg, Heidelberg, Germany; Department of Internal and Integrative Medicine (P.K.), Kliniken Essen-Mitte, University of Duisburg-Essen, Essen, Germany; Department of Internal Medicine III (G.M.), Medical University of Vienna, Vienna, Austria; Department of Internal Medicine I (W.H.), Klinikum Saarbrücken, Saarbrücken, Germany; and Department of Psychosomatic Medicine (W.H.), Technische Universität München, München, Germany.
ABSTRACT:
Objective:

To assess the efficacy, tolerability, and safety of hypnosis in adult irritable bowel syndrome by a meta-analysis of randomized controlled trials.

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.


Journal of Neurogastroenterol Motil 2014; 20(2): 152-162
The Efficacy of Hypnotherapy in the Treatment of Irritable Bowel Syndrome: A Systematic Review and Meta-analysis
JHan Hee Lee1, Yoon Young Choi2, and Myung-Gyu Choi1,*
1Division of Gastroenterology, Department of Internal Medicine, College of Medicine,
The Catholic University of Korea, Seoul, Korea;,
2Department of Surgery, Yonsei University College of Medicine, Seoul, Korea, Conflicts of interest: None.

Link to full report
ABSTRACT:
Background/Aims
Hypnotherapy is considered as a promising intervention for irritable bowel syndrome (IBS), but the evidence is still limited. The aims of this study were to conduct a systematic review and meta-analysis to estimate the efficacy of hypnotherapy for the treatment of IBS.

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.


 
2017

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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