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IBS  Irritable bowel syndrome

There's lots of research demonstrating how hypnotherapy is effective in reducing pain, bloating, abnormal stools, anxiety, sleep disturbances and improving all-round quality of life, for patients diagnosed with IBS. Hypnotherapy should be considered a "must-do" in the treatment of IBS.

From the research below...

“There is evidence that, in addition to its psychological effects, 
hypnotherapy can modulate gastrointestinal physiology, alter the 
central processing of noxious stimuli, and even influence immune 
function”. (Whorwell) 

"Over 10 sessions of treatment an overall reduction of 64% was seen 
in primary IBS symptoms. At 9-months follow-up this had improved further to a 72% reduction in primary symptoms and lower anxiety levels. The marked 
improvement seen with this client is consistent with the view that hypnosis is an effective adjunct to IBS treatments". (Walters)

 

 

Whorwell, Peter J. (Jun 2008). Hypnotherapy for Irritable Bowel 
Syndrome: The Response of Colonic and Noncolonic Symptoms. 
Journal of Psychosomatic Research, Vol 64(6), 621-623. 

There is now good evidence that hypnotherapy benefits a substantial proportion of 
patients with irritable bowel 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 noncolonic symptoms 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. 


Kraft, Tom; Kraft, David. (Dec 2007). Irritable Bowel Syndrome: 
Symptomatic Treatment versus Integrative Psychotherapy. 
Contemporary Hypnosis, Vol 24(4), 161-177. 

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, 
anti-diarrhoeals and the new serotonergic modifying agonists/antagonists), dietary 
control (fibre, lactose free products, partially hydrolysed 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. 


Walters, Valerie J.; Oakley, David A. (Sep 2006). Hypnotic Imagery 
as an Adjunct to Therapy for Irritable Bowel Syndrome: An 
Experimental Case Report. Contemporary Hypnosis, Vol 23(3), 141-149. 

Irritable bowel syndrome (IBS) is a debilitating condition affecting between 14 and 
25% of the general population. Medication has been reported to be of limited 
efficacy. However, there is increasing evidence suggesting that hypnotic imagery 
can be an effective adjunct to therapy for this problem. The present experimental 
single case study aims to illustrate the process of psychological treatment of IBS 
with the adjunct of hypnosis and to explore the effectiveness of particular 
interventions. Over 10 sessions of treatment an overall reduction of 64% was seen 
in primary IBS symptoms. At 9-months follow-up this had improved further to a 
72% reduction in primary symptoms and lower anxiety levels. The marked 
improvement seen with this client is consistent with the view that hypnosis is an 
effective adjunct to IBS treatments.

 
Gholamrezaei, Ali; Ardestani, Samaneh Khanpour; Emami, 
Mohammad Hasan. (Jul 2006). Where Does Hypnotherapy Stand in 
the Management of Irritable Bowel Syndrome? A Systematic 
Review. The Journal of Alternative and Complementary Medicine, Vol 
12(6), 517-527. 

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. 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. 


Smith, Graeme D. (Jun 2006). Effect of Nurse-led Gut-directed 
Hypnotherapy upon Health-related Quality of Life in Patients with 
Irritable Bowel Syndrome. Journal of Clinical Nursing, Vol 15(6), 
678-684. 

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. 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. 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. 


Palsson, Olafur S.; Turner, Marsha J.; Whitehead, William E. (Jan 
2006). Hypnosis Home Treatment for Irritable Bowel Syndrome: A 
Pilot Study. International Journal of Clinical and Experimental 
Hypnosis, Vol 54(1), 85-99. 

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. 


Brock, Annette J. (Nov 2005). The Use of Hypnosis for Irritable 
Bowel Syndrome. Australian Journal of Clinical & Experimental 
Hypnosis, Vol 33(2), 218-231. 

This case illustrates the use of hypnosis in the management of irritable bowel 
syndrome (IBS) in a young woman recently diagnosed with this distressing 
condition. The use of the relaxation response, combined with suggestions designed 
to modify gut motility, as well as the use of an abdominal pain reduction technique, 
enabled this young woman to modify stress, restore sleep to normal, reduce 
abdominal pain, and develop a sense of self-efficacy in managing this functional 
disorder of the gut. 


Galovski, Tara E.; Blanchard, Edward B. (Jul 2002). Hypnotherapy 
and Refractory Irritable Bowel Syndrome: A Single Case Study. 
American Journal of Clinical Hypnosis, Vol 45(1), 31-37. 

The current study describes the successful administration of hypnotherapy with a 
subject (male, aged 55 yrs) suffering from refractory Irritable Bowel Syndrome 
(IBS) and Generalized Anxiety Disorder. 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 Centre 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 2-yr 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. 


Blanchard, Edward B. (2001). Irritable Bowel Syndrome: 
Psychosocial Assessment and Treatment. Washington, DC: American 
Psychological Association. 

Reviews research on the effectiveness of psychological treatments for irritable 
bowel syndrome (IBS), describes the basic requirements for a thorough 
psychological assessment, and then provides detailed short-term treatment manuals 
for the 3 major modalities shown to be most effective for this population: (1) 
cognitive therapy; (2) cognitive-behavioural therapy; (3) and hypnotherapy. Session-by-session

treatment plans for each of these therapies include the rationale for the 
session, goals and objectives, structured activities, and homework assignments. 
Also provided are assessment forms, symptom diaries, cognitive monitoring forms, 
and educational handouts. Instructions for modifying the 3 treatments for use with 
the individuals and with groups are provided as well as helpful advice for 
collaborating with gastroenterologists and other referring physicians. 


Blanchard, Edward B. (2001). Hypnotherapy Treatment Manual for 
Irritable Bowel Syndrome. In Blanchard, Edward B. (Ed.), Irritable 
Bowel Syndrome: Psychosocial Assessment and Treatment, (pp. 277-
302). Washington, DC: American Psychological Association. 

This chapter gives a hypnotherapy treatment manual for irritable bowel syndrome 
(IBS), as described by P. Whorwell. These protocols are intended for therapists who 
have prior clinical experience and training in hypnotherapy. Introductory material, a 
basic induction script for the relaxation method, an ego strengthening script, 
specific instructions for IBS clients, suggestions for self-hypnosis and relaxation, a 
reorientation script, an eye fixation and closure script, a script for progressive 
relaxation, a tree metaphor, and alternative and additional inductions are given for  
the first 2 sessions. For the third session and beyond, techniques for gut-directed 
therapy (for IBS) and suggestions for self-hypnosis and relaxation are detailed. 


Galovski, Tara E.; Blanchard, Edward B. (Dec 1998). The Treatment 
of Irritable Bowel Syndrome with Hypnotherapy. Applied 
Psychophysiology and Biofeedback, Vol 23(4), 219-232. 

P. J. Whorwell et al (1984) demonstrated that hypnotherapy was effective in the 
treatment of irritable bowel syndrome (IBS) in the UK. This study replicated that 
work in the US. Six matched pairs of IBS patients (aged 23–58 yrs) were randomly 
assigned to either a gut-directed hypnotherapy (6 subjects) or to a symptom monitoring 
wait-list control condition (6 subjects) 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 to symptom monitoring. Results from the entire treated sample (11 subjects; 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-mo follow-up point indicated good maintenance of treatment gains. 
No significant correlation was found between initial susceptibility to hypnosis and 
treatment gain.

 

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