The International Journal of Clinical and Experimental Hypnosis
Volume 54, Number 1 - January 2006 - English
Special Issue on Irritable Bowel Syndrome
Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder characterized by abdominal pain associated with altered stool frequency and consistency and other bowel symptoms. IBS affects 10 to 15% of the adult population and has poorly understood and complex etiology. It is a costly problem for society and leads to considerable emotional and physical suffering, quality of life impairment, and disability for many patients.
Conventional medical approaches to IBS treatment are unsatisfactory for more than half of all patients, leaving them with significant chronic symptoms. Extensive efforts have been made to identify alternative therapies to improve clinical outcomes in IBS management. To date, hypnosis (along with cognitive-behavioral therapy) has the most empirical data as effective for this purpose.
A dozen published studies show hypnosis treatment to have a substantial and broad therapeutic impact on IBS in the majority of patients, resulting in improvement in bowel symptoms, psychological well being, and quality of life that typically lasts for years.
This special issue of the International Journal of Clinical and Experimental Hypnosis offers a comprehensive overview of the evidence of the utility of hypnosis as treatment for IBS and how such treatment can be most successfully conducted. Dr. Whitehead’s article is a complete, systematic review of the published studies in this area of research. A pair of articles by Drs. Whorwell and Gonsalkorale, respectively, describes in detail their team’s highly successful and extensively researched approach to hypnosis treatment of IBS in Manchester, England. An article by Dr. Palsson describes the development, use, and empirical testing of the North Carolina Protocol, the only fully scripted approach to IBS treatment. An article by Dr. Simren examines what research has been able to determine about the mechanisms underlying the effects of hypnosis on IBS. The issue concludes with two pilot studies hinting at further possibilities for this treatment approach: A pilot study by Dr. Palsson and colleagues suggests that hypnosis treatment conducted at home by means of audio recordings may be helpful in IBS, and a pilot trial by Drs. Barabasz and Barabasz gives indication of possible advantages to customization of hypnotic inductions in IBS treatment.
Hypnosis for Irritable Bowel Syndrome: The Empirical Evidence of Therapeutic Effects
William E. Whitehead
Abstract: 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.
Effective Management of Irritable Bowel Syndrome: The Manchester Model
Peter J. Whorwell
Abstract: 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.
Gut-Directed Hypnotherapy: The Manchester Approach for Treatment of Irritable Bowel Syndrome
Wendy M. Gonsalkorale
Abstract: 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.
Standardized hypnosis treatment for irritable bowel syndrome: The North Carolina Protocol
Olafur S. Palsson
Abstract: The North Carolina protocol is a 7-session hypnosis-treatment approach for irritable bowel syndrome that is unique in that the entire course of treatment is designed for verbatim delivery. The protocol has been tested in 2 published research studies and found to benefit more than 80% of patients. This article describes the development, content, and testing of the protocol, and how it is used in clinical practice.
Hypnosis for Irritable Bowel Syndrome: The Quest for the Mechanism of Action
Hypnosis Home Treatment for Irritable Bowel Syndrome: A Pilot Study
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.
Hypnosis Home Treatment for Irritable Bowel Syndrome: A Pilot Study
Olafur S. Palsson, Marsha J. Turner, William E. Whitehead
Abstract: 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.
Effects of Tailored and Manualized Hypnotic Inductions for Complicated Irritable Bowel Syndrome Patients
Arreed Barabasz, Marianne Barabasz
Abstract: This modest clinical pilot study was intended to provide preliminary data on the effects of hypnotic inductions tailored to each patient at each session compared to Palsson’s manualized protocol. Tailored inductions were developed on the basis of hypnotherapeutic and hypnoanalytic techniques in A. Barabasz and J. G. Watkins (2005). Patients (N = 8) who had not previously responded to any form of treatment were assigned randomly to either 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 the 10-month follow-up. 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 emotional distress apparent immediately posttreatment was significantly attenuated.