Hypnotherapy for functional digestive disorders

One of hypnotherapies most well researched, yet least well-known areas to the public, is how effective it is in treating functional digestive disorders. Functional digestive disorders are those where nothing is physically observably wrong, i.e. no tissue damage or unusual masses, and yet the digestion does not work as you would want. The most well know examples are irritable bowel syndrome (IBS) and functional dyspepsia.

Gut-directed hypnotherapy (GDH)

A specific set of techniques have been brought together to treat functional digestive disorders, these are collectively known as Gut Directed Hypnotherapy (GDH) and include:

• Direct suggestions for gut calm, gut health and gut strength.
• Visualisations: these can be the patient’s own imagery or standard ones can be used. In the ‘The River’ imagery is used to send calming imagery to the gut, to flow freely and calmly. In ‘The warm hand’, a warm light is transferred from the hand into the gut, sending a signal directly to the digestion to both clam.
• Desensitisation is used to reduce anticipatory tension around situations and trigger foods.
• Recordings are used to regulatory and frequently reinforce imagery and direct suggestions.

Historically, most of this work has been done in-person and on a one-to-one basis. However, research has found that other ways of conducting hypnotherapy for IBS are not only viable but possibly more effective.

Group hypnotherapy for IBS?

Hypnotherapy has been conducted to groups of people for various issues for years but has never become the normal way of practicing. It may not have caught on because of the additional administrative burden. However, there is good evidence that for IBS work it is associated with better outcomes than individual therapy. Various theorises for this have been forwarded, such as peer support and the effect of group oxytocin bonding, but none have yet been demonstrated scientifically.

So, with group work appearing beneficial to people with IBS, it is natural that ways of reducing the administrative barriers are sought. This is where video conferencing come in.

Online hypnotherapy for IBS

Research has demonstrated no significant difference between the experience of being hypnotised in-person and online (Rasch & Cordi 2024). Further, the outcomes of hypnotherapy for IBS appear to be similar when done in-person and online. Which leads to the question; what happens if you combine group hypnotherapy with online hypnotherapy?

Online group hypnotherapy for IBS

Luckily for us a team working out of Sweden has decided to address this question. A report of a pilot study of gut directed hypnotherapy for IBS which was conducted to an online group has recently been published.  The key characteristic are:

• 51 adult participants, 42 of whom were female.
• All participants fulfilled Rome IV criteria for IBS.
• 8 sessions of live video conferencing therapy were conducted in groups of 6-8 participants over 12 weeks.
• GDH was based on the North Carolina protocol of hypnotherapy for IBS.

Key Results

• More than half were classified as ‘Responders’. A responder was someone whose symptoms reduced by ≥50 points on the IBS-severity scoring system (IBS-SSS). This is a commonly used and generally accepted measure of change which makes a substantial enough difference to be beneficial.
• Median IBS-SSS scores dropped by over a quarter from baseline to assessment 6 months after treatment.
• Other metrics showed a reduction in anxiety and depression and a general improvement in health-related quality of life.

Study limitation

The main limits to the studies generalisability come from it being a pilot study. Pilot studies are usually conducted to see if the evidence justifies the cost of a larger study. As such they tend not to be quite as rigorous as a full study, and a couple of aspects jump out:

• Small population – 51 participants is unlikely to be a sufficiently large sample to get a full representative distribution of people living with IBS.
• No formal control group – A comparison group was used from a previous study. This is not a true comparator as it was not time-synchronous with the treatment group and thus is open to different variables.

Neither of these invalidate the research, they simple caution against over-generalisation. These findings do however represent the highest level of evidence currently available to us and thus current evidence says that group online hypnotherapy is a valid approach.

Group online hypnotherapy for IBS – Implications for hypnotherapists and People living with IBS

The first thing we can say is that as it appears that group online hypnotherapy for IBS is effective and as such is a valid approach. This approach could make hypnotherapy for IBS:

• Easier to access – Hypnotherapists specialising in IBS have tended to be few and far between. By going online those specialisms become much easier for potential patients to access.
• Cheaper to access – By offering group work a hypnotherapist can reduce the price for individual patients.
• Potentially more profitable for hypnotherapists – As groups can be up to 8 participants the hypnotherapist could be offering group entry at substantially less than their one-to-one rate whilst still earning more overall.

Is group online hypnotherapy the way of the future?

From an evidence perspective it is too early to say if group online hypnotherapy for other issues will be effective. However, we may be able to say that it looks like a valid way forward for functional disorders which is justifiable on the reduction of cost and increase accessibility.

Dr Matt Krouwel has a PhD in treating IBS with Hypnotherapy and has been a hypnotherapist for over 25 years.

References

Lövdahl, J., Törnblom, H., Ringström, G., Palsson, O. S., & Simrén, M. (2026). Online Group Hypnotherapy for Irritable Bowel Syndrome—a Pilot Study. Neurogastroenterology & Motility, 38(5), e70328.

Rasch, B., & Cordi, M. J. (2024). The influence of experience and modality of presentation (online vs. offline) on hypnotizability. Frontiers in Psychology, 14, 1293070.

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Gut-directed hypnotherapy (GDH)

There are a distinct set of features to GDH, which include:

• Imagery – This is used primarily to encourage regularity in the digestion, and to encourage the awareness of healing within the digestive system.
• Direct suggestion – Suggestions are used to encourage digestive calmness, regularity and enhance the perception of the strength and durability of the digestive track.
• Physical sensation counter conditioning – This is used to moderate the experience of digestive discomfort and pain.
• Systematic desensitisation – This is used to help reduce anxiety around agreed upon some foods.
• Multiple treatment sessions – Typically 6-12
• Sessions should be as close to one per week as possible.
• Hypnotic recordings – These are used to support deeper hypnotic learnings and as ongoing support after formal therapy has concluded.

Hypnotherapy for IBS – Does it work?

Yes! Hypnotherapy for IBS is one of the most well researched areas of hypnotherapy which allows us to say conclusively that it does work, for most people. So, who does it work for:

• People who have received a diagnosis of IBS by either their GP or from a specialist.
• Studies suggest approximately 75-80% of those people with a diagnosis of IBS will benefit from hypnotherapy.
• People who benefit from hypnotherapy for IBS tend to notice changes after 3-5 sessions.
• People who do 8-12 sessions tend to experience the most benefit.
• Benefits tend to grow over time, even after therapy has finished. Research has found that benefits can continue to grow over several years.

Why does it work?

Several ways in which hypnotherapy for IBS may create the changes it does have been proposed, the main two currently are:

• Perceptual changes – Hypnotherapy creates changes in the levels of discomfort and pain experienced the person with IBS. Less pain and discomfort for many is benefit enough, but there is a secondary positive impact. With a reduced burden of pain/discomfort the person with IBS can be less tense. This means that their digestion is now less disrupted by stress and adrenaline. This results over time in a general calming and balancing of the digestion.
• Re-reregulation of the gut-brain – Reduced stress both in life and specifically around symptoms and food triggers reduces disruption of digestion through by the physical constriction. With the digestion less disrupted it has the chance to re-regulate.

Most likely both contribute to beneficial change.

For a more detailed and academic exploration if these topics see chapter 1 of thesis.

The Author

Dr Matt Krouwel is a hypnotherapist and health scientist with PhD in hypnotherapy for IBS. He is a member of both the BSCH and NCH.

The post Hypnotherapy for IBS (Irritable Bowel Syndrome) appeared first on Matthew Krouwel Hypnotherapist.

• Abdominal pain.
• Abdominal bloating.

Frequently, a high degree of volatility in patterns of bowel movements will be present. This ranges from diarrhoea to constipation, and sufferers may vary between both. This range in IBS presentations has resulted in four distinct subtypes

• Predominance of diarrhoea (IBS-D).
• Predominance of constipation (IBS-C).
• mix of these two bowel movement types (IBS-M),
• ‘unclassifiable’ (IBS-U).

Symptoms of IBS

IBS is not a direct threat to life but has substantial negative impacts of quality of life, which is mostly the result of the abdominal pain. However, other factors are likely to contribute, most commonly:

• The sense of urgency around bowel movements which may result in them fearing they are at risk of soiling themselves.
• Experience of soiling themselves.

Both of which cause significant fear of embarrassment.  The fear of embarrassment can result in limiting coping behaviours. Two notable limiting coping behaviours are:

• Toilet mapping – This is where a person with IBS will only go to places where they know the locations of all publicly available toilets.
• House bound – Where the person with IBS feels the risk of soiling themselves is so high that they cannot leave home. Sometimes this is related to public toilet phobia.

Other common negative impacts of IBS are:

• Limited sex life – This may occur for several reasons, such as: The discomfort of IBS dulls sex drive and can upset comfort with the feel and look of the body. In some cases, people worry about a loss of bowel control occurring during sex due to stimulation or distinction.
• Limited social life – People with IBS may avoid social situations because of the socially awkward nature of using other people toilets or that dietary limitation due to IBS may prevent them from relaxing into shared meals.

Causes of IBS

The potential causes of IBS are many and various and poorly understood, current thinking includes:

• Unhealthy Microbiota (Gut bacteria) – For one reason or another the composition of a person’s gut bacteria is unhealthy. This could be an overgrowth of bacteria or an unhealthy mix of bacteria. However, introducing health gut bacteria has yet to show reliable improvements for people with IBS.
• Dysregulation of the gut brain connection – The brain and gut fail to communicate effectively. This maybe the result of unhealth microbiota (see above).
• Diet – Lots of people report food-based triggers for IBS. Lactose and gluten intolerance are common.  Eating processed foods like tinned meat, fruit compotes, confectionary, whole cereals and legumes have all been linked to IBS. Again, it is theorised that these may result in alterations to the microbiome.
• High histamine foods – Histamine, one of the bodies organic chemicals produced as an immune response, appears in some foods. When this is present it can alter the digestion of carbohydrates potentially causes IBS.
• Stress – Post-traumatic stress disorder (PTSD) and early life stressors have both been linked with IBS. This suggests that stress may be in-part a cause of IBS. However, stress is believed to keep IBS going once it has started, so its role may be that it keeps it going once started by something else.
• Other risk factors – there are many factors which have been linked to IBS without much understanding of how they may cause it, these include: low birth weight, sleep problems, air pollution,

How common is IBS?

A large scale study published in 2021 found that globally about 4.1% of adults had IBS, of whom;

• 2% are female.
• 2% had IBS-D
• 3% had IBS-C
• 3% had IBS-M

Treatment of IBS

The of treatment has been the reduction of symptoms. Initially, the first treatments are:

• Increase in dietary fibre.
• Stool bulking agents.

These work well for some but have only moderate benefit overall.

• Soluble fibre, fibre which dissolves in water to make a gel like substance in the digestion, appears to be the most reliable.

Should these fail to produce sufficient benefit people tend to move on to:

• Antispasmodics – These relax digestive movement, reducing cramps.
• Tricyclic antidepressants – A small dose of these appears to re-regulate the brain-gut connection.

However, for lots of people these conventional medical interventions do not work sufficiently well and many turn to more natural and psychological treatments.

Natural and psychological treatments for IBS

A vast range of these exist covering everything from exercise to shamanism. Broadly these can be grouped into categories:

• Biologically based therapies – Using herbs and food to improve digestion. These are the most used. This is probably because as it makes the most sense to people to use a biology-based approach for what is seen as a biological problem. Of these the FODMAP diet programme is the most well researched. Unfortunate, the unfortunately the FODMAP diet is difficult to follow. Another effective treatment is peppermint oil.
• Mind-body interventions – These look to increase the mind’s ability to influence the body, as with hypnotherapy, biofeedback and CBT.
• Energy therapies – these use various types of energy to create change, a common example of which is reiki.
• Manipulative and body-based therapies – using movement to create change as with exercise and massage.

For a more detailed and academic version of this go feel free to read chapter 1 of my thesis

The author

Dr Matt Krouwel PhD is a hypnotherapist with a doctorate in hypnotherapy for IBS. He is based in Birmingham (UK) and works with IBS both in-person and online.

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 Treating ARFID with hypnotherapy.

I cannot speak for all hypnotherapist, as hypnotherapy contains a broad variety of skills, techniques, philosophies and approaches but here are some of the more common approaches used when conducting hypnotherapy for ARFID.

Hypnotherapy when ARFID presents as anxiety

Most hypnotherapist have a set of techniques for dealing directly with anxiety triggers. Generally this involves invoking the known trigger mentally and then applying the technique to introduce a new way of being. These techniques include;

• Systematic desensitization.
• Eye movement desensitization and reprocessing (EMDR).
• Various Neurolinguistic Programming (NLP) approaches such as Anchoring, and the Swish technique.

Using these techniques it is common for a person to be able to bring an increasing range of previously challenging foods into their dietary repertoire. It is not uncommon for people to actually discover that some of the foods they reintroduce are actually pleasant. This usually occurs because the nature of their pallet and sensory experience has changed since the problem started.

Hypnotherapy when AFRID is developed as a result of trauma

Sometimes a trauma will be obviously a part of the development of the problem. When this is the case, it is likely that the hypnotherapist will look to process this in some way. Common tools for this include;

• Eye movement desensitization and reprocessing (EMDR).
• Regression to the trauma so that it can be processed by a mind which knows that it survived.
• Metaphorical releases of the pent up energies created by the trauma through visualisation.

Altering sensory experience of food

Hypnotherapy has the capacity to nudge sensory awareness so that some elements come forward in perception. By shifting awarenesses challenging foods can become inoffensive or even enjoyable. This can be done through techniques;

• Direct suggestion for forgetting disliked elements and noticing preferred elements (sweetness, smoothness, elements of aroma).
• Visualisation of ideal forms of the food
• Accessing memories of more pleasant foods whilst eating the food

When AFRID is the result of Low hunger levels.

When a person with AFRID does not feel hunger a common cause is poor interoception. Interoception is our awareness of our own internal body, how well we feel things like hunger and heartrate. A hypnotherapist may look to enhance this through techniques like;

• Body scan; a practice in which a person experiences the different areas of their body and the sensations experienced by those areas. Commonly, this is done through a recording or by teaching it and through repetition it can enhance
• Suggestions for bodily awareness; these can be very direct or through a visualisation to help enhance awareness of the sensations of hunger.

Further, for Low hunger, if it does not appear to be based on poor interoception  lifestyle changes may be required.  These could include;

• Engaging with higher calorific foods.
• Organising eating times so they are less reliant upon biological prompting.
• Dietary changes to prompt the development of a robust biome which often aids in hunger signalling.

These are just a few examples, and many people will have tried some of them. The hypnotherapist’s job is to discuss these with their patient and find out what they tried, how well it went and what new strategies and tool may help.

I hope this blog has given you the information you need to feel confident to move to the next stage and book a therapist. If you want to contact me for a free consultation feel free, otherwise look for a therapist

The author

Dr Matt Krouwel PhD is a hypnotherapist based in Birmingham (UK) with a specialism in anxiety and functional digestive disorders. He has 25 years experience of working with clients and patients and is a member of both the BSCH and NCH 

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Are you or anyone you know living with IBS?

I’m conducting a survey into adults (18+ years of age) who are living with irritable bowel syndrome (IBS) from anywhere in the world.

Irritable bowel syndrome (IBS) is a common digestive disorder characterised by irregular and often unpredictable bowel movements, sometimes with discomfort and pain. It does not always respond well to treatments and as such people living with it tend to try both conventional medicine and complimentary and alternative medicine (CAM), such as special diets, teas, massage therapy and much more. We are conducting this survey to help establish;

• How many people with IBS use conventional treatments, CAM treatments, or a combination of both.
• What people have tried in past and stopped using.
• Peoples attitudes towards some psychological therapies for IBS.
• People with IBS’s experience of symptoms during the Covid-19 pandemic, was everything the same, did symptoms change, and any thoughts they may have about this.

If you can spare 5-15 minutes to go through the survey, share it on any friends, family appropriate groups you may be part of that would be much appreciated.

Go to survey 

Many thanks!

IBS related links

The IBS network is a UK based charity which provides support to people with IBS.

UK’s National Health Service (NHS) IBS page

5 IBS treatment options – latest research

Psychological therapies for IBS

Do peppermint oil capsules work for IBS?

People with IBS’s opinions and attitudes towards hypnotherapy

Hypnotherapy for IBS – 35 years of success!

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Many hypnotherapists use recordings as part of their work, but few of us have had the time to assess the effectiveness and use of hypnosis recordings. In this blog we ask the question – do hypnosis recordings really work?

Hypnosis recordings – the evidence

Studies have shown that hypnosis recordings are effective for inducing trance,(1) and, as an alternative to self-hypnosis practice they are comparably effective, if less satisfying for users.(2) However the research into the therapeutic benefits of hypnosis recordings is limited, but promising. One study found that a 30 minute personalised recording helped 22 of 34 participants to experience improvements in tinnitus symptoms.(3) Another study into insomnia found benefits (4) as did one into using hypnosis to support dental surgery (5) Unfortunately, none of these used a control or comparator group so we cannot be certain that it was the recordings that caused the effects. Equally, not every study found clear evidence of benefit to recordings.(6)

Luckily, a study from the world of dentistry has provided us an example where a control was used. This study looked at 60 patients having their third molar extracted and was interested in decreases in anxiety and vomiting. Anxiety scores were lower in the recorded hypnosis group, however vomiting was higher, both to a statistically significant level .(7) So mixed results.

Unsurprisingly, the best data we have comes from hypnotherapy’s most well researched area, treating Irritable bowel syndrome (IBS). One trial tested a program of seven recorded sessions based on the gut directed hypnotherapy (GDH) approach to IBS and found improvements .(8) In this study 53% of the recorded suggestion group experienced a halving of symptoms or better, well above the level which would be considered clinically significant. 26% of the waiting-list control arm achieved the same improvement. What this shows is that recordings produced effective results well above those experienced by the control group. A further insight comes from a study of children with IBS or functional abdominal pain (FAP).(9) This study found that at the one year follow up point a home-based programme was no worse than the individual in-person hypnotherapy (10) and that ultimately this was highly cost effective.(11) However a similar study into adults found the in-person approach to be more effective. (12)

Do hypnosis recordings work? – conclusion

As the evidence stands the picture is unclear.  It seems likely that hypnosis recordings are beneficial, but  not as effective as a hypnotherapist. With the relative ease of making a recording for a client on their own mobile phone, a 10-15-minute session to help reinforce the session may well be worthwhile. However, as the evidence suggests that self-hypnosis is more satisfying to the client then it is a choice as to when to use self-hypnosis and when recorded hypnosis.

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

Hypnosis recordings – references

1. Ulett GA, Akpinar S, Itil TM. Hypnosis by video tape. International Journal of Clinical and Experimental Hypnosis. 1972;20(1):46-51.
2. Hammond DC, Haskins-Bartsch C, Grant Jr CW, McGhee M. Comparison of self-directed and tape-assisted self-hypnosis. American Journal of Clinical Hypnosis. 1988;31(2):129-37.
3. Brattberg G. An alternative method of treating tinnitus: relaxation-hypnotherapy primarily through the home use of a recorded audio cassette. The International journal of clinical and experimental hypnosis. 1983;31(2):90-7.
4. Scholz OB, Ott R. Effect and course of tape-based hypnotherapy in subjects suffering from insomnia. Australian Journal of Clinical Hypnotherapy and Hypnosis. 2000;21(2):96.
5. Hermes D, Truebger D, Hakim SG, Sieg P. Tape recorded hypnosis in oral and maxillofacial surgery—basics and first clinical experience. Journal of Cranio-Maxillofacial Surgery. 2005;33(2):123-9.
6. Horine JE. Smoking diminution as a function of multiple or single sessions of group hypnosis coupled with a take-home audio cassette tape, or of group hypnosis alone. 1991.
7. Ghoneim MM, Block RI, Sarasin DS, Davis CS, Marchman JN. Tape-recorded hypnosis instructions as adjuvant in the care of patients scheduled for third molar surgery. Anesthesia & Analgesia. 2000;90(1):64-8.
8. Palsson OS, Turner MJ, Whitehead WE. Hypnosis home treatment for irritable bowel syndrome: a pilot study. International Journal of Clinical & Experimental Hypnosis. 2006;54(1):85-99.
9. Rutten JMTM, Vlieger AM, Frankenhuis C, George EK, Groeneweg M, Norbruis OF, et al. Gut-directed hypnotherapy in children with irritable bowel syndrome or functional abdominal pain (syndrome): A randomized controlled trial on self exercises at home using CD versus individual therapy by qualified therapists. BMC Pediatrics. 2014;14 (1) (no pagination)(140).
10. Rutten JMTM, Vlieger AM, Frankenhuis C, George EK, Groeneweg M, Norbruis OF, et al. Home-based hypnotherapy self-exercises vs individual hypnotherapy with a therapist for treatment of pediatric irritable bowel syndrome, functional abdominal pain, or functional abdominal pain syndrome a randomized clinical trial. JAMA Pediatrics. 2017;171(5):470-7.
11. Van Barreveld M, Rutten J, Vlieger A, Frankenhuis C, George E, Groeneweg M, et al. Cost-effectiveness and cost-utility of home-based hypnotherapy using compact disc versus individual hypnotherapy by a therapist for pediatric irritable bowel syndrome and functional abdominal pain (syndrome). Value in Health. 2015;18 (7):A628.
12. Forbes A, MacAuley S, Chiotakakou-Faliakou E. Hypnotherapy and therapeutic audiotape: effective in previously unsuccessfully treated irritable bowel syndrome? International Journal of Colorectal Disease. 2000;15(5-6):328-34.

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Happy New year! As the old year comes to an end and we welcome in the new so it’s time to review the hypnotherapy research of 2019. I went on to google scholar, put in ‘hypnotherapy’ limited the search to 2019, title only and excluded citations only and patents and pulled up 52 articles, and did the same for ‘hypnosis’ producing 132 articles. From these I’ve pulled out some of the most important for the clinical hypnotherapist, including what may be the single biggest, and best run, clinical trial of hypnotherapy.

Hypnotherapy research 2019 – Anxiety

Although the year saw several small scale trials the big event for hypnotherapy and anxiety was a systematic review and meta-analysis carried out by Valentine, Milling, Clark, & Moriarty combined the results of 17 trials into hypnotherapy for anxiety and found that hypnotherapy had a statistically significant effect over control measures. Further they identified that hypnotherapy had greater effect when combined with other psychological approaches. These findings provide good ongoing evidence for the effectiveness of hypnotherapy as a treatment option for anxiety.

Hypnotherapy research – Irritable bowel syndrome (IBS)

The biggest event of the year was the publication of the long awaited IMAGINE study findings. The IMAGINE study, with 345 participants is possibly the largest single hypnotherapy trial ever run. It compared gut directed hypnotherapy (GDH), both one-to-one and in groups, to a comparator intervention (educational supportive therapy). Hypnotherapy was found to be more effective than the comparator. Both 1-2-1 and group were about equally effective. This study not only adds weight to the ever-increasing body of evidence that hypnotherapy is effective for IBS but strongly indicates that group work may be a valid option for financially conscious health care providers considering providing a GDH service but put off by the cost.

In another landmark study Hasan, Pearson, Morris & Whorwell showed that GDH treatments can be delivered via Skype, although the treatment was less effective than in-person. Some of the same team showed improvements in the condition of children and adolescence with IBS in an uncontrolled trial (Hasan, Cruickshanks, Whorwell, & Vasant).

In addition, Krouwel, Jolly and Greenfield examined the barriers to the use of hypnotherapy by people with IBS providing important insights, which we explored earlier this year.

Hypnotherapy research 2019 – Pain

Although a number of individual studies were carried out the big news for 2019 was Thompson, Terhune, Oram et a’sl a systematic review and meta-analysis of previous trials into hypnotherapy for pain. In total they identified 85 studies covering 3632 participants. Overall, they found that hypnotherapy was beneficial to those with medium and high hypnotisability but of little value to those with low hypnotisability.

Hypnotherapy research – Pre-operative & operative

New ground was broken this year with successful work relating to the insertion of cannulas, where hypnosis was used to ease the experience for patients (Fusco, Bernard, Roelants et al).

Santosa, Sutanto, & Septiawan, investigated the effects of hypnotherapy upon anxiety, breathlessness and the cough response in relation to bronchoscopy (the insertion of a scope into the trachea and bronchi). The intervention group showed a significant decrease in anxiety and non-significant improvements in pain and cough response.

Hypnotherapy research – Smoking cessation

The highly prestigious Cochrane foundation updated a previous meta-analysis of 14 studies with 1926 participants in total. Hypnotherapy was found to be comparable to other methods (comparators) and on a subset of participants it was found to bring added benefit to other treatments.

Hypnotherapy research 2019 – Urinary incontinence

Komesu ran a trial of 152 women with urinary incontinence and split them into two, one group on medication and one with a hypnotherapy intervention. Although medication performed better at two months after treatment, no difference was found between the effectiveness of the approaches at 6 and 12 months, meaning that by the current state of the evidence hypnotherapy was comparable to medication at medium and long term, however medication was more effective in the short term. This suggests that there may be a place for hypnotherapy as an adjunct to urinary incontinence medication or for withdrawal from medication

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

Hypnotherapy research - References

Barnes, J., McRobbie, H., Dong, C. Y., Walker, N., & Hartmann‐Boyce, J. (2019). Hypnotherapy for smoking cessation. Cochrane Database of Systematic Reviews, (6).

Flik, C. E., Laan, W., Zuithoff, N. P., van Rood, Y. R., Smout, A. J., Weusten, B. L., … & de Wit, N. J. (2019). Efficacy of individual and group hypnotherapy in irritable bowel syndrome (IMAGINE): a multicentre randomised controlled trial. The Lancet Gastroenterology & Hepatology, 4(1), 20-31.

Fusco, N., Bernard, F., Roelants, F., Watremez, C., Musellec, H., Laviolle, B., … & Branchu, P. (2019). Hypnosis and communication reduce pain and anxiety in peripheral intravenous cannulation: Effect of Language and Confusion on Pain During Peripheral Intravenous Catheterization (KTHYPE), a multicentre randomised trial. British Journal of Anaesthesia.

Hasan, S. S., Cruickshanks, P., Whorwell, P. J., & Vasant, D. H. (2019). OWE-09 Outcomes of gut-focused hypnotherapy in school children and adolescents with severe refractory Irritable Bowel Syndrome.

Hasan, S. S., Pearson, J. S., Morris, J., & Whorwell, P. J. (2019). Skype hypnotherapy for irritable bowel syndrome: effectiveness and comparison with face-to-face treatment. International Journal of Clinical and Experimental Hypnosis, 67(1), 69-80.

Komesu, Y. M., Schrader, R. M., Rogers, R. G., Sapien, R. E., Mayer, A. R., & Ketai, L. H. (2019). Hypnotherapy or Medications: A Randomized Non-Inferiority Trial in Urgency Urinary Incontinent Women. American journal of obstetrics and gynecology.

Krouwel, M., Jolly, K., & Greenfield, S. (2019). How do people with refractory irritable bowel syndrome perceive hypnotherapy?: Qualitative study. Complementary Therapies in Medicine, 45, 65-70.

Sadat Madani, S. A., & Tavallaii Zavareh, A. (2019). The Effectiveness of Cognitive Behavioral Hypnotherapy in Reducing Symptoms and Treatment of Anxiety. Health Research Journal, 4(1), 16-22.

Santosa, T. B., Sutanto, Y. S., & Septiawan, D. (2019). Hypnotherapy Effectiveness in Bronchoscopy to Control Anxiety, Breathlessness and Cough. Jurnal Respirologi Indonesia, 39(1), 21-30.

Thompson, T., Terhune, D. B., Oram, C., Sharangparni, J., Rouf, R., Solmi, M., … & Stubbs, B. (2019). The effectiveness of hypnosis for pain relief: A systematic review and meta-analysis of 85 controlled experimental trials. Neuroscience & Biobehavioral Reviews.

Valentine, K. E., Milling, L. S., Clark, L. J., & Moriarty, C. L. (2019). The Efficacy of Hypnosis as a Treatment for Anxiety: A Meta-Analysis. International Journal of Clinical and Experimental Hypnosis, 67(3), 336-363.

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If you’ve ever read one of my blogs before you may know that I’m a hypnotherapist who specialises in hypnotherapy for IBS. What, you may ask, has that to do with peppermint oil?  Well, the other day I was giving a free consultation with a potential IBS patient. As we discussed the various treatments he had tried gradually he realised that when he’d been using peppermint oil his symptoms were much improved. Long story short, I never ended up treating him because he went back onto the peppermint capsules. Not my greatest day of business. But it did get me thinking about peppermint oil and wondering do peppermint oil capsules work for IBS?

There is certainly a potential case for peppermint oil benefiting people with IBS. Peppermint oil has been found to have antimicrobial, anti-inflammatory, antioxidant, immunomodulating and anaesthetic properties (1) any one of which could prove beneficial to someone with IBS and possibly the combination even more so. But theoretical benefit is one thing, is there any evidence that it really makes a difference?

Do peppermint oil capsules work for IBS? – latest research 2019

Fortunately for me a team from John Hopkins University investigated this very question just recently (1). The team used a statistical approach known as a meta-analysis. A meta-analysis combines the findings of several randomised controlled trials (RCTs) into one with the aim of averaging out all the peculiarities which inevitably accompany an RCT. The studies they used were carefully selected to exclude anything which looked like it might skew the findings in an unfair way. Specifically, they only used studies which;

1) used peppermint for at least two weeks consistently.

2) where participants had been demonstrated to be free of other relevant organic conditions.

3) had adult populations.

4) where a recognised diagnostic measure of IBS had been used (manning or ROME criteria)

5) Used some form of comparator, such as a placebo.

From a systematic search of the published trials they identified twelve which made the grade. These covered people from eleven different countries over three continents.

Do peppermint oil capsules work for IBS? – Results

They work! The team found that peppermint oil produced a general improvement in IBS symptoms over placebo, and improved abdominal pain.

That is not to say they will work for everyone all the time. In fact, the team identified that the average number of people with IBS who would need to take peppermint capsules for one to experience a significant benefit is three. This figure is over and above placebo effect so typically in a real-world situation you might expect half of people who take it to genuinely benefit. In addition, they found that the risk of adverse events coming from taking peppermint capsules was low. Which means that Peppermint capsules are a relatively cheap and proven approach for people who experience IBS  

Do peppermint oil capsules work for IBS? – Rules for taking peppermint oil

There is a lot of conflicting advice out there and a huge variety of products. If you are going to use peppermint oil for your IBS I recommend you follow these two rules:

1.    Take it daily for minimum of 2 weeks before judging the results

2.    Buy a make with an enteric coating  

 Reference

1) Weerts, Z. Z. R. M., Masclee, A. A. M., Witteman, B. J. M., Clemens, C. H. M., Winkens, B., Brouwers, J. R. B. J., … & Tack, J. (2019). Efficacy and Safety of Peppermint Oil in a Randomized Double-blind Trial of Patients With Irritable Bowel Syndrome. Gastroenterology.

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Hypnotherapy has a proven track record as a treatment for IBS.(1 )This is so well established that the National Institute of Health and Care Excellence (NICE), the arbiter of best practice in the UK’s health system, include it within their guidelines as a possible treatment option. Despite this it seems that few people with IBS use the treatment and we wondered why?

Over the last two years I have been interviewing people with IBS about their attitude to hypnotherapy.(2) Interviews took about 30-45 minutes each. I then transcribed them and conducted what’s known as a thematic analysis.(3) Specifically, I spoke with 17 UK based adults (15 female) who were living with IBS and had never been to a hypnotherapist for it.

I learnt that most participants had some conceptualisation of hypnotherapy as a general therapeutic tool, although several had never heard of it in relation to IBS until they encountered the study. Many made joking references to the entertainment side of hypnosis, this did not appear to prohibit it’s use as there was an understanding that they were two different things.

However, how hypnotherapy, a psychological therapy, actually helped with IBS, a physical condition, was difficult for many to conceive. This is not surprising as the scientific world is also still unclear on this point.(4) Various theories exist including reduction in perception of sensation, steadying gut transit and breaking the stress cycle associated with IBS, however currently evidence is insufficient to provide a conclusive model.

All participants were interested in the idea of hypnotherapy for their IBS, some cautiously, some enthusiastically. Several liked the idea of a therapy in which nothing went into their bodies, and thus was unlikely to upset their IBS, an experience many participants had from previous treatments. However, a number of barriers to hypnotherapy were apparent including, cost, time, travel and fear of being vulnerable. Many of which would be offset by hypnotherapy via video call (like skype), which is a possibility.(5)

A fairly consistent image of their preferred hypnotherapist emerged. This was a person, gender preference was not strongly pronounced, with a strong educational background, good interpersonal skills, lots of experience and dressed in a relaxed but smart way.

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

People with IBS’s opinions and attitudes towards hypnotherapy -references

1. Ford AC, Lacy BE, Harris LA, Quigley EMM, Moayyedi P. Effect of Antidepressants and Psychological Therapies in Irritable Bowel Syndrome: An Updated Systematic Review and Meta-Analysis. Am J Gastroenterol. 2019;114(1): 21-39.
2. Krouwel M, Jolly K, Greenfield S. How do people with refractory irritable bowel syndrome perceive Hypnotherapy?: qualitative study. Complementary Therapies in Medicine. 2019;45(August 2019): 65-70.
3. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative research in psychology. 2006;3(2): 77-101.
4. Tan G, Hammond DC, Joseph G. Hypnosis and irritable bowel syndrome: a review of efficacy and mechanism of action. American Journal of Clinical Hypnosis. 2005;47(3): 161-178.
5. Hasan SS, Pearson JS, Whorwell PJ. Skype hypnotherapy for irritable bowel syndrome : Effectiveness and Comparison with Face-to-Face Treatment. International Journal of Clinical and Experimental Hypnosis. 2019.

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Hypnotherapy is a well-established and demonstrably effective treatment for IBS.¹  It has even been recognised by the UK’s arbiter of best medical practice, the National Institute of Health and Care Excellence (NICE) in their guidelines for clinicians as a legitimate treatment strategy. Which means it seems odd that more people don’t use it.  Recently I finished a piece of research into what people with irritable bowel syndrome (IBS) think about hypnotherapy as a treatment for their condition². In my study none of the people I interviewed had ever received hypnotherapy for their IBS so they were approaching it as a potential patient might.  Amongst the key findings was what keeps them from going to see a hypnotherapist, some of which are generalisable to many areas of hypnotherapy.

Barriers to hypnotherapy – Lack of knowledge and fear of side-effects

People as a whole don’t seem to have a clear understanding of what hypnosis is and how it works, although this does not prevent the majority of them from having a broadly positive view of it.³ However for many of the participants a lack of knowledge both about hypnotherapy in general and how it would help with IBS specifically were barriers. When knowledge is absent fears tend to arise the most prominent of which is the concern about possible side-effects.  Although there is evidence that hypnotherapy has few side effects⁴ this message has clearly not made it into the public consciousness. Providing information about how hypnotherapy can work for specific conditions, with references to valid medical and psychological sources may counter this problem to some degree.

Barriers to hypnotherapy – Vulnerability

Most of the people I spoke with for the study were women, and a concern was expressed by several about being under the influence of another. One person, being unsure about how much control a hypnotist has over a subject, drew a direct comparison with the case of a dentist in the US who committed sexual assaults whilst patients were under sedation. In an age where suburban Doctors have been found to be mass murderers and celebrities’ serial rapists such concerns should not be ignored. It’s hard to counter these wider social forces but little things like inviting patients to bring a friend along can make a real difference.

Barriers to hypnotherapy – Dancing chickens!

Multiple (yes multiple) participants referred to dancing chickens. There is clearly a lingering connection with the world of stage show hypnosis, with words like “fun fair” being used to summarise participants feel towards hypnotherapy. Others alluded to black magic. It should be noted that most participants who used these descriptions stated that they knew this not to be the case. This suggests a conscious–unconscious division of understanding which may be subtly undermining the validity of hypnotherapy in the public’s mind. Although it should not be forgotten that the entertainment side of hypnosis does much to nurture the image of hypnosis as powerful. Evidence suggests that for many people formal validation of hypnotherapy through association with the medical or psychological establishment leads to hypnotherapy being more acceptable.³ The reverse may also be true.

Barriers to hypnotherapy – Time, travel and cost

Many participants expressed difficulties of a practical nature; travel, time and cost. These may have been especially acute as people with IBS often experience difficulties with travel (access to facilities, cramped conditions etc). However, in the modern world we all seem to live busy lives and the time required to go somewhere might just be the tipping factor for some people. Other than concentrating marketing efforts quite locally there is little to be learnt here for the average hypnotherapist. Although not a formal finding of the study I did observe that wealthier people were willing to travel further for specialist services, so if you have a noted specialism then promoting this at well-to-do areas which are a little further afield may be profitable.

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

Barriers to hypnotherapy – references

1. Ford AC, Lacy BE, Harris LA, Quigley EMM, Moayyedi P. Effect of Antidepressants and Psychological Therapies in Irritable Bowel Syndrome: An Updated Systematic Review and Meta-Analysis. Am J Gastroenterol. 2019;114(1): 21-39.
2. Krouwel M, Jolly K, Greenfield S. How do people with refractory irritable bowel syndrome perceive Hypnotherapy?: qualitative study. Complementary Therapies in Medicine. 2019;45(August 2019): 65-70.
3. 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.
4. 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.

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