Hypnosis and Irritable Bowel Syndrome – Doctor’s Interview
What is IBS and how many people does it attack?
IBS is a set of symptoms that affects about fifteen percent of the population. It involves primarily pain and discomfort in the abdomen that is usually relieved by defecation, by going to the bathroom. It’s accompanied by other symptoms of distress and discomfort in the abdomen after eating.
Do you have any idea what the cause is?
Well that’s not clear, there are a number of ideas. We do know that people with IBS tend to have changes in the colon related to the way sensations are perceived, the way things feel. That there is some change to the lining of the colon. There is some change in the nervous system of the colon. So that whether this is caused by infection or inflammation or what we really don’t know. Research is continuing and new ideas are coming out all the time but we really don’t know what causes it.
Do things like stress have an effect on it?
It definitely makes it worse, whether it causes it or not is another issue, but stress is involved and the symptoms of IBS also cause stress because they are very uncomfortable and they are very inconvenient. So, it’s a circular situation, stress probably makes it worse, the symptoms of the disease make the stress worse so it feeds on itself that way.
Is this an easily diagnosed thing or do you think there are more than ten or fifteen percent?
Those numbers are taken from large scale studies, epidemiologic studies that are probably pretty good. Only about half the people who have IBS symptoms actually consult physicians for them according to the studies. So there are a lot of people out there with the same types of symptoms who just assume it’s normal, that that’s the way they are and don’t go to physicians. So I think that’s probably an accurate estimate of how many people have it. It does have some symptoms that can overlap. Other conditions can have similar symptoms, so it’s important to have evaluations to make sure that there is nothing else going on.
What are the traditional treatments for IBS?
Traditionally, it’s been fiber therapy and there are some medications to help reduce spasms in the gut. Relaxation training to help manage the stress whether it comes from the disease or makes the disease worse. Antidepressants have been useful in some cases which we think actually function on the nervous system in the gut to reduce the sensitivity to pain and to sensation rather than acting as antidepressants in that case. Alterations in diet, increasing fiber, having a healthier diet. Exercise, increasing exercise, basically a healthy lifestyle.
And if all of these treatments are available why are you supplying a treatment such as hypnosis?
Well there’s a large population, a large group of people with IBS who really don’t respond to the traditional treatments. Who don’t seem to improve or who are not improved enough to feel like they actually feel better.
And hypnosis has been found in studies in England to be effective with patients who don’t respond to other treatments. It has been recorded in several studies in England to be effective in treating these symptoms of people who have not responded to medical intervention.
Can you give us some specific numbers and things for the study in England?
The majority of patients in three different former studies, to eighty or ninety percent, respond to treatment of hypnosis from four to seven hypnosis sessions. Those sessions are spaced over a three month period. They have been found to be still without symptoms or still improved up to eighteen months after the termination of treatment. So this seems to be quite promising. That is why we are trying to repeat this here. It has not been tried on any large scale in this country.
A lot of people might say hypnosis and IBS are worlds apart. Can you make that connection why one relates to the other?
It is not entirely clear how hypnosis affects irritable bowel syndrome and that’s a part of what we are studying here. We are among other things measuring the psychological sensitivity of the patients with irritable bowel syndrome. We are, in particular, in this study interested in how hypnosis affects pain sensitivity and the pain of patients with irritable bowel syndrome. It is unclear exactly what produces the therapeutic effect. However, it has been found that hypnosis does affect the movement of the gut or intestinal tract. So, it may be directly related to physiological factors rather than just being a psychological treatment.
When you say it affects, how?
Well people in the hypnotic state have been found to have reduced motility of the gut or intestinal tract and so hypnosis does affect the GI tract directly in a physiological way like that. So it may be that hypnosis has its therapeutic effects both through psychological means and through affecting the physiology of the people who get the treatment.
There is also some evidence that the central nervous system is involved in IBS. The sensations that go from the gut to the brain and the sensations that come back down, the different messages that modulate the pain probably are affected by the relaxation and by the hypnosis itself too. So it may act directly on the brain and on the nervous system as well.
What is actually happening to the body during hypnosis in relation to IBS?
That is not entirely clear however, there are some findings on the effects of hypnosis on the gut or intestinal tract that suggests what might be happening. My own finding is that hypnosis does seem to reduce pain sensitivity in the gut or intestinal tract. Since abdominal pain is the center symptom in irritable bowel syndrome that might be one way that hypnosis is improving the condition. Another finding is that hypnosis slows down the motility of the gut or intestinal tract, or the movement or irregular movement of the tract. So that kind of effect might also be important. And furthermore, we have evidence of the effect of hypnosis on psychological factors from fifty years of research. So if these factors are going to be important we don’t know and a part of what we’re trying to do is to find out which are the important ingredients.
One of the problems with IBS is that it is a psychologically distressing syndrome. People do become anxious, they do have difficulty with the focusing on the symptoms, and the pain and the distress. Hypnosis has been found to help people re-channel their concentration, to focus their concentration on something other than their symptoms and kind of help them to manage their attention and what they pay attention to. So we’re hoping on a psychological level that, that will help people to cope with the symptoms as well as to reduce the actual level of symptoms that they have.
In one prior study in England it was demonstrated that hypnosis was much more effective than psychotherapy for the same length. Even psychotherapy combined with a placebo pill, an inert pill that has an inactive ingredient, so something seems to be effective in hypnosis that this is more than just the effects of regular psychotherapeutic contact.