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Mind-Body Digestive Center:
Journal Reviews
Psychosocial Risk Markers for New Onset Irritable Bowel Syndrome: Results of a Large Prospective Population-based Study- Role of Histaminergic Neurons in Hypnotic Modulation of Brain Processing of Visceral Perception
- Treatment of Non-Cardiac Chest Pain: A Controlled Trial of Hypnotherapy
- Long-term Improvement in Functional Dyspepsia Using Hypnotherapy
- Long Term Benefits of Hypnotherapy for Iritable Bowel Syndrome
Psychosocial Risk Markers for New Onset Irritable Bowel Syndrome: Results of a Large Prospective Population-based Study
Nicholl BJ, Halder SL, Macfarlane DG, Thompson S, O'Brien M, Mulesh M, McBeth J. Pain. 2008; in press.BACKGROUND:
Previous studies have examined the relationship of psychosocial factors and IBS and found that individuals who have IBS also have an increased level of depression, anxiety and other psychological symptoms. However, it is unknown if these psychosocial factors act as risk markers for the onset of IBS as they also could be understood as consequences of having the illness.
STUDY DESIGN:
A postal survey was conducted to ascertain participants' psychosocial status and severity of abdominal pain. Participants were between the ages of 25 and 65 and were randomly selected from three general practitioners' offices in north-west England. The study focused on individuals who did not have IBS at the time of the initial questionnaires. Diagnosis of IBS was based on Rome symptom criteria.
RESULTS:
86 subjects (3.5%) who were free of IBS at the outset were found to develop IBS over the 15 month time course of the study. The onset of IBS was higher in women (4.6%) than men (2.1%).
Patients with scores indicating psychological distress and excess concern about their health were more likely to develop IBS. Higher scores in Illness Behavior Scale (related to number of doctor visits and worry about illness), Estimation of Sleep Problems, HAD Anxiety and Depression scale (records feelings of anxiety or depression over the previous week), Somatic Symptom Checklist (a measure of symptoms other than IBS), Health Anxiety (worry about getting a serious illness) and Threatening Life Events (stressful experience over the previous six months) scales were all related to the prevalence of IBS at follow-up. The highest correlation was with the Illness Behavior Scale where individuals with scores in the highest third were seven times more likely to develop IBS.
Also, the more abnormal questionnaire scores, the higher probability of developing IBS. Of the 86 subjects who developed IBS, 80.2% had at least two abnormal questionnaire scores. High levels of illness behavior, anxiety, sleep problems and other somatic symptoms were all independent predictors for IBS.
COMMENTS:
This report demonstrates that people with certain psychological characteristics are more prone to develop IBS than others. While this does not mean that IBS is caused by psychological problems, it supports the idea that IBS is a mind-body illness wherein patients have a psychological substrate that contributes to the expression of symptoms. This underlines our belief that treatment, especially of patients with ongoing illness, requires a holistic mind-body approach.
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Role of Histaminergic Neurons in Hypnotic Modulation of Brain Processing of Visceral Perception
Watanabe W, Hattori T, Kanazawa M, Kano M and Fukudo S. Neurogastroenterology and Motility 19 (10), 2007BACKGROUND:
Hypnotherapy has been proved highly effective as a treatment for Irritable Bowel Syndrome. However, the mechanism by which it works is not clear.
CURRENT STUDY:
Rectal pain was produced via electrical stimulation of a rectal probe, in twelve healthy men. They were then hypnotized to a state where they experienced decreased or increased pain sensation. The subjects recorded their pain experience, indicating that the hypnotic suggestions worked. At the same time, a series of electrical wires were placed on the scalp, recording brain waves.
The results showed that electrical brain patterns were significantly reduced during the hypnotic suggestion and that the pain the subjects felt was lessened.
Finally, the investigators were interested in the biochemical mechanism behind reduced pain. They found that decrease in pain and electrical activity seemed to be related to a histamine effect on brain cells. They gave intravenous anti-histamine which both blocked the brain activity and reduced pain.
CONCLUSION AND COMMENTS:
This study shows that decrease in rectal pain by hypnotherapy is related to a change in brain electrical activity. This change is related, at least in part, to the effect of hypnotherapy on brain histamine activity.
Pain sensation in IBS normally originates in the colon, travels via nerves to the spinal cord, and then up to the brain where the pain is experienced by the patient. Because of the kind of electrical changes noted, the authors suggest that the mechanism by which hypnotherapy works is by increasing the brain's ability to block transmission of pain at the spinal cord level so the pain sensation never reaches the brain.
We think this article is worth reviewing because it is one of the few research studies addressing hypnotherapy mechanisms in relation to the kind of pain experienced by patients with IBS.
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Treatment of Non-Cardiac Chest Pain: A Controlled Trial of Hypnotherapy
Jones H, Cooper P, Miller V, Brooks PJ, Whorwell PJ. Gut 2006; 55: 1403-1408.The purpose of this article was to test the effectiveness of a hypnotherapy program for patients suffering from chest pain who had normal coronary angiograms and no evidence of acid reflux. This group of patients is described as having atypical chest pain and fit into the same functional gastrointestinal category as irritable bowel syndrome and functional dyspepsia (or ulcer-like pain). All of these conditions can be affected by psychological factors; IBS and functional dyspepsia are already known to be helped by hypnotherapy. Prescription medications have been of limited help to patients with atypical chest pain.
STUDY DESIGN:
28 patients entered the study and were divided into 15 who received hypnotherapy for 11 sessions, and 13 who received supportive therapy by a research assistant, not a licensed therapist. A series of questionnaires filled out at the beginning of the program and at the end included measures of overall improvement, pain severity and anxiety or depression.
RESULTS:
The two main measures were relief of pain and general well-being. In the hypnotherapy group, 80% had significant improvement in pain and 73% in general well-being. In contrast, the control supportive therapy group had only 23% improvement in both categories. There was also a significant reduction in medication taken by patients in the hypnotherapy group for their chest pain. Not surprisingly, there was no change in depression or anxiety scores, since hypnotherapy is directed at symptoms and a sense of calm, not specific psychological change.
CONCLUSIONS:
Hypnotherapy appears to be an effective treatment method for patients with unexplained chest pain.
EDITORIAL COMMENT:
Hypnotherapy has been shown to be highly effective for patients with chronic Irritable Bowel Syndrome and a group hypnotherapy program is part of the services available at the Mind-Body Digestive Center. Hypnotherapy has also been shown to be effective treatment for patients with functional dyspepsia (the feeling of acid indigestion that does not respond to antacid therapy).
In this report, this treatment has been convincingly shown to help patients with functional chest pain and we have treated some patients with this syndrome. The article restricted patients to those with normal coronary angiogram and no evidence of acid reflux. But the authors state that these criteria are very restrictive and describe more pragmatic criteria such as a normal electrocardiogram and lack of response to strong antacid therapy, for establishing a diagnosis of atypical or functional chest pain. We agree and encourage patients suffering from this illness to seek hypnotherapy.
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Long-term Improvement in Functional Dyspepsia Using Hypnotherapy
E.L. Calvert, L.A. Houghton, P. Cooper, J. Morris and P.J. Whorwell Gastroenterology 2002; 123: 1778-1785BACKGROUND:
Hypnotherapy has been shown to be effective in the treatment of irritable bowel syndrome (IBS) and in the improvement of symptoms and quality of life. This study intends to determine if hypnotherapy can be as effective in the treatment of functional dyspepsia (FD) as it is in IBS and its effectiveness will be compared to the use of supportive therapy with medication as well as medical treatment.
MATERIALS AND METHODS:
A total of 126 patients were divided into one of three groups: hypnotherapy (32 patients), supportive therapy plus placebo medication (48 patients) or medical treatment with medication (46 patients). They received treatment for 16 weeks and subsequently underwent a follow-up after 40 weeks. During the treatment phase, patients received 12, 30 minute sessions for individuals in the hypnotherapy and supportive therapy group, while individuals in the medical group only received four visits in which medication was disbursed. Patients' symptoms, quality of life, anxiety, depression and the economic impact of functional dyspepsia were assessed.
RESULTS:
After the completion of treatment, a significant improvement was found in the hypnotherapy group compared to the other two groups. At the end of the treatment phase, the median symptom improvement for patients in the hypnotherapy group was 59%, whereas it was 40.7% for the supportive therapy plus placebo group and 33% for the medical treatment group. A difference was also seen in individual scores that supports hypnotherapy's effectiveness.
At the follow-up phase, hypnotherapy patients' symptoms improved (73%) a great deal more than the other two groups: supportive (34%) and medical (43%). All symptoms, except for nausea, improved in the hypnotherapy group, whereas improvement was not maintained in the other groups.
With regards to quality of life, patients in the hypnotherapy groups significantly improved (42%) at the end of the treatment phase as compared to the other two groups: medical (11%) and supportive (10%). At the follow-up phase, quality of life for patients in the hypnotherapy group improved (44%) in comparison to the medical group (20%), however, the supportive group exhibited a gradually increasing quality of life (43%). Anxiety was reduced in both hypnotherapy (from 8.5 to 5) and supportive (from 10 to 6.5) groups during treatment. However, no differences were significant when all 3 groups were examined.
It is important to note that 82% of patients from the supportive group and 90% of patients from the medical group ended up using some form of medication, where 0% of patients from the hypnotherapy group did. Also, the total number of medical consultations was significantly lower after hypnotherapy as opposed to supportive group therapy and medical treatment.
DISCUSSION:
This study indicates that for both the short and long-term, hypnotherapy is more successful than supportive therapy plus medication as well as medical treatment in managing the symptoms of functional dyspepsia as well as the patients' quality of life. In addition, there are economic advantages to the use of hypnotherapy as the need for medication is non-existent. Therefore, money does not need to be expended on medication over a long period of time to help manage symptoms.
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Long Term Benefits of Hypnotherapy for
Irritable Bowel Syndrome
W M Gonsalkorale, V Miller, A Afzal, P J WhorwellGut 2003:52:1623-1629
Gut directed hypnotherapy is now being used to treat Irritable Bowel Syndrome. There is strong evidence from a number of research reports that hypnotherapy can relieve the symptoms of irritable bowel syndrome in the short term. However, there is no long-term data on its benefits and this information is essential before the technique can be widely recommended. This study aimed to answer this question.
In this article, gut directed hypnotherapy comprised up to 12 weekly 1 hr sessions. Each session consists of induction of the hypnotic state and deepening procedures, followed by "ego strengthening" suggestions relevant to the individual. These are accompanied by further suggestions and interventions, such as inducing warmth in the abdomen using the hands and imagery directed towards controlling normal gut function.
A set of 3 questionnaires was mailed to 273 patients with IBS, who had received gut directed hypnotherapy at least one year previously. The questionnaires focused on rating the patients IBS symptoms, as well as their quality of life, anxiety, and depression.
RESULTS:
Directly after completion of hypnotherapy, 147 patients (86.8%) claimed their symptoms improved, while 27 (13.2%) reported no change in symptoms. No patients reported worsening symptoms. In response to the questionnaires administered over one year later, 81.3 % of those who had improvement in the symptoms maintained their improvement, with a majority stating their symptoms had improved even further.
Patients were followed for up to five years after termination of treatment and there was no significant decrease in symptom improvement. Of all the patients, 93.1% considered the course of hypnotherapy had been worthwhile.
Before hypnotherapy, all patients showed similar quality of life measures. Directly after therapy, those who reported an improvement in IBS symptoms also noted an improvement in quality of life. In the follow up study, those whose symptom improvement was sustained still had an improved quality of life.
Scores for anxiety and depression were similar across all patients before hypnotherapy treatment. Anxiety and depression improved in all patients, but overall improvement was greater in the groups that reported improvement in their IBS symptoms.
It is important to note that the continued improvement seen by patients in this study cannot be explained by the use of other treatments after finishing hypnotherapy. Only 14 (9.7%) of those who reported improved symptoms tried other treatments, (including dietary changes, alternative medicines, yoga, and reflexology) and found these helpful.
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