Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder characterized by chronic abdominal pain or cramps, and altered bowel functioning (diarrhea and/or obstipation). Other gastrointestinal symptoms include bloating and gas. Most of those suffering IBS have mild symptoms, but there is still a substantial number of patients with severe symptoms with considerable impairment of functioning in daily life, and loss of work and school days.
The cause of IBS is unknown and to date no specific abnormality has been found in IBS patients. Although the pathophysiology is unclear, IBS may be explained by a combination of both physiological and psychological factors. Some of the factors involve the smooth muscles that contract to move food through the intestines, and others involve abnormalities in the nervous system regulating the digestion, such as an overreaction to the stretches of the gut caused by gas or stool. There are several psychological factors that predict whether somebody will get IBS or not: Anxiety, depression, high levels of psychological distress, and sleep problems are risk factors for IBS.
Partially because the precise cause of IBS is not known, conventional treatment has proven difficult. Usually the initial therapy starts with education of the patient about the nature of IBS, reassurance that IBS is a benign condition, advice about diet (e.g. exclusion of gas-producing foods) and physical activity.
Medications target symptoms such as pain, bloating, diarrhea, and constipation but show little evidence of effectiveness for IBS therapy.
Psychological treatments have proven a promising alternative therapy compared to standard medical care for severe IBS. Of all the tested psychological therapies, cognitive-behavioural therapy and hypnotherapy have been best backed by scientific evidence.
The first trial on hypnosis and IBS was done by Dr Whorwell and colleagues in 1984. Thirty patients with severe IBS refractory to standard medical treatment were allocated to either a group that received seven sessions of hypnotherapy, or a group who received psychotherapy plus placebo pills. Overall changes in abdominal pain, bowel habits, abdominal distension, and general well-being were significantly greater in the hypnotherapy group.
A recent meta-analysis of 8 randomized controlled trials showed that hypnotherapy for IBS is superior to control conditions (e.g. usual medical care, supportive therapy, waiting list), provides adequate symptom relief, and is safe and well tolerated.
Typically a hypnotherapy programme for IBS consists of 7-12 individual sessions over a period of 3 months. Usually a treatment session starts with an induction and deepening consisting of suggestions for muscle relaxation and imagery of a favourite place of relaxation, followed by suggestions for ego-strengthening, general well-being, and mental calm. Further sessions also include so-called gut-directed techniques aiming at normalizing and controlling gut function. One of the latter techniques involves moving one hand onto the abdomen and inducing a feeling of warmth and comfort. Metaphors are often used during the treatment sessions: In the case of IBS with diarrhea, the instestine may be thought of as a river, which could be fast and turbulent; the patient could then be imagining it moving slowly and smoothly. Between therapy sessions, patients are asked to practice self-hypnosis at home on a daily basis in order to improve the effectiveness of the treatment.
The hypnotherapeutic treatment strategy depends on the patient’s needs, and several other techniques are available. If there are reasons to use analytical techniques to look for the root cause of the problem, regression and dissociative techniques may be used. Feared or avoided situations (e.g. patients avoiding travelling because of the fear that there might not be a bathroom nearby) can be rehearsed in imagination using pseudoorientation in time. Glove analgesia is a good alternative in the control of abdominal pain in IBS.
More than half of the refractory patients will benefit
Early studies by Whorwell and colleagues showed that – at a follow-up after 18 months - 84% of all patients improved (and the sucess rate for patients with classical symptoms was even better with 95%). A recent audit of 1000 patients reported a significant reduction of severity of IBS symptoms in 76% of participants in a gut-directed hypnotherapy programme.
Treatment benefits usually last for several years
Studies by Gonsalkorale and colleagues found that 81% of patients retained the therapeutic improvements long term (for up to 5 years after treatment).
There are „positive side-effects“: Improvements of psychological symptoms and quality of life
Hypnotic therapy of IBS is associated with improvements of quality of life, psychological well-being, self-efficacy, and with a reduction of symptoms of anxiety, depression, and somatization.
Can we actually measure the effects of physiological and psychological stress on the body? Using hypnosis is a safe and highly reproducible way to induce specific emotions.
Emotions such as excitement and anger increase the contractions of the intestine, and happiness has a calming effect on our digestive system (a reduction of the contraction rate). This might explain some everyday experiences such as abdominal cramps or more frequent defection during especially stressful events in our life, and also help to understand why hypnosis is effective in the treatment of irritable bowel syndrome.
Reference: Olafur S. Palsson (2015) Hypnosis Treatment of Gastrointestinal Disorders: A Comprehensive Review of the Empirical Evidence, American Journal of Clinical Hypnosis, 58:2, 134-158.
You can read more about irritable bowel syndrome in my blog.