Gut-directed hypnotherapy delivered by psychologists for the management of irritable bowel syndrome (IBS) appears as effective in group or individual sessions, potentially offering a more accessible treatment option.
A Dutch study, published in The Lancet Gastroenterology & Hepatology, randomised 354 adults with IBS to fortnightly, 45-minute individual hypnotherapy sessions, 60-minute group sessions or education and supportive care.
After twelve weeks of treatment, adequate relief of IBS symptoms was reported by more patients who received individual (40% of the group) and group hypnotherapy (33%) than those given education and supportive care (17%).
The benefits persisted through to follow-up at 12 months with 42%, 50%, and 22% of patients in each group respectively reporting adequate relief.
However patients from all three groups showed improvements in IBS symptom severity, quality of life, psychological complaints, IBS-related cognitions, and self-efficacy from baseline, with slightly better outcomes for the hypnotherapy treatments than controls.
In all groups, total medical costs diminished between baseline and 12 months.
“In our trial, better adequate relief scores were not accompanied by significant improvements in IBS symptom scores,” the study’s authors said.
“The explanation for this finding might be that, in contrast to educational therapy, hypnotherapy improves the perception of IBS symptoms without having a major effect on symptom severity.”
“Thus, the main effect of hypnotherapy might be diminishing the impact of symptoms on patients by changing their mind-set and improving internal coping mechanisms.”
They said their findings add to the existing evidence that hypnotherapy is effective in patients with refractory IBS seen in tertiary care. They found patients referred by a specialist were more likely to respond than patients referred by their GP.
Writing in a linked Comment, Professor Olafur Palsson, from the University of North Carolina in the US, said the therapeutic impact of hypnosis in the study was only modest at best.
He said the hypnotherapy might have been suboptimal in amount or implementation.
“However, as the authors note, the smaller therapeutic effect in this trial compared with most hypnotherapy trials in tertiary care might have been because IBS in primary and secondary care is different to that in tertiary care—perhaps simpler in nature and with less involvement of psychological factors.”
“Therefore, despite this impressive investigative effort by Flik and colleagues, it remains unclear whether gut-directed hypnotherapy is well suited for the treatment of patients with IBS in primary and secondary care, and future trials are needed to provide definitive answers.”
The study said more research was required to determine the optimum number of hypnotherapy sessions, the effect that patient expectations may have on outcomes, and the extent to which hypnotherapy outcomes are influenced by the magnitude of the psychological complaints of the patient.
Gut-directed hypnotherapy is included as a management option in GESA’s IBS Online Tool for GPs launched earlier this year.
It says hypnotherapy can be effective in 70-80% of patients after an average of 6-7 sessions.