the participant feel calm and relaxed , thus allowing them to enter an altered state of consciousness . This differs from other forms of psychological therapy where treatment is provided to the patient in a conscious state . |
Irritable bowel syndrome affects 10-20 % of the general population . |
and physiological outcomes , including motility
, visceral sensitivity , immune function , and central processing . 16-21 , 23 However , the precise mechanisms by which gut-directed hypnotherapy exerts these effects are poorly understood .
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The provision of gut-directed hypnotherapy through digital therapeutics is one way to overcome some of these barriers .
The author has helped develop a digitally delivered gut-directed hypnotherapy program that is designed as a self-manage-
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Limitations of hypnotherapy
Gut-directed hypnotherapy ( in person or
digitally delivered ) may not be appropriate for all patients . This includes those who lack motivation , have an unresolved trauma history or significant psychopa-
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Once in an altered state of conscious- |
Gut-directed hypnotherapy has been |
ment tool for people with IBS ( see online |
thology , do not have access to a digital |
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ness , suggestions are made to the patient for the control and normalisation of gastrointestinal function , normally on a repetitive basis .
One example of such a suggestion is asking the patient to imagine swallowing medicine with the aim that it will improve
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shown to reduce fasting distal colonic motility in patients with IBS . 16 It was also shown to improve rectal sensitivity in those with diarrhoea-predominant IBS , an effect which was later confirmed within all IBS subtypes . 18 Functional MRI studies have demonstrated that patients |
resource ). The program guides users through a six-week gut-directed hypnotherapy program , which includes daily gut-directed hypnotherapy sessions , educational material about the brain – gut axis , and diaphragmatic breathing exercises . A recent retrospective evaluation of out- |
device , or who lack technological skills to navigate digital care .
Conclusion
Gut-directed hypnotherapy should be considered as a first-line gut-directed psychotherapy to treat global IBS symp-
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gastrointestinal function . Patients are |
with IBS have greater activation of the |
comes with the app , conducted by Monash |
toms . It is generally considered safe |
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guided to envisage the medicine providing a protective coating of the intestinal tract , |
anterior cingulate cortex in response to pain . 23 Gut-directed hypnotherapy has a |
University researchers and including data for 190 users who have completed |
and tolerable for adults and children . App-delivered gut-directed hypnother- |
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reducing pain and improving bowel habits |
the advised treatment course , found sig- |
apy has similar rates of response to that |
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thus re-establishing dysregulated gut-tobrain pathways . Another example is to ask the patient to place their hands on their abdomen and imagine that the warmth generated by the hands provides a sense of calmness and control over the gut .
The hypnotic exercise is repeated , preferably daily , for at least six weeks .
Most patients respond favourably
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There is strong evidence that gut-directed hypnotherapy can influence psychological and physiological outcomes .
normalising effect on functional MRI fea-
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nificant improvements in IBS symptoms to levels that are statistically significant , clinically relevant , and similar to rates seen in face-to-face trials . 22 While adherence to the program was low , the study found that the app-delivered program could increase access to healthcare , reduce treatment costs and enable efficiencies in providing IBS care . 22 |
reported for face-to-face therapy and can increase the availability and reduce the costs associated with this therapeutic approach .
Conflict of interest Dr Peters acts as a consultant to Mindset Health , receives a percentage of sales from Nerva , and holds shares in Mindset Health .
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between weeks four and six . If there is no change in physical symptoms by week six , the patient is unlikely to respond and is deemed a non-responder to this form of treatment . 15
Hypnotherapeutic effects on irritable bowel syndrome features
There is strong evidence that gut-directed
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hypnotherapy can influence psychological |
tures of aberrant central processing of visceral signals in those with IBS . 20
Barriers to uptake
Despite the durable effects of gut-directed
hypnotherapy , several factors have precluded its widespread use . These include limited access to qualified hypnotherapists , the financial burden for a specialist therapeutic course , and the time commitment needed to complete treatment .
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Positive effects on psychological outcomes have also been demonstrated with use of the app , including reduction of PHQ-4 ( four-item patient health questionnaire for anxiety and depression ) scores from ‘ moderate ’ at baseline to ‘ mild ’ at completion . Users who scored within moderate and severe PHQ-4 categories experienced greater improvements to their psychological state than those in the mild and normal categories . |
References on request from kate . kelso @ adg . com . au
Online resource
• Nerva — evidence-based gutdirected hypnotherapy app ( fees apply ) try . nervaibs . com
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