IBS (irritable bowel syndrome) is a persistent and difficult to treat condition that can seriously affect the quality of life. Worldwide, about one in five people suffer from the symptoms of this condition, such as bloating, abdominal pain, diarrhea and constipation. For many sufferers, drug and dietary treatments are not successful. Psychological interventions have previously been proven effective, but are only applied on a small scale due to a shortage of trained therapists. In addition, the studies that demonstrate effect have been conducted in highly specialized tertiary centers, while most IBS patients are treated in primary and secondary care (by/via the general practitioner and in the hospital).
For the IMAGINE study, led by (non-practicing) clinical psychologist and psychotherapist Carla Flik, 354 adults with IBS were recruited, who had been referred by general practitioners and specialists to eleven hospitals throughout the Netherlands. Three hundred subjects were randomly selected for one of three treatment options: six hypnotherapy sessions spread over twelve weeks. 150 patients received 45-minute individual sessions and 150 patients received 60-minute group sessions (six patients). The remaining 54 subjects (the control group) received six 60-minute sessions with information and supportive therapy. They were given a detailed explanation of IBS, the complaints, thoughts about the complaints, coping mechanisms, limitations and avoidance behavior, and the effects on social relationships. The guidelines on nutrition and the benefits of exercise were also discussed, and an explanation was given of the stress system and how to deal with stress.
Immediately after the treatment and another nine months later, the subjects assessed whether they had experienced sufficient relief from their complaints. Furthermore, the severity of symptoms, quality of life, psychological symptoms, dysfunctional cognitions, self-efficacy and health costs and sickness absence were measured.
The results show that many more subjects from the two hypnotherapy groups reported satisfactory relief immediately after the treatment than those receiving information and supportive therapy. And this benefit still increased 9 months after the treatment. Although the symptoms did not affect the subjects in hypnotherapy as much, the severity of the symptoms did not appear to differ significantly from those of the control group. It seems that hypnotherapy in IBS patients in primary and secondary care works mainly through the way of thinking and internal coping mechanisms. Carla Flik: "We do not yet know exactly how bowel-focused hypnotherapy works, but hypnotherapy can give patients more control over their autonomous body processes. This allows them to better cope with pain and better regulate the functioning of their intestines."
The treatment with hypnotherapy was given by trained psychologists. They used positive visualizations, presenting patients with images to gain control over their digestive system and reduce pain and discomfort. Patients were also given a CD so they could practice self-hypnosis exercises at home for 15-20 minutes every day.
"Our study shows that hypnotherapy is a potential treatment for patients with IBS, regardless of the severity of the symptoms and the subtype of IBS," Carla says. "It is also promising to see that group hypnotherapy is just as effective as individual sessions, which may enable more people to be treated with it at a lower cost. Our findings are promising but more research is needed to find out which number of hypnotherapy sessions is optimal, what effect the patient's expectations may have on the outcome of the treatment and to what extent the results of hypnotherapy are influenced by the severity of the patient's psychological complaints."