Helen R. Carruthers

Hypnotherapy for irritable bowel syndrome: an audit of one thousand adult patients.

Gut‐focused hypnotherapy improves the symptoms of irritable bowel syndrome (IBS) with benefits being sustained for many years. Despite this, the technique has not been widely adopted by healthcare systems, possibly due to relatively small numbers in published studies and uncertainty about how it should be provided.

Using Art to Help Understand the Imagery of Irritable Bowel Syndrome and Its Response to Hypnotherapy

Abstract A medical artist asked 109 patients if they had an image of their IBS pre- and posthypnotherapy, making precise watercolor paintings of any images described. Results were related to treatment outcome, symptoms, anxiety, depression, and absorption (hypnotizability); 49% of patients had an image, and a wide variety were recorded and painted. Imagery was significantly associated with gender (p < .05), anxiety (p < .05), noncolonic symptomatology (p < .05), and absorption (p = .001); 57.8% of responders compared with 35.5% of nonresponders to hypnotherapy had an image of their disease (p < .05) before treatment, and color images were associated with better outcomes (p = .05) than monochrome ones. All images changed in responders, often becoming more nonspecific in nature. Inquiring about IBS imagery helps to identify potential responders and nonresponders to hypnotherapy and may also provide insights into how patients think about their illness.

Mood color choice helps to predict response to hypnotherapy in patients with irritable bowel syndrome

BackgroundApproximately two thirds of patients with irritable bowel syndrome (IBS) respond well to hypnotherapy. However, it is time consuming as well as expensive to provide and therefore a way of predicting outcome would be extremely useful. The use of imagery and color form an integral part of the hypnotherapeutic process and we have hypothesised that investigating color and how it relates to mood might help to predict response to treatment. In order to undertake this study we have previously developed and validated a method of presenting colors to individuals for research purposes called the Manchester Color Wheel (MCW). Using this instrument we have been able to classify colors into positive, neutral and negative shades and this study aimed to assess their predictive role in hypnotherapy.Methods156 consecutive IBS patients (aged 14-74, mean 42.0 years, 127 (81%) females, 29 (19%) males) were studied. Before treatment, each patient was asked to relate their mood to a color on the MCW as well as completing the IBS Symptom Severity Score, the Hospital Anxiety and Depression (HAD) Scale, the Non-colonic Symptom Scale, the Quality of Life Scale and the Tellegen Absorption Scale (TAS) which is a measure of hypnotisability. Following hypnotherapy all these measures were repeated with the exception of the TAS.ResultsFor patients with a positive mood color the odds of responding to hypnotherapy were nine times higher than that of those choosing either a neutral or negative color or no color at all (odds ratio: 8.889; p = 0.042). Furthermore, a high TAS score and the presence of HAD anxiety also had good predictive value (odds ratio: 4.024; p = 0.092, 3.917; p < 0.001 respectively) with these markers and a positive mood color being independent of each other. In addition, these factors could be combined to give an even stronger prediction of outcome. Twice as many responders (63, 77.8%) had a positive mood color or were anxious or had a high TAS score compared with 32 (42.7%) without these factors (p < 0.001).ConclusionA positive mood color, especially when combined with HAD anxiety and a high TAS score, predict a good response to hypnotherapy.

Reactivity to images in health and irritable bowel syndrome.

Background  We have been using a medical artist to record and paint the images patients have of their irritable bowel syndrome (IBS) and have hypothesized that the reaction to such images might differ in health and IBS, which could have practical implications for future research.

Irritable bowel syndrome: A comparison of subtypes

Irritable bowel syndrome (IBS) is traditionally divided into subtypes depending on the bowel habit abnormality, but there is little clarity in the literature about whether these subtypes differ symptomatically or psychologically. Furthermore, there are conflicting reports on the relationship between symptom severity and psychological status. The aim of this study was to address these issues in a large cohort of patients defined by bowel habit.

The Manchester Colour Wheel: Enhancing its Utility

The Manchester Colour Wheel was developed to investigate the role of colour in the perception of illness in gastroenterology. During validation it was found that positive, neutral, or negative connotations of the shade of a colour were more important than the colour itself. However, when asked to relate mood to a colour, the response rate was greater in individuals with mood disorders than healthy controls. This study assessed whether response rate could be made more uniform by changing the wording of the question. Mood / colour choice was compared, using two slightly different questions, in 105 and 203 healthy volunteers, resulting in response rates of 39% and 95% respectively, with the latter not associated with increased false positive responses. These results show that adjustment of the wording of a mood-related question may allow equal response rates irrespective of the mood status of participants.

Minor digestive symptoms and their impact in the general population: a cluster analysis approach:

Background: The classification and treatment of patients who do not meet the criteria for a functional gastrointestinal (GI) disorder has not been well established. This study aimed to record the prevalence of minor digestive symptoms (MDSs) in the general population attempting to divide them into symptom clusters as well as trying to assess their impact and the way sufferers cope with them. Methods: Following face-to-face interviews, a web-based, self-administered questionnaire was designed to capture a range of GI sensations using 34 questions and 12 images depicting abdominal symptoms. A randomly selected sample of 1515 women and 409 men representing the general population in France was studied. Cluster analysis was used to identify groups of respondents with naturally co-occurring symptoms. Data were also collected on other factors such as exacerbating and relieving strategies. Results: MDSs were reported at least every 2 months in 66.5% of women and 47.7% of men. A total of 11 symptom clusters were identified: constipation-like, flatulence, abdominal pressure, abdominal swelling, acid reflux, diarrhoea-like, intestinal heaviness, intestinal pain, gurgling, burning and gastric pain. Despite being minor, these problems had a major impact on vitality and self-image as well as emotional, social and physical well-being. Respondents considered lifestyle, food and disordered function as the main factors responsible for MDSs. Physical measures and dietary modification were the most frequent strategies adopted to obtain relief. Conclusions: MDSs are common and improved methods of recognition are needed so that better management strategies can be developed for individuals with these symptoms. The definition of symptom clusters may offer one way of achieving this goal.

Letter: efficacy of hypnotherapy in one thousand patients with irritable bowel syndrome – authors' reply

overestimation of its efficacy. It would therefore be important to know how many patients, in total, commenced hypnotherapy during the study period. Second, the authors stated that it would be meaningless to report how many patients had failed conventional medications prior to commencement of hypnotherapy. However, these data would still be valuable in order for readers to better understand how refractory these patients were to medical therapies. In addition, concomitant medical therapies may have had a significant impact on response rates to hypnotherapy. For instance, did the dual combination of pharmacological therapy with hypnotherapy make up the vast majority of the 42% of patients with the greatest reduction in IBS symptom severity score (IBS-SSS)? Third, 76% of patients reported a 50-point reduction in IBS-SSS and 42% of patients had a 150-point reduction, after 3 months. We would be interested to know whether any of their patients were in remission at the end of treatment (with an IBS-SSS <75 points) and, given that efficacy was only measured at 3 months, whether treatment response was durable? Did the authors collect data concerning re-consultation rates with symptoms beyond this time frame? Finally, it is important to point out that the study was conducted at a specialist unit, with hypnotherapists who possessed 5 years of experience. Data from a recent study by Lindfors et al. suggest that specialised research centres have higher treatment effectiveness than other hospitals, so it may be difficult to reproduce these impressive results elsewhere.