Hypnotherapy for IBS Looks Convincing in Randomized Trials

Damian McNamara

November 07, 2017

BARCELONA — More patients with irritable bowel syndrome (IBS) reported relief of pain and discomfort after hypnotherapy than after education and supportive care, interim results from a randomized controlled trial conducted at 13 centers indicate.

Most evidence supporting hypnotherapy for IBS in the literature involves highly specialized therapists at secondary and tertiary care centers delivering 10 sessions or more of therapy, said investigator Catharina Flik, MD, from University Medical Center Utrecht in the Netherlands.

"I'm interested in demonstrating its effectiveness in a broader perspective — primary care, for example," she said here at United European Gastroenterology Week 2017.

In their ongoing 1-year study, Dr Flik and her colleagues are assessing the effectiveness of hypnotherapy in patients with irritable bowel syndrome.

How Hypnotherapy Might Help in IBS

Hypnotherapy imbues a sense of control and self-efficacy in patients, Dr Flik explained. It changes their cognitions, allowing them to be more open to suggestion from a therapist and increasing their control over autonomic body processes such as how they process pain in the brain and the spine.

The bidirectional pathway between the brain and gut and the evidence supporting the influence of hypnotherapy on gastrointestinal health were recently described in a Medscape Perspective interview with Laurie Keefer, PhD, from the Icahn School of Medicine at Mount Sinai in New York City.

Of the 354 patients who were referred by primary care doctors and hospital specialists, 150 attended six biweekly sessions of individual hypnotherapy, 150 attended six biweekly sessions of group hypnotherapy, and 54 received education and supportive care with an audio CD.

Patients were asked: In the past 7 days, have you had adequate relief of your IBS pain and discomfort? Those who answered yes at least 3 of every 4 weeks were considered responders.

At 3 months, adequate relief of pain and discomfort was reported by more patients who received individual hypnotherapy and group hypnotherapy than those who received education and supportive care (40% vs 34% vs 17%; P = .041).

Although the rates reported for the two hypnotherapy types were slightly different, group hypnotherapy was, in fact, noninferior to individual hypnotherapy.

Patients will be followed up for 9 months after the end of treatment.

Similar Study in Sweden

Similar conclusions were reached in a randomized controlled trial of 108 patients with IBS symptoms refractory to standard treatment conducted in Sweden, also presented at the meeting.

Patients were randomized to attend eight 1-hour sessions of hypnotherapy either individually (n = 51) or in groups of six to eight people (n = 57). All subtypes of IBS were represented in the study cohort, said investigator Jenny Lövdahl, RN, from the University of Gothenburg in Sweden.

At baseline, about two-thirds of participants reported severe IBS, assessed with the Irritable Bowel Syndrome Severity Scoring System (IBS-SSS). Responders were defined as people who experienced a reduction of at least 50 points in the IBS-SSS score.

After 12 weeks of gut-directed hypnotherapy, administered by Lövdahl, response rates in the individual sessions were not significantly different from those in the group sessions (69% vs 57%; P = .018), again suggesting noninferiority.

Pain intensity, pain frequency, bloating severity, bowel habit dissatisfaction, and daily life interference associated with IBS were all significantly better after treatment.

"There were clear improvements in IBS symptoms after 12 weeks of hypnotherapy," Lövdahl reported. "And in a between-group comparison, we could not see any differences."

In addition, on the Short Health Scale questionnaire — used to assess the subjective health of the participants — "we could see clear improvements, with no significant difference between groups," she added.

"In the future, we want to look for predictors of response to find the most appropriate treatment for each patient," she noted.

Group sessions might be an effective way to deliver IBS hypnotherapy to more patients at a lower cost, Lövdahl said.

The group approach appears feasible, even if some patients need convincing. "A lot of patients felt, beforehand, that they would not like hypnotherapy in a group," said Dr Flik. However, acceptance improved with education, and "afterward, they were very glad to have been in the group."

"Very Good, Rigorously Designed Trials"

"The studies are quite practical. The nice thing is that they were conducted in different settings but had almost the same research question," said session comoderator Daniel Keszthelyi, MD, PhD, from Maastricht University in the Netherlands

"They are really very good, rigorously designed trials," he told Medscape Medical News.

There are common misconceptions about hypnotherapy. "Some patients might think it's Voodoo," he explained, adding that the "same thing goes for physicians."

"When I see patients with IBS, I discuss all drug options and psychological therapies at the same time," so medication and hypnotherapy strategies are presented as equally effective, he added.

"Hypnotherapy, in general, is something that is really, really helping patients," Dr Keszthelyi said.

He reported that he is planning to evaluate an online version of hypnotherapy for individuals and groups (conducted over Skype, for example). One goal is to compare the practicality of online and traditional hypnotherapy.

/Hypnotherapy, in general, is something that is really, really helping patients./

The presenters were both asked by members of the audience what was covered in each treatment session.

"We did only hypnotherapy," Dr Flik said. "That's one difference between our results and other studies with group hypnotherapy, because they also do some education and discussion in groups."

"Our focus was hypnotherapy," Lövdahl reported. "In some groups, there was a little time left and patients started discussing their symptoms among themselves. That might have helped patients in those groups, but it was not something we directed them to do."

Session comoderator Philippe Van Hootegem, MD, from AZ Saint Lucas in Ghent, Belgium, asked Dr Flik how responsive the patients were.

"About 10% of the whole population was not hypnotizable, 80% were good enough for the exercises, and 10% were very good and able to concentrate and go to another level," Dr Flik reported.

Dr Flik and Ms Lövdahl have disclosed no relevant financial relationships.

United European Gastroenterology (UEG) Week 2017: Abstracts OP281 and OP282. Presented October 31, 2017.

Follow Medscape Gastroenterology on Twitter @MedscapeGastro and Damian McNamara @MedReporter


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