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Standardized Hypnosis Treatment for Irritable Bowel Syndrome: The North Carolina Protocol

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Abstract

The North Carolina protocol is a seven-session hypnosis-treatment approach for irritable bowel syndrome that is unique in that the entire course of treatment is designed for verbatim delivery. The protocol has been tested in two published research studies and found to benefit more than 80% of patients. This article describes the development, content, and testing of the protocol, and how it is used in clinical practice.

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... Gut-directed clinical hypnosis has been well established as an effective intervention for the treatment of functional gastrointestinal disorders (Blanchard & Scharff, 2002;Gholamrezaei, Ardestani, & Emami, 2006;Palsson, 2006;Palsson & van Tilburg, 2015;Peter, Tran, Michalski, & Moser, 2018;Popa, Chiarioni, David, & Dumitrascu, 2019;Whorwell, Prior, & Faragher, 1984). These approaches rely heavily on the promotion of relaxation, the physical sensation of warmth, the assertion of control over the gut, changing gastrointestinal symptoms and functioning, metaphors or guided imagery for healthy gut function, normalization of bowel functioning, altered perceptual experience of symptoms, immunity to intestinal disturbances from internal or external stimuli, reduced attention to bowel functioning, increased sense of health and comfort, and ego-strengthening. ...
... As noted above, gut-directed clinical hypnosis is an effective treatment modality and one of the behavioral health interventions with the strongest empirical support (Blanchard & Scharff, 2002). However, psychobiological mechanisms associated with positive outcomes remain elusive (Palsson, 2006). ...
Article
Functional gastrointestinal disorders, i.e., abdominal conditions without identifiable structural etiologies, are seen frequently in primary care and specialty practices. As subtle physiological processes have been identified as potential contributing factors to these functional disorders, these disorders have been recently relabeled, Disorders of Gut-Brain Interaction (DGBI). Moreover, some of these processes, e.g., sympathetic nervous system activity and inflammation, are being increasingly related to psychosocial factors such as situational stress and histories of trauma, abuse, and neglect. As the activity of the autonomic nervous system (ANS) has been long considered to be a contributory factor for DGBI, the present study utilized a theory-driven model based on the Polyvagal Theory to optimize ANS activity for the promotion of healthy digestive activity. Specifically, a hypnotic intervention to increase neuroception of safety was employed with three female college students diagnosed with functional dyspepsia and irritable bowel syndrome in a single-subject design. This intervention was found to be associated with increases in the experience of safe/warm positive affect and decreases in symptoms of functional dyspepsia and irritable bowel syndrome as well as depression and anxiety. The hypnotic intervention for the promotion of a sense of safety is recommended for the treatment of other functional somatic disorders as well as trauma-related conditions. Potential complications related to individuals with prolonged trauma and attachment issues also are reviewed.
... Hypnotherapy is hypnosis [31] used with the intention of generating a beneficial outcome. The earliest trials of hypnotherapy for the treatment of IBS date back to the early 1980 s [32,33] using a package of broadly similar techniques, the most well-known of which are the Manchester Model [18] and the North Carolina Protocol [34] which have been termed gut-directed hypnotherapy (GDH) [35]; these models were quickly adopted as the norm [36,37]. ...
... • Frequency of sessions: < 1 per week compared to ≥1 session in a week [34,76]. • Hypnotherapist characteristics: Female compared to male [53]. ...
... Our first scripted hypnosis treatment protocol was designed for IBS treatment and was written in 1994 by Dr. Olafur Palsson in collaboration with Dr. William Whitehead (Palsson, 2006). Palsson had earlier demonstrated that a six-session scripted group hypnosis intervention for severe stress symptoms could have not only psychological and well-being benefits but also result in desirable physiological changes (Palsson, 1993). ...
... Additionally, Palsson has supported use of the IBS protocol by training clinicians in its use in advanced workshops at the Annual Meetings of the American Society of Clinical Hypnosis, and by providing patients seeking hypnosis treatment for IBS with a nationwide online U.S. listing (on the website ibshypnosis.com) of therapists who offer treatment with the protocol and accept direct patient self-referrals. Some guidelines for clinical use of the protocol are provided in Palsson's (2006) ...
Article
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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.
... This evidence suggests that the pathophysiology of IBS involves the brain-gut axis (Salt and Neimark, 2002), and 'gut-directed' hypnotherapy has been shown to be a successful intervention in breaking abnormal cycles occurring within this axis (Camilleri, 2001;Farhadi et al., 2001). Studies have especially shown the efficacy of hypnosis in the treatment of IBS (Palsson, 1998;Whorwell, 1987Whorwell, , 2006, but these studies only addressed physiological symptoms ('gut-directed' hypnotherapy) and did not take into account psychological symptoms such as anxiety and depression which are part of the IBS symptom picture. ...
... Psychological distress, which can trigger or exacerbate symptoms (Jarrett et al., 1998;Koloski et al., 2003), has been shown to be an important component of IBS symptoms and probably should be considered when treatment strategies are designed. To our knowledge, studies on hypnotherapy as a treatment for IBS have not taken this into account (Anbar, 2001;Forbes et al., 2000;Gonsalkorale et al., 2002;Harvey et al., 1989;Palsson, 1998;Whorwell, 1987). By using scripts that specifically target each individual patient's emotional/psychological symptoms (in conjunction with scripts for the physiological aspects of the disease), the therapist in this trial attempted to address the whole patient profile. ...
Article
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Background Hypnotherapy has been reported as being beneficial in the treatment of irritable bowel syndrome (IBS). We aimed to test the hypothesis that patients with IBS treated ‘holistically’ by hypnosis (i.e. by combined psychological and physiological symptom imagery) would have greater improvement in their IBS symptoms than patients treated by hypnosis using standard ‘gut-directed’ hypnotherapy, and both would be superior to simple relaxation therapy. Methods Patients (n = 51) with Rome II criteria were randomised to ‘individualised’ (holistic) hypnotherapy, standard ‘gut-directed’ hypnotherapy or relaxation therapy for a period of 11 weeks with two follow-up assessments at 2 weeks and at 3 months after the completion of the trial. The primary outcome was bowel symptom severity scale (BSSS). Results All the participants in this study improved their IBS symptoms (pain, bloating, constipation and diarrhoea) and physical functioning at the end of the treatment from baseline, but this was not significantly different across the treatment arms. Conclusion Neither ‘individualised’ nor ‘gut-directed’ hypnotherapy is superior to relaxation therapy in IBS.
... A 10 minute baseline was collected prior to hypnotic induction by having participants sit and relax, with eyes closed. Following the baseline, the 10 minute hypnotic induction was performed by an experienced therapist (JH) using the following standard procedure [28]. ...
... Most studies on IBS therapy use audiotapes to allow the patients to practice at home [31]. Others have proposed a stand-alone audio-taped home-treatment approach [28]. Audio-taped hypnosis is known to be effective, but less effective than the presence of a live hypnotherapist [32]. ...
Article
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The effects of hypnosis on physiological (gastrointestinal) functions are incompletely understood, and it is unknown whether they are hypnosis-specific and gut-specific, or simply unspecific effects of relaxation. Sixty-two healthy female volunteers were randomly assigned to either a single session of hypnotic suggestion of ingesting an appetizing meal and an unappetizing meal, or to relax and concentrate on having an appetizing or unappetizing meal, while the electrogastrogram (EGG) was recorded. At the end of the session, participants drank water until they felt full, in order to detect EGG-signal changes after ingestion of a true gastric load. During both conditions participants reported their subjective well-being, hunger and disgust at several time points. Imagining eating food induced subjective feelings of hunger and disgust as well as changes in the EGG similar to, but more pronounced than those seen with a real gastric water load during both hypnosis and relaxation conditions. These effects were more pronounced when imagining an appetizing meal than with an unappetizing meal. There was no significant difference between the hypnosis and relaxation conditions. Imagination with and without hypnosis exhibits similar changes in subjective and objective measures in response to imagining an appetizing and an unappetizing food, indicating high sensitivity but low specificity.
... The lack of standardized hypnosis treatment protocols for chronic pain has slowed its adoption, uptake, and recognition as an empirically supported treatment (Elkins et al., 2007). Recent efforts by experts in the field have led to several manualized protocols to standardize approaches to hypnosis, including the one used in this investigation (Jensen, 2011;Palsson, 2006;Williams et al., 2020). It is important to note the potential for research integration into clinical services. ...
Article
Although strong evidence exists for using individual hypnosis to treat pain, evidence regarding group applications is limited. This project evaluated changes in multiple outcome measures in persons with chronic pain treated with 8 weeks of group hypnosis. Eighty-five adults with diverse chronic pain etiologies completed an 8-session, structured group hypnosis treatment. Pain intensity, pain interference, and global health were evaluated at baseline, posttreatment, and 3- and 6-months posttreatment. Linear mixed effects models assessed changes in outcomes over time. In a model testing, all three outcome measures simultaneously, participants improved substantially from pre- to posttreatment and maintained improvement across follow-up. Analyses of individual outcomes showed significant pre- to posttreatment reductions in pain intensity and interference, which were maintained for pain intensity and continued to improve for pain interference across follow-up. The findings provide compelling preliminary evidence that a group format is an effective delivery system for teaching individual skills in using hypnosis for chronic pain management. Larger randomized controlled trials are warranted to demonstrate equivalence of outcomes between treatment modes.
... In many countries gut-directed hypnotherapy is usually delivered by psychologists or other mental health professionals, and in many communities, these clinicians are not available except perhaps in major tertiary care centres. Using a standardised protocol enables a broader range of health care professionals to provide the treatment, 22 thereby increasing availability. We have tested the feasibility of nurse-administered hypnotherapy with results comparable to the already existing data of other studies. ...
Article
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Background Gut‐directed hypnotherapy improves symptoms for patients with irritable bowel syndrome (IBS). Group hypnotherapy, as well as hypnotherapy administered by nurses, can increase treatment availability, but there are few comparisons between individual and group‐based hypnotherapy. Aim We aimed to evaluate and compare the effectiveness of nurse‐administered hypnotherapy for IBS delivered individually or in groups. Methods IBS patients were randomised to individual or group hypnotherapy (8 sessions, 12 weeks). The primary endpoint was changes in severity of IBS symptoms. A responder was defined as reduction of IBS severity scoring system (IBS‐SSS) ≥50 points at the end of treatment compared to baseline. The effects on extracolonic and psychological symptoms, and quality of life were also assessed. Symptoms were also followed up 6 months after treatment start. Results A total of 119 patients were randomised (61 individual, 58 group hypnotherapy). Patients reported improvements in IBS symptoms (IBS‐SSS) (individual: 332 (273–401) (median, IQR), versus 216 (140–308), (p < 0.0001), group: 315 (239–382), versus 217 (149–314), (p < 0.0001)), with no differences between the groups (p = 0.16). Extracolonic symptoms, psychological symptoms and quality of life also improved, without clear differences between the groups. Sixty‐nine percent of the individual hypnotherapy patients were responders after treatment versus 57% of the group hypnotherapy patients (p = 0.25). Symptom improvements were also seen at follow‐up. Conclusions Nurse‐administered gut‐directed hypnotherapy, delivered individually or in groups, relieves IBS symptoms, improves psychological symptoms and quality of life. Group hypnotherapy can be an efficacious alternative, enabling more patients to benefit from the treatment (ClinicalTrials.gov ID no of study: NCT03432078).
...  Suggestions for digestive calm, reduced sensitivity, increased comfort and the establishment of healthy digestive rhythm, possibly coupled with calming imagery such as waves lapping on a shore. 8  The 'Warm hand visualisation', in which suggestions are used to enable the patient to access the idea of a warm hand, often enhanced by imagining the hand as a warm colour. Patients then learn to transfer this perceived warmth into their gut, mimicking the effect of resting a hot water bottle on their stomach. ...
Article
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Background Hypnotherapy has been shown to be effective at relieving global gastrointestinal symptoms (GGS) in irritable bowel syndrome (IBS). This study examines the impact of hypnotherapy delivery and participant characteristics on IBS outcomes. Methods This systematic review searched CINAHL, Cochrane Library, Conference Citation Index, Embase, PubMed, PsycARTICLES, PsychINFO, Science Citation index-expanded, Social Science Citation Index. Titles and abstracts, then full-text articles were screened against inclusion criteria: trials with a concurrent comparator of hypnotherapy in adults with IBS diagnosed using Manning or ROME criteria, which provided symptom data. Included studies were extracted and assessed for bias using Cochrane Collaboration 2011 guidance. Random-effects meta-analysis was conducted with sub-group analysis to assess the impact of delivery characteristics on outcomes. Results Twelve trials were included, 7 in the meta-analyses. Hypnotherapy reduced the risk of GGS, but this was not statistically significant, (standardised mean difference (SMD) 0.24, [-0.06, 0.54], I² 66%). Higher frequency of sessions (≥1/week) reduced GGS (SMD 0.45 [0.23,0.67] I² 0%), as did higher volumes of intervention (≥8 sessions with ≥6 hours of contact) (SMD 0.51 [0.27,0.76] I² 0%) and group interventions (SMD 0.45 [0.03, 0.88] I² 62%). Only volume of intervention produced a significant effect between the subgroups. Conclusion This review suggests that high volume hypnotherapy is more beneficial than low and should be adopted for GDH. Both high frequency and group interventions are effective in reducing GGS in IBS. However, the sample size is small and more studies are needed to confirm this.
... and gastrointestinal symptoms, several psychological interventions have demonstrated therapeutic utility in IBS. Psychotherapies such as relaxation-directed hypnotherapy, 14,15 general hypnotherapy, [16][17][18] autogenic training, 19,20 and gut-directed hypnotherapy 21,22 improve IBS-related psychological abnormalities. Non-hypnosis approaches such as cognitive-behavioral therapy (CBT), 23,24 mindfulness, 25,26 biofeedback, 27,28 and psychology education 29,30 also produce psy- chological improvements in IBS. ...
... The earliest study on hypnotherapy in children with FAP or IBS by Vlieger et al. [25] used gut-directed hypnotherapy (six sessions) in an adapted form for children. Another well-investigated hypnotherapeutic approach, the 'North Carolina hypnosis protocol', was developed by Palsson [39]. It is a standardized seven-session protocol addressing reduced attention to bowel symptoms, altered perceptual experience of the symptoms, increased overall sense of health and comfort, immunity to intestinal disturbance, and normalization of bowel functioning [40]. ...
Article
Objective: Psychosocial treatments for chronic abdominal pain in childhood or adolescence are effective, but time consuming and hardly available. In the present study, gut-directed hypnotherapy (GDHT) and unspecific hypnotherapy (UHT) were compared to evaluate the feasibility and efficacy of a hypnotherapeutic self-help intervention. Participants and methods: Children/adolescents between 6 and 17 years of age with chronic abdominal pain were randomized to GDHT or UHT. The treatment period was 12 weeks each. Measurements were performed before and after treatment. The primary outcome was a pain diary. Analysis was carried out as per protocol. Results: Of 45 participants included, 13 were lost to follow-up. Thirty-two participants (14 GHDT, 18 UHT) were analyzed. Dropouts had higher pain severity. Completers in both conditions showed good adherence and a similar decrease in days with pain and pain duration. Pain intensity decreased only in the UHT condition. Eleven participants (two GDHT, nine UHT) achieved clinical remission (>80% improvement) and 13 participants (seven GDHT, six UHT) improved significantly (30-80%). Conclusion: Results suggest a high efficacy of standardized home-based hypnotherapy for children/adolescents with abdominal pain. Children/adolescents with high pain severity are at risk of dropping out. The UHT condition showed slight evidence of superiority, but conditions were equivalent on most outcomes. Taken together, self-help approaches based on hypnotherapy could close a treatment gap and prevent chronification.
... Eine Besonderheit stellt dabei die langfristige Wirksamkeit der Therapie auch bei Anwendung in Gruppen zu je sechs Personen dar, die in einer gastroenterologischen Abteilung integriert werden konnte. Die gesundheitsökonomischen Vorteile eines solchen Settings liegen auf der Hand.Mit dem North Carolina Protocol liegt ein weiteres, etwas abweichendes, strenger standardisiertes Behandlungsprotokoll von Olafur Palsson vor, welches für sieben Sitzungen im zweiwöchigen Abstand konzipiert ist(Palsson 2006) und im US-amerikanischen Raum von etwa 600 Therapeuten angeboten wird(Palsson 2015). Die Wirksamkeitsstudien in Tabelle 1 vonPalsson et al. (2002) undKeefer et al. (2013) beziehen sich auf dieses Behandlungsprotokoll. Der letztgenannten Studie kommt besondere Bedeutung für die Anwendung von Hypnose bei chronisch entzündlichen Darmerkrankungen zu, siehe dazu den entsprechenden Abschnitt. ...
Article
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The brain-gut axis comprises the interactions of the brain with the spinal cord, the sympathetic, parasympathetic, and enteric divisions of the autonomic innervation of the digestive tract and the intestinal microbiome with its metabolites. This bidirectional communication enables an effective treatment method for functional gastrointestinal disorders (irritable bowel syndrome, functional dyspepsia), namely, gut-directed hypnosis. A series of randomized controlled studies show remarkable long-Term success even with therapy-refractory complaints. Gut-directed hypnosis is therefore recommended to be included in guidelines for the treatment of irritable bowel syndrome. It can be performed in individual or group settings in 10 sessions and can be well integrated into a treatment concept in gastroenterological centers as well. There are also indications for efficacy in children with functional bowel diseases. Preliminary studies indicate that hypnosis may have an additive therapy effect over conventional medical treatment in inflammatory bowel diseases.
... Diese Methode erlangte mit einer 1984 in The Lancet publizierten Arbeit Bekanntheit und wurde in der Gastroenterologischen Abteilung auf der Universitätsklinik in Manchester implementiert. Von den in Tabelle 1 aufgeführten Arbeiten beziehen sich jene von Galovski und Blanchard (1998) Mit dem North Carolina Protocol liegt ein weiteres, etwas abweichendes, strenger standardisiertes Behandlungsprotokoll von Olafur Palsson vor, welches für sieben Sitzungen im zweiwöchigen Abstand konzipiert ist (Palsson 2006) und im US-amerikanischen Raum von etwa 600 Therapeuten angeboten wird (Palsson 2015 . Von etwas über 200 untersuchten Patienten sprachen über 71 % auf die Therapie an und konnten die erzielte Symptomreduktion dann bis über fünf Jahre mehrheitlich (81 %) halten. ...
Article
Full-text available
Brain-gut axis and gut-directed hypnosis – success of an integrated psychosomatic treatment in gastroenterology The brain-gut axis comprises the interactions of the brain with the spinal cord, the sympathetic, parasympathetic, and enteric divisions of the autonomic innervation of the digestive tract and the intestinal microbiome with its metabolites. This bidirectional communication enables an effective treatment method for functional gastrointestinal disorders (irritable bowel syndrome, functional dyspepsia), namely, gut-directed hypnosis. A series of randomized controlled studies show remarkable long-term success even with therapy-refractory complaints. Gut-directed hypnosis is therefore recommended to be included in guidelines for the treatment of irritable bowel syndrome. It can be performed in individual or group settings in 10 sessions and can be well integrated into a treatment concept in gastroenterological centers as well. There are also indications for efficacy in children with functional bowel diseases. Preliminary studies indicate that hypnosis may have an additive therapy effect over conventional medical treatment in inflammatory bowel diseases.
... Due to difficulty in locating hypnotherapy practitioners as well as difficulties with standardizing research on the topic, Pallson et al. have developed a manual gut-focused hypnotherapy treatment consisting of eight gut-focused hypnotherapy sessions [60,61]. The treatment has been shown to be effective in reducing symptoms and has even been converted to audio recorded format for use in self-hypnosis practice in the home. ...
Article
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Irritable Bowel Syndrome (IBS) is a functional gastrointestinal disorder (FGID) that results from a combination of altered gut motility, visceral hypersensitivity and dysregulation of brain-gut neural functioning. Symptoms may range from mild to severe with severity correlating to the degree of psychosocial difficulties; milder symptoms may occur in the absence of psychopathology and may not require medical or psychological intervention. Gastroenterologists regularly encounter patients with more severe FGIDs, who may benefit from psychological services to address modification of stressful factors, enabling symptoms, and to enhance coping and adaptation to these symptoms. This chapter serves as a primer on the role of psychological factors in IBS and how clinicians may include psychological approaches into patient treatment. We discuss the role of predisposing, precipitating and perpetuating factors in IBS. This understanding involves the biopsychosocial model which can be applied to demonstrate a vicious cycle of patient experiences. Different psychological treatments are briefly discussed as are ways that clinicians can use these methods with IBS patients and psychologists working with FGIDs.
... When it comes to constructing a treatment plan for patients who will likely benefit from esophageal-directed hypnotherapy, researchers at Northwestern University have utilized structured, scripted protocols for most of these conditions. Our protocols have all been developed through adaptations of scripts used for IBS and inflammatory bowel diseases which have been previously published by the author (LK) and colleagues (Keefer et al., 2013;Palsson, 2006) (Table 1). ...
Article
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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.
... There are two empirically validated models of gut-directed hypnotherapy: the Manchester Model (P. J. Whorwell, 2006) and the North Carolina Protocol (Palsson, 2006). Traditionally, these protocols are administered biweekly, between 7 and 12 times. ...
Chapter
This chapter focuses on chronic gastrointestinal disorders and places particular emphasis on that which is most relevant to health psychologists. The past decade has realized several advances in the understanding of the etiology and maintenance of irritable bowel syndrome (IBS), which is now framed around an empirically supported biopsychosocial model, first laid out in a presidential address to the American Gastroenterological Association in 1998 (Drossman 1998; Drossman et al. 1999) and gradually adopted over the next several years (Halpert & Drossman 2005; Levy et al. 2006). In the 2001 version of this chapter, the conceptualization of gastrointestinal syndromes remained in the psychosomatic realm, thereby emphasizing the contributions of psychopathology, child abuse, and stress to the development and expression of IBS. While each of these areas has a role in the current conceptual model of IBS, they are much less central than previously thought. Advances in cognitive neuroscience have described specific cognitive-affective processes that affect pain and gastrointestinal motility; these have informed psychological treatment. Finally, advances in IBS research have led to increased understanding of the psychological aspects of other gastrointestinal conditions, particularly esophageal disorders and inflammatory bowel diseases.Keywords:gastrointestinal;irritable bowel;esophageal disorders;inflammatory bowel diseases;psychosocial
... This successful research on hypnotic analgesia has gone a long way towards convincing the medical community that it is time to embrace hypnosis in alleviating chronic pain and other related health problems. The use of hypnosis has also been established to some degree with asthma, eating disorders, irritable bowel syndrome, obesity, sleep disorders, smoking cessation, wound healing, and simply coping with the stress of being a medical patient (Covino et al., 2010; Ginandes, Brooks, Sando, Jones, & Aker, 2003; Palsson, 2006). The effective research that has been done with hypnosis in medical settings has opened a great deal of territory for clinicians within the transpersonal tradition who are interested in mind/body medicine (Achterberg, 2002; Dossey, 1995). ...
Chapter
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This chapter explains the historical examination of hypnosis that highlights its relationship to the fields of consciousness studies, mind-body medicine, parapsychology, and transpersonal psychology. It examines some of the major clinical traditions in existence today and looks to their relevance from a transpersonal perspective. The four primary paradigms taught within the hypnosis community are the psychoanalytic, Ericksonian, socio-cognitive, and health/medical approaches. Research in hypnosis continues to be on the leading edge of discoveries that challenge conventional understandings of human nature and human potential. Hypnosis may also be of critical assistance in future studies of the nature of mind using methods of neuroscience and neurophenomenology; from a transpersonal perspective it can be anticipated that such combined efforts might reach similar perspectives as the ancient wisdom teachings of many mystical traditions such as Dzogchen and Tibetan Buddhism.
... The other one is the North Carolina Protocol, a seven-session hypnosis-treatment, unique because the entire course of treatment is designed for verbatim delivery. Research has shown that this protocol benefit more than 80% of patients (Palsson, 2006). Both protocols have proven that the treatment with hypnosis has an important impact that is well maintained for most patients for years after the end of treatment. ...
... The other one is the North Carolina Protocol, a seven-session hypnosis-treatment, unique because the entire course of treatment is designed for verbatim delivery. Research has shown that this protocol benefit more than 80% of patients (Palsson, 2006). Both protocols have proven that the treatment with hypnosis has an important impact that is well maintained for most patients for years after the end of treatment. ...
Chapter
Full-text available
In this chapter, we describe the use of this approach for difficult cases and/or emergencies based on the Valencia Model, albeit introducing substantial modifications to adapt it to the specific characteristics of the intervention in these cases. Difficult cases and/or emergencies are defined as follows: 1) people who have gone through a number of treatments without receiving significant benefits, and, consequently, they have fewer therapeutic options; 2) people in despair (for several reasons); 3) people whose problem needs to be solved or improved immediately; 4) people in shock; 5) people who, due to their poor clinical condition, are not amenable to start a treatment using the choice techniques for their problem, such as exposure, behavioral activation, etc. In point of fact, our approach puts forth three intervention models for difficult cases and/or emergencies, which correspond to the different types of cases that have been considered as the most relevant according to our clinical experience.
... The other one is the North Carolina Protocol, a seven-session hypnosis-treatment, unique because the entire course of treatment is designed for verbatim delivery. Research has shown that this protocol benefit more than 80% of patients (Palsson, 2006). Both protocols have proven that the treatment with hypnosis has an important impact that is well maintained for most patients for years after the end of treatment. ...
Chapter
Full-text available
In this chapter, we describe the use of this approach for difficult cases and/or emergencies based on the Valencia Model, albeit introducing substantial modifications to adapt it to the specific characteristics of the intervention in these cases. Difficult cases and/or emergencies are defined as follows: 1) people who have gone through a number of treatments without receiving significant benefits, and, consequently, they have fewer therapeutic options; 2) people in despair (for several reasons); 3) people whose problem needs to be solved or improved immediately; 4) people in shock; 5) people who, due to their poor clinical condition, are not amenable to start a treatment using the choice techniques for their problem, such as exposure, behavioral activation, etc. In point of fact, our approach puts forth three intervention models for difficult cases and/or emergencies, which correspond to the different types of cases that have been considered as the most relevant according to our clinical experience.
... It is the only approach for IBS fully scripted to standardize and ensure the uniformity of patient care. The validity of the protocol has been evaluated and has been shown to benefit more than 80% of patients (Palsson, 2006). ...
Article
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Hypnosis is a valuable clinical intervention for the treatment of a wide variety of psychological and medical problems which helps improve the quality of life in patients. This paper reviews the state of the evidence regarding the efficacy of hypnosis taking into account the most rigorous research results in this respect, together with other studies of clinical relevance although they do not fulfill stringent methodological criteria. Overall, the findings of research indicate that hypnosis used as an adjunctive to other medical or psychological interventions increases the efficacy and/or efficiency of these interventions. Moreover, hypnosis efficacy is well established in certain clinical applications, especially pain management and other medical conditions, and there is acceptable evidence of its efficacy in treating depression, sleep disorders, smoking cessation, obesity, asthma, and enuresis in children. According to the literature to date, continued research using randomized, controlled methodologies as well as adequate sample sizes is well justified, and it is essential in order to establish the efficacy of hypnosis in other areas.
... The hypnotherapy protocol used a script based on Palsson's individual therapy model (Palsson, 2006), which, in turn, was derived from Whorwell's original description (Whorwell et al., 1984), with one important exception—patients were seen in groups. Seven biweekly sessions, each lasting 45 minutes, were led by a clinical psychologist trained in Palsson's model. ...
Article
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Abstract This study tested whether group gut-focused hypnotherapy would improve irritable bowel syndrome (IBS). Several possible outcome predictors were also studied. Before treatment, 75 patients completed a Symptom Severity Scale, a Mind-Body attribution questionnaire, and a Quality of Relationship Inventory (QRI). The symptom scale was completed posttreatment, 3, 6, and 12 months later. There was significant symptom reduction at each data point (p < .001). Sixty percent had a reduction of more than 50 points, indicative of clinical improvement. Initial severity score (p = .0004) and QRI conflict (p = .057) were directly correlated with a response to hypnotherapy, while attribution of symptoms to mind (emotional) causation was inversely correlated (p = .0056). The authors conclude that group hypnotherapy is effective in patients with IBS.
Article
Hypnotherapy is one of the treatments for irritable bowel syndrome (IBS).Meta-analysis was to evaluate the effectiveness of its use and to identify the most optimal conditions for its implementation. We analyzed Scientific medical databases PubMed, EMBASE, eLibrary for the period from 2005 to 2022. Studies performed on adult samples of patients with a confirmed diagnosis of IBS on the basis of Rome II–IV with a control group were selected. Included studies were analyzed for risks of bias and publication bias. Clinical efficacy was assessed by comparing data on gastrointestinal symptoms reduction and psychological condition. A subgroup analysis was used to compare the effectiveness of group and individual hypnotherapy, as well as the number of sessions conducted. Nine studies (867 patients) were included in the final meta-analysis. Hypnotherapy was significantly more effective in reducing gastrointestinal symptoms in patients with IBS compared to controls (SMD=0.25 [95% CI 0.02–0.49], I2=53%, p=0.03), with positive effects persisting up to one year (SMD=0.34[95% CI 0.07–0.60], p=0.01). Hypnotherapy resulted in an equalization of the psychological distress (MD=1.09[95% CI from –1.27 to 3.44], p=0.37), but the results were not significant. Group hypnotherapy (SMD=0.35[95% CI 0.01–0.70], p=0.05) and higher amount of hypnotherapy sessions during treatment (SMD=0.35 [95%CI 0.14–0.57], p=0.001) were more effective. Based on the results of this systematic review, it is fair to assume that the most effective use of hypnotherapy in patients with IBS, including those with therapy-resistant forms, is more than 7 sessions of group hypnotherapy more than once a week with a minimum session time of 45 minutes.
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Functional dyspepsia (FD) is a common disorder of gut–brain interaction, affecting approximately 7% of individuals in the community, with most patients managed in primary care. The last British Society of Gastroenterology (BSG) guideline for the management of dyspepsia was published in 1996. In the interim, substantial advances have been made in understanding the complex pathophysiology of FD, and there has been a considerable amount of new evidence published concerning its diagnosis and classification, with the advent of the Rome IV criteria, and management. The primary aim of this guideline, commissioned by the BSG, is to review and summarise the current evidence to inform and guide clinical practice, by providing a practical framework for evidence-based diagnosis and treatment of patients. The approach to investigating the patient presenting with dyspepsia is discussed, and efficacy of drugs in FD summarised based on evidence derived from a comprehensive search of the medical literature, which was used to inform an update of a series of pairwise and network meta-analyses. Specific recommendations have been made according to the Grading of Recommendations Assessment, Development and Evaluation system. These provide both the strength of the recommendations and the overall quality of evidence. Finally, in this guideline, we consider novel treatments that are in development, as well as highlighting areas of unmet need and priorities for future research.
Article
This study aimed to examine the potential feasibility of an online hypnotic intervention for women with persistent pelvic pain. The secondary aim was to explore the effect of the hypnosis intervention on anxiety, depression, pain severity, coping, pain catastrophizing, and pain disability in comparison to a no-intervention control. Twenty women with persistent pelvic pain completed assessment questionnaires and were recruited from a variety of social media sites related to persistent pelvic pain and randomized to either control or hypnotic intervention groups. The intervention group completed a 7-week online hypnotic intervention. Results found a 30% dropout rate and modest compliance (90%-40%) with practice of audio recordings. Comments from the 7 participants who completed the hypnosis intervention indicated it was acceptable. Significant reductions in screening measures of anxiety and depression were found; however, there were no significant effects shown for pain severity, avoidant coping, pain catastrophizing, or pain disability. The intervention is potentially feasible, but further refinement and optimization is needed to increase retention, compliance, and potential effects.
Article
Background and Aims Functional gastrointestinal disorders are common and costly to the healthcare system. In the MANTRA study, we demonstrated that multidisciplinary care resulted in superior clinical and cost outcomes, when compared with standard gastroenterologist-only care at end of treatment. In this study we evaluate the longer-term outcomes. Methods In a single-centre, pragmatic trial patients with Rome IV criteria-defined functional gastrointestinal disorders were randomized 1:2 to a gastroenterologist-only standard-care vs. a multi-disciplinary clinic comprising gastroenterologists, dieticians, gut-hypnotherapists, psychiatrists and biofeedback physiotherapists. Outcomes in this study were assessed 12 months after the end of treatment. Global symptom improvement was assessed using a 5-point Likert scale. Symptoms, specific disorder status, psychological state, quality-of-life, and cost were additional outcomes. A modified intention-to-treat analysis was performed. Results Of 188 randomized patients, 143 (46 standard-care, 97 multi-disciplinary) formed the longer term modified intention-to-treat analysis. 62% of multi-disciplinary clinic patients saw allied clinicians. 65% (30/46) standard-care versus 76% (74/97) multi-disciplinary clinic patients achieved global symptom improvement 12 months after end of treatment (P=0.17) while 20% (9/46) versus 37% (36/97) rated their symptoms as “5/5 much better” (P=0.04). ≥50-point reduction in Irritable Bowel Syndrome (IBS) Severity Scoring System occurred in 38% versus 66% (P=0·02) respectively for IBS patients. Anxiety and depression were greater in the standard-care than multi-disciplinary clinic (12 vs 10, P=0·19) and quality of life lower in standard-care than the multi-disciplinary clinic (0.75 vs. 0.77, P=0·03). An incremental cost-effectivness ratio found that for every additional $3555AUD spent in the multidisciplinary clinic a further quality adjusted life year was gained. Conclusion Twelve months after the completion of treatment, integrated multidisciplinary clinical care achieved a greater proportion of patients with improvement of symptoms, psychological state, quality of life and cost, compared with gastroenterologist-only care.
Article
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Background and Aims This Rome Foundation Working Team Report reflects the consensus of an international, interdisciplinary team of experts regarding the use of behavioral interventions in patients with disorders of gut-brain interaction (DGBI), specifically Brain-Gut Behavior Therapies (BGBT). Methods The committee members reviewed the extant scientific literature and whenever possible, addressed gaps in this literature through the lens of their clinical and scientific expertise. Delphi method was used to create consensus on the goals, structure and framework before writing the report. The report is broken into five parts: 1) Definition and evidence for Brain-Gut Behavior Therapies (BGBT); 2) The Gut-Brain Axis as the mechanistic basis for BGBT; 3) Targets of Brain-Gut Behavior Therapies; 4) Common and Unique Therapeutic techniques seen in BGBT; and 5) Who and How to Refer for BGBT Conclusions We chose to not only review for the reader the 5 existing classes of BGBT and their evidence, but to connect DGBI-specific behavioral targets and techniques as they relate directly, or in some cases indirectly, to the Gut-Brain-Axis. In doing so, we expect to increase GI providers’ confidence in identifying and referring appropriate candidates for BGBT and also support clinical decision making for mental health professionals providing BGBT. Both gastrointestinal medical providers and behavioral health providers have an opportunity to optimize care for DGBI through a collaborative, integrated approach that begins with an effective patient-provider relationship, thoughtful communication about the brain-gut-axis and, when appropriate, a well-communicated referral to BGBT.
Article
Irritable bowel syndrome (IBS) is a disorder of gut-brain interaction (DGBI) that is associated with significant physical, emotional, and occupational burden. Factors such as early life stress, sleep disruption, maladaptive coping strategies, symptom hypervigilance, and visceral hypersensitivity negatively affect gut-brain communication and increase the likelihood of developing IBS or worsen IBS severity. Behavioral strategies, such as cognitive behavioral therapy, gut-directed hypnosis, and mindfulness-based treatments, have shown benefit in improving gastrointestinal (GI)-specific quality of life, as well as reducing GI symptoms. Partnering with a GI-specific mental health provider can assist gastroenterologists in providing comprehensive treatment of IBS and other DGBIs.
Chapter
The brain and gut are highly interconnected through bidirectional neural pathways that influence digestive health and illness. Disorders of the gastrointestinal (GI) tract are particularly susceptible to the influence of psychological factors, directly impacting GI function and visceral sensation, as well as affecting behavior patterns and cognitive-emotional processes which can underlie symptom experience. This article focuses on two high impact GI diseases, inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS), illustrating the role of psychological functioning in disease course and clinical outcomes, as well as the contribution of psychological care to the management of these conditions. The article provides important epidemiological and etiological background on each disease. It presents the unique and overlapping characteristics of IBD and IBS regarding general clinical features, disease-defining symptoms, and common medical and psychiatric comorbidities. Medical diagnostic processes are described along with the value of and approach for psychological evaluation of these patients, including assessment strategies and validated measures for clinically relevant domains (e.g., pain, depression, self-efficacy, quality of life). The current state of evidence for psychological therapies for IBD and IBS, such as cognitive behavioral therapy, hypnosis, and third wave approaches, is examined. Drawing upon cutting edge research, the article provides a contemporary, comprehensive, and concise review of these two disorders, their psychosocial underpinnings, and clinical management. Many clinical pearls supporting applied practice are offered for those looking for a hands-on resource for the growing field of psychogastroenterology.
Article
Irritable bowel syndrome (IBS) remains one of the most common gastrointestinal disorders seen by clinicians in both primary and secondary care. Since publication of the last British Society of Gastroenterology (BSG) guideline in 2007, substantial advances have been made in understanding its complex pathophysiology, resulting in its re-classification as a disorder of gut-brain interaction, rather than a functional gastrointestinal disorder. Moreover, there has been a considerable amount of new evidence published concerning the diagnosis, investigation and management of IBS. The primary aim of this guideline, commissioned by the BSG, is to review and summarise the current evidence to inform and guide clinical practice, by providing a practical framework for evidence-based management of patients. One of the strengths of this guideline is that the recommendations for treatment are based on evidence derived from a comprehensive search of the medical literature, which was used to inform an update of a series of trial-based and network meta-analyses assessing the efficacy of dietary, pharmacological and psychological therapies in treating IBS. Specific recommendations have been made according to the Grading of Recommendations Assessment, Development and Evaluation system, summarising both the strength of the recommendations and the overall quality of evidence. Finally, this guideline identifies novel treatments that are in development, as well as highlighting areas of unmet need for future research.
Chapter
For some patients with gastroparesis, symptoms of nausea, vomiting, early satiety, and dyspepsia may be debilitating and not satisfactorily resolved by conventional medical treatments. Others feel that conventional treatments trigger undesirable side effects or have concerns about their long-term use. “Alternative” therapies, such as acupuncture, psychotherapy and behavioral interventions, dietary change, herbal remedies, and cannabis, remain attractive options. This chapter is written to prepare the practitioner who is approached by patients curious about the efficacy and safety of these therapies. These approaches are highlighted in social media, may be used alone or in conjunction with standard conventional care. Research on the application of complementary medicine in this patient population is encouraging; however, more studies are needed to clearly elucidate the benefits and potential harms.
Article
Background Functional gastrointestinal disorders are common and costly to the health-care system. Most specialist care is provided by a gastroenterologist, but only a minority of patients have improvement in symptoms. Although they have proven to be effective, psychological, behavioural, and dietary therapies are not provided routinely. We aimed to compare the outcome of gastroenterologist-only standard care with multidisciplinary care. Methods In an open-label, single-centre, pragmatic trial, consecutive new referrals of eligible patients aged 18–80 years with Rome IV criteria-defined functional gastrointestinal disorders were randomly assigned (1:2) to receive gastroenterologist-only standard care or multidisciplinary clinic care. The multidisciplinary clinic included gastroenterologists, dietitians, gut-focused hypnotherapists, psychiatrists, and behavioural (biofeedback) physiotherapists. Randomisation was stratified by Rome IV disorder and whether referred from gastroenterology or colorectal clinic. Outcomes were assessed at clinic discharge or 9 months after the initial visit. The primary outcome was a score of 4 (slightly better) or 5 (much better) on a 5-point Likert scale assessing global symptom improvement. Modified intention-to-treat analysis included all patients who attended at least one clinic visit and who had answered the primary outcome question. This study is registered with ClinicalTrials.gov, NCT03078634. Findings Between March 16, 2017, and May 10, 2018, 1632 patients referred to the hospital gastrointestinal clinics were screened, of whom 442 were eligible for a screening telephone call and 188 were randomly assigned to receive either standard care (n=65) or multidisciplinary care (n=123). 144 patients formed the modified intention-to-treat analysis (n=46 in the standard-care group and n=98 in the multidisciplinary-care group), 90 (63%) of whom were women. 61 (62%) of 98 patients in the multidisciplinary-care group patients saw allied clinicians. 26 (57%) patients in the standard-care group and 82 (84%) patients in the multidisciplinary-care group had global symptom improvement (risk ratio 1·50 [95% CI 1·13–1·93]; p=0·00045). 29 (63%) patients in the standard-care group and 81 (83%) patients in the multidisciplinary-care group had adequate relief of symptoms in the past 7 days (p=0·010). Patients in the multidisciplinary-care group were more likely to experience a 50% or higher reduction in all Gastrointestinal Symptom Severity Index symptom clusters than were patients in the standard-care group. Of the patients with irritable bowel syndrome, a 50-point or higher reduction in IBS-SSS occurred in 10 (38%) of 26 patients in the standard care group compared with 39 (66%) of 59 patients in the multidisciplinary-care group (p=0·017). Of the patients with functional dyspepsia, a 50% reduction in the Nepean Dyspepsia Index was noted in three (11%) of 11 patients in the standard-care group and in 13 (46%) of 28 in the multidisciplinary-care group (p=0·47). After treatment, the median HADS scores were higher in the standard-care group than in the multidisciplinary-care group (13 [8–20] vs 10 [6–16]; p=0·096) and the median EQ-5D-5L quality of life visual analogue scale was lower in the standard-care group compared with the multidisciplinary-care group (70 [IQR 50–80] vs 75 [65–85]; p=0·0087). The eight SF-36 scales did not differ between the groups at discharge. After treatment, median Somatic Symptom Scale-8 score was higher in the standard-care group than in the multidisciplinary-care group (10 [IQR 7–7] vs 9 [5–13]; p=0·082). Cost per successful outcome was higher in the standard-care group than the multidisciplinary-care group. Interpretation Integrated multidisciplinary clinical care appears to be superior to gastroenterologist-only care in relation to symptoms, specific functional disorders, psychological state, quality of life, and cost of care for the treatment of functional gastrointestinal disorders. Consideration should be given to providing multidisciplinary care for patients with a functional gastrointestinal disorder. Funding None.
Article
Background: Gastrointestinal conditions are multifactorial in nature, and certain patients can benefit greatly from brain-gut psychotherapies delivered by mental health professionals who specialize in psychogastroenterology. This study aimed to identify features associated with improvements in GI-specific quality of life scores following behavioral health interventions (BHI). The second aim was to create a psychogastroenterology referral care pathway incorporating identified characteristics for greatest benefit from GI-specific behavioral therapy. Methods: We performed a prospective observational study of 101 (63 women; median age, 45 years) gastroenterology patients referred for psychogastroenterology consultation at a single center. Patients attended an average of seven sessions with a single GI psychologist where evidence-based brain-gut psychotherapies were employed. GI-specific quality of life (IBS-QOL) and psychological distress (BSI-18) were assessed before and after BHI. Patients completed self-reported questionnaires. We performed a multivariable analysis to determine predictors associated with IBS-QOL score improvement. Key results: A total of 53 (52.5%) patients experienced improvement in IBS-QOL score. Patients with improved IBS-QOL scores had significantly higher baseline BSI general domain T-scores (61.9 vs. 56.9, P = 0.002). Female gender (odds ratio [OR], 3.2), pretreatment BSI somatization T-score ≥63 (OR, 3.7), and a diagnosis of depression (OR, 4.2) were associated with greater odds of IBS-QOL score improvement following BHI. Conclusions and inferences: We identified factors associated with response to GI-specific BHI to aid in optimizing the utilization of psychogastroenterology services and provide referring providers with information to inform treatment recommendations. Female patients with disorders of gut-brain interaction (DGBIs), high somatization, and depression should be considered a priority for brain-gut psychotherapies.
Article
Objectives: Hypnotherapy is recognised in the UK's National Institute for Health and Care Excellence (NICE) guidelines as a potential treatment for Irritable Bowel Syndrome (IBS). However, little is known about the views of people with IBS regarding hypnotherapy. This qualitative study aimed to identify perceptions of and barriers to hypnotherapy for IBS by people with the condition. Design: One-to-one semi-structured interviews using thematic analysis. Setting: Convenience sampling in the UK. Participants were recruited by poster advertising and online IBS support groups. Interviews were conducted at the interviewees' preferred location or via video calling. Participants: 17 people (15 female, 2 male) who self-identified as having refractory IBS according to a provided definition. Results: Four hypnotherapy related themes arose from the data: conceptualisation of hypnotherapy, hypnotherapy for IBS, barriers to hypnotherapy for IBS, ideal format of hypnotherapy for IBS. Participants saw hypnosis as an altered state in which change was possible, but many had not considered it for IBS. They were broadly open to hypnotherapy for IBS, but a variety of potential barriers were apparent, including cost and therapist validity. Group hypnotherapy was less acceptable than one-to-one treatment. Hypnotherapy via video call was seen as convenient, but there were concerns about its effectiveness. Conclusion: People with IBS may be put off hypnotherapy by a lack of understanding of how it works for their condition and lack of awareness of it as a therapeutic option. Uptake may be improved through effective promotion of the approach which addresses its mechanisms of effect.
Article
Introduction: Irritable bowel syndrome (IBS) is a common condition which has significant impact on quality of life and has proven resistant to treatment. Hypnotherapy was recommended in National Institute of Health and Care Excellence (NICE) guidelines for the treatment of the refractory form of IBS in 2008. There is a dearth of research into the acceptability of hypnotherapy to people with IBS for their condition. Methods: A qualitative study will be undertaken consisting of semi-structured one-to-one interviews with UK adults who have had a diagnosis of IBS for more than 12 months and continue to experience symptoms despite pharmacological intervention. Recruitment will be via large scale employers and through online IBS support and self-help groups, with snowballing from interviewees. Fifteen to twenty-five interviews will be conducted, both in person and via electronic real-time communications platforms (video calling) such as Skype. Interviews will be analysed using the framework method and will be coded twice. The first time will be inductive open coding for naturally occurring themes and the second will be theory driven deductive coding from a set of codes relating to Max Weber's antagonistic sources of power, ‘Bureaucracy’ and ‘Charisma’ which will help to identify people's conceptualisation of hypnosis. Results: Findings will be disseminated at conferences and through peer-reviewed journals. Conclusion: The study will aid in identifying possible barriers to the use of hypnotherapy in the treatment of IBS, particularly any which relate to the perceptions of hypnosis and hypnotherapy.
Article
Chronic digestive diseases including irritable bowel syndrome, gastroesophageal reflux disease and inflammatory bowel diseases cannot be disentangled from their psychological context-the substantial burden of these diseases is co-determined by symptom and disease severity and the ability of patients to cope with their symptoms without significant interruption to daily life. The growing field of psychogastroenterology focuses on the application of scientifically-based psychological principles and techniques to the alleviation of digestive symptoms. In this clinical practice update we describe the structure and efficacy of two major classes of psychotherapy-cognitive behavior therapy and gut-directed hypnotherapy. We focus on the impact of these brain-gut psychotherapies on GI symptoms as well as their ability to facilitate improved coping, resilience and self-regulation. The importance of the gastroenterologist in the promotion of integrated psychological care cannot be understated and recommendations are provided on how to address psychological issues and make an effective referral for brain-gut psychotherapy in routine practice.
Chapter
Relaxation techniques are an increasingly important part of modern therapeutic paradigms for numerous biopsychosocial disorders. In essence, all relaxation techniques elicit a broad relaxation response associated with characteristic changes in physiological, muscular, and cognitive/affective processes. Core relaxation techniques of the therapeutic arsenal include breathing techniques, guided imagery, progressive muscle relaxation, biofeedback, autogenic training, hypnosis, and meditation. This chapter describes the theory, clinical implementation, and efficacy research associated with each of these approaches. Technique-specific and broad clinical indications and contraindications are discussed. While an abundance of research has focused on the question of whether relaxation works, minimal research has focused on answering the question of how relaxation works. In this chapter we argue that to demonstrate the true public health value of relaxation interventions, future research needs to verify not only that various relaxation techniques work, but that they work for the reasons specified by the associated theory.
Article
Full-text available
Psychological interventions have been designed and implemented effectively in a wide range of medical conditions, including Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Diseases (IBD). The psychological treatments for IBS and IBD with the strongest evidence base include: cognitive behavioral therapy, hypnosis, and mindfulness-based therapies. The evidence for each of these therapies is reviewed here for both IBS and IBD. In general, there is a stronger and larger evidence base to support the use of psychological interventions in IBS compared with IBD. This is likely due to the high level of psychiatric comorbidity associated with IBS and the involvement of the stress-response in symptom presentation of IBS. Further research in psychosocial interventions for IBD is necessary. Finally, the importance of conceptualizing both IBS and IBD in a biopsychosocial model is discussed and several resources for accessing Clinical Health Psychology materials and referrals are provided.
Article
Hypnosis is always about momentum and change of perspective. It is through suggestion, not coercion, that hypnotist asks patients to think about, see, feel, and experience their world in a different way. When it works well, it can be one of the summit experiences in a patient's life. The use of hypnosis with children has a long and storied past. Documented work with hypnosis started with the very early clinicians, including Anton Mesmer in the 1700s. Since then, children have been included in the work of all the well-known hypnotherapists. While the child hypnosis literature is not as extensive as the adult literature, there is a rich history of creative applications of hypnosis embedded within sound therapeutic practices. This article highlights how hypnosis has been used to treat a variety of medical and psychological ailments in children, to alleviate symptoms and to aid in coping with pain and distress.
Book
Advanced Hypnotherapy focuses on tested hypnoanalytic techniques, with step-by-step procedures for integrating hypnosis into psychoanalytic processes. In its examination of the latest thinking, research, and techniques, the book discusses historical origins of hypnosis as well as how to apply it to current events, such as using hypnosis in the treatment of trauma with soldiers coming out of the war in Iraq. The text shows how hypnosis can be combined with pscyhoanalysis to make it possible to understand the subjective world of clients. Its accessible nature, rich detail, and significant updates make the book an invaluable resource for the professional who wishes to incorporate hypnosis into his or her practice. With the authors' extensive and impressive knowledge, careful updates, and comprehensive coverage of the proper and appropriate techniques to use, this volume is an indispensable addition to the field.
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Clinical hypnosis is an efficient and effective tool for addressing the mind/body connection for many patients with functional respiratory disorders. Such patients can benefit from learning self-hypnosis techniques in as little as 10 min, which can help them rapidly improve or resolve their symptoms altogether, as ­demonstrated in several published case series. Asthma sometimes has been shown to improve with the use of hypnosis perhaps because of the large number of patients who have a functional component as part of their presentation. Keys to successful hypnosis include establishment of rapport with patients and their families, facilitating patients’ self-mastery, and following patients’ expectations, motivation, lead, and interests. Clinicians who have completed 3- to 4-day hypnosis training workshops learn to appreciate better the power of communication and usually find that their language and nonverbal interactions with patients improve, even when they are not employing formal hypnosis. Practical considerations regarding provision of clinical hypnosis in a primary care setting are discussed in this chapter; a sample text of an hypnotic encounter intended to achieve relaxation is provided; and case studies are presented that include links to videos demonstrating instruction in ­hypnosis to children and adults, with accompanying quiz questions and explanatory material regarding patients with chest pain, dyspnea, habit cough, vocal cord ­dysfunction, and insomnia.
Article
Hypnotherapy has been investigated for 30 years as a treatment for gastrointestinal (GI) disorders. There are presently 35 studies in the published empirical literature, including 17 randomized controlled trials (RCTs) that have assessed clinical outcomes of such treatment. This body of research is reviewed comprehensively in this article. Twenty-four of the studies have tested hypnotherapy for adult irritable bowel syndrome (IBS) and 5 have focused on IBS or abdominal pain in children. All IBS hypnotherapy studies have reported significant improvement in gastrointestinal symptoms, and 7 out of 10 RCTs in adults and all 3 RCTs in pediatric patient samples found superior outcomes for hypnosis compared to control groups. Collectively this body of research shows unequivocally that for both adults and children with IBS, hypnosis treatment is highly efficacious in reducing bowel symptoms and can offer lasting and substantial symptom relief for a large proportion of patients who do not respond adequately to usual medical treatment approaches. For other GI disorders the evidence is more limited, but preliminary indications of therapeutic potential can be seen in the single randomized controlled trials published to date on hypnotherapy for functional dyspepsia, functional chest pain, and ulcerative colitis. Further controlled hypnotherapy trials in those three disorders should be a high priority. The mechanisms underlying the impact of hypnosis on GI problems are still unclear, but findings from a number of studies suggest that they involve both modulation of gut functioning and changes in the brain's handling of sensory signals from the GI tract.
Article
Functional abdominal pain is a mind-body, psychosocial, and self-reinforcing experience with significant consequences for the sufferer and the surrounding support network. The occurrence of unpredictable symptoms and their severity add an element of dread and feeling out-of-control to daily life and often reduce overall functioning in a downward spiral. Two clinical presentations of functional abdominal pain are offered in this article (composites to protect confidentiality) dealing with abdominal pain syndrome and abdominal migraines. The treatment demonstrates the use of hypnotic principles for self-regulation, exploration, and meaning-making. Hypnosis treatment is conducted in combination with mindfulness-based interventions and Traditional Chinese Medicine’s (TCM) teachings regarding abdominal health and illness. The clinical examples illustrate medical findings that suggest children with early life stress and an early onset of gastrointestinal somatization may not simply outgrow their functional abdominal pain but may suffer into adulthood.
Article
Inflammatory bowel disease (IBD) is an autoimmune disorder characterized by lifelong relapsing gastrointestinal symptoms and associated with high rates of chronic pain, depression, and anxiety. In this review the author covers the existing literature including randomized controlled studies, open trials, and case reports as well as expert opinion in evaluating how hypnotherapy can be most beneficial in adolescents and adults with IBD. Hypnotherapy evidence for functional gastrointestinal disorders (FGIDs) is also reviewed as many of the gut-focused hypnotherapy (GHT) approaches used in IBD trials were developed for this latter population. Collectively, the strongest evidence of use of hypnotherapy is its association with reduced IBD-related inflammation and improved health-related quality of life with mixed results in terms of its effects on psychological and pain outcomes in adults with IBD. Studies of hypnotherapy for FGID symptoms show consistently more positive results. Post-operative hypnotherapy may also be helpful based on findings in other surgical samples. Adolescents with IBD have not been as systematically studied but small case series support the use of hypnotherapy to improve inflammation and pain. Future studies are needed to better delineate the specific brain-gut pathways which are most influenced by hypnotherapy in the IBD population and to investigate the longer-term course of the positive short-term findings.
Article
Functional heartburn (FH) is a benign but burdensome condition characterized by painful, burning epigastric sensations in the absence of acid reflux or symptom-reflux correlation. Esophageal hypersensitivity and its psychological counterpart, esophageal hypervigilance (EHv) drive symptom experience. Hypnotherapy (HYP) is an established and preferred intervention for refractory symptoms in functional gastrointestinal disorders (FGIDs) and could be applied to FH. The objective of this study was to determine the feasibility, acceptability, and clinical utility of 7 weekly sessions of esophageal-directed HYP (EHYP) on heartburn symptoms, quality of life, and EHv. Similar to other work in FGIDs and regardless of hypnotizability, there were consistent and significant changes in heartburn symptoms, visceral anxiety, and quality of life and a trend for improvement in catastrophizing. We would recommend EHYP in FH patients who are either non-responsive to medications or who would prefer a lifestyle intervention.
Inflammatory bowel diseases (IBD) are chronic disorders of unknown aetiology which are characterized by episodes of exacerbations and remissions. There is evidence that perceived distress contributes to IBD symptom flares; anxiety and depression are frequently found in patients with the active disease. Because there is no cure, treatment has to focus on prevention of complications, induction/maintenance of remission and improvement of quality of life. Gut-directed hypnotherapy (GHT) has been used successfully in functional gastrointestinal disorders. Few experimental studies and case reports have been published for IBD; GHT increases the health-related quality of life and reduces symptoms. Additionally, GHT seems to have an immune-modulating effect and is able to augment clinical remission in patients with quiescent ulcerative colitis.
Article
Hypnotherapy is an effective treatment in irritable bowel syndrome (IBS). It is often delivered by a psychotherapist and is costly and time consuming. Nurse-administered hypnotherapy could increase availability and reduce costs. In this study the authors evaluate the effectiveness of nurse-administered, gut-directed hypnotherapy and identify factors predicting treatment outcome. Eighty-five patients were included in the study. Participants received hypnotherapy by a nurse once/week for 12 weeks. Patients reported marked improvement in gastrointestinal (GI) and extra-colonic symptoms after treatment, as well as a reduction in GI-specific anxiety, general anxiety, and depression. Fifty-eight percent were responders after the 12 weeks treatment period, and of these 82% had a favorable clinical response already at week 6. Women were more likely than men to respond favorably to the treatment. Nurse-administered hypnotherapy is an effective treatment for IBS. Being female and reporting a favorable response to treatment by week 6 predicted a positive treatment response at the end of the 12 weeks treatment period.
Article
This article details a self-hypnosis technique designed to teach patients how to manage acute or chronic pain through directed focus. The focused suggestion with somatic anchoring technique has been used with various types of pain, including somatic pain (arthritis, post-injury pain from bone breaks, or muscle tears), visceral pain (related to irritable bowel disease), and neuropathic pain (related to multiple sclerosis). This technique combines cognitive restructuring and mindfulness meditation with indirect and direct suggestions during hypnosis. The case examples demonstrate how the focused suggestion with somatic anchoring technique is used with both acute and chronic pain conditions when use of long-term medication has been relatively ineffective.
Article
30 patients with severe refractory irritable-bowel syndrome were randomly allocated to treatment with either hypnotherapy or psychotherapy and placebo. The psychotherapy patients showed a small but significant improvement in abdominal pain, abdominal distension, and general well-being but not in bowel habit. The hypnotherapy patients showed a dramatic improvement in all features, the difference between the two groups being highly significant. In the hypnotherapy group no relapses were recorded during the 3-month follow-up period, and no substitution symptoms were observed.
Article
Hypnosis improves irritable bowel syndrome (IBS), but the mechanism is unknown. Possible physiological and psychological mechanisms were investigated in two studies. Patients with severe irritable bowel syndrome received seven biweekly hypnosis sessions and used hypnosis audiotapes at home. Rectal pain thresholds and smooth muscle tone were measured with a barostat before and after treatment in 18 patients (study I), and treatment changes in heart rate, blood pressure, skin conductance, finger temperature, and forehead electromyographic activity were assessed in 24 patients (study II). Somatization, anxiety, and depression were also measured. All central IBS symptoms improved substantially from treatment in both studies. Rectal pain thresholds, rectal smooth muscle tone, and autonomic functioning (except sweat gland reactivity) were unaffected by hypnosis treatment. However, somatization and psychological distress showed large decreases. In conclusion, hypnosis improves IBS symptoms through reductions in psychological distress and somatization. Improvements were unrelated to changes in the physiological parameters measured.