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Therapy, Hypnosis for Irritable Bowel?
Cognitive Behavioral Therapy, Hypnosis May Help Patients With Irritable Bowel
Syndrome (IBS)
By Miranda Hitti
WebMD Medical News
Reviewed By Louise Chang, MD
on Wednesday, 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 diabetes management, arthritis 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.
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.