• 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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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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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 pain^{1, 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 conducted^{6, 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 introduced^9.

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.

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A recently published article by the Manchester IBS research group has found that on-line hypnotherapy for IBS works (Hasan et al 2019). By this they mean that hypnotherapy, the use of suggestions and metaphors in the hypnotic state can be done over Skype or Face time and help people with IBS.

On-line hypnotherapy for IBS – what is it

Hypnotherapy has for many years been used to treat IBS and has a good track record of success. (Ford et al 2014) It appears to be most effective for people with IBS which is considered refractory to treatment. This is defined by 3 things (Dalrymple & Bullock, 2008).

1. Having had IBS for over a year.
2. Not having responded sufficiently to standard medical treatment.
3. Having developed an ongoing profile of symptoms.

A specific approach called Gut-Directed Hypnotherapy (GDH) (Gonsalkorale 2006) has been developed for the treatment of IBS (it is also used for functional dyspepsia). This consist of
• Visualisations of healthy gut operations, usually metaphorical. These will often be personalised to fit the person with IBS’s own mental imagery.
• Pain control imagery and suggestions. These are to help when pain and discomfort occur by both reducing and blocking the sensation.
• Suggestions for stronger and healthier gut functioning.
All delivered in a light hypnotic state. Treatment is usually 6-12 sessions of 45-60 minutes with the use of a 10-15-minute recorded session each day.

On-line hypnotherapy for IBS – Is it as good as in-person therapy?

In short, no. The research showed that although on-line hypnotherapy was effective it was not as effective as in-person therapy. This may be due to factors with on-line therapy such as dropped calls and disturbance or disruption to the sound quality*. It may also be due to more esoteric factors of rapport induced by the mode of communication.

On-line hypnotherapy for IBS – Why would I use on-line Hypnotherapy?

There are a couple of major reasons why someone might opt for on-line hypnotherapy for IBS over in-person therapy.
1. Because of the nature of the problem some people with IBS are effectively house bound. The chance to have a hypnotherapist come into their home via the internet may be their only opportunity to receive therapy.
2. Not all hypnotherapists are the same, some will have different training to others and this may not include GDH training. On-line hypnotherapy may be the only way a person can access specialist services.

*On-line hypnotherapists include suggestion to ensure the patient safely wakens in the event of a broken call.

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

On-line hypnotherapy for IBS – references

Dalrymple, J., & Bullock, I. (2008). Diagnosis and management of irritable bowel syndrome in adults in primary care: summary of NICE guidance. Bmj, 336(7643), 556-558.
Ford, A. C., Quigley, E. M., Lacy, B. E., Lembo, A. J., Saito, Y. A., Schiller, L. R., … & Moayyedi, P. (2014). Effect of antidepressants and psychological therapies, including hypnotherapy, in irritable bowel syndrome: systematic review and meta-analysis. The American journal of gastroenterology, 109(9), 1350.
Gonsalkorale, W. M. (2006). Gut-directed hypnotherapy: the Manchester approach for treatment of irritable bowel syndrome. International Journal of Clinical and Experimental Hypnosis, 54(1), 27-50.
Hasan, S. S., Pearson, J. S., & 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.

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Functional dyspepsia (FD) is a disorder of the digestion, specifically movement and sensation in the gut are not acting appropriately. In FD the reason for this failure to act properly cannot be observed in any physical sense, there is no blockage or malformation but rather the digestion is misfiring for some reason. FD is believed to effect between 11-29% of people, although many of these may not be diagnosed cases. (Mahadeva and Goh 2006)  Functional dyspepsia is not considered life threatening but does have significant impacts upon the person’s quality of life.(Talley et al 2006)

Typically suffers experience such symptoms as;

·         Heartburn and acid reflux.

·         Nausea.

·         Gas and bloating.

It is generally treated with medication including;

·         Acid neutralisers (i.e. Gaviscon).

·         Proton pump inhibitors.

·         H2 receptor antagonists.

And Life style changes are strongly advised, specifically;

·         Smoking cessation.

·         Weight reduction.

·         Reduction in alcohol consumption.

·         Avoidance of trigger food (often spicy and acidic foods).

·         Smaller meals.

·         Avoiding food 3-4 hours before bed.

However, most treatment has limited effect and the opinion amongst clinicians is starting to favour the use of hypnotherapy.(Sharma 2008)

Hypnotherapy for Functional dyspepsia – The evidence

The key study which underscores the use of hypnotherapy for Functional dyspepsia is a 2002 study carried out by the team at Witherington Hospital in Manchester (UK). (Calvert et al)  Patients with functional dyspepsia were randomise to one of three groups;  

1.    Supportive therapy with a placebo – an experienced researcher giving advice on management and listening to the concerns of patients for 12 x 30minute sessions over 16 weeks.

2.    Medical treatment – four visits to receive advised medication. Over 16 weeks.

3.    Hypnotherapy – 12×30 minute sessions over 16 weeks.

At the end of the 16 weeks of treatment patients were then tested against baseline scores of symptoms and quality of life, this was repeated at 56 weeks. At both 16 and 56 weeks hypnotherapy showed greater improvements than the other two interventions for both symptoms and quality of life. It is noteworthy that hypnotherapy patients appeared to carry on getting better, they showed even greater improvement at 56 weeks than they did at 16. Although this study by no means answers all the questions around hypnotherapy for FD (Chitkara & Talley 2003), it does highlight its effectiveness.

Hypnotherapy for Functional dyspepsia – The treatment

The model of treatment used in the Manchester study (Calvert et al 2002) employed the following elements.

1)    Education and explanation – What FG is & how hypnotherapy can help.

2)    Hypnotic induction using eye fixation followed by progressive relaxation and deepening.

3)    Suggestions for feeling better and imagery to encourage symptom reduction. Specifically, the patient places their hand on their abdomen and imagine a reduction of symptoms.

4)    Direct suggestions to encourage healthy peristalsis, reduced digestive sensitivity and healthy secretion of acids and mucus

5)    Visualisation of a comfortable gastric transition, preferably using a metaphor.  

A hypnotherapist may wish to help the person with FD in making behavioural changes in line with the recommended lifestyle changes (see above). In addition to the smoking cessation and weight loss work the therapist may consider desensitisation to trigger foods where anticipatory anxiety may have become a factor.  

The author – Matt Krouwel is a clinical hypnotherapist specialising in digestive issues. He is currently conduction research with the University of Birmingham (UK).

Hypnotherapy for Functional dyspepsia – References

Calvert, E. L., Houghton, L. A., Cooper, P., Morris, J., & Whorwell, P. J. (2002). Long-term improvement in functional dyspepsia using hypnotherapy. Gastroenterology, 123(6), 1778-1785.

Chitkara, D., & Talley, N. J. (2003). Hypnotherapy for functional dyspepsia: do the results add up?. Gastroenterology, 125(2), 636.

Mahadeva, S., & Goh, K.-L. (2006). Epidemiology of functional dyspepsia: A global perspective. World Journal of Gastroenterology : WJG, 12(17), 2661–2666. http://doi.org/10.3748/wjg.v12.i17.2661

Sharma, R. L. (2008). Functional Dyspepsia: At least recommend hypnotherapy. Bmj, 337(7674), 832.

Talley, N. J., Locke, G. R., Lahr, B. D., Zinsmeister, A. R., Tougas, G., Ligozio, G., … Tack, J. (2006). Functional dyspepsia, delayed gastric emptying, and impaired quality of life. Gut, 55(7), 933–939. http://doi.org/10.1136/gut.2005.078634

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