Psychological Treatments in Functional Gastrointestinal Disorders: A Primer for the Gastroenterologist

Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina at Chapel Hill.
Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association (Impact Factor: 7.9). 10/2012; 11(3). DOI: 10.1016/j.cgh.2012.10.031
Source: PubMed


The functional gastrointestinal disorders (FGIDs) often show inadequate response to usual medical care. Psychological treatments can help improve FGID patient outcomes, and such treatment should be considered for patients who have moderate or severe symptoms after 3 to 6 months of medical care, and those whose symptoms are clearly exacerbated by stress or emotional symptoms. Effective psychological treatments, based on multiple randomized controlled trials, include cognitive behavioral therapy (CBT) and hypnosis for irritable bowel syndrome and pediatric functional abdominal pain; CBT for functional chest pain; and biofeedback for dyssynergic constipation in adults. Successful referral by the gastroenterologist for psychological treatment is facilitated by educating the patient about the rationale for such treatment, reassurance about the diagnosis and continuation of medical care, firm doctor-patient therapeutic alliance, and identification of, and communication with, an appropriate psychological services provider.

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    • "Cognitive behavioral therapy (CBT), anorectal biofeedback, and hypnosis treatment are the three most extensively empirically tested psychological therapy modalities for FGIDs (Palsson & Whitehead, 2013). Even though the empirical literature on hypnosis treatment is smaller than for CBT and biofeedback, it is still substantial and includes a dozen randomized controlled trials (Palsson & Whitehead, 2013). The first study on this approach for GI disorders was a randomized placebo-controlled trial by Dr. Peter Whorwell and colleagues, published in Lancet in 1984, comparing the clinical effects of a seven-session course of gut-directed hypnotherapy to seven sessions of supportive therapy combined with placebo pills in 30 patients with severe IBS. "
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    ABSTRACT: Completely scripted treatment courses for verbatim interventions are uncommon in the field of clinical hypnosis. This approach was adopted for by a North Carolina research team for treating gastrointestinal disorders 20 years ago and has been used in hypnosis treatment of irritable bowel syndrome and ulcerative colitis, as well as in guided imagery treatment for functional abdominal pain. Treatment with these scripted protocols is delivered in a fixed series of sessions over a 2- or 3-month period. They have been found efficacious for improving bowel symptoms in several clinical trials, even in patients who have been entirely unresponsive to medical treatment. Response rates in clinical trials have ranged from 53% to 94%, and the therapeutic benefits have been shown to be well maintained at 6-, 10-, or 12-month follow-ups in different studies. This article describes the development and research on these protocols and summarizes the advantages and limitations of this fully scripted treatment approach.
    The American journal of clinical hypnosis 07/2015; 58(1). DOI:10.1080/00029157.2015.1012705 · 0.53 Impact Factor
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    • "In a small pilot study by the authors, HYP was recently established as a preferred intervention for functional heartburn (Riehl et al., 2015). As with other work in the treatment of functional GI disorders (Palsson & Whitehead, 2013) there were consistent and significant changes in heartburn symptoms, visceral anxiety and quality of life, and a trend for improvement in catastrophizing for patients who enrolled in a 7-session esophageal-directed HYP protocol (Riehl et al., 2015). "
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    ABSTRACT: Hypnotherapy is an evidence based intervention for the treatment of functional bowel disorders, particularly irritable bowel syndrome. While similar in pathophysiology, less is known about the utility of hypnotherapy in the upper gastrointestinal tract. Esophageal disorders, most of which are functional in nature, cause painful and uncomfortable symptoms that impact patient quality of life and are difficult to treat from a medical perspective. After a thorough medical workup and a failed trial of proton pump inhibitor therapy, options for treatment are significantly limited. While the pathophysiology is likely multifactorial, two critical factors are believed to drive esophageal symptoms—visceral hypersensitivity and symptom hypervigilance. The goal of esophageal directed hypnotherapy is to promote a deep state of relaxation with focused attention allowing the patient to learn to modulate physiological sensations and symptoms that are not easily addressed with conventional medical intervention. Currently, the use of hypnosis is suitable for dysphagia, globus, functional chest pain/non-cardiac chest pain, dyspepsia, and functional heartburn. In this article the authors will provide a rationale for the use of hypnosis in these disorders, presenting the science whenever available, describing their approach with these patients, and sharing a case study representing a successful outcome.
    The American journal of clinical hypnosis 06/2015; 58(1):22-33. DOI:10.1080/00029157.2015.1025355 · 0.53 Impact Factor
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    • "Despite advances in medical and pharmaceutical interventions , treatment largely remains insufficient (Palsson and Whitehead 2013). The psychological comorbidity associated with FGIDs as well as the efficacy of psychological interventions are well documented (Drossman 2006; Palsson and Whitehead 2013), but the mechanisms of action are still reported to be unknown (Brandt et al. 2009). Defining FGIDs by the absence of identified disease biomarkers, ignores physiological dysfunction of ''brain-gut'' interaction associated with FGIDs. "
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    ABSTRACT: Irritable bowel syndrome (IBS) and Functional Abdominal Pain (FAP) are among the most commonly reported Functional Gastrointestinal Disorders. Both have been associated with varying autonomic dysregulation. Heart Rate Variability Biofeedback (HRVB) has recently begun to show efficacy in the treatment of both IBS and FAP. The purpose of this multiple clinical replication series was to analyze the clinical outcomes of utilizing HRVB in a clinical setting. Archival data of twenty-seven consecutive pediatric outpatients diagnosed with IBS or FAP who received HRVB were analyzed. Clinical outcomes were self-report and categorized as full or remission with patient satisfaction, or no improvement. Qualitative reports of patient experiences were also noted. Full remission was achieved by 69.2 % and partial remission was achieved by 30.8 % of IBS patients. Full remission was achieved by 63.6 % and partial remission was achieved by 36.4 % of FAP patients. No patients in either group did not improve to a level of patient satisfaction or >50 %. Patient's commonly reported feeling validated in their discomfort as a result of psychophysiological education. Results suggest that HRVB is a promising intervention for pediatric outpatients with IBS or FAP. Randomized controlled trials are necessary to accurately determine clinical efficacy of HRVB in the treatment of IBS and FAP.
    Applied Psychophysiology and Biofeedback 10/2014; 39(3-4). DOI:10.1007/s10484-014-9261-x · 1.13 Impact Factor
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