Vivien Miller

Long term benefits of hypnotherapy for irritable bowel syndrome

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.

Treatment of non cardiac chest pain: a controlled trial of hypnotherapy

Background: Non-cardiac chest pain (NCCP) is an extremely debilitating condition of uncertain origin which is difficult to treat and consequently has a high psychological morbidity. Hypnotherapy has been shown to be effective in related conditions such as irritable bowel syndrome where its beneficial effects are long lasting. Aims: This study aimed to assess the efficacy of hypnotherapy in a selected group of patients with angina-like chest pain in whom coronary angiography was normal and oesophageal reflux was not contributory. Patients and methods: Twenty eight patients fulfilling the entry criteria were randomised to receive, after a four week baseline period, either 12 sessions of hypnotherapy or supportive therapy plus placebo medication over a 17 week period. The primary outcome measure was global assessment of chest pain improvement. Secondary variables were a change in scores for quality of life, pain severity, pain frequency, anxiety, and depression, as well as any alteration in the use of medication. Results: Twelve of 15 (80%) hypnotherapy patients compared with three of 13 (23%) controls experienced a global improvement in pain (p = 0.008) which was associated with a significantly greater reduction in pain intensity (p = 0.046) although not frequency. Hypnotherapy also resulted in a significantly greater improvement in overall well being in addition to a reduction in medication usage. There were no differences favouring hypnotherapy with respect to anxiety or depression scores. Conclusion: Hypnotherapy appears to have use in this highly selected group of NCCP patients and warrants further assessment in the broader context of this disorder.

Suicidal ideation in patients with irritable bowel syndrome

BACKGROUND & AIMS Irritable bowel syndrome (IBS) traditionally is considered as more of a nuisance than having especially serious consequences. However, this is not the picture witnessed in tertiary care where we have encountered some tragic cases, prompting an assessment of suicidal ideation in such patients. METHODS One hundred follow-up, tertiary care IBS (tIBS) patients were compared with 100 secondary IBS (sIBS), 100 primary IBS (pIBS) care patients, and 100 patients with active inflammatory bowel disease (IBD). Patients were asked if they had either seriously contemplated or attempted suicide specifically because of their bowel problem as opposed to other issues. The hospital anxiety depression score was recorded, as were other clinical details on all patients. RESULTS A total of 38% of tIBS patients had contemplated suicide because of their symptoms compared with 16% and 4% in the sIBS and pIBS groups (tIBS vs. sIBS vs. pIBS, P = .002, P < .001). The figure for IBD was 15% (tIBS v. IBD, P < .001). Five tIBS and 1 IBD patient had attempted suicide for gastrointestinal reasons. Mean depression scores did not exceed threshold (10) in the sIBS group contemplating suicide (9.7), but were increased in the equivalent tIBS group (11.7). Hopelessness because of symptom severity, interference with life, and inadequacy of treatment were highlighted as crucial issues for all IBS patients. CONCLUSIONS IBS has the potential for a fatal outcome from suicide with depression not accounting for all the variance in suicidal ideation. Our observations emphasize the level of hopelessness felt by these patients and the need for improvement in the services provided to them.

Treatment of Inflammatory Bowel Disease: A Role for Hypnotherapy?

Abstract Fifteen patients with severe or very severe inflammatory bowel disease on corticosteroids but not responding to medication received 12 sessions of “gut-focused hypnotherapy” and were followed up for a mean duration of 5.4 years with disease severity being graded as remission, mild, moderate, severe, or very severe. Two patients (13.4%) failed to respond and required surgery. At follow-up for the remaining 13 patients, 4 (26.6%) were in complete remission, 8 (53.3%) had mild severity, and 1 (6.7%) was moderately severe. Quality of life became good or excellent in 12 (79.9%). Corticosteroid requirements dramatically declined with 60% of patients stopping them completely and not requiring any during follow-up. Hypnotherapy appears to be a promising adjunctive treatment for inflammatory bowel disease and has steroid sparing effects. Controlled trials to clearly define its role in this disease area are justified.

Hypnotherapy for Functional Gastrointestinal Disorders: A Review

Abstract Patients with functional gastrointestinal disorders, such as irritable bowel syndrome, functional dyspepsia, and noncardiac chest pain, can suffer from a range of severe symptoms that often substantially erode quality of life. Unfortunately, these conditions are notoriously difficult to treat, with many patients failing to improve despite being prescribed a wide variety of conventional medications. As a consequence, the potential benefits of hypnotherapy have been explored with evidence that this approach not only relieves symptoms but also appears to restore many of the putative psychological and physiological abnormalities associated with these conditions toward normal. These observations suggest that this form of treatment has considerable potential in aiding the management of functional gastrointestinal disorders and should be integrated into the ongoing medical care that these patients are receiving.

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.

Gender and Irritable bowel syndrome: The male connection

Background/Goals: Irritable bowel syndrome is more common in women; and this is generally considered to be caused by increased susceptibility. However, the opposite possibility that being male might actually protect from the disorder in some way, has largely been ignored. We have noticed that men with IBS seem to display less masculine and more feminine qualities and it was the purpose of this study to confirm or refute this clinical observation. Study: Seventy consecutive male, secondary care outpatients fulfilling the Rome 1 criteria for irritable bowel syndrome and 70 controls completed a questionnaire to determine male and female-trait scores. In addition, all subjects were assessed using the hospital anxiety depression inventory. Results: A highly significant reduction in male-trait scores was observed in the irritable bowel syndrome patients compared with controls (−10.5[−15.7,−5.2] P < 0.001). There were no differences between the groups with respect to female-trait scores. The prevalence of homosexuality was no different between patients and controls. Conclusion: Men with irritable bowel syndrome exhibit less male characteristics and it remains to be determined whether this is cause or effect. Whatever the explanation, this study adds another dimension to the role of gender in functional gastrointestinal disorders.

Hypnotherapy for non-cardiac chest pain: long-term follow-up.

We have been researching the effects of hypnotherapy in gastroenterology for many years and recently reported in Gut 1 that a course of 12 sessions of hypnotherapy seems to be beneficial in the treatment of non-cardiac chest pain. In a study on 28 patients comparing the effects of either hypnotherapy or a similar duration of supportive listening combined with placebo medication (control group), the active treatment resulted in a much better outcome. Of the 15 patients randomised to hypnotherapy, 12 (80%) responded to treatment, as judged by either a complete or …

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.