Hypnotherapy and the treatment of Irritable Bowel Syndrome

by Tony Edwards

Hello there. My name is Tony Edwards and I am a Hypnotherapist and Psychotherapist in private practice in Colchester and am the author of several SNHS course including Advanced Hypnotherapy.

What is Irritable Bowel Syndrome?

Irritable Bowel Syndrome (IBS) is a common disorder of the intestines that leads to cramp-like pains, gassiness, bloating, and noticeable changes in bowel habits. The symptoms of IBS can be different in each sufferer. Some people with IBS suffer from constipation, that is to say difficult or infrequent bowel movements. Others suffer from diarrhoea with frequent loose stools, often accompanied by an urgent need to move the bowels. A further set of sufferers experience both. Sometimes the person with IBS has a cramp-like urge to move the bowels but is completely unable to do so.

Although symptoms can be observed to vary between individuals, the following list sets out some common symptoms of IBS:

• Abdominal pain and discomfort
• Abdominal contractions, spasms, or cramps
• Diarrhoea
• Constipation
• Bloating
• Nausea
• Excess wind
• Vomiting
• Indigestion

IBS sufferers may experience a combination of some of these symptoms, with one symptom in particular occurring more regularly or with greater severity. The symptoms vary from the mild, where the quality of life is not really affected, to the extremely severe, prompting the sufferer to seek medical assistance.

The nature of symptoms exhibited by IBS sufferers is such that all complementary therapists dealing with what, by the client’s description of symptoms, is apparently IBS should ensure that their client has already been examined by their medical practitioner, and that no structural cause for the symptoms has been found. Only when it has been established by a qualified doctor that no structural cause can be determined should complementary therapies be employed. If a client has not sought medical opinion then a responsible therapist must ensure that this was their client’s first concern. Because Irritable Bowel Syndrome is such a loose collection of symptoms, there is no one definitive ‘cure’ for IBS. However, there are a number of self-help treatments that can alleviate and improve symptoms, such as diet and complementary therapies such as hypnosis.

Through the years, IBS has been called by many names; colitis, mucous colitis, spastic colon, spastic bowel, and functional bowel disease. However the majority of these terms are inaccurate. For example, Colitis means inflammation of the large intestine, the colon. IBS, however, does not cause inflammation and therefore should not be confused with another disorder, ulcerative colitis.

The cause of IBS is not known, and as yet there is no absolute cure. A doctor of medicine would call it a functional disorder because there is no sign of any disease when the colon is examined. IBS causes a great deal of discomfort and distress, but it does not appear to cause permanent harm to the intestines and does not lead to intestinal bleeding of the bowel or to the development of serious diseases such as cancer. For some people IBS is just a mild annoyance, but for others it can be completely disabling. Those who suffer greatly may be unable to go to social events, unable to go to work, or even to travel even short distances. Fortunately most people with IBS do manage to control their symptoms through medications prescribed by their physicians, management of diet, stress management, and hypnotherapy.

The colon, which is about 6 feet long, connects the small intestine with the rectum and anus. The major function of the colon is to absorb water and salts from digestive products that enter from the small intestine. Around two litres of liquid matter enter the colon from the small intestine each day. This material may remain there for several days until most of the fluid and salts are absorbed into the body. The stool then passes through the colon by a pattern of movements to the left side of the colon, where it is stored until a bowel movement occurs.

For many people, eating a proper diet lessens IBS symptoms. However, before a person changes their diet it would be advisable for them to keep a journal noting which foods seem to cause distress. These findings can then be discussed with a dietician or medical adviser. A change in diet can help IBS symptoms, even though such symptoms vary between different people. So do peoples’ reactions to different foods vary. In general terms, a change of diet to increase the amount of soluble fibre can be extremely beneficial. To achieve this the diet should contain more fruit, vegetables, and wholegrain foods, coupled with plenty of fresh drinking water. Some foods can be potential irritants and their consumption will trigger IBS symptoms.

Typical foodstuffs known to trigger symptoms of IBS are:

• caffeine
• alcohol
• spicy foods
• wheat
• citrus fruits

Foods that are considered to be beneficial are:

• soya milk
• bio-yoghurt
• peppermint tea
• cod
• chicken
• asparagus
• artichokes
• carrots
• bananas

The potential for abnormal function of the colon is always present in people with IBS, but in order for symptoms to present themselves there must be some form of trigger event. As I have already mentioned, evidence suggests the most likely culprits are diet and emotional stress. Many people report that their symptoms occur following a meal or when they are under stress. No one is sure why this happens, but scientists have some clues. Understanding IBS is important because it is easily confused with other similar digestive disorders, such as inflammatory bowel diseases.

How Hypnotherapy can help with IBS

As pointed out above, one of the main trigger causes of IBS is stress. It is stress that sets off the stomach cramps, spasms, or other symptoms given above.
Powerful emotions like anger, aggression, fear and depression trigger the body’s stress response. Basically this is the flight/fight reaction to a stressful situation. This in turn can affect the body’s ability to digest food because our digestive system works better when we are relaxed.

When people have experienced upsetting incidents in the past the emotional memories of those events can stay inside the mind. This leads to an over sensitivity to current day stresses. With these repressed under current of stress permanently present, the body often develops problems with digestion. These digestive problems lead in turn to the physical symptoms of irritable bowel syndrome that we have already discussed.
Hypnotherapy can be effective by helping the sufferer to relax, thus easing the symptoms that are causing stress. Hypnotherapy can be effective in teaching powerful creative visualisation techniques, for example, getting the subject to imagine the symptoms being relieved. When the subject is in a hypnotic trance the unconscious mind becomes receptive to suggestion. In fact, once the conscious mind’s censor has been by-passed and the unconscious mind has accepted a suggestion, then that suggestion must be implemented. In other words an accepted suggestion must be followed by motor action; the motor action in this case is the relief and control of IBS symptoms.

One approach that has proved an important breakthrough in treatment is known as Gut Directed Hypnotherapy. This was developed around twenty years ago by Manchester doctor Peter Whorwell and research has shown it can obtain relief of symptoms for 60-80% of sufferers. More importantly, follow-up studies have indicated that where improvements occur they tend to be long-lasting (rather than offering just temporary relief). The approach involves induction of hypnosis followed by a sequence of suggestions aimed at normalising bowel movements and removing pain and bloating. Treatment is usually short-term. In-between sessions, individuals listen to a specially designed tape on a daily basis to reinforce the treatment. They also monitor their progress by completing various charts.

In the United States of America, Hypnotherapy has in fact proven highly effective in alleviating all of the various IBS symptoms. In one recent study, Dr. Olafur S. Palsson and colleagues at the Eastern Virginia Medical School in Norfolk, Virginia, USA, provided 24 IBS patients, 15 women and 9 men, with seven sessions of hypnosis treatment. In addition, the patients used hypnosis audiotapes at home. At the end of the 14-week study period, 21 of the 24 patients “rated themselves improved in all central IBS symptoms after treatment,” the researchers report. Significant improvement was found in abdominal pain, bloating, stool consistency and bowel movement frequency. Palsson’s group also measured the autonomic nervous system, which regulates the digestive system and other involuntary body activities. After the course of hypnotherapy, the autonomic nervous system was less easily stimulated. The researchers propose that this calming effect “may plausibly contribute to the symptom improvement”. [Palsson O, Turner M, Johnson D. Hypnotherapy for irritable bowel syndrome: symptom improvement and autonomic nervous system effects. Program and abstracts of Digestive Disease Week 2000; May 21-24, 2000; San Diego, California. Abstract 997].

Over 15 years of solid scientific research has demonstrated hypnotherapy as an effective, safe and inexpensive choice for IBS symptom alleviation. It has been so overwhelmingly successful in this regard that Adriane Fugh-Berman, MD, chair of the National Women’s Health Network in Washington, DC, USA, has said that “hypnosis should be the treatment of choice for IBS cases which have not responded to conventional therapy”. In view of the fact that the “conventional therapy” offered to most IBS patients ranges from nothing at all to a lifetime prescription for semi-effective anti-spasmodic drugs, this statement may be taken as the closest thing to a whole-hearted endorsement a complementary therapy can hope to get from mainstream medicine.

For IBS, one of hypnotherapy’s greatest benefits is its well-established ability to reduce the effects of stress. The subject’s state of mind can have a direct impact on their physical well-being, even when they are in the best of health. If a person is struggling with IBS, the tension, anxiety, and depression that comes from living with an incurable illness can actually undermine the defensive abilities of the immune system and further compromise basic health. Hypnotherapy can reduce this stress and its resultant negative impact by placing the sufferer in a deeply relaxed state, promoting positive thoughts and coping strategies, and clearing the mind of its negative attitudes.

IBS in fact is uniquely suited to treatment by hypnotherapy for several reasons. First, as just noted, stress-related attacks can be significantly reduced. Second, one of the most impressive aspects from hypnotherapy, and of tremendous benefit to IBS sufferers, is its well-documented ability to relieve virtually all types and degrees of pain.

Despite the fact that the neural mechanisms underlying the modulation of pain perception by hypnosis remain obscure, its effects are definitely real. One recent study, using positron emission tomography to identify the brain areas in which hypnosis modulates cerebral responses to a noxious stimulus found that noxious stimulation caused an increase in regional cerebral blood flow in the thalamic nuclei and anterior cingulate and insular cortices. It concluded that: “The hypnotic state induced a significant activation of a right-sided extrastriate area and the anterior cingulate cortex. The interaction analysis showed that the activity in the anterior (mid-)cingulate cortex was related to pain perception and unpleasantness differently in the hypnotic state than in control situations. The result of the study was the realisation that Hypnosis decreased both pain sensation and the unpleasantness of noxious stimuli. the conclusions of the study where that both intensity and unpleasantness of the noxious stimuli are reduced during the hypnotic state. In addition to this it was found that hypnotic modulation of pain is mediated by the anterior cingulate cortex.” [Neural mechanisms of antinociceptive effects of hypnosis. Faymonville ME, Laureys S, Degueldre C, DelFiore G, Luxen A, Franck G, Lamy M, Maquet P. Departments of Anesthesiology and Intensive Care Medicine and Neurology, and the Cyclotron Research Centre, University Hospital of Liege, Liege, Belgium. Anesthesiology 2000 May;92(5):1257-67].

An important point to note is that IBS is not a disease at all but a syndrome. If sufferers can prevent the symptoms, or be released from them, then they have effectively been cured of the disorder. The underlying dysfunction may still be present but if the subject no longer suffers noticeable effects from it, then they will be living an IBS-free life. This outcome is a definite possibility from hypnotherapy treatments.
As with many other alternative therapies, though there is solid evidence that hypnotherapy can provide lasting health benefits for many patients, there is uncertainty about precisely how and why the treatments work. Most scientists believe that hypnotherapy acts upon the unconscious, and affects the body’s regulation of involuntary reactions that are normally beyond a person’s control. Hypnotherapy puts these autonomic responses under the patient’s power. Fortunately, treatment is suitable for people of all ages and physical conditions, as there are no risks or side effects.

How are hypnotherapy treatments for IBS conducted?

The preferred manner is a series of one-to-one sessions with a qualified hypnotherapist in his or her consulting room, coupled with the use of self-hypnosis at home to the hypnotherapist’s direction. The therapist should discuss the client’s IBS symptoms together with what the client hopes to achieve in terms of reduction of discomfort.

The client then lies down in a comfortable position on a couch and the therapist uses one of several techniques to induce the state of hypnosis. Once this state is entered the client will feel deeply relaxed, and he or she will then be asked to stop thinking consciously. As stress, worries, pain, and negative thoughts are cleared from the mind the client focuses with intense concentration on the instructions the hypnotherapist is giving. The suggestions offered by the hypnotherapist may use imagery or other creative thinking to help the symptoms diminish or disappear once the client has returned to a normal waking state.

As with all endeavours of this nature, to achieve results, a patient needs self-motivation, repetition, and believable suggestions. For IBS sufferers, the first requirement is practically a moot point. No one is more likely to want an improvement in their health than an IBS sufferer. Having this clear intention and motivation for change will help the hypnotic suggestions take hold in the subconscious to the end that there will be successful outcomes to the treatment in the client’s daily life.

Repetition of the suggestions must be reinforced by further repetition. Typically, hypnotherapy sessions need to be repeated on a regular basis until an improvement becomes noticeable. The therapist may also give the client a specially prepared CD-Rom to listen to on the days when the client does not have an personal session with the hypnotherapist. generally speaking, a single hypnotherapy session or two will not be enough to overcome IBS – it will take a little time and dedication to therapy on the part of the client.

A very important point underlying successful hypnotherapy is the use of believable suggestions. If the client’s subconscious is to accept a suggestion, the conscious mind must first allow that the suggestion itself is a real possibility. This is why it is crucial that a hypnotherapist be knowledgeable about the particular clinical problem, be it IBS or otherwise. The hypnotherapist needs to know how it physically and emotionally affects the client, and what constitutes a realistic approach to the client’s symptoms.

Bibliography
Hypnosis to Help Irritable Bowel Syndrome (IBS) CD ~Charles Vald
IBS for Dummies by Carolyn Dean & Christine Wheeler
IBS (Irritable Bowel Syndrome): The First Year by Heather Van Vorous

Tony Edwards is certified as a Registered Clinical Hypnotherapist within the General Hypnotherapy Register and by the validation board of the General Hypnotherapy Standards Council. He has earned advanced qualifications in Clinical Hypnotherapy and Hypnoanalysis. He has further advanced qualifications in Psychotherapy and Behaviour Modification, in Stress Management and Consultancy, in Transpersonal Psychology and in Meridian Energy Therapies.

Tony is a Member of the International Association of Hypnoanalysts, a Member of the British Institute of Hypnotherapy, and a Fellow of the Royal Society for the Promotion of Health. He is also a Member of the Association for Meridian Energy Therapies and other professional bodies concerned with Hypnotherapy and Psychotherapy. He is a Member of the NHS Directory of Complementary and Alternative Practitioners and is a Member of the Past Life Therapists Association.

Tony may be contacted by telephone at: +44 (0)1206 503561

© A J Edwards, Colchester, Essex, 2006