Hypnosis, even in "real world," may help IBS

NEW YORK (Reuters Health) - Hypnosis may help some people with stubborn cases of irritable bowel syndrome (IBS) find some relief from their symptoms, a new study suggests.

A number of studies since the 1980s have found that “gut-directed” hypnosis can help some people with IBS when standard treatment fails. The new study is different in that patients were treated by therapists in their communities rather than at highly specialized medical centers.

So, the researchers say, the findings give a better idea of how hypnosis might work for IBS in the “real world.”

In two separate studies, they randomly assigned 138 patients with IBS that had resisted standard therapy to either a dozen sessions of hypnosis or to a “control” group.

In one study, which included 90 patients, 38 percent of hypnosis patients were treatment “responders” after 3 months -- meaning their symptom scores had dropped by at least 25 percent. That compared with 11 percent of patients in the control group, who only received advice on diet and relaxation techniques.

In the second study, of 48 patients, one-quarter of the hypnosis group were responders, compared with 13 percent of the control group (where patients were put on a wait-list for hypnosis therapy). That difference was not statistically significant, which means it could have been due to chance.

The hypnosis patients did, though, have a bigger average drop in symptoms of pain and bloating.

People with IBS have repeated bouts of abdominal cramps, bloating, constipation and diarrhea. Standard treatment includes diet changes, as well as anti-diarrheal medication and, for constipation, laxatives or fiber supplements.

For many people, that’s enough to bring symptom relief, said Olafur S. Palsson, an associate professor of medicine at the University of North Carolina, Chapel Hill.

But for people with tougher-to-treat IBS, psychological therapies -- namely, hypnosis and cognitive behavioral therapy -- have proven effective in clinical trials.

Palsson, who was not involved in the current study, researches and uses hypnosis therapy in treating IBS.

“This study shows that hypnosis can work in ‘real life,’ in the community setting, and not only the specialized research setting,” Palsson said.

But the benefits were not as strong as those seen in some past studies -- where up to 80 percent of patients had significant improvements in their IBS symptoms.

The current pair of studies took two approaches: in one, hypnosis patients saw psychologists in private practice who were experienced in hypnotherapy; in the second, hypnosis patients saw one psychologist at a gastroenterology outpatient clinic.

It’s possible that the best way to receive hypnosis therapy for IBS is as part of “optimized management” that includes standard medical care, according to senior researcher Dr. Magnus Simren of the University of Gothenburg in Sweden.

But finding a source for hypnosis therapy -- either on its own or along with regular medical care -- is a big obstacle.

IBS-directed hypnotherapy is not widely available, Simren told Reuters Health in an email. And, partly because of that, it’s generally used only for patients with IBS symptoms that do not respond to standard care.

It makes sense, Palsson said, to try standard measures like diet changes and laxatives first. If they do not make a dent in your symptoms after a few months, psychological approaches might be worthwhile -- if you can find them.

The exact cause of IBS is unknown. But the “gut-brain” connection is thought to be important, and anxiety over symptoms can make the physical symptoms worse.

Cognitive-behavioral therapy (CBT), which aims to change the unhealthy thinking patterns and behaviors that contribute to people’s health problems, appears to help some people with IBS.

In gut-directed hypnosis, the idea is to give people a feeling of control over their digestive symptoms. In this study, for instance, patients were given “suggestions” for normalizing their bowel function -- like images of a river “floating smoothly.”

No one knows exactly why the technique seems to work for some stubborn cases of IBS, according to Palsson. He said it’s been thought that hypnosis might change pain sensitivity in the intestines, but research suggests that is not what’s going on.

Hypnosis has not been directly tested against CBT for treating IBS, Palsson said. But based on the results from separate studies, he added, they seem to be comparably effective.

The problem with both is availability. IBS patients in major cities may be able to find either therapy relatively easily, according to Palsson. But in smaller cities and towns, it may well be impossible.

It’s important, Palsson said, to see a licensed health professional with experience not just in hypnosis, but specifically gut-directed hypnosis.

“Only a limited number of therapists have those skills,” he said.

And if you do find someone, there’s the cost -- which only some insurance plans would cover. It’s generally recommended that you have seven to 12 sessions, and seven sessions would cost around $1,000, on average, according to Palsson.

One of the “most promising” aspects of hypnosis therapy is that its effects seem to last, Palsson said. Studies so far suggest that patients who do improve initially typically maintain the benefits for up to five years.

In the current pair of studies, benefits were still apparent one year later. In the larger of the two, 42 percent of hypnosis patients were considered responders one year later (actually higher than the 38 percent who were responders after three months).

Palsson and his colleagues have also done a small pilot study to see whether the therapist can be taken out of the equation altogether.

They had 19 IBS patients follow a scripted hypnosis “protocol” at home for three months, and found that 10 responded to the treatment with more than a 50 percent drop in IBS severity.

But it’s hard to draw conclusions from such a small study, Palsson noted, and more research into home self-hypnosis is needed.

He also stressed that “hypnosis is not a cure for IBS. Most people who respond still have symptoms -- but they are improved.” And that improvement, Palsson added, can make a big difference in the quality of a patient’s life.

SOURCE: American Journal of Gastroenterology, online October 4, 2011.