By Will Boggs, MD
NEW YORK (Reuters Health) Mar 14 - Patients with refractory irritable bowel syndrome (IBS) have improved symptoms and quality of life following gut-directed group hypnosis, researchers from Austria report.
Many IBS treatment guidelines recommend gut-directed hypnotherapy, "but it should be made more available," Dr. Gabriele Moser from the Medical University of Vienna told Reuters Health by email.
Indeed, Dr. Moser says, "In gastroenterology centers it should be offered as a routine treatment, and gut-directed hypnotherapists should be a part of each gastroenterology team."
"One problem is the low availability of therapists, and there has been a great need to optimize this intervention," Dr. Perjohan Lindfors from Sabbatsbergs Hospital in Stockholm, Sweden, who has published research on gut-directed therapy for IBS, told Reuters Health. "Mosel et al. show in this paper great results when delivering hypnotherapy in a group format, which is a way to increase the cost effectiveness and make this intervention available to more patients."
Dr. Moser and colleagues conducted a randomized controlled trial involving 90 patients whose IBS was refractory to their former treatment (symptomatic medication, psychotherapy, relaxation methods, etc.).
All 46 patients randomized to group hypnotherapy were hypnotized with no side effects, according to the report February 19th online in The American Journal of Gastroenterology. The control group received supportive talks with medication.
At the end of 12 weeks, 28 (60.8%) of patient getting group hypnotherapy had significant improvements in their IBS impact scale scores, compared with 18 (40.9%) of the 44 controls (p=0.046).
By 12 months, 25 hypnotherapy patients and 11 controls still had significant improvements (54.3% vs 25%; p=0.004).
The strongest effects of hypnotherapy were seen in daily activities, fatigue, and emotional aspects of IBS, the researchers note.
Compared with controls, the hypnotherapy patients also showed significant improvements in quality of life as measured by the Short-Form-36 (SF-36) and by visual analog scales that assessed physical well being, psychological well being, and life satisfaction.
Group hypnotherapy was more effective than control treatment in relieving constipation, abdominal pain, and flatulence, but there was no significant difference between treatments for reducing diarrhea.
Patients randomized to group hypnotherapy experienced significant reductions in anxiety and depression, whereas controls maintained their anxiety and depression scores near baseline.
"Physicians now have good news for their patients who do not have an adequate relief with any medication: a relatively short (10 sessions) therapy, performed within three months, is available in a cheaper setting (group sessions) and more than 50% have a long term effect (many over years)," Dr. Moser concluded. "There are no side effects, and it is easy to learn."
Patients practice hypnosis at home and get a compact disc from their physician to do it whenever necessary, Dr. Moser said.
The therapist should be experienced in these techniques. "A minimum of 20 hours training in medical hypnosis and further 16 hours training for gut directed hypnosis (offered by experienced physicians or psychotherapists) is necessary," Dr. Moser said. "An additional training or education in psychotherapy or psychosomatic medicine should be provided when treating refractory IBS patients (more than 60% of patients with severe IBS have psychological disturbances)."
Dr. Peter Whorwell from Wythenshawe Hospital, Manchester, UK has also studied hypnotherapy for IBS. He told Reuters Health, "Hypnotherapy should start to be integrated into the care of patients in general rather than being a stand-alone treatment."
He added that, because of its cost, hypnotherapy probably should be used when conventional treatments have failed.
Am J Gastroenterol 2013.
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