A Comparative Analysis of Clinical Outcomes in the Refractive IBS Patient
22nd February, 2010
The successful use of clinical hypnotherapy (CHT) for the treatment of patients with irritable bowel syndrome has been established in at least 14 published studies (1) (2) where it has been shown to produce significant reduction in the cardinal IBS
symptoms and associated symptoms such as anxiety. The success of this treatment method in the clinical setting is contingent upon the protocol being gutdirected or gutspecific,
i.e. directly addressing the digestive tract, balancing the dismotility
and restoring its proper function while allowing the patient to take part in their own healing.
Sufferers who consider hypnotherapy currently tend to do so as a 'last resort' rather than a first approach after diagnosis.
In treating IBS patients since 1991, I recognised a consistent trend in therapy outcomes and decided to investigate this further with an informal observational study. From September 2003 to January 2005, I assigned 40 patients with the same primary IBS diagnostic criteria into two groups.
The first group consisted of 20 IBS patients of longstanding,
termed as refractory where no previous medical interventions provided relief. Age ranges for this group was 27 years to 66 years; average age was 42.2 years; comprised of 10 males
average age 38.7 years, 10 females average age 45.6 years.
The second group included 20 newly diagnosed IBS patients with ages ranging from (24 years) to (64 years); average age (40.1 years), there were (10) males average age 40.2 years and (10) females average age 40.1years.
The newly diagnosed patients had no prior IBS treatment intervention upon their arrival to me, however, they may have presented with symptoms for varying degrees of time.
The clinical protocol (3) consisted of an initial intake consultation session, where the IBS patient discusses symptoms and concerns. A lifestyle, QOL and symptom questionnaire was also completed at this time, and again upon therapy completion to assess improvement rating.
The intake session was followed by an introductory session, where the patient was apprised of the method of CHT and assurances were given. Following that, five gutspecific sessions were presented to the patient dealing with:
1) Building a foundation of selfesteem, relaxation and familiarity with the technique,
2) IBS and related symptoms, balancing of the digestive motility, the braingut connection,
3) pain, discomfort, bloating issues,
4) assurance that the patient always has control over their own healing and
5) reinforcement of previous sessions and resolution.
Standard treatment would allow for patients being seen five times over a 12-14 week period and all participants received a recording of each session which was listened to according to a specific schedule.
Psychological State and QOL of IBS Patient Prior to receiving CHT.
The intake information of the Refractory IBS Patient presented with two findings:
1. Higher Failure Expectation after years of frustration and unsuccessful treatment resolution.
2. Patients presented with more comorbid emotional, psychological and physical symptomology and poor QOL, in addition to "basic" IBS symptoms. (4) This finding led me to believe that in many cases, if IBS is not initially treated on the
psychological level, the condition usually escalates into a multifaceted condition.
The intake information for the Newly Diagnosed presented with two findings:
1. Less expectation for either failure or success for therapy outcome.
2. General absence of comorbid psychological, emotional and additional physical symptomology.
Outcome of CHT treatment Improvement levels for both patient groups were within the same symptom reduction range – with an average of 90% symptom reduction overall for 20 IBS and related symptoms listed.
However, refractory IBS patients who had received other forms of treatment first, had a longer recovery and symptom reduction time frame. It was found that for these patients, the time required to move forward to the next session became extended by an average of 1 to 3 weeks (or more in some cases) depending upon
severity and longevity of symptoms and the resultant psychological issues. This group's confidence and self esteem was very low, and their ability to see things in perspective was significantly reduced.
When talking about the psychological elements most of these patients wept. After sometimes years of pain and discomfort, and the following of unsuccessful treatment options it was clear this
group of sufferers had become emotionally drained. Having presented with, for example, such symptoms as diarrhoea, 3 or more times a day, often uncontrollable and explosive for years, it was therefore not surprising that such patients presented with anxiety or various levels of depression.
Before these sufferers could even begin to work through the IBS, the hypnotherapy sessions first provided a strong emotional base that increased selfesteem, confidence, and allowed the sufferer to begin a journey of self improvement and management, and thereby equip themselves emotionally to move away from the symptoms and the familiarity of IBS thoughts and commence recovery initially at the emotional level.
The newly diagnosed group who received CHT as a first line of treatment showed a much quicker response towards their improvement in IBS symptoms, and did not require extensions in the standard protocol time frame. It was my observation that early intervention with CHT may reduce or eliminate the multifaceted
component of IBS, thus leading to earlier/less prolonged symptom
reduction. My findings appeared to confirm this trend that was observed early on.
Since the subconscious mind does not have to deal with nonpresent comorbid complaints with the majority of newly diagnosed patients, the IBS symptoms are dealt with initially and directly and resolved more quickly. For the refractory patient, internal and emotional energies relegated to coping with the longstanding burden of IBS usually must first be dealt with by the subconscious before IBS issues can be addressed.
Implications and Conclusion
A negative aspect in all this is that in determining if CHT for IBS should be considered as a first line of treatment, it should be noted if the patient may have underlying "true" clinical psychological conditions that may become masked by the IBS related issues, and which will still need to be addressed directly. As
assessment tools, the QOL intake session may provide an insight to this, as a pattern for onset of symptoms and onset of emotional trends may be correlated: simply put – the comorbid
psychological condition may be secondary to the ongoing, longstanding IBS. Another potential negative perspective is the
availability of a trained clinical hypnotherapist whom the physician may refer the newly diagnosed patient to at the outset of diagnosis when indicated. However, for the primary IBS patient, this observation is promising.
This bears out a real look at providing CHT concurrently as a complementary therapy as a first line of treatment upon initial IBS diagnosis, and may prove to be a good defence in treating the whole person as the method has shown to improve the IBS symptom reduction rate, and may curtail or even eliminate possible further decline in QOL and psychological issues. (4)
So what does this tell us?
Further studies using clinical hypnotherapy initially alongside traditional medical interventions (medication) may prove helpful in considering the holistic nature of the condition and its optimal treatment. Can the experiences of the refractory IBS patient who may endure the emotional burdens of hopelessness, (5) treatment
resolution frustration, elevated stress and anxiety levels secondary to IBS, negativity, reduced QOL, and other multiple areas of suffering be alleviated or even eliminated if a psychological approach such as CHT be administered in conjunction
with conventional treatment recommendations upon the initial diagnosis of IBS?
It is the finding of this practice that this can be achieved when hypnotherapy is delivered professionally, however further investigation should be encouraged.
1. Tan G, Hammond DC, Joseph G. Hypnosis and irritable bowel syndrome: a review of efficacy and mechanism of action. Am J Clin Hypn. 2005 Jan;47(3):16178.
2. Hauser W. Medizinische Klinik I, Klinikum Saarbrucken gGmbH, Saarbrucken.
Hypnosis in Gastroenterology. Z Gastroenterol 2003 May;41 5:40512 PMID: 12772053
3. In 1996 Mahoney was invited to participate in a separate medical research study funded through the UK National Health Service Practice Based Commissioning system which was monitored and audited by the PBC Medical Centre GP lead.
Medical centre GPs and hospital gastroenterologists screened 20 IBS patients: all were longterm sufferers, had undergone all medical diagnostic tests, and had taken prescription medications without attaining significant relief from their symptoms. Each patient underwent Mahoney's original protocol of the introductory
and five subsequent hypnotherapy sessions. At the end of the project, feedback sheets from the patients indicated an overall reduction of 80% in symptom severity and frequency of presentation. In 1997, Mahoney developed new processes for
IBS clinical protocol. Patients were monitored using audio tapes both during the program and for the next three subsequent years: 1998 through 2001. The final results of this study are intended for independent publication in 2012 so that they may be subject to peer review and analysis. Success rates were close to or
exceeding 90% for all symptoms and patients.
4. Spiegel BM, Gralnek IM, Bolus R, Chang L, Dulai GS, Mayer EA, Naliboff B. Clinical determinants of healthrelated quality of life in patients with irritable bowel syndrome. Arch Intern Med. 2004 Sep 13;164(16):177380. 5.Miller V, Hopkins L, Whorwell PJ. Suicidal ideation in patients with irritable bowel syndrome. Clin Gastroenterol Hepatol. 2004 Dec;2(12):10648. 6. Pinto C, Lele MV, Joglekar AS, Panwar VS, Dhavale HS. Stressful lifeevents,
anxiety, depression and coping in patients of irritable bowel syndrome. J Assoc Physicians India. 2000 Jun;48(6):58993.
7. Whitehead WE, Crowell MD. Psychologic considerations in the irritable bowel syndrome. Gastroenterol Clin North Am. 1991 Jun;20(2):24967. 8. Lackner JM, Quigley BM. Pain catastrophizing mediates the relationship between worry and pain suffering in patients with irritable bowel syndrome. Behav Res Ther.
2005 Jul;43(7):94357. Epub 2004 Sep 25. 9. Spiller RC. Potential future therapies for irritable bowel syndrome: will disease modifying therapy as opposed to symptomatic control become a reality?
Gastroenterol Clin North Am. 2005 Jun;34(2):33754. 10. Palsson OS, Drossman DA. Psychiatric and psychological dysfunction in irritable bowel syndrome and the role of psychological treatments. Gastroenterol Clin North Am. 2005 Jun;34(2):281303.
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