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Hypnotherapy may help ease irritable bowel syndrome

Symptom relief may last for up to nine months, indicate clinical trial results

Caroline White

Friday, 23 November 2018

Hypnotherapy might ease relieve irritable bowel syndrome (IBS) symptoms for some patients for up to nine months after treatment, finds one of the largest studies of its kind, published today in The Lancet Gastroenterology & Hepatology journal.

The study,* a randomised controlled trial of 354 adults with IBS in primary and secondary care, found that IBS patients given hypnotherapy reported a greater overall improvement in their condition and were more able to cope with, and were less troubled by, their symptoms than those who received educational supportive therapy. However, hypnotherapy did not appear to reduce the severity of symptoms.

IBS affects around one in five people worldwide and is persistent and difficult-to-treat, with symptoms that can seriously affect quality of life including abdominal pain, bloating, diarrhoea, and constipation. 

Psychological interventions have proved effective, but a shortage of suitably trained therapists hampers their widespread use. Hypnotherapy research has already produced promising results for IBS, but most studies have been done in highly specialised centres rather than in primary and secondary care where most patients are treated. 

The IMAGINE study recruited 354 adults (aged 18-65 years) with IBS who were referred to 11 hospitals across the Netherlands between May 2011 and April 2016. Participants were randomly assigned to receive either individual sessions lasting 45 minutes (150 patients) or group sessions (150) twice weekly for six weeks, or just education and supportive care (54). 

Hypnotherapy treatment was provided by psychologists who were trained as hypnotherapists and involved a technique of positive visualisation during which patients were given suggestions about how they could gain control over their digestive system to reduce feelings of pain and discomfort. Patients were also given a CD so they could practice self-hypnosis exercises at home for 15-20 minutes every day.

Participants completed assessments on their level of symptom severity, quality of life, psychological symptoms, healthcare costs, and time off sick at the start of the trial, immediately after treatment (three months) and again nine months later. The level of symptom relief was assessed immediately after treatment and nine months later. 

Immediately after treatment, participants in the two hypnotherapy groups reported satisfactory relief at substantially higher rates than those who received educational supportive care alone.

After three months of treatment, adequate relief of IBS symptoms was reported by more patients who received individual (40%; 41/102 for whom data were available) and group hypnotherapy (33%; 31/91) than those given education and supportive care (17%; 6/35).

The benefits were still evident nine months later (42% [38/91], 50% [40/80], and 22% [7/31]). But this wasn’t accompanied by a significant improvement in symptom severity.

“Our study indicates that hypnotherapy could be considered as a treatment option for patients with IBS, irrespective of symptom severity and IBS subtype,” says Dr Carla Flik from the University Medical Center Utrecht, Netherlands, who led the research.

“It is also promising to see that group hypnotherapy is as effective as individual sessions, which may mean that more people could be treated with it at lower cost, should it be confirmed in further studies.”

She adds: “What’s striking about these findings is the extent to which patient’s perception of their illness has an effect on their suffering, and that their perception of symptoms appears to be as important as actual symptom severity.

“We do not know exactly how gut-directed hypnotherapy works, but it may change patients’ mindset and internal coping mechanisms, enabling them to increase their control over autonomic body processes, such as how they process pain and modulate gut activity.”

The authors note some limitations to their research, including a relatively high drop-out rate of 15-22%, and the failure of a substantial number of participants to complete questionnaires at three and nine months. The inexperience of therapists in dealing with IBS, and the low number (six) of hypnotherapy sessions provided (half the usual number), might also have underestimated the effects of hypnotherapy.

In a linked Comment, Professor Olafur Palsson, University of North Carolina at Chapel Hill, USA discusses factors that may have contributed to the “modest” therapeutic impact of hypnosis in the study. 

“The hypnotherapy tested in this study might have been suboptimal in amount or implementation. However, as the authors note, the smaller therapeutic effect in this trial compared with most hypnotherapy trials in tertiary care might have been because IBS in primary and secondary care is different to that in tertiary care —perhaps simpler in nature and with less involvement of psychological factors.

“Therefore, despite this impressive investigative effort by Flik and colleagues, it remains unclear whether gut-directed hypnotherapy is well suited for the treatment of patients with IBS in primary and secondary care, and future trials are needed to provide definitive answers.”

* Flik CE, et al. Efficacy of individual and group hypnotherapy in irritable bowel syndrome (IMAGINE): A multicentre randomised controlled trial. The Lancet Gastroenterology and Hepatology, 22 November 2018

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