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Hypnosis Treatment for Severe Irritable Bowel Syndrome: Investigation of Mechanism and Effects on Symptoms
Abstract
Hypnosis improves irritable bowel syndrome (IBS), but the mechanism is unknown. Possible physiological and psychological mechanisms were investigated in two studies. Patients with severe irritable bowel syndrome received seven biweekly hypnosis sessions and used hypnosis audiotapes at home. Rectal pain thresholds and smooth muscle tone were measured with a barostat before and after treatment in 18 patients (study I), and treatment changes in heart rate, blood pressure, skin conductance, finger temperature, and forehead electromyographic activity were assessed in 24 patients (study II). Somatization, anxiety, and depression were also measured. All central IBS symptoms improved substantially from treatment in both studies. Rectal pain thresholds, rectal smooth muscle tone, and autonomic functioning (except sweat gland reactivity) were unaffected by hypnosis treatment. However, somatization and psychological distress showed large decreases. In conclusion, hypnosis improves IBS symptoms through reductions in psychological distress and somatization. Improvements were unrelated to changes in the physiological parameters measured.
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In hypnosis studies, significant reductions in maladaptive IBS-related cognitions, affective symptoms, and somatization are frequently reported along with improvement in gastrointestinal symptoms.
“In studies of hypnosis, significant reductions in maladaptive IBS-related cognitions, affective symptoms, and somatization are frequently reported along with improvement in gastrointestinal symptoms (Gonsalkorale et al., 2004; Palsson et al., 2002).”
From Therapeutic mechanisms of a mindfulness-based treatment for IBS: effects on visceral sensitivity, catastrophizing, and affective processing of pain sensations. (2012) · cites this paper as Palsson et al., 2002
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“In studies of hypnosis, significant reductions in maladaptive IBS-related cognitions, affective symptoms, and somatization are frequently reported along with improvement in gastrointestinal symptoms (Gonsalkorale et al., 2004; Palsson et al., 2002).”
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“Two protocols in particular, the 7-session North Carolina Protocol60 and the 12-session Manchester protocol61 have demonstrated similar benefits in refractory IBS, with up to 80% of patients acquiring at least a 50% reduction in IBS Severity Scoring.62,63 The fully scripted North Carolina Protocol has been delivered a…”
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“Of all the physiological parameters measured, only finger skin conductance (that is, sweat gland activity) showed a small change after treatment (see Palsson et al., 2002, for further details).”
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“Others did not demonstrate such an effect (233).”
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“In addition, the Palsson group has also included measure of somatization and ANS functions (Palsson et al., 2002).”
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“A reduction of somatisation score has been reported to occur with treatment of IBS by hypnotherapy, where it was accompanied by reduction of anxiety rather than depression [20].”
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“Hypnotherapy Hypnotherapy is hypothesized to be a potential treatment for pediatric FAPDs because of its possible influence on gastrointestinal motility [203], visceral sensitivity [204,205], psychologic factors [206,207], and/or effects within the central nervous system [208].”
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Complementary and alternative medicine for IBS in adults: mind-body interventions.
Kearney, D. J., & Brown-Chang, J. (2008) · Nature Clinical Practice Gastroenterology & Hepatology · doi:10.1038/ncpgasthep1257 · Cited by 57
“performed barostat testing (to measure rectal pain threshold and smooth muscle tone) in 18 patients, and measured autonomic function (including heart rate, blood pressure, skin conductance, finger temperature and forehead electromyographic activity) in 24 patients, before and after seven sessions of hypnotherapy”
MethodMind-body treatments of irritable bowel syndrome symptoms: An updated meta-analysis
Shah, K., Ramos-Garcia, M., Bhavsar, J., & Lehrer, P. M. (2019) · Behaviour Research and Therapy · doi:10.1016/j.brat.2019.103462 · Cited by 55
Review article: the history of hypnotherapy and its role in the irritable bowel syndrome
Whorwell, P. J. (2005) · Alimentary Pharmacology & Therapeutics · doi:10.1111/j.1365-2036.2005.02697.x · Cited by 54
Extraintestinal manifestations in irritable bowel syndrome: A systematic review
Ohlsson, B. (2022) · Therapeutic Advances in Gastroenterology · doi:10.1177/17562848221114558 · Cited by 52
Pilot evaluation of hypnosis for the treatment of hot flashes in breast cancer survivors
Elkins, G. R., Marcus, J. D., Stearns, V., & Rajab, M. H. (2006) · Psycho-Oncology · doi:10.1002/pon.1096 · Cited by 53
Underlying molecular and cellular mechanisms in childhood irritable bowel syndrome
Chumpitazi, B. P., & Shulman, R. J. (2016) · Molecular and Cellular Pediatrics · doi:10.1186/s40348-016-0036-8 · Cited by 52
“Hypnotherapy (hypnosis with therapeutic intent) appears, in part, to use descending inhibitory pathways for control of pain [17] while also reducing psychological factors such as stress [18]; it has demonstrated efficacy in several randomized controlled trials for childhood IBS [19].”
BackgroundHundscheid, H. W., Pepels, M. J. A. E., Engels, L. G. J. B., & Loffeld, R. J. L. F. (2006) · Journal of Gastroenterology and Hepatology · doi:10.1111/j.1440-1746.2006.04741.x · Cited by 54
A case–control study of childhood trauma in the development of irritable bowel syndrome
Halland, M., Almazar, A. E., Lee, R., Atkinson, E. J., Larson, J. J., Talley, N. J., & Saito, Y. A. (2014) · Neurogastroenterology & Motility · doi:10.1111/nmo.12353 · Cited by 54
Aubert, A. E., Verheyden, B., Beckers, F., Tack, J., & Vandenberghe, J. (2009) · Neuropsychobiology · doi:10.1159/000239686 · Cited by 53
Rutten, J. M. T. M., Vlieger, A. M., Frankenhuis, C., George, E. K., Groeneweg, M., Norbruis, O. F., Ten, W. T. A., van Wering, H. M., Dijkgraaf, M. G. W., Merkus, M. P., et al. (2014) · BMC Pediatrics · doi:10.1186/1471-2431-14-140 · Cited by 49
“In the last 30 years, multiple trials have demonstrated that gut-directed hypnotherapy (HT) is an effective therapy in patients with IBS [14-25].”
BackgroundIntestinal Microbiome in Irritable Bowel Syndrome before and after Gut-Directed Hypnotherapy
Peter, J., Fournier, C., Keip, B., Rittershaus, N., Stephanou-Rieser, N., Durdević, M., Dejaco, C., Michalski, M., & Moser, G. (2018) · International Journal of Molecular Sciences · doi:10.3390/ijms19113619 · Cited by 49
“Studies have reported evidence for reductions in dysfunctional cognition [32,33], alterations in cerebral pain processing [34], rectal sensitivity [35,36], and change in autonomous nervous system functioning [37].”
BackgroundHypnosis Home Treatment for Irritable Bowel Syndrome:A Pilot Study
Palsson, O. S., Turner, M. J., & Whitehead, W. E. (2006) · International Journal of Clinical and Experimental Hypnosis · doi:10.1080/00207140500328666 · Cited by 54
“Both of these treatments have been found in a number of studies, including randomized controlled trials ( Drossman et al, 2003 ; Palsson, Turner, Johnson, Burnett, & Whitehead, 2002 ; Payne & Blanchard, 1995 ; Whorwell, Prior, & Faragher, 1984 ), to substantially benefit the majority of treated IBS patients.”
BackgroundSelf-citationCentrally Acting Therapies for Irritable Bowel Syndrome
Grover, M., & Drossman, D. A. (2011) · Gastroenterology Clinics of North America · doi:10.1016/j.gtc.2010.12.003 · Cited by 52
Hypnosis for Irritable Bowel Syndrome:The Empirical Evidence of Therapeutic Effects
Whitehead, W. E. (2005) · International Journal of Clinical and Experimental Hypnosis · doi:10.1080/00207140500328708 · Cited by 47
“At the other end, the use of 12 or more sessions, which is now the norm for the Manchester group, does not seem to add anything to success rates, as the studies with the highest success rates have used 7-session protocols (Palsson et al., 2002; Whorwell et al., 1984).”
BackgroundMethodInfluentialSelf-citationHypnotherapy for treatment of irritable bowel syndrome
Webb, A. N., Kukuruzovic, R., Catto-Smith, A. G., & Sawyer, S. M. (2007) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd005110.pub2 · Cited by 147
Mullin, G. E., Shepherd, S. J., Roland, B. C., Ireton-Jones, C. S., & Matarese, L. E. (2014) · Journal of Parenteral and Enteral Nutrition · doi:10.1177/0148607114545329 · Cited by 47
The Potential Role of a Self-Management Intervention for Ulcerative Colitis
Keefer, L., Kiebles, J. L., Kwiatek, M. A., Palsson, O. S., Taft, T., Martinovich, Z., & Barrett, T. A. (2011) · Biological Research For Nursing · doi:10.1177/1099800410397629 · Cited by 43
Self-citationVlieger, A. M., van den Berg, M. M., Frankenhuis, C., Bongers, M. E. J., Tromp, E., & Benninga, M. A. (2009) · The American Journal of Gastroenterology · doi:10.1038/ajg.2009.613 · Cited by 39
Irritable bowel syndrome: recent developments in diagnosis, pathophysiology, and treatment
El‐Salhy, M., Hatlebakk, J. G., Gilja, O. H., & Hausken, T. (2014) · Expert Review of Gastroenterology & Hepatology · doi:10.1586/17474124.2014.888952 · Cited by 39
Management Strategies for Abdominal Bloating and Distension.
Foley, A., Burgell, R., Barrett, J. S., & Gibson, P. R. (2014) · Europe PMC (PubMed Central) · Cited by 38
Empirically supported use of psychiatric medications in adolescents and adults with IBD
Thorkelson, G., Bielefeldt, K., & Szigethy, E. (2016) · Inflammatory Bowel Diseases · doi:10.1097/mib.0000000000000734 · Cited by 39
Smith, G. D. (2006) · Journal of Clinical Nursing · doi:10.1111/j.1365-2702.2006.01356.x · Cited by 50
“Others have also commented upon this observation (Palsson et al. 2002).”
BackgroundHenrich, J. F., Knittle, K. P., Gucht, V. D., Warren, S., Dombrowski, S. U., & Maes, S. (2014) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2014.12.009 · Cited by 40
“One article [26] included two studies, and only study 2 was suitable”
BackgroundInfluentialWhere Does Hypnotherapy Stand in the Management of Irritable Bowel Syndrome? A Systematic Review
Gholamrezaei, A., Ardestani, S. K., & Emami, M. H. (2006) · The Journal of Alternative and Complementary Medicine · doi:10.1089/acm.2006.12.517 · Cited by 37
Impact of hypnosis on psychophysiological measures: a scoping literature review
Fernandez, A., Urwicz, L., Vuilleumier, P., & Berna, C. (2021) · American Journal of Clinical Hypnosis · doi:10.1080/00029157.2021.1873099 · Cited by 35
The role of hypnotherapy for the treatment of inflammatory bowel diseases
Moser, G. (2014) · Expert Review of Gastroenterology & Hepatology · doi:10.1586/17474124.2014.917955 · Cited by 33
“Data of two studies (with adults and children) suggest that clinical improvements are unrelated to changes in the physiological parameters measured [35,40].”
BackgroundPajak, R., Lackner, J. M., & Kamboj, S. K. (2013) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2013.05.007 · Cited by 41
“The two studies that formally describe their intervention as ‘hypnosis’ adapted the existing treatment protocols used by these research groups in their clinical work with IBS patients [66,77].”
Krouwel, M., Farley, A., Greenfield, S., Ismail, T., & Jolly, K. (2021) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2021.102672 · Cited by 33
Wu, J. C. Y. (2010) · PubMed Central · Cited by 32
Hypnotic modulation of autonomic nervous system (ANS) activity
De Benedittis, G. (2024) · Brain Sciences · doi:10.3390/brainsci14030249 · Cited by 32
“Palsson et al. [63] conducted a longitudinal study examining the effects of hypnosis on ANS and clinical symptoms in patients with irritable bowel syndrome (IBS).”
BackgroundHalland, M., & Talley, N. J. (2012) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/nrgastro.2012.207 · Cited by 32
Psychopharmacologic and Behavioral Treatments for Functional Gastrointestinal Disorders
Grover, M., & Drossman, D. A. (2009) · Gastrointestinal Endoscopy Clinics of North America · doi:10.1016/j.giec.2008.12.001 · Cited by 30
“The mechanism is unclear, though there is some evidence that it reduces gut contractility and aids in normalization of pain thresholds after balloon rectal distension,(12) though this has not been confirmed by other investigators.(79) Some researchers have demonstrated changes similar to those after CBT,(11) with redu…”
ResultHypnotherapy for Inflammatory Bowel Disease Across the Lifespan
Szigethy, E. (2015) · American Journal of Clinical Hypnosis · doi:10.1080/00029157.2015.1040112 · Cited by 31
“, 2011), a growing number of hypnosis studies are showing a conditioned response effect of hypnotherapy lasting much longer than the relatively short-term benefit linked to placebo responses (Palsson et al., 2002; Vlieger et al., 2012).”
BackgroundBarabasz, A., & Barabasz, M. (2005) · International Journal of Clinical and Experimental Hypnosis · doi:10.1080/00207140500322982 · Cited by 30
Videlock, E. J., & Chang, L. (2016) · Wiley eBooks · doi:10.1002/9781119127437.ch65 · Cited by 32
Age Regression: Tailored versus Scripted Inductions
Barabasz, A., & Christensen, C. (2006) · American Journal of Clinical Hypnosis · doi:10.1080/00029157.2006.10401532 · Cited by 28
The effect of hypnosis on pain and peripheral blood flow in sickle-cell disease: a pilot study
Bhatt, R. R., Martin, S. R., Evans, S., Lung, K. C., Coates, T. D., Zeltzer, L. K., & Tsao, J. (2017) · Journal of Pain Research · doi:10.2147/jpr.s131859 · Cited by 27
Peters, S., Gibson, P. R., & Halmos, E. P. (2023) · Neurogastroenterology & Motility · doi:10.1111/nmo.14533 · Cited by 30
Patient satisfaction after gut‐directed hypnotherapy in irritable bowel syndrome
Lindfors, P., Ljótsson, B., Bjornsson, E., Abrahamsson, H., & Simrén, M. (2012) · Neurogastroenterology & Motility · doi:10.1111/nmo.12022 · Cited by 26
Hypnosis for Irritable Bowel Syndrome:The Quest for the Mechanism of Action
Simrén, M. (2005) · International Journal of Clinical and Experimental Hypnosis · doi:10.1080/00207140500327239 · Cited by 26
Pinto, P. R., Paredes, A. C., & Almeida, A. (2018) · Pain Medicine · doi:10.1093/pm/pny309 · Cited by 26
“In fact, there is considerable evidence for the effectiveness of hypnosis as an empirically supported clinical intervention in managing symptoms such as pain [22,45–48] and in promoting psychological well-being [49,50].”
BackgroundSpiller, R. (2011) · Gastroenterology Clinics of North America · doi:10.1016/j.gtc.2011.01.001 · Cited by 62
Cognitive-Behavioral Hypnotherapy in the Treatment of Irritable-Bowel-Syndrome-Induced Agoraphobia
Golden, W. L. (2007) · International Journal of Clinical and Experimental Hypnosis · doi:10.1080/00207140601177889 · Cited by 24
Group Hypnotherapy for Irritable Bowel Syndrome With Long-Term Follow-Up
Gerson, C. D., Gerson, J., & Gerson, M.-J. (2013) · International Journal of Clinical and Experimental Hypnosis · doi:10.1080/00207144.2012.700620 · Cited by 29
“Since then, success with this approach has been replicated in a number of publications (Galovski & Blanchard, 1998; Palsson et al., 2002) and has been extended to chronic functional abdominal pain (Vlieger, Mendo-Frankenhuis, Wolfkamp, Tromp, & Benninga, 2007), nonulcer dyspepsia (Calvert, Houghton, Cooper, Morris, &…”
Palsson, O. S., & van Tilburg, M. A. L. (2015) · American Journal of Clinical Hypnosis · doi:10.1080/00029157.2015.1012705 · Cited by 24
Self-citationAdvances in the management of irritable bowel syndrome
Cash, B. D., & Chey, W. D. (2003) · Current Gastroenterology Reports · doi:10.1007/s11894-003-0035-5 · Cited by 24
“this area. Palsson et al. [ 78 ] reported the results of studies evaluating the role of hypnosis for IBS.”
ResultGulewitsch, M. D., & Schlarb, A. A. (2017) · European Journal of Gastroenterology & Hepatology · doi:10.1097/meg.0000000000000984 · Cited by 23
Lövdahl, J., Ringström, G., Agerforz, P., Törnblom, H., & Simrén, M. (2015) · American Journal of Clinical Hypnosis · doi:10.1080/00029157.2015.1030492 · Cited by 24
Metadata
- Authors
- Palsson, O. S., Turner, M. J., Johnson, D. A., Burnett, C. K., & Whitehead, W. E.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- Eastern Virginia Medical School (US)
- Venue
- Digestive Diseases and Sciences
- Published
- 2002-11
- Volume
- 47
- Issue
- 11
- Pages
- 2605-2614
- ISSN
- 0163-2116 (ISSN-L)
- 1573-2568
- OpenAlex
- W210136871
- Cited by
- 195
- References
- 38
- Citations by year
- 2026: 5 · 2025: 6 · 2024: 4 · 2023: 2 · 2022: 10 · 2021: 7 · 2020: 3 · 2019: 5 · 2018: 6 · 2017: 8 · 2016: 4 · 2015: 11 · 2014: 14 · 2013: 11 · 2012: 14
- FWCI
- 7.30
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Digestive Diseases and Sciences (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK031369, R01 DK31369)
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- hypnosis, irritable bowel syndrome, hypnotherapy, somatization, psychological distress, anxiety, depression, autonomic nervous system, heart rate, skin conductance, electromyography, therapeutic mechanisms
- MeSH terms
- Adult, Colonic Diseases, Functional, Female, Humans, Hypnosis, Male, Psychometrics, Stress, Psychological, Abdominal Pain
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