Hypnotherapy should be considered as a possible treatment for patients with irritable bowel syndrome (IBS) in primary and secondary care, found a Dutch trial.
People with IBS can experience symptoms such as abdominal pain and abnormal bowel movements to various degrees of severity, and they can also face mental health problems, including anxiety and depression. Some common approaches to managing IBS are by carefully controlling one's diet, improving one's lifestyle choices, and, if necessary, seeking mental health therapy. In the past, some research has suggested that people with IBS may also benefit from hypnotherapy sessions.
Now, specialists at the University Medical Centre Utrecht and other institutions in the Netherlands have decided to delve deeper into the question of whether hypnotherapy can improve IBS symptoms – and if so, in what way. The study assessed the efficacy of individual and group hypnotherapy in IBS. It is the largest study to date to look into this issue.
In the study, the researchers worked with 354 participants aged 18–65 with IBS. The scientists randomly selected participants to take part in one of three interventions: individual 45-minute hypnotherapy sessions twice per week for 6 weeks (150 participants); group hypnotherapy sessions with the same timeframe (150 participants); and dedicated educational supportive care sessions (54 participants).
For the delivery of the hypnotherapy sessions, the team recruited psychologists who had trained in hypnotherapy. During the sessions, the hypnotherapists applied techniques of positive visualisation, providing suggestions about pain and discomfort management.They also gave the participants CDs containing materials that would allow them to practice hypnosis techniques on their own for 15–20 minutes on a daily basis.
The researchers asked the participants to fill in questionnaires assessing various factors relevant to the study – including the severity of their IBS symptoms, their quality of life, how much they spent on healthcare, and how often they had to miss work due to the condition.
The assessments took place at baseline, at the 3-month mark, and at the 9-month mark. The team also evaluated to what extent participants experienced relief immediately after the intervention (at the 3-month mark) and then again 9 months later.
The scientists found that the people with IBS who had participated in hypnotherapy – whether individual or group-based – experienced the most satisfactory degree of symptom relief, compared with participants in the educational supportive care group.
Participants who underwent hypnotherapy were still enjoying the benefits 9 months after the treatment. However, the researchers claim that despite reporting satisfactory rates of symptom relief, the participants did not actually see a significant improvement in symptom severity as such.
"We do not know exactly how gut-directed hypnotherapy works," says lead researcher Dr Carla Flik, "but it may change patients' mindset and internal coping mechanisms, enabling them to increase their control over autonomic body processes, such as how they process pain and modulate gut activity."
Other than symptom relief, the tested-for factors – including quality of life, psychological problems, healthcare costs, and work absence – remained roughly the same among all the participants following the interventions.
The researchers also admit that their study faced a few limitations. For example, some participants – 22 (15%) of those in the individual hypnotherapy group, another 22 (15%) of those in the group hypnotherapy sessions, and 11 (20%) of those in the educational supportive care group – dropped out of the study.
Also, a significant number of participants did not manage to fill in all the questionnaires, which, the researchers say, may have impacted the findings.
However, the researchers note that the results they recorded in the recent study may, in fact, have been an underestimation, since the hypnotherapists did not have previous experience in treating people with IBS, specifically.
Also, the participants only received six hypnotherapy sessions, which is only half the number of sessions that a person would normally expect to receive. "What's striking about these findings is the extent to which patients' perception of their illness has an effect on their suffering, and that their perception of symptoms appears to be as important as actual symptom severity," adds Flik.
Background: Hypnotherapy for irritable bowel syndrome (IBS) has been used primarily in patients with refractory symptoms in specialised departments and delivered on an individual basis. We aimed to test the hypothesis that hypnotherapy would be more effective than educational supportive therapy, and that group hypnotherapy would be non-inferior to individual hypnotherapy for patients with IBS referred from primary and secondary care.
Methods: We did a multicentre randomised controlled trial (IMAGINE) in 11 hospitals in the Netherlands. Patients with IBS, aged 18–65 years, who were referred from primary or secondary care were randomly allocated (3:3:1) in blocks of six using a computer-based random number table procedure by staff not involved in the treatment to receive six sessions of individual or group hypnotherapy or group educational supportive therapy (control group). The primary outcome was adequate relief of IBS symptoms, with responders defined as patients who reported adequate relief when asked once weekly on three or four occasions in 4 consecutive weeks. We compared hypnotherapy (both groups) with control in the intention-to-treat population (excluding individuals subsequently found to be ineligible for enrolment), and assessed non-inferiority of group hypnotherapy versus individual hypnotherapy in the per-protocol population (with a non-inferiority margin of 15%) at 3 months and 12 months. This trial is registered with ISRCTN, number ISRCTN22888906, and is completed.
Findings: Between May 31, 2011, and April 6, 2016, 494 patients referred for psychological treatment for IBS were assessed for eligibility, of whom 354 were randomly allocated to the three groups: 150 to individual hypnotherapy, 150 to group hypnotherapy, and 54 to educational supportive therapy. After exclusion of individuals subsequently found to be ineligible for enrolment, 142 patients in the individual hypnotherapy group, 146 in the group hypnotherapy group, and 54 in the control group were included in the intention-to-treat population. Of these, 22 (15%) patients in the individual hypnotherapy group, 22 (15%) in the group hypnotherapy group, and 11 (20%) in the control group dropped out before or during therapy. In the intention-to-treat analysis, the adequate response rate was 40·8% (95% CI 31·7–50·5) in the individual hypnotherapy group, 33·2% (24·3–43·5) in the group hypnotherapy group, and 16·7% (7·6–32·6) in the control group at 3 months. At 12 months, 40·8% (31·3–51·1) of patients in the individual hypnotherapy group, 49·5% (38·8–60·0) of patients in the group hypnotherapy group, and 22.6% (11·5–39·5) of patients in the control group reported adequate relief. Hypnotherapy was more effective than control at 3 months (odds ratio 2·9, 95% CI 1·2–7·4, p=0·0240) and 12 months (2·8, 1·2–6·7, p=0·0185). In the per-protocol analysis, 49·9% (39·2–60·6) in the individual hypnotherapy group and 42·7% (32·3–53·8) in the group hypnotherapy group had adequate relief at 3 months, and 55·5% (43·4–67·1) of individual and 51·7% (40·2–63·0) of group hypnotherapy patients reported adequate relief at 12 months. Group hypnotherapy was therefore non-inferior to individual hypnotherapy. Eight unexpected serious adverse reactions (six in the individual hypnotherapy group and two in the group hypnotherapy group) were reported, most of which were cancer or inflammatory bowel disease, and were judged by the medical ethics committee as not being related to the therapy.
Interpretation: Hypnotherapy should be considered as a possible treatment for patients with IBS in primary and secondary care. Furthermore, group therapy could allow many more patients to be treated for the same cost.
Carla E Flik, Wijnand Laan, Nicolaas P A Zuithoff, Yanda R van Rood, André J P M Smout, Bas L A M Weusten, Peter J Whorwell, Niek J de Wit