IBS, while not normally thought of as a life threatening condition, is certainly a quality of lift threatening issue. It is an issue that is certainly frustrating for the person suffering from IBS, but often equally as frustrating to diagnose and for the physician to treat. The following is from a manuscript written by William Whitehead, Ph.D. in the Division of Gastroenterology & Hepatology at the University of North Carolina at Chapel Hill:
Irritable bowel syndrome (IBS) is a prevalent and complicated functional gastrointestinal disorder with poorly understood etiology, which has proven difficult to treat for both primary care medicine and gastroenterology. Many IBS patients experience little or no relief in their bowel symptoms from conventional medical interventions. For example, we recently found in a large HMO survey that only 49% of patients who visited primary care doctors for IBS reported that their symptoms were at least somewhat better 6 months later (Whitehead, 2006).
The abstract of the paper goes on to cite not only that not only is hypnosis a best researched intervention for IBS, but states that the body of research consistently shows hypnosis to have a substantial therapeutic impact on IBS, even for patients unresponsive to standard medical interventions. Additionally the paper cites, the median response rate to hypnosis treatment is 87%, and that psychological symptoms and life functioning improve after treatment, as well as therapeutic gains are well maintained for most patients for years after the end of treatment.
The efficacy of hypnotherapy in the treatment of Irritable Bowel Syndrome is neither new, nor a secret to the medical research community. In fact it is actually very well documented by research physicians all over the world. Not the least of which is Dr. Peter Whorwell, Professor of Medicine and Gastroenterology at the University of Manchester in the U.K. Dr. Whorewell, a leader in the area of IBS research has defined hypnosis as not a last ditch effort to help IBS sufferers, but as the definitive method of choice by citing as much as a 100% success rate in some of his studies, outlined below. It’s also important to note that these impressive results aren’t isolated to the British. Dr. Whorewell’s research has been duplicated the world over, including here in this country by Dr. Olafur S. Palsson, a clinical psychologist and health researcher at the University of North Carolina School of Medicine.
Another notable point is that the research in this area isn’t something that has just been discovered in the past few years. Dr. Whorewell’s clinical research studies reach back over thirty years, one of which that was published in the prestigious British Medical Journal, The Lancet, sought to explore the results of hypnotherapy vs. that of psychotherapy in the treatment of the IBS patients. In this study, all the patients were diagnosed with Severe Refractory Irritable Bowel Syndrome and were randomly allocated to treatment through either hypnotherapy, or psychotherapy. The results of this study dating back three decades states:
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 (Whorewell, Prior, & Faragher, 1984).
Moving ahead a few years, in 1987 Dr. Whorewell went back to work and completed a follow up study entitled “Hypnotherapy in severe irritable bowel syndrome: further experience.” In this very significant study from the Department of Medicine, University Hospital of South Manchester, the study followed up on fifteen of the patients with severe intractable irritable bowel syndrome who had been previously reported as having been successfully treated with hypnotherapy. The follow up period was cited as being a mean of 18 months. Quoting from the study regarding these fifteen patients, “All patients remain in remission although two have experienced a single relapse overcome by an additional session of hypnotherapy.” The study also added 35 additional patients to expand the research study to 50 people of various ages and would yield less than ideal results for those over the age of 50, but show extreme promise for those under 50 years of age. Specifically the findings cite, “Patients over the age of 50 years responded very poorly (25%) where as 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...(Whorwell, Prior, & Colgan, 1987).
While the above study will obviously be disconcerting for IBS sufferers over the age of 50, there is actually a ray of hope. Melissa Roth, a respected hypnotherapist who teaches IBS and Fibromyalgia Specialist certification courses as well as several autonomic and chronic illness classes has done an immense amount of work in this area, and in fact was both an IBS and Fibromyalgia sufferer herself. Stating that she did not want to discriminate against an age group of which she was a part, Melissa created a protocol that could be adapted to those over the age of 50. In her lectures she does explain that her research has shown that “it does take more sessions with people over the age of 50, but that should be no reason to turn them away.” Additionally she cites that most clients over 50 do not get complete symptom relief, but many will get greater than 50-75% alleviation.
The research into the efficacy of hypnotherapy for IBS intervention continued to show favorable results, and the studies even began working with specific symptoms in various areas of IBS. A few years later in a paper entitled, “Changes in rectal sensitivity after hypnotherapy in patients with irritable bowel syndrome,” published in 1990, the researchers stated, “Hypnotherapy has been shown to be highly successful in the treatment of the irritable bowel syndrome. Its mechanism of action, however, remains unknown” (Prior, Colgan, & Whorwell, 1990). Many of the results yielded in this study have to do with the how, why, and physiology of the gastrointestinal system, and while very useful to the medical community would likely not be of much use or understanding to the lay person. The study did state however that results showed a trend towards normalization of rectal sensitivity and this trend was also observed I patients with constipation-predominant irritable bowel syndrome.
Moving ahead several years the research continued to show such promising results in the treatment of IBS, that it led to the establishment of the first treatment clinic in the United Kingdom staffed by six hypnotherapists to provide hypnotherapy as a clinical service. This subsequently led to a study published in the American Journal of Gastroenterology in 2002. The study presented an audit on the first 250 unselected patients treated. The patients underwent 12 sessions of hypnotherapy over a three month period, were given instruction in self-hypnosis, and were given required homework for between sessions. Although males who were dealing some diarrhea issues didn’t do as well as other patients citing the potential of some pathophysiological implications, overall the results were very optimistic stating, “Marked improvement was seen in all symptom measures, quality of life, and anxiety and depression…, in keeping with previous studies.” The study went on to cite under conclusions that, “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” (Gonsalkorale, Houghton, & Whorwell, 2002).
As demonstrated in the aforementioned study, the case for the efficacy of hypnotherapy in the treatment of IBS was gaining momentum, and clearly becoming stronger. By this time however the medical community obviously was starting to ask obvious questions about the long term effects. After all by now two decades worth of research was documenting hypnotherapy as the go to treatment for IBS, and showing results that were someone remarkable, but how successful was it long term? Seeking to answer that question, another study was just about to be published in a prominent gastrointestinal medical journal.
This study presented the first long term follow-up (5+ years), documenting the results of a large number of patients who had undergone hypnotherapy for IBS symptoms. The results published in the paper, “Long term benefits of hypnotherapy for irritable bowel syndrome,” cited that overall, 71% of the IBS patients had initially responded to [hypnotherapy], and that of these 81% maintained their improvement over time. Of the other 19%, the majority claimed that their deterioration of symptoms had only been slight. Additionally it was stated that “There were no significant differences in the symptom scores between patients assessed at 1, 2, 3, 4, or 5+ years following treatment.” This landmark first long term follow-up study concluded in its entirety:
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 (Gonsalkorale, Miller, Afzal, & Whorwell, 2003)
It is important to note at this point that while impressive, the studies listed in this article are but a handful of those that were documenting the favorable results of hypnosis in the treatment of IBS. Therefore by this time in addition to the medical community, the psychological community was also taking note and conducting their own research studies. One researcher very well known to the hypnotherapy community was Dr. D. Corydon Hammond who along with other colleagues conducted a very meticulous study that would later be published in the American Journal of Clinical Hypnosis. In part, the paper stated that despite the prevalence of IBS, there remains a significant lack of efficacious medical treatments. The researchers went on to state that after reviewing a total of 14 published studies on the efficacy of hypnosis in treating IBS:
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 (Tan, Hammond, & Gurrala, 2005).
One last study points to the efficacy of using hypnosis to combat IBS in children. As most any well trained hypnotherapist will quickly attest, children are often some of the best candidates for hypnotherapy as their minds are open to such things. Children are often very hypnotically talented as the term is often used in the profession, which is not only a blessing to the child and the hypnotherapist, but to the parent as well. The pains and symptoms of IBS are terrible for an adult to endure, but as most parents would likely agree, having the symptoms themselves would be easier to endure than to have to watch their own child endure them. Fortunately the clinical research has shown hypnotherapy to be not only effective for combating IBS In adults, but in children as well.
The results of this last study we will address were published in a paper entitled, “Hypnotherapy for Children with Functional Abdominal Pain or Irritable Bowel Syndrome: A Randomized Controlled Trial.” The study consisted of pediatric patients who were 8-18 years of age, and compared a group who received hypnotherapy, against a group treated with “standard medical procedures.” The hypnotherapy group received 6 sessions over a 3 month period, and follow-ups were conducted at 6 and 12 months thereafter. One very important, and from a hypnotherapist’s point of view a very desirable point of this study was that no fixed hypnotic scripts were used, and subsequent sessions were often modified on the basis of feedback from the client. This is very substantial, as if you or your child were coming in for IBS sessions, an observant hypnotherapist would do the very same thing. Using fixed scripts may sound good for a clinical study where you want to measure everyone by the same criteria, but in practice not everyone will respond to the same metaphors, or suggestions. Therefore this study may be viewed from a hypnotherapist's position as significant.
Aside from the standard “gut specific” type suggestions, the children were also given a variety of non-analgesic suggestions for relaxation, sleep improvement, and ego-strengthening to increase self-confidence, and well-being. The kids were also given a recorded session and encouraged to listen to it on a daily basis or to practice self-hypnosis. The results were very good for the children in the hypnotherapy treatment group. At the one year follow-up, pain intensity scores decreased from 13.5 to 1.3 for the hypno-kids for a 12.2 point reduction. The children in the standard medical treatment group didn’t do as well. Their average pain scores went from 14.1 down to 8.0 for only a 6.1 point drop. As for pain frequency, again the hyno-kids went down 12.4 points and the kids in the standard medical treatment group only went down 5.1 points.
The study concluded hypnotherapy was highly superior, with significantly greater reduction in pain scores when compared against standard medical treatment. At the one year follow-up, successful treatment was accomplished in 85% of the hypnotherapy group as compared to 25% of the standard medical treatment group. The conclusions ended stating that hypnotherapy is highly effective in the treatment of children with longstanding functional abdominal pain or IBS (Vlieger, Menko-Frakenhuis, Wolfkamp, Tromp, & Benninga, 2007).
As has been shown, scholarly clinical research shows hypnotherapy to offer hope to the IBS sufferer. If you’re battling irritable bowel syndrome, and would like to discuss hypnotherapy as an option please contact us online, or call the office at 469-225-9040.
Of course as with any case where there is a possible underlying medical etiology, and especially with something such as abdominal pain, it is crucial that the condition be evaluated by you physician. Undiagnosed abdominal pain is nothing to take lightly. Therefore a medical referral is required for sessions.
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William Carpenter holds a certification for Hypnosis for Immune Disorders, as well as a dual certification in Hypnosis and Pain Management from the American Hypnosis Association.
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Other hypnotherapy certifications include Fibromyalgia Specialist, and Irritable Bowel Syndrome Specialist.
References
Gonsalkorale, W. M., Houghton, L. A., & Whorwell, P. J. (2002). Hypnotherapy in irritable bowel syndrome: a large-scale audit of a clinical service with examination of factors influencing responsiveness. The American journal of gastroenterology, 97(4), 954-961.
Gonsalkorale, W. M., Miller, V., Afzal, A., & Whorwell, P. J. (2003). Long term benefits of hypnotherapy for irritable bowel syndrome. Gut, 52(11), 1623-1629.
Prior, A., Colgan, S. M., & Whorwell, P. J. (1990). Changes in rectal sensitivity after hypnotherapy in patients with irritable bowel syndrome. Gut, 31(8), 896-898.
Tan, G., Hammond, D. C., & Gurrala, J. (2005). Hypnosis and irritable bowel syndrome: a review of efficacy and mechanism of action. American Journal of Clinical Hypnosis, 47(3), 161-178.
Vlieger, A. M., Menko–Frankenhuis, C., Wolfkamp, S., Tromp, E., & Benninga, M. A. (2007). Hypnotherapy for children with functional abdominal pain or irritable bowel syndrome: a randomized controlled trial. Gastroenterology, 133(5), 1430-1436.
Whitehead, W. E. (2006). Hypnosis for irritable bowel syndrome: the empirical evidence of therapeutic effects. International Journal of Clinical and Experimental Hypnosis, 54(1), 7-20.
Whorwell, P. J., Prior, A., & Colgan, S. M. (1987). Hypnotherapy in severe irritable bowel syndrome: further experience. Gut, 28(4), 423-425.
Whorwell, P. J., Prior, A., & Faragher, E. B. (1984). Controlled trial of hypnotherapy in the treatment of severe refractory irritable-bowel syndrome. The Lancet, 324(8414), 1232-1234.
