Using gut-directed hypnotherapy to treat IBS can have long-lasting benefits.
When you have abdominal pain — and bathroom issues — wouldn’t it be wonderful if you could send your digestive tract soothing messages?
U.S. medical centers have begun to do just that — using “gut-directed hypnotherapy” to treat irritable bowel syndrome (IBS) and ulcerative colitis.
They’ve been looking especially for a new option to treat IBS, as up to half of IBS sufferers are dissatisfied with the results of standard medical management, and continue to have frequent symptoms like diarrhea, constipation, bloating, and sharp stabs of pain in the abdomen or continual aches.
For Anna*, IBS symptoms had become so unpredictable she was afraid to book trips. “When I filled out my symptom checklist,” she said, “I broke down and cried. I realized how much IBS had taken over my life.”
Nine months after completing an online hypnotherapy program, metaMe Connect, Anna says she’s returned to “normalcy.” She’s now able to plan ahead without worrying that she won’t be well. “I don’t have fear and I don’t make decisions based on fear,” she said.
Because IBS can be so difficult to treat, in the last decade, gut-directed hypnotherapy programs have spread around the country.
Mount Sinai in New York, the University of Michigan, Beth Israel Deaconess Medical Center in Boston, the University of Washington in Seattle, Baylor College of Medicine in Houston and Loyola University Medical Center and Northwestern Memorial Hospital in the Chicago area now offer or suggest hypnotherapy to IBS patients.
Gut-directed hypnotherapy is a form of hypnosis. Patients meet in person or by video-conference with a therapist, or listen to recordings that guide them step by step into a relaxed state.
Once patients enter the hypnotic state, they are taken through visualization exercises and hear suggestions designed to calm their digestive tract and wean them away from focusing on gut sensations.
Unlike a meditation tape anyone might pick up, this therapy has been standardized and tested — a key reason it has won acceptance from gastroenterologists at major hospitals.
More than 20 years ago, clinical psychologist Olafur Palsson, PsyD, at the University of North Carolina, in Chapel Hill, began using a specific set of scripts in a protocol that now has been studied extensively.
From 53 to 94 percent of IBS patients responded to the treatment, depending on the trial, with benefits lasting as long as a year.
The therapy addresses a problem that seems to accompany several gastrointestinal ailments: miscommunication between the gut and the brain. The smooth muscles of the intestinal wall can be hyper-reactive, altering the normal patterns of muscle contraction. Additionally, the brain can also be misinterpreting normal signals from the gut.
This disconnect between the gut and the brain can trigger the many possible symptoms of IBS — and play a role in other problems.
Hypnotherapy has been found to be most effective with abdominal pain, cutting it by an average of half or more in many studies.
“This is not a psychological issue, it’s neurological,” observes Daniel Bernstein, who has Crohn’s disease and who launched metaMe Connect. “You are retraining how your brain and gut communicate.”
Many people struggle with digestive symptoms but never mention them to a doctor. It’s common to try many remedies on your own — probiotics, avoiding spicy foods, or going gluten-free.
But after one or two close calls of barely making it to the bathroom, people begin to rearrange their lives to avoid crises.
Anna’s experience of growing fear is common.
“The things I was trying weren’t working, and it seemed to come out of nowhere,” she explained.
Over time, and especially in periods of stress, that fear makes the problem worse.
Getting a diagnosis is a step to effective help. To diagnose IBS — which is estimated to affect up to 15 percent of American adults — doctors look for these signs: at least three months with frequent abdominal pain that is relieved after you defecate and that originally began with a change in the frequency or quality of your stool.
IBS also tends to follow a stomach flu or round of antibiotics.
Blood in your stool, weight loss, fever, or anemia suggest other possible diagnoses. You should be checked for an autoimmune problem like Crohn’s, colitis, or celiac if you’re experiencing these symptoms. You may also want to have a radiologic test of your abdomen looking for growths.
By definition, IBS does not have one clear cause. But new science has been suggesting possible factors like genetic variations and altered gut microbiomes for subgroups of patients, Palsson notes.
One of the more common treatments is the low-FODMAPs diet, which rules out many vegetables and fruits as well as gluten. FODMAPS stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, all molecules in food.
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The program takes three months to complete and requires daily attention. Patients receive a 15-minute recording to listen to every day, or at least five times a week.
They also have seven 40-minute sessions with a therapist (either in person or in a video conference) at two-week intervals.
During the sessions, listeners are invited to an imaginary setting and asked to visualize a number of images such as a mountain cabin with thick and strong walls that “allow you to be comfortable and at ease inside no matter how ferociously the winter storms blow outside.” They’ll also hear reassurance in the scripts that they don’t need to be successful at visualizing, just to experience what they can.
The scripts do not address diarrhea or constipation or any other symptom directly. Instead, they describe the goal, with suggestions such as: “You become more comfortable and healthy every day, undisturbed and peaceful inside like this beautiful secluded garden.”
A hypnotic state doesn’t look strange to an observer, though it’s ideal to listen to the script in privacy, without any risk of interruption. After the trance, people are completely alert, so it’s possible to listen at any time of day.
The imaginary play makes the program seem ideal for children with digestive trouble, typically unexplained abdominal pain.
Colicky infants, toddlers with heartburn, and any child with chronic unexplained diarrhea or constipation, sometimes accompanied by nausea, dizziness, and pain may have IBS.
Working with Palsson, his colleague Miranda van Tilburg, PhD, developed a shorter protocol designed for at-home use by children ages 6 to 12.
These sessions invite listeners to float on a cloud, drift on the ocean in a gently rocking boat, or fly a magic carpet controlled by their mind. In shorter sessions, they go down a slide, swing on a swing, ride a sleigh on a snowy mountain, or bounce on the moon.
Because children often rub their painful stomach or ask for heating pads, the kids’ tapes describe a brightly shining gem-like object with magic healing properties, which melts into the hand like butter, and can heal.
In another tape, children hear that their favorite drink applies a protective coating to their stomach, and each time they drink it, the coating gets thicker.
Six months after completion, more than 60 percent of children who went through this program had maintained their progress, cutting symptoms by at least half, the team reports, adding “most children with both abdominal pain and headaches reported improvements in both.
Additionally, many parents reported improvements in sleep and focus at school.”
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Part of the attraction of the North Carolina protocol is that it’s designed to work with a wide variety of patients, whether they have diarrhea, constipation, or pain. Patients do not need to be especially receptive to suggestion for hypnotherapy to succeed.
However, anxiety is a disadvantage. “Hypnotherapy works best with people who don’t have a lot of anxiety about their symptoms, but really feel it physically, rather than people who spend time in their heads, avoiding situations or worrying about how to cure themselves,” explained Laurie Keefer, PhD, the Director for Psychobehavioral Research with the Division of Gastroenterology at Mount Sinai in New York.
The second group might do better with cognitive behavioral therapy (CBT), which teaches you how to change your mental habits.
People also might have more trouble with hypnotherapy if they’re skeptical or depressed. “You have to be open to it,” Keefer observed. “People with depression or anxiety tend to struggle with it, and a therapist would work to address the barriers. You might do breathing exercises or a progressive muscle relaxation exercise at the beginning of each of the longer sessions.”
Another disadvantage: The three-month program requires patience.
“Most patients don’t see progress until their fourth or fifth session, and sometimes even later than that,” notes Bernstein.
However, researchers are investigating ways to shorten the program, Keefer notes.
To find a local practitioner using the North Carolina model, check the site ibshypnosis.com.
*Name has been changed to protect privacy.