Hypnotherapy for IBS – 35 years of success!

Irritable bowel syndrome (IBS) is a chronic functional disorder of the gut and bowel characterised by substantial fluctuations in bowel movement and is often associated with pain1, 2. It causes misery for millions of people worldwide, with an estimated prevalence of about 1 in 10 people suffering worldwide3. IBS often resists standard treatment which is why other treatment options have been looked at over the years – amongst these, hypnotherapy has proven itself repeatedly.

Hypnotherapy for IBS – the early days

All the ways back in 1927 we have accounts of gastrointestinal disorders being treated with relaxation methods4 however things really get going in the 1980’s  with the first Randomised controlled trial (RCT) for hypnotherapy to treat IBS5. This trial saw 30 people with IBS which had not responded to treatment for over a year divided into two groups, one for hypnotherapy the other for psychotherapy with placebo. All 15 hypnotherapy patients saw their symptoms substantially reduced or entirely gone. The results for the hypnotherapy group were markedly better than for the control group. A replication study was conducted6, 7 and similar results noted.

Later studies by the same team demonstrated that hypnotherapy for IBS not only tackle the symptoms of IBS, but had wider impacts on quality of life and even reduced the effects of some other disorders8. Hypnotherapy wasn’t just treating their symptoms, it was transforming their lives.

The hypnotherapy used in these early studies was remarkable simple. It used only relaxation suggestions, some general and some directed at the gut. None of the psychoanalysis (hypno-analysis) which was dominant in talking therapies at the time was used, this was direct suggestions to relax and nothing more, and it worked. Later visualisations would be introduced9.

Hypnotherapy for IBS – the 21st century

The early noughties saw a plethora of research using GDH 10-18 with consistently positive results. Leading to the landmark review by the renowned Cochrane collaboration19 in 2007. This review is significant because it leads to hypnotherapy being included in National Institute of healthcare excellence guideline (NICE) for the treatment of IBS. NICE is the arbiter of ‘best practice’ in the UK’s National Health service (NHS) and IBS is the only condition for which hypnotherapy is recommended20.

Since then research has been broadened and included such areas as group hypnosis21, recorded suggestion22, internet hypnosis and working with childhood IBS23. In addition to the original centre of excellence where it all started in Manchester (UK)24, other places specialising in hypnotherapy for IBS have arisen in the UK, such as Sandwell25, and Edinburgh (UK)26. Internationally there are centres of excellence in Austria27, Holland28, The US29, Sweden and Switzerland30.

Hypnotherapy for IBS – the future?

Since those modest beginnings in 1984 hypnotherapy has gained substantial acceptability with doctors31 and has a general wide acceptability with the public32. So we can only anticipate a growth in the use of hypnotherapy for IBS by both the private paying public, but probably driven by medical institutions following the lead of research evidence.

The author – Matt Krouwel is a hypnotherapist and post graduate researcher into hypnotherapy for IBS at the University of Birmingham (UK)

Hypnotherapy for IBS – references

  1. Drossman DA, Hasler WL. Rome IV—functional GI disorders: disorders of gut-brain interaction. Gastroenterology. 2016;150(6): 1257-1261.
  2. Lacy BE, Weiser K. Gastrointestinal motility disorders: An update. Digestive Diseases. 2006;24(3-4): 228-242.
  3. Lovell RM, Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clinical Gastroenterology and Hepatology. 2012;10(7): 712-721. e714.
  4. Jacobson E. Spastic esophagus and mucous colitis: Etiology and treatment by progressive relaxation. Archives of Internal Medicine. 1927;39(3): 433-445.
  5. Whorwell PJ, Prior A, Faragher EB. Controlled trial of hypnotherapy in the treatment of severe refractory irritable-bowel syndrome. Lancet. 1984;2(8414): 1232-1234.
  6. Whorwell PJ. Hypnotherapy in the irritable bowel syndrome. Stress Medicine. 1987;3(1): 5-7.
  7. Whorwell PJ, Prior A, Colgan SM. Hypnotherapy in Severe Irritable-Bowel-Syndrome – Further Experience. Gut. 1987;28(4): 423-425.
  8. Houghton LA, Heyman DJ, Whorwell PJ. Symptomatology, quality of life and economic features of irritable bowel syndrome–the effect of hypnotherapy. Alimentary Pharmacology & Therapeutics. 1996;10(1): 91-95.
  9. Zimmerman J. Cleaning up the river: a metaphor for functional digestive disorders. American Journal of Clinical Hypnosis. 2003;45(4): 353-359.
  10. Palsson OS, Turner MJ, Johnson DA. Hypnotherapy for irritable bowel syndrome: Symptom improvement and autonomic nervous system effects. Gastroenterology. 2000;118(4): A174-A174.
  11. Galovski TE, Blanchard EB. Hypnotherapy and refractory irritable bowel syndrome: a single case study. American Journal of Clinical Hypnosis. 2002;45(1): 31-37.
  12. Gonsalkorale WM, Miller V, Afzal A, Whorwell PJ. Hypnotherapy for irritable bowel syndrome: Improvement is long-lasting and reduces health care costs. Gastroenterology. 2002;122(4): A69-A69.
  13. 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. American Journal of Gastroenterology. 2002;97(4): 954-961.
  14. Smith GD, Palmer KR. The impact of gut directed hypnotherapy upon health related quality of life in patients suffering from irritable bowel syndrome. Gut. 2002;50: A3-A3.
  15. Lea R, Houghton LA, Calvert EL, et al. Gut-focused hypnotherapy normalizes disordered rectal sensitivity in patients with irritable bowel syndrome. Alimentary Pharmacology & Therapeutics. 2003;17(5): 635-642.
  16. Roberts L, Wilson S, Singh S, Roalfe A, Greenfield S. Gut-directed hypnotherapy for irritable bowel syndrome: piloting a primary care-based randomised controlled trial. British journal of general practice. 2006;56(523): 115‐121.
  17. Gonsalkorale WM, Miller V, Afzal A, Whorwell PJ. Long term benefits of hypnotherapy for irritable bowel syndrome. Gut. 2003;52(11): 1623-1629.
  18. Simren M, Ringstrom G, Bjornsson ES, Abrahamsson H. Effects of hypnotherapy on gastrointestinal and psychological symptoms, quality of life and cognitive function in irritable bowel syndrome (IBS). Gastroenterology. 2003;124(4): A533-A533.
  19. Webb AN, Kukuruzovic R, Catto-Smith AG, Sawyer SM. Hypnotherapy for treatment of irritable bowel syndrome. Cochrane Database of Systematic Reviews. 2007: N.PAG-N.PAG.
  20. Dalrymple J, Bullock I. Diagnosis and management of irritable bowel syndrome in adults in primary care: Summary of NICE guidance. Bmj. 2008;336(7643): 556-558.
  21. Flik CE, Laan W, Zuithoff NP, et al. Efficacy of individual and group hypnotherapy in irritable bowel syndrome (IMAGINE): a multicentre randomised controlled trial. The Lancet Gastroenterology & Hepatology. 2018.
  22. van Tilburg MAL, Chitkara DK, Palsson OS, et al. Audio-Recorded Guided Imagery Treatment Reduces Functional Abdominal Pain in Children: A Pilot Study. Pediatrics. 2009;124(5): E890-E897.
  23. Vlieger AM, Menko-Frankenhuis C, Wolfkamp SCS, Tromp E, Benninga MA. Hypnotherapy for children with functional abdominal pain or irritable bowel syndrome: A randomized controlled trial. Gastroenterology. 2007;133(5): 1430-1436.
  24. Miller V, Hasan SS, Archbold S, Carruthers HR, Morris J, Whorwell PJ. Hypnotherapy for irritable bowel syndrome: An audit of 1000 patients. Gastroenterology. 2012;1): S296.
  25. Bremner H. Designing and delivering a hypnotherapy service for irritable bowel syndrome in primary care. Frontline Gastroenterology. 2012;3(3): 210-215.
  26. Dobbin A, Dobbin J, Ross SC, Graham C, Ford MJ. Randomised controlled trial of brief intervention with biofeedback and hypnotherapy in patients with refractory irritable bowel syndrome. Journal of the Royal College of Physicians of Edinburgh. 2013;43(1): 15-23.
  27. Moser G, Tragner S, Gajowniczek EE, et al. Gut-directed hypnotherapy for patients with functional GI disorders. Journal of Psychosomatic Research. 2010;68 (6): 650-651.
  28. Flik CE, van Rood YR, Laan W, et al. A Randomised Controlled Trial on hypnotherapy for Irritable Bowel Syndrome: Design and methodological challenges (the IMAGINE study). BMC Gastroenterology. 2011: 137.
  29. Palsson OS. Is hypnotherapy helpful for irritable bowel syndrome in primary and secondary care? Lancet Gastroenterol Hepatol. 2019;4(1): 2-3.
  30. Lindfors P, Unge P, Arvidsson P, et al. Effects of gut-directed hypnotherapy on IBS in different clinical settings-results from two randomized, controlled trials. American Journal of Gastroenterology. 2012;107(2): 276-285.
  31. Cox S, De Lusignan S, Chan T. General practitioners believe that hypnotherapy could be a useful treatment for irritable bowel syndrome in primary care. BMC Family Practice. 2004;5 (no pagination)(22).
  32. Krouwel M, Jolly K, Greenfield S. What the public think about hypnosis and hypnotherapy: A narrative review of literature covering opinions and attitudes of the general public 1996-2016. Complementary Therapies in Medicine. 2017.