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Anderson EJ, Peters SL, Gibson PR, Halmos EP. Comparison of Digitally Delivered Gut-Directed Hypnotherapy Program With an Active Control for Irritable Bowel Syndrome. Am J Gastroenterol 2024:00000434-990000000-01218. [PMID: 38940439 DOI: 10.14309/ajg.0000000000002921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 06/24/2024] [Indexed: 06/29/2024]
Abstract
INTRODUCTION Gut-directed hypnotherapy (GDH) treats irritable bowel syndrome (IBS), but its accessibility is limited. This problem may be overcome by digital delivery. The aim of this study was to perform a randomized control trial comparing the efficacy of a digitally delivered program with and without GDH in IBS. METHODS Adults with IBS were randomized to a 42-session daily digital program with the GDH Program (Nerva) or without (Active Control). Questionnaires were completed to assess gastrointestinal symptoms through IBS Symptom Severity Scale (IBS-SSS), quality of life, and psychological symptoms (Depression Anxiety and Stress Scale-21) at regular intervals during the program and 6 months following the conclusion on the intervention. The primary end point was the proportion of participants with ≥50-point decrease in IBS-SSS between the interventions at the end of the program. RESULTS Of 240/244 randomized participants, 121 received GDH Program-the median age 38 (range 20-65) years, 90% female, IBS-SSS 321 (interquartile range 273-367)-and 119 Active Control-36 (21-65), 91% female, IBS-SSS 303 (255-360). At program completion, 81% met the primary end point with GDH Program vs 63% Active Control ( P = 0.002). IBS-SSS was median 208 (interquartile range 154-265) with GDH and 244 (190-308) with control ( P = 0.004), 30% reduction in pain was reported by 71% compared with 35% ( P < 0.001), and IBS quality of life improved by 14 (6-25) compared with 7 (1-15), respectively ( P < 0.001). Psychological status improved similarly in both groups. DISCUSSION A digitally delivered GDH Program provided to patients with IBS was superior to the active control, with greater improvement in both gastrointestinal symptoms and quality of life and provides an equitable alternative to face-to-face behavioral strategies.
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Affiliation(s)
- Ellen J Anderson
- Department of Gastroenterology, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Simone L Peters
- Department of Gastroenterology, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
| | - Peter R Gibson
- Department of Gastroenterology, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Emma P Halmos
- Department of Gastroenterology, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
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Lövdahl J, Törnblom H. Editorial: Can we predict or not predict response to hypnotherapy? That is the question. Aliment Pharmacol Ther 2024; 59:413-414. [PMID: 38197712 DOI: 10.1111/apt.17812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
LINKED CONTENTThis article is linked to Devenney et al papers. To view these articles, visit https://doi.org/10.1111/apt.17790 and https://doi.org/10.1111/apt.17815
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Affiliation(s)
- Jenny Lövdahl
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hans Törnblom
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Devenney J, Hasan SS, Morris J, Whorwell PJ, Vasant DH. Clinical trial: predictive factors for response to gut-directed hypnotherapy for refractory irritable bowel syndrome, a post hoc analysis. Aliment Pharmacol Ther 2024; 59:269-277. [PMID: 37927144 DOI: 10.1111/apt.17790] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 09/08/2023] [Accepted: 10/19/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Gut-directed hypnotherapy is effective for patients with irritable bowel syndrome (IBS). Despite its considerable evidence base, gut-directed hypnotherapy is not widely available and remains a limited resource. This emphasises the need to select patients who are most likely to benefit. AIM To determine whether baseline patient characteristics were predictive of response to gut-directed hypnotherapy in patients with IBS METHODS: We conducted a secondary analysis of outcomes of 448 patients with refractory Rome III IBS who participated in a randomised study confirming non-inferiority of 6 compared to 12 sessions of gut-directed hypnotherapy. We compared baseline patient characteristics, including age, sex, IBS subtype, quality of life and IBS-Symptom Severity Scale (IBS-SSS), non-colonic symptom score and Hospital Anxiety and Depression (HAD) score between responders and non-responders. We defined response as ≥50-point decrease in IBS-SSS or ≥30% reduction in pain severity scores. RESULTS Overall, 76.3% achieved ≥50-point decrease in IBS-SSS. Responders had a higher baseline non-colonic symptom score (p = 0.005). Those who achieved ≥30% improvement in abdominal pain scores (59.8%) had higher baseline IBS-SSS (p = 0.03), and lower baseline HAD-depression score (p = 0.012). Fifty-four patients (12%) dropped out of gut-directed hypnotherapy. Compared to completers, dropouts had higher baseline HAD-anxiety score (p = 0.034). CONCLUSIONS These data suggest that patients with a higher burden of gastrointestinal and extraintestinal symptoms are most likely to benefit from gut-specific behavioural intervention for refractory IBS. Clinical assessment of gastrointestinal, somatic and psychological symptom profiles may play a role in selecting patients for gut-directed hypnotherapy.
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Affiliation(s)
- Jade Devenney
- Neurogastroenterology Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK
| | - Syed S Hasan
- Neurogastroenterology Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK
| | - Julie Morris
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK
| | - Peter J Whorwell
- Neurogastroenterology Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK
| | - Dipesh H Vasant
- Neurogastroenterology Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK
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Slouha E, Patel B, Mohamed A, Razeq Z, Clunes LA, Kollias TF. Psychotherapy for Irritable Bowel Syndrome: A Systematic Review. Cureus 2023; 15:e51003. [PMID: 38259396 PMCID: PMC10802926 DOI: 10.7759/cureus.51003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 01/24/2024] Open
Abstract
Psychotherapy has many forms, such as cognitive behavioral therapy (CBT), mindfulness therapy (MFT), and hypnotherapy, to name a few. Cognitive behavioral therapy is the gold standard in therapy-based treatment and is used for cognitive restructuring to reduce safety-seeking and avoidant behaviors. While the main application of psychotherapy is psychological disorders, recent studies have found that it is beneficial for somatic and physiological symptoms such as chronic pain or even irritable bowel syndrome (IBS). Irritable bowel syndrome is a common but debilitating gastrointestinal condition that has a prevalence of 12% in the United States and costs the average patient $9,776 annually in 2023. Irritatable bowel syndrome is a condition of exclusion but consists of abdominal discomfort or pain and must be associated with altered bowel habits as stated in the Rome IV criteria. At least half of these patients also exhibit extracolonic symptoms, most commonly psychological disorders like anxiety and stress. The true etiology of IBS is not understood, but ideas such as the brain-gut axis, stress response system, and gut microbiota have been evaluated. Treatment of IBS is extensive and heavily relies on the patient-physician interaction, but pharmacologic therapies have been employed and are sometimes unsuccessful. Irritable bowel syndrome impacts an individual as a whole, making them hesitate whether or not they eat a particular food or even go out to do an activity because of the unpredictable bowel pattern. Finding a better solution is essential to improving the patient's quality of life (QoL), especially by addressing how they perceive the illness, how they adjust to it, and even how they determine what foods to consume. This paper aims to evaluate whether or not psychotherapy can be employed to improve all aspects of IBS, as well as if it can reduce the cost of IBS treatment.
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Affiliation(s)
- Ethan Slouha
- Anatomical Sciences, St. George's University School of Medicine, St. George's, GRD
| | - Bansari Patel
- Pharmacy, St. George's University School of Medicine, St. George's, GRD
| | - Ahmed Mohamed
- Pharmacology, St. George's University School of Medicine, St. George's, GRD
| | - Ziyad Razeq
- Medicine, St. George's University School of Medicine, St. George's, GRD
| | - Lucy A Clunes
- Pharmacology, St. George's University School of Medicine, St. George's, GRD
| | - Theofanis F Kollias
- Microbiology, Immunology, and Pharmacology, St. George's University School of Medicine, St. George's, GRD
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Gerson J, Tawde P, Ghiasian G, Salwen-Deremer JK. Patients' experiences with virtual group gut-directed hypnotherapy: A qualitative study. Front Med (Lausanne) 2023; 10:1066452. [PMID: 36910502 PMCID: PMC9992176 DOI: 10.3389/fmed.2023.1066452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/27/2023] [Indexed: 02/24/2023] Open
Abstract
Background Hypnotherapy is a useful treatment for a variety of gastrointestinal conditions. While there is strong evidence for delivering other treatments virtually and in groups, there is no research thus far on delivering hypnotherapy in this format. Given the growth of both psychogastroenterology and telehealth, these methods should be explored as they have great potential for increasing access and cost-effectiveness of intervention. Aims This qualitative study was developed to help understand patients experiences in virtual, group-based, gut-directed hypnotherapy (GDH) in two different institutions. Methods Authors developed a qualitative interview with the assistance of two patient partners and then recruited patients from New York University and Dartmouth Health to participate. Interviews were completed one-on-one with patients who started and then completed GDH (≥5 visits) and who did not complete GDH (≤3 visits). Data were coded and then analyzed using thematic analysis. Results Twenty-one patients from NYU and Dartmouth participated in qualitative interviews. Broadly, patients reported coming to GDH because they believed in the importance of the mind-body connection or were desperate for treatment. Regardless of why patients came to GDH, they generally reported positive outcomes for GI symptoms and for other physical and mental health conditions. Most patients appreciated the group and virtual formats, though some concerns about inflexible schedules and lack of anonymity were voiced. Despite these concerns, there was broad support for virtual, group-based GDH and general excitement for behavioral health programming. Conclusion Virtual, group-based GDH is an acceptable treatment for patients from rural and urban settings. Given the possible improvements in access and cost-effectiveness that this treatment modality can provide, GI practices may want to consider it in lieu of or in addition to the traditional one-on-one treatment format. Barriers and facilitators and recommendations for practice are discussed.
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Affiliation(s)
- Jessica Gerson
- Division of Gastroenterology, Inflammatory Bowel Disease Center, New York University (NYU) Langone Health, New York, NY, United States
| | - Prianca Tawde
- The Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Ghoncheh Ghiasian
- Division of Gastroenterology, Inflammatory Bowel Disease Center, New York University (NYU) Langone Health, New York, NY, United States
| | - Jessica K Salwen-Deremer
- Departments of Psychiatry and Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States
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Császár-Nagy N, Bókkon I. Hypnotherapy and IBS: Implicit, long-term stress memory in the ENS? Heliyon 2022; 9:e12751. [PMID: 36685398 PMCID: PMC9849985 DOI: 10.1016/j.heliyon.2022.e12751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 09/20/2022] [Accepted: 12/27/2022] [Indexed: 01/01/2023] Open
Abstract
The association between irritable bowel syndrome (IBS) and psychiatric and mood disorders may be more fundamental than was previously believed. Prenatal, perinatal, postnatal, and early-age conditions can have a key role in the development of IBS. Subthreshold mental disorders (SMDs) could also be a significant source of countless diverse diseases and may be a cause of IBS development. We hypothesize that stress-induced implicit memories may persist throughout life by epigenetic processes in the enteric nervous system (ENS). These stress-induced implicit memories may play an essential role in the emergence and maintenance of IBS. In recent decades, numerous studies have proven that hypnosis can improve the primary symptoms of IBS and also reduce noncolonic symptoms such as anxiety and depression and improve quality of life and cognitive function. These significant beneficial effects of hypnosis on IBS may be because hypnosis allows access to unconscious brain processes.
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Affiliation(s)
- N. Császár-Nagy
- National University of Public Services, Budapest, Hungary,Psychosomatic Outpatient Clinics, Budapest, Hungary
| | - I. Bókkon
- Psychosomatic Outpatient Clinics, Budapest, Hungary,Vision Research Institute, Neuroscience and Consciousness Research Department, Lowell, MA, USA,Corresponding author. H-1238, Budapest, Láng Endre 68, Hungary.
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Lövdahl J, Törnblom H, Ringström G, Palsson OS, Simrén M. Randomised clinical trial: individual versus group hypnotherapy for irritable bowel syndrome. Aliment Pharmacol Ther 2022; 55:1501-1511. [PMID: 35505463 PMCID: PMC9324196 DOI: 10.1111/apt.16934] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/09/2021] [Accepted: 04/08/2022] [Indexed: 12/14/2022]
Abstract
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).
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Affiliation(s)
- Jenny Lövdahl
- Department of Molecular and Clinical MedicineSahlgrenska AcademyGothenburgSweden
| | - Hans Törnblom
- Department of Molecular and Clinical MedicineSahlgrenska AcademyGothenburgSweden
| | - Gisela Ringström
- Department of Molecular and Clinical MedicineSahlgrenska AcademyGothenburgSweden
| | - Olafur S. Palsson
- Division of Gastroenterology and HepatologyUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Magnus Simrén
- Department of Molecular and Clinical MedicineSahlgrenska AcademyGothenburgSweden
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8
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Gillan C. Review article: the effectiveness of group and self-help hypnotherapy for irritable bowel syndrome and the implications for improving patients' choice and access to treatment. Aliment Pharmacol Ther 2021; 54:1389-1404. [PMID: 34591988 DOI: 10.1111/apt.16623] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/04/2021] [Accepted: 09/15/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Individual hypnotherapy (IH) is a recognised treatment for irritable bowel syndrome (IBS). However, it is not widely available to patients due to its resource-intensive nature, lack of adequately trained therapists, and scepticism about hypnosis. Non-individualised hypnotherapy approaches, such as group and self-help hypnotherapy, could maximise existing therapist resources by treating more patients at the same time, thus widening patient access to treatment without incurring additional expenditure. AIMS To investigate the research literature for non-individualised approaches to hypnotherapy for IBS and to determine their effectiveness for reducing symptom severity and/or providing adequate relief. METHODS A literature review of published peer-reviewed studies was conducted. Quantitative research was selected to determine the effectiveness of the interventions. RESULTS Ten studies were eligible for inclusion. Three delivered group hypnotherapy, three integrated hypnosis within a group concept, and four utilised a self-help home hypnotherapy treatment using audio recordings. Both group hypnotherapy for adults and the self-help home hypnotherapy treatment for children were effective interventions that may be non-inferior to IH for patients with mild-to-moderate symptoms. Treatment benefits were long-lasting. The evidence for the integrative group concept and home treatment for adults was less compelling. CONCLUSIONS Group hypnotherapy for adults, and self-help hypnotherapy for children, may be cost-effective treatments that can widen access for patients with milder IBS in primary care settings. Further research is needed to determine the effectiveness of group hypnotherapy for patients with severe, refractory IBS.
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Affiliation(s)
- Carolyn Gillan
- School of Nursing and Midwifery, University of Plymouth, Plymouth, UK
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Chey WD, Keefer L, Whelan K, Gibson PR. Behavioral and Diet Therapies in Integrated Care for Patients With Irritable Bowel Syndrome. Gastroenterology 2021; 160:47-62. [PMID: 33091411 DOI: 10.1053/j.gastro.2020.06.099] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/08/2020] [Accepted: 06/06/2020] [Indexed: 02/06/2023]
Abstract
Irritable bowel syndrome (IBS) is a common, symptom-based condition that has negative effects on quality of life and costs health care systems billions of dollars each year. Until recently, management of IBS has focused on over-the-counter and prescription medications that reduce symptoms in fewer than one-half of patients. Patients have increasingly sought natural solutions for their IBS symptoms. However, behavioral techniques and dietary modifications can be effective in treatment of IBS. Behavioral interventions include gastrointestinal-focused cognitive behavioral therapy and gut-directed hypnotherapy to modify interactions between the gut and the brain. In this pathway, benign sensations from the gut induce maladaptive cognitive or affective processes that amplify symptom perception. Symptoms occur in response to cognitive and affective factors that trigger fear of symptoms or lack of acceptance of disease, or from stressors in the external environment. Among the many dietary interventions used to treat patients with IBS, a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols is the most commonly recommended by health care providers and has the most evidence for efficacy. Patient with IBS who choose to follow a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols should be aware of its 3 phases: restriction, reintroduction, and personalization. Management of IBS should include an integrated care model in which behavioral interventions, dietary modification, and medications are considered as equal partners. This approach offers the greatest likelihood for success in management of patients with IBS.
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Affiliation(s)
- William D Chey
- Division of Gastroenterology, Michigan Medicine, Ann Arbor, Michigan.
| | | | - Kevin Whelan
- Department of Nutritional Sciences, King's College London, London, United Kingdom
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Flik CE, Laan W, Zuithoff NPA, van Rood YR, Smout AJPM, Weusten BLAM, Whorwell PJ, de Wit NJ. Efficacy of individual and group hypnotherapy in irritable bowel syndrome (IMAGINE): a multicentre randomised controlled trial. Lancet Gastroenterol Hepatol 2019; 4:20-31. [DOI: 10.1016/s2468-1253(18)30310-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 09/20/2018] [Accepted: 09/21/2018] [Indexed: 12/15/2022]
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Li Q, Zhang BP, Huang SG, Ouyang WW, Xie JH, Wen ZH, Yang XB. Efficacy and indication optimization of Chinese medicine (Tiao-Chang Ke-Min granules) for diarrhea-predominant irritable bowel syndrome: study protocol for a randomized controlled trial. Trials 2018; 19:367. [PMID: 29996882 PMCID: PMC6042407 DOI: 10.1186/s13063-018-2754-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 06/20/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a chronic, recurring condition, prevalent in the general population. Current medication treatments usually leave patients undertreated. Nowadays, Chinese medicine (CM) is being considered as a promising treatment approach for IBS. However, due to methodological limitations, there is no strong evidence to support CM. Although IBS relapses are common, the relapse assessment has always been neglected in CM study designs. Meanwhile, in clinical practice and studies, it has been found that certain CM formulas can only benefit certain kinds of patients. Discovering what population and illness characteristics likely respond to outcomes may help improve the effectiveness of CM. The aims of this study are to evaluate the efficacy and safety of Tiao-Chang Ke-Min (TCKM) granules for IBS, especially in reducing IBS symptoms' relapse, by a high-quality randomized controlled trial and then to optimize the indication of the TCKM granules. METHODS/DESIGN This is a parallel-group, randomized, double-blind, placebo-controlled trial embedded with outcome predictive factors. Eligible patients with diarrhea-predominant IBS will be randomized into either a TCKM granule group or a placebo group. Patients from both groups will receive health education. The treatment duration is 4 weeks and the follow-up is 12 weeks. The primary outcome is global improvement measured with adequate relief (AR). The second outcome measures include time until relief, time until first relapse, total relapse times, long-term effectiveness, individual symptoms, IBS-Symptom Severity Score (IBS-SSS), IBS-Quality of Life Questionnaire (IBS-QOL), and Hospital Anxiety and Depression Scale (HADS). Predictive factors associated with patient and illness characteristics have been widely collected. These factors will be embedded in this trial for further identification. DISCUSSION This trial may provide high-quality evidence on the efficacy and safety of TCKM granules for IBS and a more accurate indication. Importantly, this trial will provide a new research method for improving the therapeutic effects of CM for clinicians and researchers. To address IBS relapse assessment, a series of special definitions of relapse incidents has been made for this trial. TRIAL REGISTRATION Chinese Clinical Trial Registry, ID: ChiCTR-IOR-17010600 . Registered on 9 February 2017.
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Affiliation(s)
- Qian Li
- Chinese Medicine Syndrome Research Team, Guangdong Provincial Hospital of Chinese Medicine, No. 111, DaDe Road, Guangzhou, 510120, China.,The Second Clinical College of Guangzhou University of Chinese Medicine, No. 12, JiChang Road, Guangzhou, 510405, China
| | - Bei-Ping Zhang
- Department of Gastroenterology, Guangdong Provincial Hospital of Chinese Medicine, No. 111, DaDe Road, Guangzhou, 510120, China
| | - Shao-Gang Huang
- Department of Gastroenterology, Guangdong Provincial Hospital of Chinese Medicine, No. 111, DaDe Road, Guangzhou, 510120, China
| | - Wen-Wei Ouyang
- Key Unit of Methodology in Clinical Research, Guangdong Provincial Hospital of Chinese Medicine, No. 111, Dade Road, Guangzhou, 510120, China
| | - Jian-Hui Xie
- Chinese Medicine Syndrome Research Team, Guangdong Provincial Hospital of Chinese Medicine, No. 111, DaDe Road, Guangzhou, 510120, China
| | - Ze-Huai Wen
- Key Unit of Methodology in Clinical Research, Guangdong Provincial Hospital of Chinese Medicine, No. 111, Dade Road, Guangzhou, 510120, China
| | - Xiao-Bo Yang
- Chinese Medicine Syndrome Research Team, Guangdong Provincial Hospital of Chinese Medicine, No. 111, DaDe Road, Guangzhou, 510120, China.
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12
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Psychological Interventions for Irritable Bowel Syndrome and Inflammatory Bowel Diseases. Clin Transl Gastroenterol 2017; 8:e214. [PMID: 28102860 PMCID: PMC5288603 DOI: 10.1038/ctg.2016.69] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 12/02/2016] [Accepted: 12/06/2016] [Indexed: 12/13/2022] Open
Abstract
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.
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Roohafza H, Keshteli AH, Daghaghzadeh H, Afshar H, Erfani Z, Adibi P. Life stressors, coping strategies, and social supports in patients with irritable bowel syndrome. Adv Biomed Res 2016; 5:158. [PMID: 27761433 PMCID: PMC5070037 DOI: 10.4103/2277-9175.190935] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 02/29/2016] [Indexed: 12/13/2022] Open
Abstract
Background: The frequency and the perceived intensity of life stressors, coping strategies, and social supports are very important in everybody's well-being. This study intended to estimate the relation of irritable bowel syndrome (IBS) and these factors. Materials and Methods: This was a cross-sectional study carried out in Isfahan on 2013. Data were extracted from the framework of the study on the epidemiology of psychological, alimentary health, and nutrition. Symptoms of IBS were evaluated by Talley bowel disease questionnaire. Stressful life event, modified COPE scale, and Multidimensional Scale of Perceived Social Support were also used. About 4763 subjects were completed questionnaires. Analyzing data were done by t-test and multivariate logistic regression. Results: Of all returned questionnaire, 1024 (21.5%) were diagnosed with IBS. IBS and clinically-significant IBS (IBS-S) groups have significantly experienced a higher level of perceived intensity of stressors and had a higher frequency of stressors. The mean score of social supports and the mean scores of three coping strategies (problem engagement, support seeking, and positive reinterpretation and growth) were significantly lower in subjects with either IBS-S or IBS than in those with no IBS. Multivariate logistic regression revealed a significant association between frequency of stressors and perceived intensity of stressors with IBS (odds ratio [OR] =1.09 and OR = 1.02, respectively) or IBS-S (OR = 1.09 and OR = 1.03, respectively). Conclusions: People with IBS had higher numbers of stressors, higher perception of the intensity of stressors, less adaptive coping strategies, and less social supports which should be focused in psychosocial interventions.
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Affiliation(s)
- Hamidreza Roohafza
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan, Iran
| | - Ammar Hassanzadeh Keshteli
- Integrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamed Daghaghzadeh
- Integrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid Afshar
- Psychosomatic Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Erfani
- Integrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Peyman Adibi
- Integrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Chandrashekhar R. Advantageous Use of Hypnosis in a Case of Psychogenic Vomiting. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2016; 58:347-56. [PMID: 27003484 DOI: 10.1080/00029157.2015.1046981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This case study describes in detail the role of hypnosis in treatment of a case of psychogenic vomiting. The patient, a 60-yearold woman, had been suffering for 9 months from episodes of vomiting which resulted in weight loss, dehydration, and hypokalemia. She was a conscientious woman with high standards of behavior, which did not allow an expression of the extreme hostility she felt toward her daughter-in-law. Hypnotherapeutic sessions reduced her anxiety, restored her sleep, improved mood, and helped deepen rapport, all of which created the ideal setting for Gestalt's empty chair technique. Integrating hypnosis greatly enhanced the quality of the empty chair dialogue, which by bringing about a shift in the patient's emotions from hostility to sympathy, facilitated recovery.
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Jarrett ME, Cain KC, Barney PG, Burr RL, Naliboff BD, Shulman R, Zia J, Heitkemper MM. Balance of Autonomic Nervous System Predicts Who Benefits from a Self-management Intervention Program for Irritable Bowel Syndrome. J Neurogastroenterol Motil 2015; 22:102-11. [PMID: 26459461 PMCID: PMC4699727 DOI: 10.5056/jnm15067] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Revised: 07/09/2015] [Accepted: 08/04/2015] [Indexed: 12/22/2022] Open
Abstract
Background/Aims To determine if potential biomarkers can be used to identify subgroups of people with irritable bowel syndrome (IBS) who will benefit the most or the least from a comprehensive self-management (CSM) intervention. Methods In a two-armed randomized controlled trial a CSM (n = 46) was compared to a usual care (n = 46) group with follow-up at 3 and 6 months post randomization. Biomarkers obtained at baseline included heart rate variability, salivary cortisol, interleukin-10 produced by unstimulated peripheral blood mononuclear cells, and lactulose/mannitol ratio. Linear mixed models were used to test whether these biomarkers predicted improvements in the primary outcomes including daily abdominal pain, Gastrointestinal Symptom score and IBS-specific quality of life. Results The nurse-delivered 8-session CSM intervention is more effective than usual care in reducing abdominal pain, reducing Gastrointestinal Symptom score, and enhancing quality of life. Participants with lower nighttime high frequency heart rate variability (vagal modulation) and increased low frequency/high frequency ratio (sympathovagal balance) had less benefit from CSM on abdominal pain. Salivary cortisol, IL-10, and lactulose/mannitol ratio were not statistically significant in predicting CSM benefit. Baseline symptom severity interacts with treatment, namely the benefit of CSM is greater in those with higher baseline symptoms. Conclusions Cognitively-focused therapies may be less effective in reducing abdominal pain in IBS patients with higher sympathetic tone. Whether this a centrally-mediated patient characteristic or related to heightened arousal remains to be determined.
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Affiliation(s)
- Monica E Jarrett
- Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA, USA
| | - Kevin C Cain
- Deptartment of Biostatistics and Office for Nursing Research, University of Washington, Seattle, WA, USA
| | - Pamela G Barney
- Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA, USA
| | - Robert L Burr
- Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA, USA
| | - Bruce D Naliboff
- Center for Neurovisceral Sciences & Women's Health, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Jasmine Zia
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Margaret M Heitkemper
- Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA, USA
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Darakjy J, Barabasz M, Barabasz A. Effects of Dry Flotation Restricted Environmental Stimulation on Hypnotizability and Pain Control. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2015; 58:204-14. [PMID: 26264543 DOI: 10.1080/00029157.2014.979275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The effects of dry flotation restricted environmental stimulation (REST) on hypnotizability and pain control were tested in lighted and unlighted conditions. Participants (N = 30, ages 18-30) were exposed to hypnosis maximizing (plateauing) experiences prior to the experiment. Participants were exposed to 6 hours of lighted REST (N = 10), 6 hours of unlighted REST (N = 10), or 6 hours of normal stimulation (N = 10). The Stanford Hypnotic Susceptibility Scale: Form C (SHSS: C) (Weitzenhoffer & Hilgard, 1962) and standardized ischemic pain tests were administered before and after the conditions and at a 2-week follow-up. Both REST groups shared significantly higher SHSS: C scores and significantly lower pain scores from pre-test to post-test and follow-up. The lighted REST group showed significantly higher SHSS: C scores and significantly lower pain scores than the unlighted REST group at post-test and follow-up. The findings supported Barabasz's (1982) theory of REST responding.
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Palsson OS. Hypnosis Treatment of Gastrointestinal Disorders: A Comprehensive Review of the Empirical Evidence. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2015; 58:134-58. [PMID: 26264539 DOI: 10.1080/00029157.2015.1039114] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
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.
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Palsson OS, van Tilburg M. Hypnosis and Guided Imagery Treatment for Gastrointestinal Disorders: Experience With Scripted Protocols Developed at the University of North Carolina. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2015; 58:5-21. [PMID: 26046714 DOI: 10.1080/00029157.2015.1012705] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Completely scripted treatment courses for verbatim interventions are uncommon in the field of clinical hypnosis. This approach was adopted for by a North Carolina research team for treating gastrointestinal disorders 20 years ago and has been used in hypnosis treatment of irritable bowel syndrome and ulcerative colitis, as well as in guided imagery treatment for functional abdominal pain. Treatment with these scripted protocols is delivered in a fixed series of sessions over a 2- or 3-month period. They have been found efficacious for improving bowel symptoms in several clinical trials, even in patients who have been entirely unresponsive to medical treatment. Response rates in clinical trials have ranged from 53% to 94%, and the therapeutic benefits have been shown to be well maintained at 6-, 10-, or 12-month follow-ups in different studies. This article describes the development and research on these protocols and summarizes the advantages and limitations of this fully scripted treatment approach.
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Peters SL, Muir JG, Gibson PR. Review article: gut-directed hypnotherapy in the management of irritable bowel syndrome and inflammatory bowel disease. Aliment Pharmacol Ther 2015; 41:1104-15. [PMID: 25858661 DOI: 10.1111/apt.13202] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 10/12/2014] [Accepted: 03/28/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Gut-directed hypnotherapy is being increasingly applied to patients with irritable bowel syndrome (IBS) and to a lesser extent, inflammatory bowel disease (IBD). AIM To review the technique, mechanisms of action and evidence for efficacy, and to identify gaps in the understanding of gut-directed hypnotherapy as a treatment for IBS and IBD. METHODS A review of published literature and a systematic review of clinical trials in its application to patients with IBS and IBD were performed. RESULTS Gut-directed hypnotherapy is a clearly described technique. Its potential mechanisms of action on the brain-gut axis are multiple with evidence spanning psychological effects through to physiological gastrointestinal modifications. Six of seven randomised IBS studies reported a significant reduction (all P < 0.05) in overall gastrointestinal symptoms following treatment usually compared to supportive therapy only. Response rates amongst those who received gut-directed hypnotherapy ranged between 24% and 73%. Efficacy was maintained long-term in four of five studies. A therapeutic effect was also observed in the maintenance of clinical remission in patients with ulcerative colitis. Uncontrolled trials supported the efficacy and durability of gut-directed hypnotherapy in IBS. Gaps in understanding included to whom and when it should be applied, the paucity of adequately trained hypnotherapists, and the difficulties in designing well controlled-trials. CONCLUSIONS Gut-directed hypnotherapy has durable efficacy in patients with IBS and possibly ulcerative colitis. Whether it sits in the therapeutic arsenal as a primary and/or adjunctive therapy cannot be ascertained on the current evidence base. Further research into efficacy, mechanisms of action and predictors of response is required.
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Affiliation(s)
- S L Peters
- Department of Gastroenterology, Central Clinical School, The Alfred Hospital, Monash University, Melbourne, Vic., Australia
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Grundmann O, Yoon SL. Complementary and alternative medicines in irritable bowel syndrome: An integrative view. World J Gastroenterol 2014; 20:346-362. [PMID: 24574705 PMCID: PMC3923011 DOI: 10.3748/wjg.v20.i2.346] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 11/11/2013] [Accepted: 12/13/2013] [Indexed: 02/06/2023] Open
Abstract
Irritable bowel syndrome (IBS) is a common gastrointestinal disorder with a high incidence in the general population. The diagnosis of IBS is mainly based on exclusion of other intestinal conditions through the absence of inflammatory markers and specific antigens. The current pharmacological treatment approaches available focus on reducing symptom severity while often limiting quality of life because of significant side effects. This has led to an effectiveness gap for IBS patients that seek further relief to increase their quality of life. Complementary and alternative medicines (CAM) have been associated with a higher degree of symptom management and quality of life in IBS patients. Over the past decade, a number of important clinical trials have shown that specific herbal therapies (peppermint oil and Iberogast®), hypnotherapy, cognitive behavior therapy, acupuncture, and yoga present with improved treatment outcomes in IBS patients. We propose an integrative approach to treating the diverse symptoms of IBS by combining the benefits of and need for pharmacotherapy with known CAM therapies to provide IBS patients with the best treatment outcome achievable. Initial steps in this direction are already being considered with an increasing number of practitioners recommending CAM therapies to their patients if pharmacotherapy alone does not alleviate symptoms sufficiently.
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The importance of relationships in patients with irritable bowel syndrome: a review. Gastroenterol Res Pract 2011; 2012:157340. [PMID: 22190912 PMCID: PMC3235585 DOI: 10.1155/2012/157340] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Accepted: 10/17/2011] [Indexed: 01/27/2023] Open
Abstract
Chronic illnesses such as irritable bowel syndrome are not experienced by patients in isolation. They live in a context of relationships, including spouses and partners, other family members, friends and business associates. Those relationships can have an effect, both positive and negative, on the course of illness and may also be affected by the experience of living with a chronic illness like IBS. We review the general literature regarding the effect of relationship factors on chronic illness followed by a focus on IBS symptomatology. We then discuss the challenges experienced by partners of IBS patients, followed by the effects of spousal violence, the particular relationship of mothers with IBS and their children, the effects of social support, and the importance of family dynamics and IBS. The final segment includes conclusions and recommendations. The topic, relationships and IBS, may have a significant effect on the lives of IBS patients and deserves more attention than it has received.
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