Abstract
Purpose of Review
To review the nature, current evidence of efficacy, recent developments, and future prospects for cognitive behavioral therapy (CBT) and gut-directed hypnotherapy, the two best established psychological interventions for managing gastrointestinal (GI) disorders.
Recent Findings
New large randomized controlled trials are showing that cost-effective therapy delivery formats (telephone-based, Internet-based, fewer therapist sessions, or group therapy) are effective for treating GI disorders.
Summary
CBT and hypnotherapy can produce substantial improvement in the digestive tract symptoms, psychological well-being, and quality of life of GI patients. However, they have long been hampered by limited scalability and significant cost, and only been sufficiently tested for a few GI health problems. Through adoption of more cost-effective therapy formats and teletherapy, and by expanding the scope of efficacy testing to additional GI treatment targets, these interventions have the potential to become widely available options for improving clinical outcomes for patients with hard-to-treat GI disorders.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Drossman DA. Functional gastrointestinal disorders: history, pathophysiology, clinical features and Rome IV. Gastroenterology. 2016.
Surdea-Blaga T, Baban A, Dumitrascu DL. Psychosocial determinants of irritable bowel syndrome. World J Gastroenterol. 2012;18(7):616–26.
• Labanski A, Langhorst J, Engler H, Elsenbruch S. Stress and the brain-gut axis in functional and chronic-inflammatory gastrointestinal diseases: a transdisciplinary challenge. Psychoneuroendocrinology. 2020;111:104501. An up-to-date review detailing the relevance of the brain-gut axis in functional gastrointestinal disorders and IBD.
Van Oudenhove L, Crowell MD, Drossman DA, et al. Biopsychosocial aspects of functional gastrointestinal disorders. Gastroenterology 2016.
Sun Y, Li L, Xie R, Wang B, Jiang K, Cao H. Stress triggers flare of inflammatory bowel disease in children and adults. Front Pediatr. 2019;7:432.
Gracie DJ, Hamlin PJ, Ford AC. The influence of the brain-gut axis in inflammatory bowel disease and possible implications for treatment. Lancet Gastroenterol Hepatol. 2019;4(8):632–42.
Konturek PC, Brzozowski T, Konturek SJ. Stress and the gut: pathophysiology, clinical consequences, diagnostic approach and treatment options. J Physiol Pharmacol. 2011;62(6):591–9.
Mayer EA, Tillisch K. The brain-gut axis in abdominal pain syndromes. Annu Rev Med. 2011;62:381–96.
Molina-Torres G, Rodriguez-Arrastia M, Roman P, Sanchez-Labraca N, Cardona D. Stress and the gut microbiota-brain axis. Behav Pharmacol. 2019;30(2 and 3-Spec Issue):187–200.
Dinan TG, Cryan JF. The microbiome-gut-brain axis in health and disease. Gastroenterol Clin N Am. 2017;46(1):77–89.
Tillisch K, Mayer EA, Labus JS. Quantitative meta-analysis identifies brain regions activated during rectal distension in irritable bowel syndrome. Gastroenterology. 2011;140(1):91–100.
•• Ford AC, Lacy BE, Harris LA, Quigley EMM, Moayyedi P. Effect of antidepressants and psychological therapies in irritable bowel syndrome: an updated systematic review and meta-analysis. Am J Gastroenterol. 2019;114(1):21–39. This is the latest systematic review and meta-analysis of psychological therapies for IBS, concluding that they are effective for IBS treatment, with a collective number needed to treat of 4.
• Laird KT, Tanner-Smith EE, Russell AC, Hollon SD, Walker LS. Short-term and long-term efficacy of psychological therapies for irritable bowel syndrome: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2016;14(7):937–47 e4. A recent systematic review and meta-analysis concluding that psychological therapies reduce bowel symptoms in IBS with a medium size effect that lasts at least 1 year after treatment.
• Laird KT, Tanner-Smith EE, Russell AC, Hollon SD, Walker LS. Comparative efficacy of psychological therapies for improving mental health and daily functioning in irritable bowel syndrome: a systematic review and meta-analysis. Clin Psychol Rev. 2017;51:142–52. A companion review to the reference by the same authors above, finding that psychological therapies are effective for improving psychological symptoms and life functioning of IBS patients.
Keefer L, Palsson OS, Pandolfino JE. Best practice update: incorporating psychogastroenterology into management of digestive disorders. Gastroenterology. 2018;154(5):1249–57.
Person H, Keefer L. Brain-gut therapies for pediatric functional gastrointestinal disorders and inflammatory bowel disease. Curr Gastroenterol Rep. 2019;21(4):12.
Lackner JM, Lou Coad M, Mertz HR, Wack DS, Katz LA, Krasner SS, et al. Cognitive therapy for irritable bowel syndrome is associated with reduced limbic activity, GI symptoms, and anxiety. Behav Res Ther. 2006;44(5):621–38.
Lowen MB, Mayer EA, Sjoberg M, et al. Effect of hypnotherapy and educational intervention on brain response to visceral stimulus in the irritable bowel syndrome. Aliment Pharmacol Ther. 2013;37(12):1184–97.
Palsson OS, Whitehead W, Törnblom H, Sperber AD, Simren M. Prevalence of Rome IV functional bowel disorders among adults in the United States, Canada, and the United Kingdom. Gastroenterology. 2020;158(5):1262–73.
Camilleri M, Ford AC. Pharmacotherapy for irritable bowel syndrome. J Clin Med. 2017;6(11).
• Rangan V, Ballou S, Shin A, Camilleri M, Lembo A, Beth Israel Deaconess Medical Center GIMWG. Use of treatments for irritable bowel syndrome and patient satisfaction based on the IBS in America Survey. Gastroenterology. 2019. A recent large survey of IBS patients, demonstrating their low satisfaction with existing pharmacotherapies for IBS and the substantial need for alternative therapy options such as brain-gut psychotherapies.
Lackner JM, Jaccard J, Keefer L, Brenner DM, Firth RS, Gudleski GD, et al. Improvement in gastrointestinal symptoms after cognitive behavior therapy for refractory irritable bowel syndrome. Gastroenterology. 2018;155(1):47–57.
•• Everitt HA, Landau S, O’Reilly G, et al. Assessing telephone-delivered cognitive-behavioural therapy (CBT) and web-delivered CBT versus treatment as usual in irritable bowel syndrome (ACTIB): a multicentre randomised trial. Gut. 2019;68(9):1613–23. This is the largest of all RCTs of brain-gut psychological treatment for GI disorders to date and demonstrates the therapeutic power of telephone CBT and web-based CBT for IBS treatment, two delivery format that can help make CBT more widely available to GI patients.
Palsson OS. Hypnosis treatment of gastrointestinal disorders: a comprehensive review of the empirical evidence. Am J Clin Hypn. 2015;58(2):134–58.
Flik CE, Laan W, Zuithoff NPA, van Rood YR, Smout AJPM, Weusten BLAM, et al. Efficacy of individual and group hypnotherapy in irritable bowel syndrome (IMAGINE): a multicentre randomised controlled trial. Lancet Gastroenterol Hepatol. 2019;4(1):20–31.
Ljotsson B, Hedman E, Lindfors P, et al. Long-term follow-up of internet-delivered exposure and mindfulness based treatment for irritable bowel syndrome. Behav Res Ther. 2011;49(1):58–61.
Whorwell PJ, Prior A, Colgan SM. Hypnotherapy in severe irritable bowel syndrome: further experience. Gut. 1987;28(4):423–5.
Everitt HA, Landau S, O'Reilly G, Sibelli A, Hughes S, Windgassen S, et al. Cognitive behavioural therapy for irritable bowel syndrome: 24-month follow-up of participants in the ACTIB randomised trial. Lancet Gastroenterol Hepatol. 2019;4(11):863–72.
Gonsalkorale WM, Miller V, Afzal A, Whorwell PJ. Long term benefits of hypnotherapy for irritable bowel syndrome. Gut. 2003;52(11):1623–9.
Aziz I, Palsson OS, Tornblom H, Sperber AD, Whitehead WE, Simren M. Epidemiology, clinical characteristics, and associations for symptom-based Rome IV functional dyspepsia in adults in the USA, Canada, and the UK: a cross-sectional population-based study. Lancet Gastroenterol Hepatol. 2018;3(4):252–62.
Van Oudenhove L, Vandenberghe J, Geeraerts B, et al. Determinants of symptoms in functional dyspepsia: gastric sensorimotor function, psychosocial factors or somatisation? Gut. 2008;57(12):1666–73.
Masuy I, Van Oudenhove L, Tack J. Review article: treatment options for functional dyspepsia. Aliment Pharmacol Ther. 2019;49(9):1134–72.
• Orive M, Barrio I, Orive VM, et al. A randomized controlled trial of a 10 week group psychotherapeutic treatment added to standard medical treatment in patients with functional dyspepsia. J Psychosom Res. 2015;78(6):563–8. The largest RCT to date on brain-gut psychological treatment of FD, showing substantial benefits of CBT of adjunctive therapy.
Haug TT, Wilhelmsen I, Svebak S, Berstad A, Ursin H. Psychotherapy in functional dyspepsia. J Psychosom Res. 1994;38(7):735–44.
Calvert EL, Houghton LA, Cooper P, Morris J, Whorwell PJ. Long-term improvement in functional dyspepsia using hypnotherapy. Gastroenterology. 2002;123(6):1778–85.
Durazzo M, Gargiulo G, Pellicano R. Non-cardiac chest pain: a 2018 update. Minerva Cardioangiol. 2018;66(6):770–83.
Klimes I, Mayou RA, Pearce MJ, Coles L, Fagg JR. Psychological treatment for atypical non-cardiac chest pain: a controlled evaluation. Psychol Med. 1990;20(3):605–11.
Mayou RA, Bryant BM, Sanders D, Bass C, Klimes I, Forfar C. A controlled trial of cognitive behavioural therapy for non-cardiac chest pain. Psychol Med. 1997;27(5):1021–31.
Spinhoven P, Van der Does AJ, Van Dijk E, Van Rood YR. Heart-focused anxiety as a mediating variable in the treatment of noncardiac chest pain by cognitive-behavioral therapy and paroxetine. J Psychosom Res. 2010;69(3):227–35.
van Peski-Oosterbaan AS, Spinhoven P, van Rood Y, van der Does JW, Bruschke AV, Rooijmans HG. Cognitive-behavioral therapy for noncardiac chest pain: a randomized trial. Am J Med. 1999;106(4):424–9.
Jonsbu E, Dammen T, Morken G, Moum T, Martinsen EW. Short-term cognitive behavioral therapy for non-cardiac chest pain and benign palpitations: a randomized controlled trial. J Psychosom Res. 2011;70(2):117–23.
Tyrer P, Tyrer H, Cooper S, Barrett B, Kings S, Lazarevic V, et al. Cognitive behaviour therapy for non-cardiac pain in the chest (COPIC): a multicentre randomized controlled trial with economic evaluation. BMC Psychol. 2015;3:41.
Jones H, Cooper P, Miller V, Brooks N, Whorwell PJ. Treatment of non-cardiac chest pain: a controlled trial of hypnotherapy. Gut. 2006;55(10):1403–8.
Miller V, Jones H, Whorwell PJ. Hypnotherapy for non-cardiac chest pain: long-term follow-up. Gut. 2007;56(11):1643.
Ng SC, Shi HY, Hamidi N, et al. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. Lancet. 2018;390(10114):2769–78.
Ananthakrishnan AN, Kaplan GG, Ng SC. Changing global epidemiology of inflammatory bowel diseases-sustaining healthcare delivery into the 21st century. Clin Gastroenterol Hepatol. 2020;18:1252–60.
• Li C, Hou Z, Liu Y, Ji Y, Xie L. Cognitive-behavioural therapy in patients with inflammatory bowel diseases: a systematic review and meta-analysis. Int J Nurs Pract. 2019;25(1):e12699. A systematic review and meta-analysis evaluating the effects of CBT in the treatment of patients with IBD.
•• Keefer L, Taft TH, Kiebles JL, Martinovich Z, Barrett TA, Palsson OS. Gut-directed hypnotherapy significantly augments clinical remission in quiescent ulcerative colitis. Aliment Pharmacol Ther. 2013;38(7):761–71. This was the first trial to demonstrate that psychological intervention may be able to affect the disease course in IBD.
Moss-Morris R, McAlpine L, Didsbury LP, Spence MJ. A randomized controlled trial of a cognitive behavioural therapy-based self-management intervention for irritable bowel syndrome in primary care. Psychol Med. 2010;40(1):85–94.
Everitt H, Moss-Morris R, Sibelli A, Tapp L, Coleman N, Yardley L, et al. Management of irritable bowel syndrome in primary care: the results of an exploratory randomised controlled trial of mebeverine, methylcellulose, placebo and a self-management website. BMC Gastroenterol. 2013;13:68.
Ljotsson B, Falk L, Vesterlund AW, et al. Internet-delivered exposure and mindfulness based therapy for irritable bowel syndrome--a randomized controlled trial. Behav Res Ther. 2010;48(6):531–9.
Ljotsson B, Hedman E, Andersson E, et al. Internet-delivered exposure-based treatment vs. stress management for irritable bowel syndrome: a randomized trial. Am J Gastroenterol. 2011;106(8):1481–91.
Blanchard EB, Lackner JM, Sanders K, Krasner S, Keefer L, Payne A, et al. A controlled evaluation of group cognitive therapy in the treatment of irritable bowel syndrome. Behav Res Ther. 2007;45(4):633–48.
Moser G, Tragner S, Gajowniczek EE, et al. Long-term success of GUT-directed group hypnosis for patients with refractory irritable bowel syndrome: a randomized controlled trial. Am J Gastroenterol. 2013;108(4):602–9.
Lackner JM, Jaccard J, Radziwon CD, Firth RS, Gudleski GD, Hamilton F, et al. Durability and decay of treatment benefit of cognitive behavioral therapy for irritable bowel syndrome: 12-month follow-up. Am J Gastroenterol. 2019;114(2):330–8.
Kinsinger SW, Ballou S, Keefer L. Snapshot of an integrated psychosocial gastroenterology service. World J Gastroenterol. 2015;21(6):1893–9.
Riehl ME, Kinnucan JA, Chey WD, Stidham RW. Nuances of the psychogastroenterology patient: a predictive model for gastrointestinal quality of life improvement. Neurogastroenterol Motil. 2019;31(9):e13663.
Lores T, Goess C, Mikocka-Walus A, et al. Integrated psychological care reduces healthcare costs at a hospital-based inflammatory bowel disease service. Clin Gastroenterol Hepatol. 2020.
Kiebles JL, Kwiatek MA, Pandolfino JE, Kahrilas PJ, Keefer L. Do patients with globus sensation respond to hypnotically assisted relaxation therapy? A case series report. Dis Esophagus. 2010;23(7):545–53.
Riehl ME, Keefer L. Hypnotherapy for esophageal disorders. Am J Clin Hypn. 2015;58(1):22–33.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflicts of interest.
Human and Animal Rights and Informed Consent
All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article is part of the Topical Collection on Large Intestine
Rights and permissions
About this article
Cite this article
Palsson, O.S., Ballou, S. Hypnosis and Cognitive Behavioral Therapies for the Management of Gastrointestinal Disorders. Curr Gastroenterol Rep 22, 31 (2020). https://doi.org/10.1007/s11894-020-00769-z
Published:
DOI: https://doi.org/10.1007/s11894-020-00769-z