Hypnosis Treatment for Severe Irritable Bowel Syndrome: Investigation of Mechanism and Effects on Symptoms

Abstract

Hypnosis improves irritable bowel syndrome (IBS), but the mechanism is unknown. Possible physiological and psychological mechanisms were investigated in two studies. Patients with severe irritable bowel syndrome received seven biweekly hypnosis sessions and used hypnosis audiotapes at home. Rectal pain thresholds and smooth muscle tone were measured with a barostat before and after treatment in 18 patients (study I), and treatment changes in heart rate, blood pressure, skin conductance, finger temperature, and forehead electromyographic activity were assessed in 24 patients (study II). Somatization, anxiety, and depression were also measured. All central IBS symptoms improved substantially from treatment in both studies. Rectal pain thresholds, rectal smooth muscle tone, and autonomic functioning (except sweat gland reactivity) were unaffected by hypnosis treatment. However, somatization and psychological distress showed large decreases. In conclusion, hypnosis improves IBS symptoms through reductions in psychological distress and somatization. Improvements were unrelated to changes in the physiological parameters measured.

This is a preview of subscription content, log in to check access.

REFERENCES

  1. 1.

    Thompson WG, Longstreth GF, Drossman DA, Heaton KW, Irvine EJ, Muller-Lissner SA: Functional bowel disorders and functional abdominal pain. Gut 45:43–47, 1999

    Google Scholar 

  2. 2.

    Thompson WG, The Working Team for Functional Bowel Disorders: Functional bowel disorders and functional abdominal pain. In The Functional Gastrointestinal Disorders. DA Drossman, JE Richter, NJ Talley, WG Thompson, E Corazziari, WE Whitehead (eds.). McLean, Virginia, Degnon Associates, 1994, pp 115–173

    Google Scholar 

  3. 3.

    Thompson WG, Heaton KW, Smyth GT, Smyth C: Irritable bowel syndrome: the view from general practice. Eur J Gastroenterol Hepatol 9:689–692, 1997

    Google Scholar 

  4. 4.

    Drossman DA, Li ZM, Andruzzi E, Temple RD, Talley NJ, Thompson WG, Whitehead WE, Janssens J, Funchjensen P, Corazziari E, Richter JE, Koch GG: United-States householder survey of functional gastrointestinal disorders–prevalence, sociodemography, and health impact. Dig Dis Sci 38:1569–1580, 1993

    Google Scholar 

  5. 5.

    Levy RL, Von Korff M, Whitehead WE, Stang P, Saunders K, Jhingran P, Barghout V, Feld AD: Costs of care for irritable bowel syndrome patients in a health maintenance organization. Am J Gastroenterol 96:3122–3129, 2001

    Google Scholar 

  6. 6.

    Drossman D.A., Creed FH, Olden KW, Svedlund J, Toner BB, Whitehead WE: Psychosocial aspects of the functional gastrointestinal disorders. In Rome II: The Functional Gastrointestinal Disorders. DA Drossman, E Corazziari, NJ Talley, WG Thompson, and WE Whitehead (eds). McClean, Virginia, Degnon Associates, 2000, pp 157–246.

    Google Scholar 

  7. 7.

    Whorwell PJ, Prior A, Colgan SM: Hypnotherapy in severe irritable-bowel-syndrome–further experience. Gut 28:423–425, 1987

    Google Scholar 

  8. 8.

    Whorwell PJ, Prior A, Faragher EB: Controlled trial of hypnotherapy in the treatment of severe refractory irritable-bowel syndrome. Lancet 2:1232–1234, 1984

    Google Scholar 

  9. 9.

    Galovski TE, Blanchard EB: The treatment of irritable bowel syndrome with hypnotherapy. Appl Psychophysiol Biofeedback 23:219–232, 1998

    Google Scholar 

  10. 10.

    Harvey RF, Hinton RA, Gunary RM, Barry RE: Individual and group hypnotherapy in treatment of refractory irritable bowel syndrome. Lancet 1:424–425, 1989

    Google Scholar 

  11. 11.

    Whitehead WE, Engel BT, Schuster MM: Irritable bowel syndrome–physiological and psychological differences between diarrhea-predominant and Constipation-Predominant patients. Digestive-Diseases and Sciences 25:404–413, 1980

    Google Scholar 

  12. 12.

    Mertz H, Naliboff B, Munakata J, Niazi N, Mayer EA: Altered rectal perception is a biological marker of patients with irritable bowel syndrome. Gastroenterology 109:40–52, 1995

    Google Scholar 

  13. 13.

    Ritchie R: Pain from distention of the pelvic colon by inflating a balloon in the irritable colon syndrome. Gut 14:125–132, 1973

    Google Scholar 

  14. 14.

    Bouin, M., Plourde, V., Boivin, M., Riberdy, M., Lupien, F., Laganiere, M., Verrier, P., Poitras, P: Rectal distension testing in patients with irritable bowel syndrome: sensitivity, specificity and predictive values of pain thresholds. Gastroenterology 122:1771–1777, 2002

    Google Scholar 

  15. 15.

    Whitehead WE, Palsson OS: Is rectal pain sensitivity a biological marker for irritable bowel syndrome: Psychological influences on pain perception. Gastroenterology 115:1263–1271, 1998

    Google Scholar 

  16. 16.

    Naliboff BD, Munakata J, Fullerton S, Graceley RG, Kodner A, Harraf F, Mayer EA: Evidence for two distinct perceptual alterations in irritable bowel syndrome. Gut 41:505–512, 1997

    Google Scholar 

  17. 17.

    Hilgard E, Hilgard JR: Hypnosis in the Relief of Pain. Los Altos; California, Kaufmann, 1975

    Google Scholar 

  18. 18.

    Meier W, Klucken M, Soyka D, Bromm B: Hypnotic hypo-and hyperalgesia: divergent effects on pain ratings and pain-related cerebral potentials. Pain 53:175–181, 1993

    Google Scholar 

  19. 19.

    Moret V, Forster A, Laverriere MC, Lambert H, Gaillard RC, Bourgeois P, Haynal A, Gemperle M, Buchser E: Mechanism of analgesia induced by hypnosis and acupuncture: is there a difference? Pain 45:135–140, 1991

    Google Scholar 

  20. 20.

    Houghton LA, Larder, SA, Lee, R, Gonsalkorale, WM, Whelan, V, Randles, J, Cooper, P, Cruikshanks, P, Miller, V, Whorwell PJ: Gut focused hypnotherapy normalizes rectal hypersensitivity in patients with irritable bowel syndrome (IBS). Gastroenterology 116:A1009, 1999 (Abstract)

    Google Scholar 

  21. 21.

    Kellow JE, Phillips SF, Miller LJ, and Zinsmeister AR: Dysmotility of the small intestine in irritable bowel syndrome. Gut 29:1236–1243, 1988

    Google Scholar 

  22. 22.

    Kellow JD, Gill RC, Wingate DL: Prolonged ambulant recordings of small bowel motility demonstrate abnormalities in the irritable bowel syndrome. Gastroenterology 98:1208–1218, 1990

    Google Scholar 

  23. 23.

    Schmidt T, Hackelsberger N, Widmer R, Meisel C, Pfeiffer A, Kaess H: Ambulatory 24-hour jejunal motility in diarrhea predominant irritable bowel syndrome. Scandi J Gastroentero 31:581–589, 1996

    Google Scholar 

  24. 24.

    Welgan P, Meshkinpour H, Beeler M: Effect of anger on colon motor and myoelectric activity in irritable bowel syndrome. Gastroenterology 94:1150–1156, 1988

    Google Scholar 

  25. 25.

    Whitehead WE, Crowell MD, Davidoff AL, Palsson OS, Schuster MM. Pain from rectal distension in women with irritable bowel syndrome–relationship to sexual abuse. Digestive Diseases and Sciences 42:796–804, 1997

    Google Scholar 

  26. 26.

    Camilleri M, Ford MJ: Functional gastrointestinal disease and the autonomic nervous system: a way ahead? Gastroenterology 106:1114–1118, 1994

    Google Scholar 

  27. 27.

    Palsson O, Downing B: Psychophysiological characteristics of patients with irritable bowel syndrome. Appl Psychophysiol Biofeedback 25:88, 1999

    Google Scholar 

  28. 28.

    Payne A, Blanchard EB, Holt CS, Schwarz SP: Physiological reactivity to stressors in irritable bowel syndrome patients, inflammatory bowel disease patients and non-patient controls. Behav Res Ther 30:293–300, 1992

    Google Scholar 

  29. 29.

    Hinninghofen H, Musial, F, and Enck, P: Autonomic function tests in patients with irritable bowel syndrome (IBS) and healthy controls. Gastroenterology 112, A747, 1997 (Abstract)

    Google Scholar 

  30. 30.

    Lee KT, Kim JH, Koh KC, Paik SW, Rhee JC, Kim JS: Assessment of autonomic tone over a 24-hour period in patients with irritable bowel syndrome. Gastroenterology 112:A773, 1997 (abstract)

    Google Scholar 

  31. 31.

    Levy RL, Whitehead WE, Von Korff MR, Feld AD: Intergenerational transmission of gastrointestinal illness behavior. Am J Gastroenterology 95:451–456, 2000

    Google Scholar 

  32. 32.

    Talley NJPSF, Bruce B, Zinsmeister AR, Wiltgen C, Melton LJ: Multisystem complaints in patients with the irritable bowel syndrome and functional dyspepsia. European Journal of Gastroenterology & Hepatology 3:71–77, 1991

    Google Scholar 

  33. 33.

    Derogatis L: SCL-90-R: Administration, Scoring, and Procedures Manual. Minneapolis Minnesota, National Computer Systems, 1994

    Google Scholar 

  34. 34.

    Beck A, Steer R, Brown G: The Beck Depression Inventory. San Antonio, Texas, Harcourt Brace, 1996

    Google Scholar 

  35. 35.

    Whitehead WE, Delvaux M, Azpiroz F, Barlow J, Bradley L, Camilleri M, Crowell MD, Enck P, Fioramonti J, Track J, Mayer EA, Morteau O, Phillips SF, Thompson DG, Wingate DL: Standardization of barostat procedures for testing smooth muscle tone and sensory thresholds in the gastrointestinal tract. Dig Dis Sci 42:223–241, 1997

    Google Scholar 

  36. 36.

    Gracely RH, Dubner R, McGrath PA: Narcotic analgesia: fentanyl reduces the intensity but not the unpleasantness of painful tooth pulp sensations. Science 203:1261–1263, 1979

    Google Scholar 

  37. 37.

    Palsson O, Boregowda S, Downing B: The relationship between the objective stress index (OSI) and stress-related physical symptoms. Appl Psychophysiol Biofeedback 23:125, 1998

    Google Scholar 

  38. 38.

    Palsson O, Davies S, Downing B: Psychological modulators of cardiovascular reactions to cognitive stress. Appl Psychophysiol Biofeedback 23:108, 1998

    Google Scholar 

  39. 39.

    McAllister C, McGrath F, Fielding JF: Altered skin temperature and electromyographic activity in the irritable bowel syndrome. Biomed Pharmacother 44:399–401, 1990

    Google Scholar 

  40. 40.

    Stroop J: Studies of interference in serial verbal reactions. J Exp Psychol 18:643–662, 1935

    Google Scholar 

  41. 41.

    Houghton LA, Heyman DJ, Whorwell PJ: Symptomatology, quality of life and economic features of irritable bowel syndrome-the effect of hypnotherapy. Aliment Pharmacol Ther 10:91–95, 1996

    Google Scholar 

  42. 42.

    Lipowski ZJ: Somatization: the concept and its clinical application. Am J Psychiatry 145:1358–1368, 1988

    Google Scholar 

  43. 43.

    Prior A, Colgan SM, Whorwell PJ: Changes in rectal sensitivity after hypnotherapy in patients with irritable bowel syndrome. Gut 31:896–898, 1990

    Google Scholar 

Download references

Author information

Affiliations

Authors

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Palsson, O.S., Turner, M.J., Johnson, D.A. et al. Hypnosis Treatment for Severe Irritable Bowel Syndrome: Investigation of Mechanism and Effects on Symptoms. Dig Dis Sci 47, 2605–2614 (2002). https://doi.org/10.1023/A:1020545017390

Download citation

  • irritable bowel syndrome
  • somatization
  • psychological distress
  • autonomic nervous system
  • hypnosis
  • barostat