Mind-Body Treatments Ease Irritable Bowel

Even short courses of hypnotherapy, cognitive therapy can work, studies show

THURSDAY, May 25, 2006 (HealthDay News) -- Short courses of hypnosis therapy or cognitive therapy can calm the distressing symptoms of irritable bowel syndrome (IBS) for the estimated 15 percent of adult Americans who suffer from the disorder, a new study finds.

IBS isn't a life-threatening condition, but it's an uncomfortable nuisance, with symptoms including abdominal pain, cramps, bloating, food intolerances, constipation or diarrhea.

What's more, "patients with the more severe form of IBS may have heightened sensitivity to the side effects of medications [prescribed for the condition]," noted Dr. Emeran Mayer, a professor of medicine and physiology at the University of California Los Angeles. That means "there's a very important role for these kinds of [mind-body] approaches," he said.

Mayer moderated a "Mind and Body Effects on GI Health" panel on Wednesday, part of the Digestive Disease Week 2006 annual meeting in Los Angeles.

In one study, just four sessions of cognitive therapy helped ease patient's IBS symptoms, according to researcher Dr. Jeffrey M. Lackner, director of the behavioral medicine clinic and assistant professor of medicine at the University at Buffalo School of Medicine, SUNY.

In the study, Lackner's team assigned 59 patients to either a 10-week therapy course, a four-week course, or to a wait list. Both the short and long cognitive therapy sessions covered the same ground, but the short course included a self-study workbook developed just for the study.

Included in the instruction was information meant to undo some of the stressful habits that experts say people with IBS tend to have, including negative thinking patterns which can make them anxious and exacerbate symptoms. IBS patients also tend to have poor coping skills, which causes them to react more stressfully to life's ups and downs. "These people spend a lot of time in their head, engaging in worrisome thinking," Lackner said.

Instruction in muscle-relaxation training was included, and participants were encouraged to be more flexible in their problem-solving skills and to learn skills that would help them take control of their symptoms, such as learning to relax.

"Whether the patients went to 10 sessions or four, they achieved clinically significant improvements in symptom relief and quality of life and were satisfied [with the program]," Lackner said. Previous research by others has found the same benefits from cognitive therapy.

Seventy-four percent of those who took the long course said their symptoms improved moderately to substantially, and 73 percent of the short-course patients reported the same improvements.

Likewise, hypnotherapy -- which, among other things, involves techniques such as visualizing a fully functioning GI tract -- helped IBS sufferers reduce symptoms and improve quality of life, reported Dr. Magnus Simren, an associate professor and consultant at Goteborg University in Sweden.

He led two studies testing the therapy. In one trial, 87 patients with IBS were cared for in a university hospital; in another, 48 received care in a county hospital.

In each group, about half were assigned to receive "gut-directed" hypnotherapy for one hour a week for 12 weeks, in which the therapist concentrated on helping them with their IBS. The other half of patients were assigned to a control group that did not get hypnotherapy.

Simren evaluated the patients at the start of the study, right after treatment and then again at six and 12 months later, asking them to complete questionnaires focused on their quality of life, anxiety, depression and GI symptoms.

"The hypnotherapy groups improved significantly regarding GI symptoms," he said. "The control groups did not."

While 52 percent of those getting hypnotherapy improved significantly, just 32 percent of the control group participants improved.

Improvement was most marked for abdominal pain, bloating and distension; less so for bowel habits. Improvements lasted or even increased at the one-year mark. Anxiety and depression improved at one year in the smaller study of 48 patients, but not in the group of 87. The reason for that disparity in results is unclear, Simren said.

What's also unclear is just how hypnotherapy works to fight IBS. Simren's results are in line with other studies that have also found improvements, however. According to Mayer, hypnotherapy may alter the way the brain reacts to stress, reducing levels of body arousal.

According to Simren, patients eager for relief don't much care how hypnotherapy works, just that it does. "I tell them, 'This is how you can get control of your symptoms,'" he said. And most are satisfied with that explanation. "Patients are very open-minded," he said.

The therapy doesn't necessarily have to be ongoing, the experts speculated, especially once patients learn the new skills.

While patients don't have to find a therapist who has experience dealing with IBS, it helps, Simren and Lackner agreed. "It's very important that the therapist does have an interest in bodily symptoms, not just the mind," Simren said.

More information

To learn more about IBS, visit the American Gastroenterological Association.

SOURCES: Emeran Mayer, M.D., professor, medicine and physiology, University of California at Los Angeles; Jeffrey M. Lackner, Psy.D., director, behavioral medicine clinic and assistant professor, medicine at the University at Buffalo School of Medicine, SUNY, N.Y; Magnus Simren, M.D., Ph.D., associate professor, consultant, Goteborg University, Goteborg, Sweden; May 24, 2006, presentations, Digestive Disease Week meeting, Los Angeles.
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