Therapy, Hypnosis for Irritable Bowel?

Cognitive Behavioral Therapy, Hypnosis May Help Patients With Irritable Bowel Syndrome (IBS)

Medically Reviewed by Louise Chang, MD on May 24, 2006

May 24, 2006 -- Some people may cope better with irritable bowel syndrome(IBS)irritable bowel syndrome (IBS) with help from cognitive behavioral therapy and hypnosis, three new studies show.

The studies were presented in Los Angeles, at Digestive Disease Week 2006, an international meeting of doctors, researchers, and academics.

One of the studies used cognitive behavioral therapy to teach IBS patients new ways to handle their condition. The other two studies tested hypnosis in IBS patients who hadn't been helped by other treatments.

Cognitive behavioral therapy and hypnosis were each linked to improvements in gastrointestinal symptoms, the studies show.

Not 'Hocus-pocus'

The hypnosis researchers included Magnus Simren, MD, of Sahlgrenska University Hospital's internal medicine department in Gothenburg, Sweden.

Hypnotherapy is already used to treat IBS patients, mainly at a few highly specialized gastrointestinal centers, Simren told reporters in a conference call. His team used two more common settings: a university hospital and a county hospital.

Exactly how hypnosis helps IBS isn't clear. Simren, a gastroenterologist, admits having his doubts that patients would give it a try.

"When I started with this, I was a little bit afraid that patients would be hesitant, that they would think this is hocus-pocus. But they are very open-minded to this," he says.

"When I speak to the patient, I tell them that this is a way that you can get control over your symptoms," says Simren. "They are quite satisfied with that explanation."

Hypnosis Studies

Simren's hypnosis studies had a combined total of 135 IBS patients. The patients' average age was 41; most were women.

In both studies, participants were split into two groups. One group got 12 weekly one-hour hypnotherapy sessions focused on gut-related problems. For comparison, the second group didn't get hypnosis.

In one study, the comparison group got 12 weeks of attention from doctors and nutritionists. In the other study, the comparison group got no special care.

The patients rated their gastrointestinal symptoms, quality of life, and depressiondepression at the study's start, immediately after 12 weeks of treatment, and again six and 12 months later.

During the hypnosis sessions, patients were guided into a "relaxational trance," says Simren, in which patients imagined calming images like a gently flowing river.

Simren didn't hypnotize any of the patients. The hypnosis sessions were conducted by trained hypnotherapists.

Symptoms Lessened With Hypnosis

"The hypnotherapy groups improved significantly in both studies regarding gastrointestinal symptoms and the control groups did not," Simren says.

Significant improvement (meaning improvement not likely due to chance) in gastrointestinal symptoms was seen in 52% of the hypnotherapy groups, compared with 32% of the comparison groups.

The improvements were mainly seen with symptoms of abdominal pain, distension, and bloating, rather than for bowel habits, the study shows.

"We believe that with this study we have really demonstrated that this can be performed outside highly specialized GI centers," Simren says, adding that hypnotherapy seems to have a "good effect" with symptom relief sustained after a year.

The long-term results were "promising," says Simren. "So it was good in the short-term; it also seemed to work in the long run with these patients."

Learning to Cope With IBS

Another team of researchers tested cognitive behavioral therapy on 59 IBS patients, most of whom were women.

The researchers included Jeffrey Lackner, PsyD, of the University of Buffalo, which is part of the State University of New York.

"Our work was based on a couple of beliefs," Lackner told reporters, in a teleconference. "One is that at this point, there are no pharmacological treatments or drug therapies that seem to be satisfactory for the full range of symptoms. And so the real burden of managing IBS really rests on the shoulders of patients on a day-to-day basis."

"Managing symptoms really comes down to having a set of skills," Lackner says. Those skills are often taught over 10 to 20 weeks, which is "very impractical for a significant proportion of patients," says Lackner, noting a shortage of therapists trained in cognitive behavior therapy for IBS patients.

Therapy Study

Lackner and colleagues randomly split participants into three groups:

  • 10 weekly sessions of cognitive behavior therapy.
  • 4 weekly sessions of cognitive behavior therapy with a manual to use at home.
  • Wait list for cognitive behavior therapy (comparison group).

Both therapy groups covered the same material and had 60% to 75% achieving "adequate relief and describing their symptoms as improved significantly," Lackner says. The comparison group showed no improvement.

"What we found, just in a nutshell, was that whether patients are treated with a 10-session treatment or a four-session treatment they achieved clinically significant improvement in symptom relief, in quality of life, and they were satisfied," Lackner says.

The four-session treatment was about 2.5 times as efficient as the lengthier treatment, Lackner notes.

No 'Head Shrinking'

"While we have a psychological treatment, our treatment is not shrinking heads," Lackner says.

"Our treatment is teaching patients to manage their illness. This is what is done with cardiac rehabilitation. This is done with diabetesdiabetes management, arthritisarthritis management. We need to use that same approach for IBS."

The therapy covered information on IBS, muscle relaxation training, developing a flexible set of problem-solving skills for IBS, and curbing worry about IBS.

For instance, Lackner says someone with IBS going on a date might worry that their date will think they're "weird" if they have to go to the bathroom during the date.

"We encourage them to say [to themselves], 'Listen, I don't really know what's going to happen four hours down the road. I can only deal with the evidence, the information I have available to me and I'll deal with that when it comes up."

The bottom line: "Our goal is to try to teach them to control that worried thinking in a way that reduces their symptoms," says Lackner. He and his colleagues developed the at-home workbook used in the study.

Show Sources

SOURCES: Digestive Disease Week 2006, Los Angeles, May 20-25, 2006. Magnus Simren, MD, internal medicine department, Sahlgrenska University Hospital, Gothenburg, Sweden. Jeffrey Lackner, PsyD, University of Buffalo, The State University of New York. News release, American Gastroenterological Association.

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