Irritable Bowl SyndromeI

Overview of Published Research To Date on Hypnosis for IBS
By Olafur S. Palsson, Psy.D. Last updated September 24, 2003b
Whorwell PJ; Prior A; Faragher EB. Controlled trial of hypnotherapy in the treatment of severe refractory irritable-bowel syndrome.The Lancet 1984, 2: 1232-4. This study is the earliest and perhaps the best study in this research area to date, as it was thoroughly placebo-controlled and showed dramatic contrast in response to hypnosis treatment above the placebo group. Thirty patients with severe symptoms unresponsive to other treatment were randomly chosen to receive 7 sessions of hypnotherapy (15 patients) or 7 sessions of psychotherapy plus placebo pills (15 patients). The psychotherapy group showed a small but significant improvement in abdominal pain and distension, and in general well-being but not bowel activity pattern. The hypnotherapy patients showed a dramatic improvement in all central symptom. The hypnotherapy group showed no relapses during the 3-month follow-up period.
Graph adapted from the above paper, showing group differences in two of the main IBS symptoms:

Whorwell PJ; Prior A; Colgan SM. Hypnotherapy in severe irritable bowel syndrome: further experience. Gut, 1987 Apr, 28:4, 423-5. This report summed up further experience with 35 patients added to the 15 treated with hypnotherapy in the 1984 Lancet study. For the whole 50 patient group, success rate was 95% for classic IBS cases, but substantially less for IBS patients with atypical symptom picture or significant psychological problems. The report also observed that patients over age 50 seemed to have lower success rate from this treatment.

Harvey RF; Hinton RA; Gunary RM; Barry RE. Individual and group hypnotherapy in treatment of refractory irritable bowel syndrome. Lancet, 1989 Feb, 1:8635, 424-5. This study employed a shorter hypnosis treatment course than other studies for IBS, and the success rate was lower, most likely demonstrating that a larger number of sessions is necessary for optimal benefit. Twenty out of 33 patients with refractory irritable bowel syndrome treated with four sessions of hypnotherapy in this study improved. Improvement was maintained at a 3-month treatment. These researchers further found that hypnosis treatment for IBS in groups of up to 8 patients seems as effective as individual therap
Prior A, Colgan SM, Whorwell PJ. Changes in rectal sensitivity after hypnotherapy in patients with irritable bowel syndrome. Gut 1990;31:896. This study found IBS patients to be less sensitive to pain and other sensations induced via balloon inflation in their gut while they were under hypnosis. Sensitivity to some balloon-induced gut sensations (although not pain sensitivity) was reduced following a course of hypnosis treatment.

Houghton LA; Heyman DJ; Whorwell PJ. Symptomatology, quality of life and economic features of irritable bowel syndrome--the effect of
hypnotherapy. Aliment Pharmacol Ther, 1996 Feb, 10:1, 91-5. This study compared 25 severe IBS patients treated with hypnosis to 25 patients with similar symptom severity treated with other methods, and demonstrated that in addition to significant improvement in all central IBS symptoms, hypnotherapy recipients had fewer visits to doctors, lost less time from work than the control group and rated their quality of life more improved. Those patients who had been unable to work prior to treatment resumed employment in the hypnotherapy group but not in the control group. The study quantifies the substantial economic benefits and improvement in health-related quality of life which result from hypnotherapy for IBS on top of clinical symptom improvement.
Koutsomanis D. Hypnoanalgesia in the irritable bowel syndrome. Gastroenterology 1997, 112, A764. This French study showed less analgesic medication use required and less abdominal pain experienced by a group of 12 IBS patients after a course of 6-8 analgesia-oriented hypnosis sessions followed by 4 sessions of autogenic training. Patients were evaluated at 6-month and 12-month follow-up.

Houghton LA, Larder S, Lee R, Gonsalcorale WM, Whelan V, Randles J, Cooper P, Cruikshanks P, Miller V, Whorwell PJ. Gut focused hypnotherapy normalises rectal hypersensitivity in patients with irritable bowel syndrome (IBS). Gastroenterology 1999; 116: A1009. Twenty-three patients each received 12 sessions of hypnotherapy. Significant improvement was seen in the severity and frequency of abdominal pain, bloating and satisfaction with bowel habit. A subset of the treated patients who were found to be unusually pain-sensitive in their intestines prior to treatment (as evidenced by balloon inflation tests) showed normalization of pain sensitivity, and this change correlated with their pain improvement following treatment. Such pain threshold change was not seen for the treated group as a whole.
Palsson, OS, Burnett CK, Meyer K, and Whitehead WE. Hypnosis treatment for irritable bowel syndrome. Effects on symptoms, pain threshold and muscle tone. Gastroenterology 1997;112:A803. Seventeen out of 18 patients with severe and treatment-refractory IBS who completed a 7-session standardized course of hypnosis treatment improved substantially. All central symptoms of IBS responded to treatment, including abdominal pain, diarrhea/constipation, and bloating. Psychological well-being also increased after treatment, with overall psychological symptoms, anxiety and somatization markedly decreased. Gut pain thresholds and smooth muscle tone, measured with a barostat and balloon inflation tests, were unchanged following treatment.
Vidakovic Vukic M. Hypnotherapy in the treatment of irritable bowel syndrome: methods and results in Amsterdam. Scand J Gastroenterol Suppl, 1999, 230:49-51.Reports results of treatment of 27patients of gut-directed hypnotherapy tailored to each individual patient. All of the 24 who completed treatment were found to be improve.
Galovski TE; Blanchard EB. Appl Psychophysiol Biofeedback, 1998 Dec, 23:4, 219-32. Eleven patients completed hypnotherapy, with improvement reported for all central IBS symptoms, as well as improvement in anxiety. Six of the patients were a waiting-control group for comparison, and did not show such improvement while waiting for treatment.

Gonsalkorale WM, Houghton LA, Whorwell PJ. Hypnotherapy in irritable bowel syndrome: a large-scale audit of a clinical service with examination of factors influencing responsiveness. Am J Gastroenterol 2002 Apr;97(4):954-61.
This study is notable as the largest case series of IBS patients treated with hypnosis and reported on to date. 250 unselected IBS patients were treated in a clinic in Manchester, England, using 12 sessions of hypnotherapy over a 3-month period plus home practice between sessions. Marked improvement was seen in all IBS symptoms (overall IBS severity was reduced by more than half on the average after treatment), quality of life, and anxiety and depression. All subgroups of patients appeared to do equally well except males with diarrhea, who improved far less than other patients for unknown reason.

Palsson OS, Turner MJ, Johnson DA, Burnett CK, Whitehead WE. Hypnosis treatment for severe irritable bowel syndrome: investigation of mechanism and effects on symptoms. Dig Dis Sci 2002 Nov;47(11):2605-14.
Possible physiological and psychological mechanisms of hypnosis treatment for IBS were investigated in two studies. Patients with severe IBS received seven biweekly hypnosis sessions and used hypnosis audiotapes at home. Rectal pain thresholds and smooth muscle tone were measured with a barostat before and after treatment in 18 patients (study I), and treatment changes in heart rate, blood pressure, skin conductance, finger temperature, and forehead electromyographic activity were assessed in 24 patients (study II). Somatization, anxiety, and depression were also measured. All central IBS symptoms improved substantially from treatment in both studies. Rectal pain thresholds, rectal smooth muscle tone, and autonomic functioning (except sweat gland reactivity) were unaffected by hypnosis treatment. However, somatization and psychological distress showed large decreases. In conclusion, hypnosis improves IBS symptoms through reductions in psychological distress and somatization. Improvements were unrelated to changes in the physiological parameters measured. 17 of 18 patients in study 1 and 21 of 24 patients in study 2 were judged substantially improved Improvement was well-maintained at 10-12 month follow up in study 2.

Lea R, Houghton LA, Calvert EL, Larder S, Gonsalkorale WM, Whelan V, Randles J,
Cooper P, Cruickshanks P, Miller V, Whorwell PJ.Gut-focused hypnotherapy normalizes disordered rectal sensitivity in patients with irritable bowel syndrome.Aliment Pharmacol Ther. 2003 Mar 1;17(5):635-42.
This study evaluated the rectal sensitivity changes in IBS patients who received hypnotherapy, like a previous study by the same group (see Houghton et al's study above, but using a slightly different methodology. Twenty-three IBS patients were tested before and after 12 weeks of
hypnotherapy. Following the course of hypnotherapy, the mean pain sensory threshold increased in the hypersensitive subgroup and tended to decrease in the hyposensitive group,
although the l. Reduction in gut pain sensitivity was associated with a reduction in abdominal pain. These results suggest that hypnotherapy may work at least partly by normalizing bowel perception in those patients who have abnormal gut sensitivity, while leaving normal sensation unchanged.
© Copyright 2000-2003, Olafur S. Palsson, Psy.D. All Rights Reserved.

Hypnosis May Be Useful IBS Treatment

Large Study Shows Good Long-Term Symptom Relief

By Salynn Boyles WebMD Medical News Reviewed By Brunilda Nazario, MD on Tuesday, October 21, 2003

Oct. 21, 2003 -- A new study shows hypnosis may be an effective, long-term therapy for the poorly understood and hard-to-treat gastrointestinal disorder known as irritable bowel syndrome.

In the largest long-term study of hypnotherapy for irritable bowel syndrome (IBS) to date, seven out of 10 patients reported an improvement in symptoms after treatment and four out of five responders maintained the improvement for years after stopping hypnosis. Those who did not maintain a response to hypnosis only deteriorated slightly.

"We have known that this treatment is effective, but this study confirms that patients can maintain the improvements for many years," researcher Wendy M. Gonsalkorale, PhD, tells WebMD. "There is growing interest in hypnosis for the treatment of IBS, but too few patients know about it."

Most Sufferers Are Women

As many as 58 million Americans suffer from the symptoms of irritable bowel syndrome and four out of five sufferers are women, based on figures from the American College of Gastrointerology. Typically people with IBS have recurrent symptoms of abdominal pain, distention, and altered bowel movements -- diarrhea, constipation, or a combination of both. Because there is no obvious cause for the array of gastrointestinal disturbances experienced by patients and conventional GI treatments often do not work.

It has been almost two decades since British researcher Peter Whorwell and colleagues first reported on the use of hypnotherapy in the treatment of IBS. Since that time other small studies have also shown hypnosis to be effective, but this new research, appearing in the latest issue of Gut, is the first to follow a large group of patients for years after treatment.

For the study, Gonsalkorale and Whorwell followed 204 patients for up to six years. Researchers asked patients to score their IBS symptoms, as well as their overall quality of life, and levels of depression and anxiety immediately before hypnotherapy and after the treatment. They also responded to a mailed questionnaire sent at least a year and no more than six years after treatment ended. The hypnotherapy course consisted of 12-weekly, one-hour sessions.

Almost three-quarters of the patients (71%) gave positive reports following hypnotherapy, and 81% said they maintained their improvement over time. The sustained improvements reported by most of the patients could not be attributed to other treatments because fewer than one in 10 used other treatments following hypnotherapy.

"This study demonstrates that the beneficial effects of hypnotherapy appear to last at least five years," the researchers write. "Thus, it is a viable therapeutic option for the treatment of irritable bowel syndrome."

Cheaper Than Drugs?

Researcher Olafur S. Palsson, PsyD, who has studied IBS says the number of patients in the new study and the length of follow-up put hypnosis in a favorable light and possibly show it may be the most effective long-term treatment for irritable bowel syndrome. But he says that it is still rarely offered to IBS patients and is not often covered by insurance.

"Hypnotherapy still carries the aura of mystery and magic, and is not really used much for medical conditions in this country," Palsson says. "It requires special training that clinicians in most medical settings simply do not have. And it is considered more costly than drug therapy because it requires repeated sessions."

The University of North Carolina researcher says hypnosis may actually be much cheaper than other treatments because the long-term results appear to be so promising.

"There are only a couple of medications approved for the treatment of irritable bowel syndrome, and it can be expensive to keep patients on these medications long-term," says Palsson. "For many patients, hypnotherapy is a very cost-effective way of improving outcome."

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SOURCES: Gonsalkorale, W. Gut, 2003; vol 52: pp 1623-1629. Wendy M. Gonsalkirale, PhD, senior therapist; research coordinator, hypnotherapy unit, Withington Hospital, Manchester, U.K. Olafur S. Palsson, PsyD, gastrointerology department, University of North Carolina, Chapel Hill.

Pioneer Press Posted on Sun, Oct. 12, 2003

HEALTH: Hypnosis gaining respectability among doctors, patients

BY MICHAEL WALDHOLZ Wall Street Journal

Hypnosis, often misunderstood and almost always controversial, is increasingly being employed in mainstream medicine.

Numerous scientific studies have emerged in recent years showing that the hypnotized mind can exert a real and powerful effect on the body. The new findings are leading major hospitals to try hypnosis to help relieve pain and speed recovery in a variety of illnesses.

At the University of North Carolina, hypnosis is transforming the treatment of irritable bowel syndrome, an often-intractable gastro-intestinal disorder, by helping patients to use their mind to quiet an unruly gut.

Doctors at the University of Washington's regional burn center in Seattle regularly use it to help patients alleviate excruciating pain.

Several hospitals affiliated with Harvard Medical School are employing hypnosis to speed up postsurgical recovery time. In one of the most persuasive studies yet, a Harvard researcher reports that hypnosis quickened the typical healing time of bone fractures by several weeks.

"Hypnosis may sound like magic, but we are now producing evidence showing it can be significantly therapeutic," says David Spiegel, a Stanford University psychologist. "We know it works, but we don't exactly know how, though there is some science beginning to figure that out, too."

Hypnosis can't help everyone, many practitioners say, and some physicians reject it entirely. Even those who are convinced of its effect say some people are more hypnotizable than others, perhaps based on an individual's willingness to suspend logic or to simply be open to the potential effectiveness of the process.

GOING MAINSTREAM

These days, legitimate hypnosis is often performed by psychiatrists and psychologists though people in other medical specialties are becoming licensed in it, too. It can involve just one session, but often it takes several - or listening to a tape in which a therapist guides an individual into a trancelike state.

Whatever the form, it is increasingly being used to help women give birth without drugs, for muting dental pain, treating phobias and severe anxieties, for helping people lose weight, stop smoking or even perform better in thletics or academic tests. Many health-insurance plans, even some HMOs, now will pay for hypnosis when part of an accepted medical treatment.

Until the past decade, many traditional science journals regularly declined to publish hypnosis studies, and research funding was scarce. That's changing. Spiegel, for instance, is co-author of a widely referenced randomized trial involving 241 patients at several prestigious medical centers. Published several years ago in the Lancet, a respected medical journal, it found that patients hypnotized before surgery required less pain medication, sustained fewer complications and left the hospital faster than a similar group not given hypnosis.

Using new imaging and brain-wave measuring tools, Helen Crawford, an experimental psychologist at Virginia Polytechnic Institute in Blacksburg, Va., has shown that hypnosis alters brain function, activating specific regions that control a person's ability to focus attention.

"The biological impact is very real and it can be quantified," Crawford says.

STAYING LEGITIMATE

Still, proponents say they typically spend a great deal of time dispelling commonly held myths and answering skeptics. Hypnosis, they say, cannot make people do or say something against their will.

Credible hypnotists don't wave a watch in front of their clients, as portrayed in many old movies. People who enter into a so-called hypnotic trance are not, generally, put to sleep. On the contrary, practitioners say, they refocus their concentration to gain greater control.

Even so, the field continues to be hurt by quacks, says Marc Oster, president of the American Society of Clinical Hypnosis. His group, along with the Society for Clinical and Experimental Hypnosis, publishes research studies, conducts educational seminars for health providers and certifies those who complete course work and meet other standards.

Oster suggests that people interested in hypnosis see a health provider licensed in a medical discipline who is also certified by one of the hypnosis societies - someone who "uses hypnosis as an adjunct" to a principal medical practice.

Researchers say that most people unwittingly enter into hypnosislike trances on their own in everyday life. When reading a riveting novel or watching a film or TV, many people are experiencing a trancelike state when they are so focused they become only vaguely aware of nearby noise, conversation or activity.

In a dream, when someone imagines falling off a cliff and is startled awake by the sensation of falling, they are triggering the same mental machinery that in hypnosis allows the mind to influence the body, says Dabney Ewin, a psychiatrist at Tulane University Medical School.

Katie Miley used self-hypnosis, taught to her by a Chicago-area psychologist, to help her give birth "without being so anxious and without pain medication." For weeks preceding the delivery, Miley, herself a psychologist, used tapes provided by the therapist to practiced slipping into a hypnotic state. During the birth, and as suggested by the therapist, she muted the pain by imagining the contractions "as a warm blanket enveloping me," she says.

"It was weird," she says. "I was aware of everyone in the room and I was interacting, but mentally my focus was elsewhere, and I just allowed the process to unfold."

Some of the clearest clinically measured results come from using hypnosis to mute severe and chronic pain - as the University of Washington's regional burn-treatment center in Seattle is doing with burn patients.

Patients sent there must undergo frequent therapy to sterilize their damaged skin and get new grafts. They must be awake and alert during the treatment, and even the most powerful narcotics rarely diminish the intense pain.

CHANGING FOCUS

David Patterson, a psychologist at the center, induces a hypnotic trance with a typical and relatively quick technique. Patients are told to close their eyes, breath deeply and imagine they are floating. Through a variety of verbal suggestions, Patterson then helps the patient imagine themselves elsewhere, away from the treatment.

"The pain is still there, of course, but patients simply don't experience it as before," he says.

While relieving physical pain is one of the more common uses of hypnotism, it is also the hardest to explain. Patterson and others report that hypnosis doesn't appear to act on the body's natural pain-killing chemicals, the way drugs do. Instead, scientists believe, through hypnosis a person can be trained to focus away from the pain, not on it as most people usually do.

Many athletes often unconsciously use such a technique to play through severe pain, concentrating their attention on the game or task ahead, instead of on their injury.

Hypnosis, in some form or another, has been used for more than 200 years. It began gaining credibility as a medical tool in the early decades of the past century as psychiatry and psychoanalysis began to show how the unconscious mind often rules daily life. Its usefulness was cemented when combat physicians reported using it during World War II for the wounded.

By 1958, as more doctors described their experiences in the war, the American Medical Association certified hypnosis as a legitimate treatment tool. Few doctors employed it.

But in 1996, a National Institutes of Health panel ruled hypnosis as an effective intervention for alleviating pain from cancer and other chronic conditions. These days, as many people accept that stress can exacerbate illness, the potential curative power of hypnosis is becoming more acceptable, too.

Hypnosis for Irritable Bowel Syndrome (IBS)Hypnosis has been by approved by the American Medical Association as a valid medical treatment since 1958, though the concept of using a state of hypnosis to alleviate both physical and mental ills has recurred throughout the history of medicine from ancient times. By reaching the subconscious level of the mind, hypnotherapy can be used to alter the way a person consciously perceives health problems, and also promote new manners of response to them. Hypnosis and self-hypnosis have been repeatedly proven to be highly effective means of alleviating all of the various symptoms of Irritable Bowel Syndrome (IBS, or "spastic colon"), including pain, diarrhea, constipation, bloating, nausea, and gas.[1]Hypnosis is often thought to be therapy that only affects the mind, but as mind and body are inseparably joined (particularly with IBS, given the brain-gut dysfunction current research has pinpointed), hypnosis can also help physical ailments. During a state of hypnosis, consciousness is not lost, it becomes more selective, and typically a hypnosis patient becomes aware of internal processes rather than the outside world's distractions. 

Most people report the actual experience of being hypnotized as pleasant, comfortable, and extremely relaxing. However, hypnotherapy is beneficial not only for the relaxation it induces, but for the state of suggestibility that characterizes it. In this state, the mind is open to receiving ideas and suggestions that promote positive thoughts and healing changes.[2] During normal waking hours, the window between the conscious and subconscious minds is closed, but any state of relaxation that results in alpha brain waves will open it. Typically, this happens during sleep, and dreams result. Hypnotherapy induces this same state of relaxation while the patient is awake, and allows helpful suggestions (such as those aimed at controlling health problems) to be directed into the subconscious mind. Only ten percent or so of the population is not susceptible to hypnosis - the rest of us can turn to this therapy for relief of symptoms from disorders as wide ranging as: asthma, allergies, strokes, multiple sclerosis, Parkinson's disease, cerebral palsy, high blood pressure, nausea and vomiting, irregular heartbeat, muscle spasms, paralysis, and, with well-documented success rates, Irritable Bowel Syndrome. Hypnotherapy has in fact been proven successful at reducing or even eliminating all Irritable Bowel Syndrome symptoms.[3] Over 15 years of solid scientific research has demonstrated hypnosis to be an effective, safe and inexpensive choice for IBS alleviation.[4] It has been so overwhelmingly successful in this regard that Adriane Fugh-Berman, MD, chair of the National Women's Health Network in Washington, DC, has said that hypnosis should be the treatment of choice for Irritable Bowel Syndrome cases which have not responded to conventional therapy. Since the "conventional therapy" offered to most IBS patients ranges from nothing at all to a lifetime prescription for semi-effective anti-spasmodic drugs, I take this statement as the closest thing to a whole-hearted endorsement an alternative therapy can hope to get from a mainstream medical spokesperson. For Irritable Bowel Syndrome, one of hypnotherapy's greatest benefits is its well-established ability to reduce the effects of stress. Your state of mind can have a direct impact on your physical well-being, even when you're in the best of health. If you're struggling with IBS, the tension, anxiety, and depression that comes from living with an incurable illness can actually undermine your immune system and further compromise your health. Hypnosis can reduce this stress and its resultant negative impact by placing you in a deeply relaxed state, promoting positive thoughts and coping strategies, and clearing your mind of negative attitudes. Irritable Bowel Syndrome in fact is almost uniquely suited to treatment by hypnosis or self-hypnosis, for several reasons. First, as just noted, stress-related attacks can be significantly reduced. Second, one of the most impressive aspects from hypnotherapy, and of tremendous benefit to IBS sufferers, is its well-documented ability to relieve virtually all types and degrees of pain.[5] Finally, because IBS is not a disease at all but a syndrome, if you can relieve and prevent the symptoms, you have effectively cured yourself of the disorder. The underlying dysfunction may still be present but if you suffer no noticeable effects from it, you will be living an IBS-free life. This outcome is a definite possibility from hypnotherapy treatments. As with other alternative therapies, though there is solid evidence that hypnotherapy can provide lasting health benefits for many patients, there is uncertainty about precisely how and why the treatments work. Most scientists believe that hypnotherapy acts upon the unconscious, and affects the body's regulation of involuntary reactions that are normally beyond a person's control. Hypnosis puts these autonomic responses under the patient's power. Happily, treatment is suitable for people of all ages (children as well as adults), for males and females, and there are no risks or side effects. How exactly do you start using hypnotherapy for Irritable Bowel Syndrome? You have two options. For many people, the most accessible means is through a home self-hypnosis program that is specifically gut-directed. Click here to learn about self-hypnosis for Irritable Bowel Syndrome and to listen to CD audio samples online of an IBS hypnosis program (the IBS Audio Program 100TM). Or, you can find a specially trained IBS-focused hypnotherapist in your area and schedule in-person treatment sessions. Click here to learn how to find a qualified hypnotherapist for Irritable Bowel Syndrome, and what you can expect from personal sessions. [1] For clinical studies documenting the success rates of hynosis and self-hypnosis for irritable bowel syndrome, check the IBS Research Library.[2] It's important to note that only positive suggestions produce results, as it is well-established that a person in a state of hypnosis cannot be made to do anything against their will, conscience, or moral values. Even while hypnotized the patient (not the therapist) remains in full control.[3] In one recent study, Dr. Olafur S. Palsson and colleagues at the Eastern Virginia Medical School in Norfolk, Virginia provided 24 IBS patients, 15 women and 9 men, with seven sessions of hypnosis treatment. In addition, the patients used hypnosis audiotapes at home. At the end of the 14-week study period, 21 of the 24 patients "rated themselves improved in all central IBS symptoms after treatment," the researchers report. Significant improvement was found in abdominal pain, bloating, stool consistency and bowel movement frequency. Palsson's group also measured the autonomic nervous system, which regulates the digestive system and other involuntary body activities. After the course of hypnotherapy, the autonomic nervous system was less easily stimulated. The researchers propose that this calming effect "may plausibly contribute to the symptom improvement". (Palsson O, Turner M, Johnson D. Hypnotherapy for irritable bowel syndrome: symptom improvement and autonomic nervous system effects. Program and abstracts of Digestive Disease Week 2000; May 21-24, 2000; San Diego, California. Abstract 997). [4] One of the earliest studies of hypnotherapy in IBS patients tracked 50 patients, all of whom had been diagnosed with severe intractable irritable bowel syndrome, for a mean duration of 18 months. Of these patients, divided into 3 categories of classical cases, atypical cases and cases exhibiting significant psychopathology, the response rates were 95%, 43%, and 60% respectively. Patients over the age of 50 years responded very poorly (25%) whereas those below the age of 50 with classical irritable bowel syndrome exhibited a 100% response rate. This study confirmed the successful effect of hypnotherapy. (Gut 1987 Apr;28(4):423-5. Hypnotherapy in severe irritable bowel syndrome: further experience. Whorwell PJ, Prior A, Colgan SM) [5] Despite the fact that the neural mechanisms underlying the modulation of pain perception by hypnosis remain obscure, its effects are definitely real. One recent study, using positron emission tomography to identify the brain areas in which hypnosis modulates cerebral responses to a noxious stimulus found that noxious stimulation caused an increase in regional cerebral blood flow in the thalamic nuclei and anterior cingulate and insular cortices. The hypnotic state induced a significant activation of a right-sided extrastriate area and the anterior cingulate cortex. The interaction analysis showed that the activity in the anterior (mid-)cingulate cortex was related to pain perception and unpleasantness differently in the hypnotic state than in control situations. The result? Hypnosis decreased both pain sensation and the unpleasantness of noxious stimuli. Conclusions? Both intensity and unpleasantness of the noxious stimuli are reduced during the hypnotic state. In addition, hypnotic modulation of pain is mediated by the anterior cingulate cortex. (Neural mechanisms of antinociceptive effects of hypnosis. Faymonville ME, Laureys S, Degueldre C, DelFiore G, Luxen A, Franck G, Lamy M, Maquet P. Departments of Anesthesiology and Intensive Care Medicine and Neurology, and the Cyclotron Research Centre, University Hospital of Liege, Liege, Belgium. Anesthesiology 2000 May;92(5):1257-67

FYI Gut. 2003 Nov;52(11):1623-9.

Long term benefits of hypnotherapy for irritable bowel syndrome.

Gonsalkorale WM, Miller V, Afzal A, Whorwell PJ.

Department of Medicine, University Hospital of South Manchester, Manchester, UK.

BACKGROUND: and aims: There is now good evidence from several sources that hypnotherapy can relieve the symptoms of irritable bowel syndrome in the short term. However, there is no long term data on its benefits and this information is essential before the technique can be widely recommended. This study aimed to answer this question.

PATIENTS AND METHODS: 204 patients prospectively completed questionnaires scoring symptoms, quality of life, anxiety, and depression before, immediately after, and up to six years following hypnotherapy. All subjects also subjectively assessed the effects of hypnotherapy retrospectively in order to define their "responder status".

RESULTS: 71% of patients initially responded to therapy. Of these, 81% maintained their improvement over time while the majority of the remaining 19% claimed that deterioration of symptoms had only been slight. With respect to symptom scores, all items at follow up were significantly improved on pre-hypnotherapy levels (p<0.001) and showed little change from post-hypnotherapy values. There were no significant differences in the symptom scores between patients assessed at 1, 2, 3, 4, or 5+ years following treatment. Quality of life and anxiety or depression scores were similarly still significantly improved at follow up (p<0.001) but did show some deterioration. Patients also reported a reduction in consultation rates and medication use following the completion of hypnotherapy.

CONCLUSION: 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

American College of Gastroenterology 68th Annual Scientific Meeting

Baltimore, Wednesday, October 15, 2003

"Hypnosis for IBS"

Palsson and colleagues[17] previously reported positive results associated with the use of hypnosis in patients with IBS. It was found that hypnosis (45 minutes every other week for 12 weeks as well as self-hypnosis techniques) improved both IBS symptoms (pain, bloating, and disturbed defecation) and psychologic parameters (somatization and anxiety scores). However, the real-world effectiveness of hypnotherapy presupposes motivated patients and ready access to an appropriately trained therapist.

During this year's meeting of the American College of Gastroenterology, Palsson and colleagues[18] expanded on their previous work by reporting the results of a 3-month home hypnosis program for patients with IBS. The study authors compared the improvement (in multiple symptom parameters) of 19 patients with IBS treated with self-hypnosis (conducted via audio compact disc instruction) with 57 age-, sex-, and symptom severity-matched controls treated with standard medical therapy. Fifty-three percent of the hypnosis patients had improvement in overall IBS symptoms compared with 26% of the controls (10 of 19 vs 15 of 57; P < .05). Quality of life was also significantly improved among patients who underwent hypnosis, and these treatment differences were shown to persist at 6 months. These investigators also found that patients exhibiting greater degrees of anxiety were less likely to respond to hypnotherapy, suggesting that other methods of therapy may be more useful in this subset of patients with IBS."

17. Palsson OS, Turner MJ, Johnson DA, et al. Hypnosis treatment for severe irritable bowel syndrome: Investigation of mechanism and effects on symptoms. Dig Dis Sci. 2002;47:2605-2614.

18. Palsson OS, Whitehead WE, Turner MJ. Hypnosis home treatment for irritable bowel syndrome (IBS): exploratory study. Am J Gastroenterol. 2003;98:S274. [Abstract #822

Brain-Gut Dysfunction & Irritable Bowel SyndromeIrritable Bowel Syndrome, as defined by the Rome II diagnostic guidelines, is characterized as a brain-gut dysfunction. What does this mean?The most recent evaluation model for IBS patients states that the symptoms of the disorder result from the neurologic innervation of the gastrointestinal tract, associated with altered interpretation of neurologic messages from the GI tract by the central nervous system. For IBS news, research, help, diet, recipes, & more. 

Basically, input to the central nervous system from the gastrointestinal tract arrives at several different parts of the brain which are associated with interpretation and modulation of pain perception. Neurologic output from these areas are then returned to the gastrointestinal tract via the spinal cord. This circuit (from gut to brain and brain to gut) appears to be abnormal in patients with Irritable Bowel Syndrome, though the exact abnormalities remain unclear. Visceral (gut) pain in IBS is associated with increased prefrontal cortex activation in the brain. The normal correlation between subjective pain intensity and activation of the anterior cingulate and insula cortices parts of the brain is lost in IBS. Altered visceral perception via changes in reflex responses and viscerosomatic referral areas is common in IBS. Both hyperalgesia (lower pain threshold) and allodynia (pain perceived in non-sensory pathways) are involved in the development of visceral (gut) hypersensitivity. It is believed that, as a result of central sensitization, a sensory memory response is created, which exaggerates and prolongs subsequent stimulation. The pathophysiology of this visceral hyperalgesia (lower pain threshold in the gut) is incompletely understood and appears to be stem from multiple factors. Interestingly, although people with IBS show this visceral hypersensitivity, their peripheral pain thresholds are normal or even elevated in comparison to healthy individuals. Neuroimaging has actually provided direct evidence of physiological differences between normal individuals and those suffering from IBS in the way a visceral (gut) stimulus is processed in the brain. PET scans show pronounced differences in the activation of certain parts of the brain relating to perception and pain in IBS patients versus normal individuals. MRI scans have demonstrated comparable results.This means that IBS is indisputably a physical problem. Simply put, the brain-gut interaction of people with IBS influences their bowel pain perception and motility. In a nutshell, the processing of pain information within the central nervous system varies between normal individuals and those of us with IBS, with the result that we can experience even normal GI contractions as painful. The interactions between our brains, central nervous systems, and GI systems are just not functioning properly. We have colons that react to stimuli that do not affect normal colons, and our reactions are much more severe. The end result is heightened pain sensitivity and abnormal gut motility, in the form of irregular or increased GI muscle contractions. It is this gut overreaction and altered pain perception that cause the lower abdominal cramping and accompanying diarrhea and/or constipation that characterize IBS. Interestingly, the origins of IBS may really be in our brains, and not in our bowels. Given that for many years people with IBS were dismissively told their problem was "all in their heads", it's ironic that, in the end, this may be factually true. The underlying problem might well be in our brains - but it's absolutely not in our imaginations.No one really yet knows exactly why some people develop IBS and others don't. There is mounting evidence that for some IBS sufferers the condition is precipitated by some type of grievous insult to the gut - dysentery, food poisoning, intestinal flu, abdominal surgery, even pregnancy. The theory goes that even after full physical recovery from these traumatic events, the nerves within the gut retain a "memory" of the insult and remain hyper-sensitive to further stimulation, as well as prone to subsequent over-reaction. You likely know if you experienced any abdominal trauma immediately prior to the onset of your IBS symptoms, and if you did it's probably nice to have a logical explanation for what has happened to your GI tract and why. There are those of us who are exceptions to this theory, however, who suffered no gut insult prior to the onset of IBS symptoms, and we're still patiently waiting for our explanation.Gut-directed hypnotherapy, one of the most promising methods of treating IBS, deals directly with the element of brain-gut dysfunction. Click here to learn more about IBS hypnotherapy. To find out more about the brain-gut dysfunction and Irritable Bowel Syndrome, click here to reviewThe First Year: IBS, an essential guide to successfully managing the disorder. You can also find published medical studies on brain-gut dysfunction in the IBS Research Library.Brain-gut dysfunction information excerpted from The First Year: IBS, copyright Heather Van Vorous.

RESEARCH: THE EFFECTIVENESS OF HYPNOSIS The research literature on Hypnosis is extensive. The endorsements of Hypnosis for its healing effectiveness continue to mount. In a recent report, it was revealed that a panel of the National Institutes of Health has endorsed the wider use of Hypnosis for use in conjunction with conventional medical care. Numerous clinical studies have been conducted substantiating the effectiveness of the Hypnotic state in changing individuals' lives. Some of these experimental studies have utilized poor controls for supporting generalization of results beyond the specific experimental trial reported. The research studies cited below are some of the thousands clinical trials that HAVE utilized solid experimental technique and report reliable, valid findings. These studies report a sample of the multitude of applications of Hypnosis in human living: MEDICAL APPLICATIONS

PAIN, MISCELLANEOUS: 1. Ernest Hilgard (1977) and coworkers: in extensive investigations, using experimental paradigms to induce pain (typically either a tourniquet cutting off the circulation to a limb or plunging the limb into cold water), they have demonstrated that various types of pain can be reduced by Hypnotically induced analgesia. In these studies, 66% of the high susceptibility group, but only 13% of the lower and 17% of the medium susceptibility groups, were able to reduce their pain by 1/3 or more. Twenty-six percent of the high, 57% of the medium, and 31% of the low susceptibility groups were able to reduce their pain by 10-32% when compared to controls. 2. Experimentally induced pain, while undeniably noxious, is different from the experience of patients in the clinical setting. Whereas experimental pain is brief, undergone voluntarily, and can be terminated at any time by the subject, in the clinical setting, pain is often longterm, comes against the wishes of the individual and is usually experienced as being outside of personal control. Moreover, it is a part of a disease process that directly alters both physical and mental functioning. 3. In a neurochemical study of Hypnotic control of pain conducted by Domangue (1985), patients suffering arthritic pain showed a correlation among levels of pain, anxiety and depression. Anxiety and depression were inversely related to plasma norepinephrine levels. Depression was correlated with dopamine levels and negatively correlated with levels of serotonin and beta endorphin. Following Hypnotherapy, there were clinically and statistically significant decreases in depression, anxiety and pain, and increases in beta endorphin-like substances. 4. The relationship between pain and endorphins is a complicated one. In his study, Guerra (1982) found that only particular forms of the beta endorphins found in peripheral blood during painful experience are associated with the Hypnotic response. 5. Hilgard (1982) studied children with cancer. He found Hypnosis to be effective in reducing the pain and discomfort associated with repeated unpleasant medical inventions. 6. Stam (1986) reports that patients with chronic facial pain show a greater responsiveness to suggestion as measured by the Carleton University Responsiveness to Suggestion Scale (CURSS) than do normal controls. These patients had higher Hypnotic susceptibility scores than did controls, showing a high susceptibility score to be a good predictor of response to Hypnotic treatment among such patients. 7. Domangue (1985) conducted a study of 19 patients with a variety of musculoskeletal disorders. He reported significant reductions of pain and dysphoria following Hypnosis. The reductions were associated with significant increases in plasma beta endorphin. 8. Barabasz and Barabasz (1989) studied sample of 20 patients with a variety of chronic pain syndromes. They utilized an Hypnotic technique known as Restricted Environmental Stimulation Therapy (REST). All of the patients were initially rated as having low Hypnotic susceptibility on the Stanford Hypnotic Susceptibility Scale (SHSS). Following exposure to the training technique, the subjects demonstrated significant increases in both SHSS scores and in pain reduction when compared to controls.

HEADACHE PAIN: 9. Evidence accumulated to date suggests that a number of Hypnotherapeutic approaches are highly effective in the treatment of patients with chronic migraine headaches. Although no one Hypnotherapeutic technique has been demonstrated to be most effective, all the methods appear to be superior to a standard treatment relying on pharmacological approaches alone.

10. In a study conducted by Anderson (1975), migraine patients treated with Hypnosis had a significant reduction in the number of attacks and in their severity compared to a control group who were treated with traditional medications. The difference did not become statistically significant until the second six-month follow-up period. In addition, at the end of one year, the number of patients in the Hypnosis group who had experienced no headaches for over three months was significantly higher. 11. In a controlled trial conducted by Olness (1987), self-Hypnosis was shown to be significantly more effective than either propranolol or placebo in reducing the frequency of migraine headaches in children between the ages of six and twelve years of age. 12. In a research conducted by Schlutter (1980), Hypnosis was also found to effective in dealing with the relief of tension headache. 13. Alladin (1988) reviewed the literature on Hypnosis, identifying fully a dozen different Hypnotic techniques that have been used in the treatment of chronic migraine headaches. Of these, Hypnotic training emphasizing relaxation, hand warming (which, according to Anderson, 1975) seems the simplest method of establishing increased voluntary control of the sensitive vasomotor system) and direct Hypnotic suggestions of symptom removal have all been shown to be effective in reducing the duration, intensity and frequency of migraine attacks during a ten-week treatment course and at thirteen-month follow-up when compared to controls. 14. A study (Gutfeld, G. and Rao, L., 1992) was conducted on 42 patients suffering from chronic headaches. These patients, all of whom had responded poorly to conventional treatments, were split into two groups. One received Hypnotherapy to relieve their daily headaches; the rest acted as a comparison group. The Hypnotherapy group experienced reduced frequency and duration of headaches, cutting the intensity by about 30%. "These results are impressive in such a difficult, hard-to-treat group of patients," commented Egilius Spierings, M.D., Ph.D. director of the headache section, division of neurology at Brigham and Women's Hospital.

CANCER: 15. Speigel and Bloom (1983b) reported that a study of women with metastatic breast cancer showed that patients who received group therapy with training in Hypnosis over a one-year period were able to reduce their pain experience by 50% when compared to a control group. 16. In addition, at a 10-year follow-up of these same women, the Hypnosis treatment group had a mean survival rate of 36.6 months compared to 18.9 months for the controls. This suggests that the intervention may be both important quantitative and important qualitative effects (Spiegel 1989a). 17-18. Both adolescent and adult cancer patients undergoing chemotherapy were reported by Cotanch (1985) and by Zeltzer (1984), in separate research, to have fewer symptoms of anticipatory nausea and vomiting following Hypnotic interventions.

CARDIOVASCULAR CONDITIONS, GENERAL: 19. In research by Bernardi (1982), hypertensive patients showed themselves to be significantly more effective at controlling cardiovascular responses to stressors in Hypnosis than they were in the normal waking state. This was particularly true for subjects with more marked Hypnotic ability. 20. In a study by Sletvold (1986), normotensive subjects were shown able to either increase or decrease their blood pressure significantly with Hypnosis. 21. In a 1979 research study by Jackson, subjects with Hypnotic ability were shown to improve their aerobic performance significantly in response to postHypnotic suggestion. In addition, subjects with high Hypnotic susceptibility significantly improved their performance in physical exercise using postHypnotic suggestion.

HYPERTENSION & STRESS: 22. Kuttner (1988) found that a Hypnotic approach emphasizing storytelling and imagery was significantly more effective than behavioral techniques or standard medical practice in alleviating distress during bone marrow aspirations in young children with leukemia. 23. Hypertensive subjects were found to have characteristic patterns of increased cerebral blood flow that were most marked in the left hemisphere. During Hypnosis, they could reduce cerebral blood flow more dramatically than could normotensive controls. The changes noted in this research by Galeazzi (1982) were associated with decreases in vascular resistance and diastolic blood pressure in the rest of the body. 24-25. Friedman and Taub (1977, 1978) reported the results of a trial comparing Hypnosis with biofeedback or a combination of both in essential hypertension. At the end of four weeks of treatment, all groups showed a significant reduction in blood pressure. But at six-month follow-up only the patients receiving Hypnosis had maintained the reduction. 26-27. Generally speaking, literature review supports the value of Hypnosis in analgesia and stress reduction in a number of disorders, whether following the dissociative formulation (Miller, 1986) or a social psychology approach (Noland, 1987).

RESPIRATORY CONDITIONS:

28-29. In studies by Maher-Loughnan (1962, 1970), Hypnosis was shown to alleviate the subjective distress of patients with asthma. This change was measured either by the number of attacks or the amount of medication that was needed when compared to supportive therapy. 30. In further study by Maher-Loughnan (1970) asthmatic subjects were randomly assigned to either Hypnosis or relaxation therapy. The results showed both treatment modalities of benefit to the patients, but the improvement in the Hypnotherapy group was significantly greater. There was a peak of improvement between the seventh and twelfth weeks of treatment. In addition, only the Hypnotic subjects showed improvement in physiologic measures of respiration (forced expiratory volume). 31. Ewer and Stewart (1986) reported a randomized control trial of Hypnosis in patients with moderate asthma. Patients with a high Hypnotic susceptibility showed a 74.9% improvement in bronchial hyper-responsiveness (to methacholine challenge), a 5.5% increase in peak expiratory flow rate, a 26.2% decrease in the use of bronchodilator and a 41% improvement in daily ratings outside of the clinic. Twelve patients with a high Hypnotic susceptibility score showed a 75% improvement. However, a control group of 17 patients and a second group of 10 patients with a low level of Hypnotic susceptibility showed no change in either objective or subjective measures. 32. A study by Olness (1985) showed that children trained in self-Hypnosis could significantly alter their tissue levels of oxygen as measured by transcutaneous PO2 measures.

STRENGTHENING THE IMMUNE SYSTEM:

33. Hypnosis strengthens the disease-fighting capacity of two types of immune cells, reports Patricia Ruzyla-Smith and her co-workers at Washington State University in Pullman. Thirty-three college students who achieved a Hypnotic trance easily and 32 students who had great difficulty doing so were recruited for the study. Students who underwent Hypnosis displayed larger jumps in two important classes of white blood cells than participants who received relaxation or no method. The greatest immune enhancement occurred among highly Hypnotizable students in the Hypnosis group.

INTESTINAL CONDITIONS: 34-35. Whorwell (1984) reported successful treatment of Irritable Bowel Syndrome using Hypnosis in a controlled study of a group of patients who had a severe chronic form of the disorder and had not responded to conventional therapies. Patients were randomly allocated to either psychotherapy or Hypnotherapy groups. The psychotherapy patients showed a significant improvement in measures of pain, distension and in general well-being despite a lack of change in bowel habit. In contrast, the Hypnotherapy patients showed a dramatic improvement in all measures which persisted at a two-year follow-up. (Whorwell, 1987). Hypnotherapy, including suggestions for improved gastrointestinal function and pain reduction, was significantly better than Hypnosis for simple deep muscle relaxation. 36. Harvey (1989) reported a similar improvement following Hypnotherapy in 20 of the 33 patients with refractory Irritable Bowel Syndrome at three-month follow-up. 37. Colgan (1988) reported a randomized trial of 30 patients with frequently relapsing duodenal ulcer disease. The subjects were treated for ten weeks with either Hypnotherapy or ranitidine or the drug alone. At a twelve-month follow-up, all of the drug-only patients, but only half of the drug-plus-Hypnotherapy patients, had relapsed.

HEMOPHELIA:

38. Swirsky-Saccetti (1986) reported on research with hemophiliacs. Over an eighteen-week follow-up, a group of hemophiliac patients who were taught self-Hypnosis significantly reduced both their level of self-reported distress and the amount of the factor concentrate they required to control bleeding when compared with a control group of patients who did not undergo Hypnosis. 39. A 30-month follow-up by LaBaw (1975) with hemophiliac patients demonstrated the effectiveness of group procedures for self-Hypnosis in reducing distress and the amount of blood products required when compared to control groups in patients ranging from five to forty-eight years of age.

SURGERY: 40. Patients undergoing head and neck surgery who were trained with preoperative Hypnosis had significantly shorter postoperative hospitalizations than did matched controls (Rapkin, 1988). 41. Swedish researchers studied 50 women prior to surgery. Twenty-five of the women were assigned to the experimental group who were briefly Hypnotized each day for several days before their scheduled operations. Twenty-five were assigned to a control groups who were not Hypnotized. While in a Hypnotic state, the women in the experimental group heard suggestions to relax and feel hungry. After surgery only 10 had nausea (15 experienced no nausea), compared to 17 in the no-Hypnosis control group (8 experienced no nausea).

CHILDBIRTH: 42. In 1963, Schwartz reported on a study in which Hypnotherapy was used successfully to prolong pregnancy and prevent premature delivery. 43-45. Omer (1986a, 1986b, 1987a) found that frequency of physical complaints and the general level of anxiety were correlated with premature labor and premature contractions. A brief technique emphasizing the use of self-Hypnosis was employed as an adjunct to pharmacological treatment. The prolongation of pregnancy was significantly higher for this group than for the medication-along control group, and infant weight was also significantly greater.

MISCELLANEOUS CONDITIONS: 46. In a careful single-case controlled study of a patient with Raynaud's disease, Conn (1984) showed a rapid and dramatic vasodilatation in response to Hypnotic suggestion. 47. In research reported by Spanos (1988), a pair of randomized, carefully designed studies were conducted with a group of people who had warts. Subjects who were given Hypnotic or nonHypnotic suggestions were significantly more likely to achieve wart regression than placebo or no-treatment groups. 48-49. In a report by David Spiegel in the Harvard Mental Health Letter, the following research was cited: a) Several controlled experiments have shown that Hypnosis can be effectively used to eliminate warts; and b) Studies have been done on persons suffering from pseudoseizures, in which they lose consciousness or motor control and make jerking movements typical of epilepsy (but without the associated brain damage). Such patients have been taught to limit or eliminate these symptoms by using Hypnosis.

PSYCHOLOGICAL APPLICATIONS ANXIETY:

50. In a report by David Spiegel in the Harvard Mental Health Letter, the research was cited that Hypnosis methods have been used successfully for anxiety associated with medical procedures. 51. Two hundred forty-one patients who were undergoing percutaneous vascular and renal procedures were randomly tested on three testing regimens, one of which was Hypnosis. Patients rated their pain and anxiety on 1-10 scales before, every 15 minutes during, and after the procedures. Pain remained flat over the duration of procedure time in the Hypnosis group; pain increased linearly with procedure time in both other groups. Anxiety decreased over time in all three groups; the sharpest decrease was in the group that was hypnotized. Procedure times were significantly shorter in the Hypnosis group. In addition, Hypnosis showed itself to be superior in improving hemodynamic stability.

PHOBIC REACTIONS: 52. In a report by David Spiegel in the Harvard Mental Health Letter, the following research was cited: One seven-year study showed that 50% of patients afraid of flying were improved of cured after Hypnosis treatment for a fear of flying.

DEPRESSION: 53. In a neurochemical study of Hypnotic control of pain conducted by Domangue (1985), patients suffering arthritic pain showed a correlation among levels of pain, anxiety and depression. Anxiety and depression were inversely related to plasma norepinephrine levels. Depression was correlated with dopamine levels and negatively correlated with levels of serotonin and beta endorphin. Following Hypnotherapy, there were clinically and statistically significant decreases in depression, anxiety and pain, and increases in beta endorphin-like substances.

BIBLIOGRAPHY Alladin, A. (1988). "Hypnosis in the Treatment of Severe Chronic Migraine. In M. Heap (ed.), Hypnosis: Current clinical, Experimental and Forensic Practices. London: Croom Helm. pp. 159-166. Anderson, J.A., Basker, M.A. & Dalton, R. (1975). "Migraine and Hypnotherapy." International Journal of Clinical and Experimental Hypnosis, 23, 48-58. Barabasz, A.J. & Barabasz, M. (1989). "Effects of Restricted Environmental Stimulation: Enhancement of Hypnotizability for Experimental and Chronic Pain Control." International Journal of Clinical and Experimental Hypnosis, 37, 217- 231. Bernardi, L. Galezaai, L. & Bardelli, R. (1982). " Hypnotic Responsivity of Cold Pressor Test in Normal and Hypertensive Subjects," Paper presented at the International Society of Hypnosis, 9th International Congress of Hypnosis and Psychosomatic Medicine, Glasgow, Scotland. Colgan, S.M., Faragher, E.B. & Whorwell, P.J. (1988). 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