38 CLINICAL FOCUS
38 CLINICAL FOCUS
14 JUNE 2024 ausdoc . com . au
Therapy Update
Gut-directed hypnotherapy
Gastroenterology
Dr Simone Peters is a psychophysiologist and gut-directed hypnotherapist , who practises in Melbourne , Victoria . She is an adjunct research fellow with the Alfred Health gastroenterology department and Monash University and is head of clinical content for Nerva , an app delivering evidence-based hypnotherapy techniques .
This brain – gut behavioural therapy can provide long-term benefits for patients with irritable bowel syndrome .
IRRITABLE bowel syndrome is characterised by chronic functional gastrointestinal symptoms of abdominal pain and altered bowel habits . 1 Other clinical features that are also frequently described by patients include abdominal bloating and / or distension , excessive wind and nausea . Irritable bowel syndrome is common , affecting 10-20 % of the general population and costing the healthcare system billions of dollars annually . 2
On top of the high economic costs , irritable bowel syndrome ( IBS ) also carries a huge disease burden , causing considerable negative impacts on quality of life and psychological distress comparable to organic gastrointestinal diseases , such as inflammatory bowel disease . 3 Levels of comorbid disease are also high in those with IBS and include other gastrointestinal complaints , non-gastrointestinal-related disorders such as chronic pelvic pain , CFS , fibromyalgia and psychiatric illness .
There is currently no known cure for IBS and treatment is limited to symptom management strategies . Approaches to symptom management have changed considerably over the past two decades , with the growing use of dietary and brain – gut behavioural therapies . This is especially important since the current pharmacological options for IBS — including laxatives , antidiarrhoeal agents , antispasmodics , antidepressants , probiotics , prebiotics and antibiotics — are only effective in terms of global symptom reduction in fewer than half of patients . 2
This article will outline the role of brain – gut behavioural therapies in the management of this common and potentially debilitating condition .
The role of brain – gut therapies
The pathogenesis and aetiology of IBS is likely heterogeneous , including abnormalities in motility , visceral sensation , brain – gut interactions , immune activation , genetics , and exposure or reactions to psychosocial stressors . 4
The growing acceptance of brain – gut behavioural therapies for IBS has been attributed to increasing awareness of cognitive factors in triggering symptoms and the high prevalence of psychiatric comorbidity among this patient population . 2 Such therapies include various skills-based techniques that have been adapted to address dysregulation of the brain – gut axis and to modify gastrointestinal symptoms .
CBT , relaxation therapy , dynamic psychotherapy and gut-directed hypnotherapy have been demonstrated as the most effective behavioural therapies for IBS . Gut-directed hypnotherapy is now recognised in IBS clinical management guidelines issued by the American College of Gastroenterology .
The evidence for gut-directed hypnotherapy
The first randomised controlled trial to assess the impact of individualised gut-directed hypnotherapy on IBS gastrointestinal symptoms , conducted in
There is currently no known cure for irritable bowel syndrome and treatment is limited to symptom management strategies .
1984 , compared outcomes in unselected patients with IBS refractory to standard treatment who received hypnotherapy , versus psychotherapy-treated controls . 5 This demonstrated greater improvements in the hypnotherapy group in individual symptoms of abdominal pain , distension and bowel habits . 5 Similar observations have been further substantiated by more recent studies , which describe reductions in overall and individual symptoms in
NEED TO KNOW
Irritable bowel syndrome ( IBS ) is common , affecting 10-20 % of the general population .
There are significant economic , physiological and psychological burdens as a result of IBS and related conditions .
Current pharmacological management options are only effective at reducing global symptoms in under half of affected patients .
Dietary and brain – gut behavioural therapies can be an effective treatment option for managing debilitating IBS symptoms , and gut-directed hypnotherapy is now recognised in IBS clinical management guidelines in the US .
The effects of gut-directed hypnotherapy are similar and as durable as those achieved with a low FODMAP diet for the relief of gastrointestinal symptoms .
Care can be delivered face to face or via digital means . Digital delivery may overcome barriers to care , including cost and availability of appropriately experienced practitioners , and early data show promise that digital hypnotherapy can be as effective as face-to-face therapy .
between 24-73 % of participants . 6-14 Today , gut-directed hypnotherapy is recognised as a safe management strategy that can provide long-term benefits for patients with IBS .
A positive effect has also been shown in a comparative trial , assessing efficacy of gut-directed hypnotherapy compared with the low FODMAP diet , the first-line dietary therapy applied in IBS populations . 11 In this Monash University study , 74 participants were randomised to receive gut-directed hypnotherapy , the low FODMAP diet , or a combination of both approaches . Improvements in overall symptoms were observed from baseline to week six ( end of treatment ) for hypnotherapy , diet , and combination therapy , with no difference across groups . Clinically meaningful improvement in symptoms was achieved in 72 %, 71 % and 72 % of participants in each group respectively and improvements were maintained in the long term . Individual gastrointestinal symptoms similarly improved . This finding demonstrated that durable effects of gut-directed hypnotherapy are similar to those of the low FODMAP diet for the relief of gastrointestinal symptoms .
Delivery of therapy
Gut-directed hypnotherapy involves an initial introduction where suggestions for imaginative experiences are presented , and metaphors are used to help bring about change . The purpose of introducing a hypnotic induction in this way is to help