Irritable Bowel Syndrome (IBS) is a common condition which can cause a range of symptoms including abdominal pain, nausea, diarrhoea, bloating, excess wind and constipation which can significantly affect quality of life (1). There are no definitive tests that diagnose IBS but other causes such as coeliac disease or inflammatory bowel disease can be ruled out with blood or stool tests. It can be frustrating however to be left with symptoms and no clear cause once investigations have been all clear, but it may help to recognise that IBS is classified as a ‘disorder of gut brain interaction (DGBI)’ because research has identified that in IBS there is a miscommunication between the gut, the gut microbiome and the brain (2). This results in changes in gut motility, visceral hypersensitivity (so you notice sensations at a lower level) and immune function and can also impact mood (3). That is not to say that IBS is ‘all in the mind’ though, they are real symptoms that can impact on quality of life and whether they were triggered by a stressful event, an infection or other causes, the signalling between the brain and gut can be addressed with hypnotherapy.
Professor Peter Whorwell first developed gut directed hypnotherapy (GDH) and published work on this in 1984 (4) so it is not a new therapy, but unfortunately only a few centres currently provide GDH within the NHS despite it being recommended by the National Institute of Care and Clinical Excellence (NICE) (1) and the British Society of Gastroenterology (5). GDH involves the use of imagery and metaphors to calm the gut, reduce pain and gut reactivity and normalise bowel function once a deep state of relaxation has been induced. Metaphors that might be used include picturing the gut as a river and modifying the flow of the river depending on whether the individual has constipation or diarrhoea (6). Or abdominal pain may be soothed by feeling warmth coming from a hand placed on the abdomen (6) or picturing a wave of soothing medication passing through the gut (7).
Over the last 40 years, many researchers have shown that GDH can be beneficial when given individually (6-8), in group settings (9) and online (10). They have also shown that it can help improve non-colonic symptoms such as nausea, early satiety and fatigue, and also mood and quality of life (6-9). One study also found it to be as effective as a low FODMAP diet (11). Benefit may be found from courses of between 6 and 12 sessions (12, 13) so it is not a quick fix and participants do need to be prepared to attend sessions and practice with recordings in between.
Following our training with BSCAH, we set up The Contented Gut (www.thecontentedgut.com) to provide online group courses of GDH using validated scripts, in order to provide an affordable and accessible option to as many people as possible. We do not expect or ask participants to share any personal information or converse with others in the group unless they wish to, but participants often find the rapport and support from other group members helpful and the dedicated time set aside in their diary helps them to maintain the regular practice. For those not wanting to take part in a group however, individual sessions using the published scripted protocols or other techniques with us or other BSCAH therapists can be an effective way of gaining control over IBS symptoms.
Liane Reeves
References
1. National Institute for Health and Care Excellence. Addendum to NICE guideline CG61, irritable bowel syndrome in adults : diagnosis and management of irritable bowel syndrome in primary care. NICE guideline CG61 1 [Internet]. 2015 29 March 2021:[1 online resource ( PDF file (319 pages)) p.]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK550725/ NLM Bookshelf Books.
2. Drossman DA, Hasler WL. Rome IV-Functional GI Disorders: Disorders of Gut-Brain Interaction. Gastroenterology. 2016;150(6):1257-61.
3. Mayer EA, Nance K, Chen S. The Gut-Brain Axis. Annu Rev Med. 2022;73:439-53.
4. Whorwell PJ, Prior A, Faragher EB. Controlled trial of hypnotherapy in the treatment of severe refractory irritable-bowel syndrome. Lancet. 1984;2(8414):1232-4.
5. Vasant DH, Paine PA, Black CJ, Houghton LA, Everitt HA, Corsetti M, et al. British Society of Gastroenterology guidelines on the management of irritable bowel syndrome. Gut. 2021;70(7):1214-40.
6. Vasant DH, Whorwell PJ. Gut-focused hypnotherapy for Functional Gastrointestinal Disorders: Evidence-base, practical aspects, and the Manchester Protocol. Neurogastroenterol Motil [Internet]. 2019 08 PMC6850508]; 31(8):[e13573 p.]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30815936.
7. Palsson OS. Standardized hypnosis treatment for irritable bowel syndrome: the North Carolina protocol. Int J Clin Exp Hypn. 2006;54(1):51-64.
8. Miller V, Carruthers HR, Morris J, Hasan SS, Archbold S, Whorwell PJ. Hypnotherapy for irritable bowel syndrome: an audit of one thousand adult patients. Aliment Pharmacol Ther. 2015;41(9):844-55.
9. Lövdahl J, Törnblom H, Ringström G, Palsson OS, Simrén M. Randomised clinical trial: individual versus group hypnotherapy for irritable bowel syndrome. Aliment Pharmacol Ther. 2022;55(12):1501-11.
10. Hasan SS, Vasant D. The Emerging New Reality of Hypnosis Teletherapy: A Major New Mode of Delivery of Hypnotherapy and Clinical Hypnosis Training. Int J Clin Exp Hypn. 2023;71(2):153-64.
11. Peters SL, Yao CK, Philpott H, Yelland GW, Muir JG, Gibson PR. Randomised clinical trial: the efficacy of gut-directed hypnotherapy is similar to that of the low FODMAP diet for the treatment of irritable bowel syndrome. Aliment Pharmacol Ther. 2016;44(5):447-59.
12. Hasan SS, Whorwell PJ, Miller V, Morris J, Vasant DH. Six vs 12 Sessions of Gut-focused Hypnotherapy for Irritable Bowel Syndrome: A Randomized Trial. Gastroenterology. 2021;160(7):2605-7.e3.
13. Palsson OS, van Tilburg M. Hypnosis and Guided Imagery Treatment for Gastrointestinal Disorders: Experience With Scripted Protocols Developed at the University of North Carolina. Am J Clin Hypn. 2015;58(1):5-21.
