Tim Brunson DCH

Welcome to The International Hypnosis Research Institute Web site. Our intention is to support and promote the further worldwide integration of comprehensive evidence-based research and clinical hypnotherapy with mainstream mental health, medicine, and coaching. We do so by disseminating, supporting, and conducting research, providing professional level education, advocating increased level of practitioner competency, and supporting the viability and success of clinical practitioners. Although currently over 80% of our membership is comprised of mental health practitioners, we fully recognize the role, support, involvement, and needs of those in the medical and coaching fields. This site is not intended as a source of medical or psychological advice. -- Tim Brunson, PhD

Efficacy, Tolerability, and Safety of Hypnosis in Adult Irritable Bowel Syndrome: Systematic Review



OBJECTIVE: To assess the efficacy, tolerability, and safety of hypnosis in adult irritable bowel syndrome by a meta-analysis of randomized controlled trials. METHODS: Studies were identified by a literature search of the databases Allied and Complementary Medicine Database, Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, PubMed, PsycINFO, and Scopus (from inception to June 30, 2013). Primary outcomes were adequate symptom relief, global gastrointestinal score, and safety. Summary relative risks (RRs) with number needed to treat (NNT) and standardized mean differences (SMDs) with 95% confidence intervals (95% CIs) were calculated using random-effects models. RESULTS: Eight randomized controlled trials with a total of 464 patients and a median of 8.5 (7-12) hypnosis sessions over a median of 12 (5-12) weeks were included into the analysis. At the end of therapy, hypnosis was superior to control conditions in producing adequate symptom relief (RR, 1.69 [95% CI = 1.14-2.51]; NNT, 5 [3-10]) and in reducing global gastrointestinal score (SMD, 0.32 [95% CI = -0.56 to -0.08]). At long-term follow-up, hypnosis was superior to controls in adequate symptom relief (RR, 2.17 [95% CI = 1.22-3.87]; NNT, 3 [2-10]), but not in reducing global gastrointestinal score (SMD, -0.57 [-1.40 to 0.26]). One (0.4%) of 238 patients in the hypnosis group dropped out due to an adverse event (panic attack). CONCLUSION: This meta-analysis demonstrated that hypnosis was safe and provided long-term adequate symptom relief in 54% of patients with irritable bowel syndrome refractory to conventional therapy.

Psychosom Med. 2014 Jun 4. Schaefert R(1), Klose P, Moser G, Häuser W. Author information: (1)From the Department of General Internal Medicine and Psychosomatics (R.S.), University of Heidelberg, Heidelberg, Germany; Department of Internal and Integrative Medicine (P.K.), Kliniken Essen-Mitte, University of Duisburg-Essen, Essen, Germany; Department of Internal Medicine III (G.M.), Medical University of Vienna, Vienna, Austria; Department of Internal Medicine I (W.H.), Klinikum Saarbrücken, Saarbrücken, Germany; and Department of Psychosomatic Medicine (W.H.), Technische Universität München, München, Germany.

The role of hypnotherapy for the treatment of inflammatory bowel diseases.



Inflammatory bowel diseases (IBD) are chronic disorders of unknown aetiology which are characterized by episodes of exacerbations and remissions. There is evidence that perceived distress contributes to IBD symptom flares; anxiety and depression are frequently found in patients with the active disease. Because there is no cure, treatment has to focus on prevention of complications, induction/maintenance of remission and improvement of quality of life. Gut-directed hypnotherapy (GHT) has been used successfully in functional gastrointestinal disorders. Few experimental studies and case reports have been published for IBD; GHT increases the health-related quality of life and reduces symptoms. Additionally, GHT seems to have an immune-modulating effect and is able to augment clinical remission in patients with quiescent ulcerative colitis.

Expert Rev Gastroenterol Hepatol. 2014 May 12:1-6. Moser G. Author information: Abteilung für Gastroenterologie und Hepatologie, Univ. Klinik für Innere Medizin III, Währinger Gürtel 18-20, A-1090 Wien, Austria.

The Efficacy of Hypnotherapy in the Treatment of Irritable Bowel Syndrome...



Full title: The Efficacy of Hypnotherapy in the Treatment of Irritable Bowel Syndrome: A Systematic Review and Meta-analysis.

Background/Aims: Hypnotherapy is considered as a promising intervention for irritable bowel syndrome (IBS), but the evidence is still limited. The aims of this study were to conduct a systematic review and meta-analysis to estimate the efficacy of hypnotherapy for the treatment of IBS. Methods: A literature search was performed using MEDLINE (PubMed), Embase, PsycINFO and the Cochrane Central Register of Controlled Trials (CENTRAL database). Only randomized controlled trials that compared hypnotherapy with any other conven-tional treatment or no treatment in patients with IBS were included. Studies had to report outcomes as IBS symptom score or quality of life. The mean change in outcome score was used to pool these outcomes for the meta-analysis. Data were syn-thesized using the standardized mean difference for continuous data. Results: Seven randomized controlled trials (6 papers) involving 374 patients with IBS were identified. Performance bias was high in all trials because it was impossible to blind participants and therapists in this type of intervention. The outcomes in this meta-anal-ysis were evaluated at 3 months for short-term effects and at 1 year for long-term effects. The change in abdominal pain score at 3 months was significant in the hypnotherapy group (standardized mean difference, -0.83; 95% CI, -1.65 to -0.01). Three of the 4 trials showed greater improvement in overall gastrointestinal symptoms in the hypnotherapy group. Conclusions: This study provides clearer evidence that hypnotherapy has beneficial short-term effects in improving gastrointestinal symptoms of patients with IBS.

J Neurogastroenterol Motil. 2014 Apr 30;20(2):152-162. doi: 10.5056/jnm.2014.20.2.152. Lee HH(1), Choi YY(2), Choi MG(1). Author information: (1)Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea. (2)Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.

Efficacy of combined cognitive-behavior therapy and hypnotherapy in anorexia nervosa: a case study.



A 22-year-old female diagnosed with anorexia nervosa received brief psychotherapy within a span of 1.5 months. Detailed cognitive-behavioral assessment was done and eating attitude was rated. Intervention of eating behavior and cognitive restructuring were initiated along with regular practice of self-hypnosis with ego-strengthening suggestions. Age regression was done to identify conflicts. Significant improvement in eating attitude was noted after 8 sessions without relapse at 3 months. Details of the psychotherapy are discussed.

Int J Clin Exp Hypn. 2014;62(2):224-30. doi: 10.1080/00207144.2014.869140. Roy PK. Author information: a Institute of Psychiatry , Kolkata , India.

Dynamic hypnosis, IBS, and the value of individualizing treatment: a clinical perspective.



Hypnosis has already been proven efficient in treatment of irritable bowel syndrome (IBS). The author was responsible for the hypnotherapy in a Swedish study and adds her clinical experience with IBS patients within and beyond that study. The hypnosis was labeled dynamic, and the treatment utilized the therapists' clinical competence and individually tailored techniques, including gut-oriented symptom relief and hypnoanalysis, separately or in combination. The author presents 2 cases, 1 with a focus on symptom relief and 1 on exploring traumatic causes. She illustrates her clinical rationale for technical flexibility from trauma resolving hypnoanalysis to symptom-alleviating suggestive hypnosis, including dynamics beyond the symptom when such are part of the case history.

Int J Clin Exp Hypn. 2014;62(2):145-63. doi: 10.1080/00207144.2014.869127. Carolusson S. Author information: a Carolusson & Carolusson AB , Göteborg , Sweden.

The efficacy and methodological challenges of psychotherapy for adults...



Full title: The efficacy and methodological challenges of psychotherapy for adults with inflammatory bowel disease: a review.

Adults with inflammatory bowel disease (IBD) are at a greater risk of anxiety and depression and impaired quality of life (QoL) compared with healthy controls and other chronic physical illness groups. Consequently, the development and evaluation of well-defined and theoretically robust psychotherapeutic interventions for adults with IBD are desirable. To date, interventions have, for the most part, used multiple cross-theoretical approaches. Published reviews are heterogeneous in terms both of categorization of psychotherapeutic approaches and also of conclusions relating to efficacy. A recent Cochrane meta-analysis of randomized controlled trials found no evidence for the efficacy of these interventions in adults, as in a number of previous reviews, ideologically disparate interventions (e.g., psychodynamic and cognitive behavioral) were grouped together. We aimed to extend the currently available literature on psychological intervention in IBD by: evaluating the efficacy of specific strategies (i.e., stress management, psychodynamic, cognitive behavioral therapy, or hypnosis) in improving psychological symptoms and QoL, including all controlled and noncontrolled studies, and explicating the methodological problems in published trials. Sixteen studies (5 stress management, 4 psychodynamic, 5 cognitive behavioral therapy, and 2 hypnosis) were evaluated. Interventions predominantly based on stress management showed only modest benefits for IBD or mental health symptoms or QoL. Cognitive behavioral therapy studies showed generally consistent benefits in terms of anxiety and depression symptoms, but inconsistent outcomes regarding IBD symptoms. Psychodynamically informed interventions reduced depressive and anxiety symptoms, but not IBD severity. Both hypnosis studies, albeit using different methods, seemed to have a more positive impact on disease severity than mental health symptoms or QoL. Our results suggest that while further well-designed and evaluated interventions are needed, psychological input can make a positive contribution to best practice multidisciplinary treatment of adults with IBD.

Inflamm Bowel Dis. 2013 Nov;19(12):2704-15. Knowles SR, Monshat K, Castle DJ. *Department of Psychological Sciences and Statistics, Faculty of Life and Social Sciences, Swinburne University of Technology, Melbourne, Australia; Department of Psychiatry, St Vincent's Hospital, Melbourne, Australia; and ‡Department of Psychiatry, The University of Melbourne, Melbourne, Australia.

Sensitivity and specificity of hypnosis effects on gastric myoelectrical activity.



OBJECTIVES: The effects of hypnosis on physiological (gastrointestinal) functions are incompletely understood, and it is unknown whether they are hypnosis-specific and gut-specific, or simply unspecific effects of relaxation. DESIGN: Sixty-two healthy female volunteers were randomly assigned to either a single session of hypnotic suggestion of ingesting an appetizing meal and an unappetizing meal, or to relax and concentrate on having an appetizing or unappetizing meal, while the electrogastrogram (EGG) was recorded. At the end of the session, participants drank water until they felt full, in order to detect EGG-signal changes after ingestion of a true gastric load. During both conditions participants reported their subjective well-being, hunger and disgust at several time points. RESULTS: Imagining eating food induced subjective feelings of hunger and disgust as well as changes in the EGG similar to, but more pronounced than those seen with a real gastric water load during both hypnosis and relaxation conditions. These effects were more pronounced when imagining an appetizing meal than with an unappetizing meal. There was no significant difference between the hypnosis and relaxation conditions. CONCLUSION: Imagination with and without hypnosis exhibits similar changes in subjective and objective measures in response to imagining an appetizing and an unappetizing food, indicating high sensitivity but low specificity.

PLoS One. 2013 Dec 16;8(12):e83486. Enck P(1), Hefner J(2), Herbert BM(3), Mazurak N(4), Weimer K(1), Muth ER(5), Zipfel S(1), Martens U(1). (1)Department of Psychosomatic Medicine, University Hospital, Tübingen, Germany. (2)Department of Internal Medicine II, University Hospital, Würzburg, Germany. (3)Department of Health Psychology, Institute of Psychology and Education, University of Ulm, Ulm, Germany. (4)Central Research Department, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine. (5)Department of Psychology, Clemson University, Clemson, South Carolina, United States of America.

Management of refractory irritable bowel syndrome and comorbid mental ill-health: challenges...



Full Title: Management of refractory irritable bowel syndrome and comorbid mental ill-health: challenges, reflections and patient's perspective of life on the body-mind

This complex case illustrates how blurred the divide between body and mind can be. In a patient with refractory irritable bowel symptoms, the emergence of new social problems exacerbate both psychiatric (anxiety and depression) and physical symptoms. Treatment of the physical symptomatology consisted of acute hospital treatments initially and subsequent primary care consultations. Psychiatric treatment consists of psychopharmacological (venlafaxine and mirtazapine) and psychotherapeutic approaches (cognitive behavioural therapy initially, and clinical hypnosis). The objectives of psychiatric treatment were to stabilise symptoms, reduce hospital admissions and foster self-management. The gains of management are presented. Social difficulties encountered over the period of treatment were legal processes to gain custody of son, bereavement, financial difficulties occasioned by stoppage of welfare benefits and legal processes involved in welfare appeal. Importantly, the patient's perceptive of treatment and care is presented. Detrimental effects that current welfare reforms in the UK may have on health are highlighted.

BMJ Case Rep. 2013 Jun 27;2013. pii: bcr2013009545. doi: 10.1136/bcr-2013-009545. Udo I, Gash A. Department of Liaison Psychiatry, Roseberry Park Hospital, Tees Esk Wear Valleys NHS Foundation Trust, Middlesbrough, UK. dr_itoro@yahoo.com

The Efficacy and Methodological Challenges of Psychotherapy for Adults...



Full Title: The Efficacy and Methodological Challenges of Psychotherapy for Adults with Inflammatory Bowel Disease: A Review.

Adults with inflammatory bowel disease (IBD) are at a greater risk of anxiety and depression and impaired quality of life (QoL) compared with healthy controls and other chronic physical illness groups. Consequently, the development and evaluation of well-defined and theoretically robust psychotherapeutic interventions for adults with IBD are desirable. To date, interventions have, for the most part, used multiple cross-theoretical approaches. Published reviews are heterogeneous in terms both of categorization of psychotherapeutic approaches and also of conclusions relating to efficacy. A recent Cochrane meta-analysis of randomized controlled trials found no evidence for the efficacy of these interventions in adults, as in a number of previous reviews, ideologically disparate interventions (e.g., psychodynamic and cognitive behavioral) were grouped together. We aimed to extend the currently available literature on psychological intervention in IBD by: evaluating the efficacy of specific strategies (i.e., stress management, psychodynamic, cognitive behavioral therapy, or hypnosis) in improving psychological symptoms and QoL, including all controlled and noncontrolled studies, and explicating the methodological problems in published trials. Sixteen studies (5 stress management, 4 psychodynamic, 5 cognitive behavioral therapy, and 2 hypnosis) were evaluated. Interventions predominantly based on stress management showed only modest benefits for IBD or mental health symptoms or QoL. Cognitive behavioral therapy studies showed generally consistent benefits in terms of anxiety and depression symptoms, but inconsistent outcomes regarding IBD symptoms. Psychodynamically informed interventions reduced depressive and anxiety symptoms, but not IBD severity. Both hypnosis studies, albeit using different methods, seemed to have a more positive impact on disease severity than mental health symptoms or QoL. Our results suggest that while further well-designed and evaluated interventions are needed, psychological input can make a positive contribution to best practice multidisciplinary treatment of adults with IBD.

Inflamm Bowel Dis. 2013 Jul 10. Knowles SR, Monshat K, Castle DJ. *Department of Psychological Sciences and Statistics, Faculty of Life and Social Sciences, Swinburne University of Technology, Melbourne, Australia; †Department of Psychiatry, St Vincent's Hospital, Melbourne, Australia; and ‡Department of Psychiatry, The University of Melbourne, Melbourne, Australia.

Long-Term Success of GUT-Directed Group Hypnosis for Patients With Refractory IBS



Full title: Long-Term Success of GUT-Directed Group Hypnosis for Patients With Refractory Irritable Bowel Syndrome: A Randomized Controlled Trial.

Gut-directed hypnotherapy (GHT) in individual sessions is highly effective in the treatment of irritable bowel syndrome (IBS). This study aimed to assess the long-term effect of GHT in group sessions for refractory IBS. A total of 164 patients with IBS (Rome-III-criteria) were screened, and 100 refractory to usual treatment were randomized 1:1 either to supportive talks with medical treatment (SMT) or to SMT with GHT (10 weekly sessions within 12 weeks). The primary end point was a clinically important improvement on several dimensions of daily life (assessed by IBS impact scale) after treatment and 12-month follow-up. The secondary end point was improvement in general quality of life (QOL; Medical Outcome Study Short-Form-36), psychological status (Hospital Anxiety Depression Scale) and reduction of single IBS symptoms. Analysis was by intention to treat. A total of 90 patients received allocated intervention. After treatment, 28 (60.8%) out of 46 GHT patients and 18 (40.9%) out of 44 SMTs improved (absolute difference 20.0%; 95% confidence interval (CI): 0-40.2%; P=0.046); over 15 months, 54.3% of GHT patients and 25.0% of controls improved (absolute difference 29.4%; 95% CI 10.1-48.6%; P=0.004). GHT with SMT improved physical and psychological well being significantly more than SMT alone (P<0.001). Gender, age, disease duration and IBS type did not have an influence on the long-term success of GHT. GHT improves IBS-related QOL, is superior to SMT alone, and shows a long-term effect even in refractory IBS.

Am J Gastroenterol. 2013 Apr;108(4):602-9. doi: 10.1038/ajg.2013.19. Moser G, Trägner S, Gajowniczek EE, Mikulits A, Michalski M, Kazemi-Shirazi L, Kulnigg-Dabsch S, Führer M, Ponocny-Seliger E, Dejaco C, Miehsler W. Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.

Psychological Treatments in Functional Gastrointestinal Disorders...



Full title: Psychological Treatments in Functional Gastrointestinal Disorders: A Primer for the Gastroenterologist.

The functional gastrointestinal disorders (FGIDs) often show inadequate response to usual medical care. Psychological treatments can help improve functional gastrointestinal disorder patient outcomes, and such treatment should be considered for patients who have moderate or severe symptoms after 3-6 months of medical care and those whose symptoms are clearly exacerbated by stress or emotional symptoms. Effective psychological treatments, which are based on multiple randomized controlled trials, include cognitive behavioral therapy and hypnosis for irritable bowel syndrome and pediatric functional abdominal pain, cognitive behavioral therapy for functional chest pain, and biofeedback for dyssynergic constipation in adults. Successful referral by the gastroenterologist for psychological treatment is facilitated by educating the patient about the rationale for such treatment, reassurance about the diagnosis and continuation of medical care, firm doctor-patient therapeutic alliance, and identification of and communication with an appropriate psychological services provider.

Clin Gastroenterol Hepatol. 2012 Oct 24. pii: S1542-3565(12)01286-4. doi: 10.1016/j.cgh.2012.10.031. Palsson OS, Whitehead WE. Center for Functional Gastrointestinal and Motility Disorders, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

Hypnosis to alleviate the symptoms of ciguatera toxicity: a case study.



Ciguatera toxicity is a poisoning from consuming reef fish that had fed on dinoflagellates such as Gambierdiscus toxicus found along coral reefs. The toxin is oil soluble, odorless, colorless, tasteless, heat stable, and is concentrated in larger carnivorous fish such as amberjack, barracuda, eel, grouper, red snapper, sea bass, and Spanish mackerel. Onset of symptoms is usually within 6-12 hours after ingestion. Gastrointestinal symptoms lasting 1-2 days include abdominal pain, nausea, vomiting, and diarrhea. Neurological symptoms may persist for weeks or several months or--rarely--years and include circumoral and extremity paresthesias, temperature sensation reversal, itching, weakness, ataxia, and others. A patient with burning hands and feet who had not found relief using other methods had diagnosis of ciguatera toxicity assisted by hypnotically refreshed memory followed by rapid relief with hypnotic suggestions in 1 session and remained free of symptoms.

Am J Clin Hypn. 2012 Jan;54(3):179-83. Laser ED, Shenefelt PD. Department of Dermatology and Cutaneous Surgery, MDC 079, College of Medicine, University of South Florida, 12901 Bruce B. Downs Boulevard, Tampa, FL 33612, USA.

Long-term follow-up of gut-directed hypnotherapy vs. standard care in children...



Full title: Long-term follow-up of gut-directed hypnotherapy vs. standard care in children with functional abdominal pain or irritable bowel syndrome.

OBJECTIVES: We previously showed that gut-directed hypnotherapy (HT) is highly effective in the treatment of children with functional abdominal pain (FAP) and irritable bowel syndrome (IBS). Aim of this follow-up study was to investigate the long-term effects of HT vs. standard medical treatment plus supportive therapy (SMT). METHODS: All 52 participants of our previous randomized controlled trial (RCT) were invited to complete a standardized abdominal pain diary, on which pain frequency and pain intensity were scored. Furthermore, the Children's Somatization Inventory (CSI) and a general quality of life (QOL) questionnaire were filled out. Clinical remission was defined as > 80% improvement in pain scores compared with baseline.
RESULTS: All 27 HT patients and 22 out of 25 SMT patients participated in this study. Two patients of the SMT group were lost to follow-up and one refused to participate. After a mean duration of 4.8 years follow-up (3.4-6.7), HT was still highly superior to conventional therapy with 68 vs. 20% of the patients in remission after treatment (P = 0.005). Pain intensity and pain frequency scores at follow-up were 2.8 and 2.3, respectively, in the HT group compared with 7.3 and 7.1 in the SMT group (P < 0.01). Also, somatization scores were lower in the HT group (15.2 vs. 22.8; P = 0.04). No differences were found in QOL, doctors' visits, and missed days of school or work between the two groups.
CONCLUSIONS: The beneficial effects of gut-directed HT are long lasting in children with FAP or IBS with two thirds still in remission almost 5 years after treatment, making it a highly valuable therapeutic option.

J Gastroenterol. 2012 Apr;107(4):627-31. doi: 10.1038/ajg.2011.487 Vlieger AM, Rutten JM, Govers AM, Frankenhuis C, Benninga MA. Department of Pediatrics, St Antonius Hospital, Nieuwegein, The Netherlands. a.vlieger@antoniusziekenhuis.nl

Pharmacologic and complementary and alternative medicine therapies for irritable bowel syndrome.



Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder characterized by episodic abdominal pain or discomfort in association with altered bowel habits (diarrhea and/or constipation). Other gastrointestinal symptoms, such as bloating and flatulence, are also common. A variety of factors are believed to play a role in the development of IBS symptoms, including altered bowel motility, visceral hypersensitivity, psychosocial stressors, altered brain-gut interactions, immune activation/low grade inflammation, alterations in the gut microbiome, and genetic factors. In the absence of biomarkers that can distinguish between IBS subgroups on the basis of pathophysiology, treatment of this condition is predicated upon a patient's most bothersome symptoms. In clinical trials, effective therapies have only offered a therapeutic gain over placebos of 7-15%. Evidence based therapies for the global symptoms of constipation predominant IBS (IBS-C) include lubiprostone and tegaserod; evidence based therapies for the global symptoms of diarrhea predominant IBS (IBS-D) include the probiotic Bifidobacter infantis, the nonabsorbable antibiotic rifaximin, and alosetron. Additionally, there is persuasive evidence to suggest that selected antispasmodics and antidepressants are of benefit for the treatment of abdominal pain in IBS patients. Finally, several emerging therapies with novel mechanisms of action are in development. Complementary and alternative medicine therapies including probiotics, herbal therapies and acupuncture are gaining popularity among IBS sufferers, although concerns regarding manufacturing standards and the paucity of high quality efficacy and safety data remain.

Gut Liver. 2011 Sep;5(3):253-66. Epub 2011 Aug 18. Chey WD, Maneerattaporn M, Saad R. Division of Gastroenterology, University of Michigan Health System, Ann Arbor, MI, USA.

Decreased pain inhibition in irritable bowel syndrome depends on altered descending modulation...



Full Title: Decreased pain inhibition in irritable bowel syndrome depends on altered descending modulation and higher-order brain processes.

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder involving abdominal pain and bowel dysfunction. IBS pain symptoms have been hypothesized to depend on peripheral and central mechanisms, but the pathophysiology is still unclear. The aim of the present study was to assess the contribution of cerebral and cerebrospinal processes to pain inhibition deficits in IBS. Fourteen female patients with diarrhea-predominant IBS (IBS-D) and 14 healthy female volunteers were recruited. Acute pain and the nociceptive withdrawal reflex (RIII reflex) were evoked by transcutaneous electrical stimulation of the right sural nerve with modulation by hetero-segmental counter-irritation produced by sustained cold pain applied on the left forearm. Psychological symptoms were assessed by questionnaires. Shock pain decreased significantly during counter-irritation in the controls (P<0.001) but not in IBS patients (P=0.52). Similarly, RIII-reflex amplitude declined during counter-irritation in the controls (P=0.009) but not in IBS patients (P=0.11). Furthermore, pain-related anxiety increased during counter-irritation in IBS patients (P=0.003) but not in the controls (P=0.74). Interestingly, across all subjects, counter-irritation analgesia was positively correlated with RIII-reflex inhibition (r=0.39, P=0.04) and negatively with pain-related anxiety (r=-0.61, P<0.001). In addition, individual differences in counter-irritation analgesia were predicted independently by the modulation of RIII responses (P=0.03) and by pain catastrophizing (P=0.01), with the latter mediating the effect of pain-related anxiety. In conclusion, these results demonstrate that pain inhibition deficits in female IBS-D patients depend on two potentially separable mechanisms reflecting: (1) altered descending modulation and (2) higher-order brain processes underlying regulation of pain and affect.

Neuroscience. 2011 Nov 10;195C:166-175. Piché M, Bouin M, Arsenault M, Poitras P, Rainville P. Department of Chiropractic, Université du Québec à Trois-Rivières, C.P 500, Trois-Rivières, QC, Canada G9A 5H7; Groupe de Recherche sur le Système Nerveux Central (GRSNC), Université de Montréal, C.P 6128, Succursale Centre-Ville, Montreal, QC, Canada H3C 3J7; Centre de Recherche en Neuropsychologie et Cognition (CERNEC), Université de Montréal, C.P 6128, Succursale Centre-Ville, Montreal, QC, Canada H3C 3J7; Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), 4545, Chemin Queen-Mary Montréal (Québec), H3W 1W4.

Tandem hypnosis with identical bulimic twins: case report.



Hypnosis has been used in the treatment of bulimia nervosa from the early 1980s. Dissociation theory identified a certain subgroup of eating disordered patients with dissociative signs and symptoms. These patients react well to hypnotherapy. Simultaneous hypnosis ("tandem hypnosis") in the treatment of two female 19-year-old monozygotic twins led to a very successful outcome after 6 sessions. During the therapy, attempts were made to work through the physical abuse the subjects suffered from their father. Hypnobehavioural methods were used and treatment was combined with five individual sessions. In the cases presented here, the subjects' traumatic history, their high hypnotic susceptibility, and the effectiveness of hypnotherapy seem to support the dissociative mechanism of symptom development. A systemic approach involving the integration of family therapeutical and hypnotherapeutical interventions proved to be useful. The role of these types of hypnotherapy interventions is still undervalued.

Am J Clin Hypn. 2011 Apr;53(4):271-81. Túry F, Wildmann M, Szentes A. Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary 1089 Budapest, Nagyvárad tér 4. tury@t-online.hu

Inflammatory bowel disease.



This article reviews the etiology, clinical characteristics, and treatment of inflammatory bowel disease (IBD) and associated psychological sequelae in children and adolescents with this lifelong disease. Pediatric-onset IBD, consisting of Crohn's disease and ulcerative colitis, has significant medical morbidity and in many young persons is also associated with psychological and psychosocial challenges. Depression and anxiety are particularly prevalent and have a multifaceted etiology, including IBD-related factors such as cytokines and steroids used to treat IBD and psychosocial stress. A growing number of empirically supported interventions, such as cognitive behavioral therapy, hypnosis, and educational resources, help youth and their parents cope with IBD as well as the psychological and psychosocial sequelae. While there is convincing evidence that such interventions can help improve anxiety, depression, and health-related quality of life, their effects on IBD severity and course await further study.

Child Adolesc Psychiatr Clin N Am. 2010 Apr;19(2):301-18, ix. Szigethy E, McLafferty L, Goyal A. Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA. szigethye@upmc.edu

Management of stress in inflammatory bowel disease: a therapeutic option?



There is increasing evidence that psychological stress and associated mood disorders are linked with, and can adversely affect the course of, inflammatory bowel disease (IBD). Unfortunately, owing to methodological difficulties inherent in undertaking appropriately targeted and blinded trials, there are limited high-quality data regarding the effects on IBD of interventions aimed to ameliorate stress and mood disorders. Nevertheless, patients want psychological intervention as well as conventional medical strategies. Emerging trial evidence supports the suggestion that psychologically orientated therapy may ameliorate IBD-associated mood disorders, but there are no strong data as of yet to indicate that stress management has a beneficial effect on the activity or course of IBD. As yet, which, when and how interventions targeted at psychological stress and mood disturbances should be offered to individual patients with IBD is not clear.

Expert Rev Gastroenterol Hepatol. 2009 Dec;3(6):661-79. Goodhand JR, Wahed M, Rampton DS. Centre for Gastroenterology, Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, 4 Newark Street, London, E1 2AT, UK. j.goodhand@qmul.ac.uk

Standardized hypnosis treatment for irritable bowel syndrome



Full Title: Standardized hypnosis treatment for irritable bowel syndrome: the North Carolina protocol

The North Carolina protocol is a seven-session hypnosis-treatment approach for irritable bowel syndrome that is unique in that the entire course of treatment is designed for verbatim delivery. The protocol has been tested in two published research studies and found to benefit more than 80% of patients. This article describes the development, content, and testing of the protocol, and how it is used in clinical practice.

Int J Clin Exp Hypn. 2006 Jan;54(1):51-64. Palsson OS. Division of Digestive Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. opalsson@med.unc.edu

Hypnosis home treatment for irritable bowel syndrome: a pilot study



Hypnosis treatment often improves irritable bowel syndrome (IBS), but the costs and reliance on specialized therapists limit its availability. A 3-month home-treatment version of a scripted hypnosis protocol previously shown to improve all central IBS symptoms was completed by 19 IBS patients. Outcomes were compared to those of 57 matched IBS patients from a separate study receiving only standard medical care. Ten of the hypnosis subjects (53%) responded to treatment by 3-month follow-up (response defined as more than 50% reduction in IBS severity) vs. 15 (26%) of controls. Hypnosis subjects improved more in quality of life scores compared to controls. Anxiety predicted poor treatment response. Hypnosis responders remained improved at 6-month follow-up. Although response rate was lower than previously observed in therapist-delivered treatment, hypnosis home treatment may double the proportion of IBS patients improving significantly across 6 months.

Int J Clin Exp Hypn. 2006 Jan;54(1):85-99. Palsson OS, Turner MJ, Whitehead WE. Division of Digestive Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. opalsson@med.unc.edu

Brief cognitive-behavioral internet therapy for irritable bowel syndrome



While cognitive-behavioral therapy for IBS is quite effective, the limited availability of competent therapists and lack of access to treatment remain problematic. This paper reports on a small, randomized, controlled trial of a five week internet based cognitive-behavioral intervention for IBS with limited therapist feedback via e-mail. Fifty-four IBS patients were recruited via the internet and randomly assigned to either immediate treatment or a wait-list control group. Thirty-one subjects completed the post-treatment assessment. 77% of treatment completers also completed a 3-month follow-up assessment. Treatment completers experienced statistically and clinically significant declines in IBS symptoms and improvements in quality of life. Those gains were substantially maintained at follow-up. Treatment efficacy was partially mediated by reductions in the tendency to catastrophize the social and occupational implications of symptoms, suggesting that catastrophizing may be an important target for treatment.

Behav Res Ther. 2009 Sep;47(9):797-802. Epub 2009 May 20. Hunt MG, Moshier S, Milonova M. Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104-6241, USA. mhunt@psych.upenn.edu

Long term benefits of hypnotherapy for irritable bowel syndrome



BACKGROUND AND AIMS: There is now good evidence from several sources that hypnotherapy can relieve the symptoms of irritable bowel syndrome in the short term. However, there is no long term data on its benefits and this information is essential before the technique can be widely recommended. This study aimed to answer this question. PATIENTS AND METHODS: 204 patients prospectively completed questionnaires scoring symptoms, quality of life, anxiety, and depression before, immediately after, and up to six years following hypnotherapy. All subjects also subjectively assessed the effects of hypnotherapy retrospectively in order to define their "responder status". RESULTS: 71% of patients initially responded to therapy. Of these, 81% maintained their improvement over time while the majority of the remaining 19% claimed that deterioration of symptoms had only been slight. With respect to symptom scores, all items at follow up were significantly improved on pre-hypnotherapy levels (p<0.001) and showed little change from post-hypnotherapy values. There were no significant differences in the symptom scores between patients assessed at 1, 2, 3, 4, or 5+ years following treatment. Quality of life and anxiety or depression scores were similarly still significantly improved at follow up (p<0.001) but did show some deterioration. Patients also reported a reduction in consultation rates and medication use following the completion of hypnotherapy. CONCLUSION: This study demonstrates that the beneficial effects of hypnotherapy appear to last at least five years. Thus it is a viable therapeutic option for the treatment of irritable bowel syndrome.

Gut. 2003 Nov;52(11):1623-9. Gonsalkorale WM, Miller V, Afzal A, Whorwell PJ. Department of Medicine, University Hospital of South Manchester, Manchester, UK. wgonsalkorale@compuserve.com

Mind-body complementary alternative medicine use and quality of life in adolescents with inflammator



Full Title: Mind-body complementary alternative medicine use and quality of life in adolescents with inflammatory bowel disease.

BACKGROUND:: Mind-body complementary and alternative medicine (CAM) modalities (e.g., relaxation or meditation) for symptom management have not been well studied in adolescents with inflammatory bowel disease (IBD). The purposes of this study were to: 1) determine the prevalence of 5 types of mind-body CAM use, and consideration of use for symptom management; 2) assess characteristics associated with regular mind-body CAM use; and 3) examine whether regular and/or considered mind-body CAM use are associated with health-related quality of life (HRQOL). METHODS:: Sixty-seven adolescents with IBD ages 12-19 recruited from a children's hospital completed a questionnaire on CAM use and the Pediatric Quality of Life Inventory. Logistic regression models were estimated for regular and considered CAM use. RESULTS:: Participants mean (SD) age was 15.5 (2.1) years; 37 (55%) were female; 53 (79%) were white; and 20 (30%) had moderate disease severity. Adolescents used prayer (62%), relaxation (40%), and imagery (21%) once/day to once/week for symptom management. In multivariate analyses, females were more likely to use relaxation (odds ratio [OR] = 4.38, 95% confidence interval [CI] = 1.25-15.29, c statistic = 0.73). Younger adolescents were more likely to regularly use (OR = 0.63, 95% CI = 0.42-0.95, c statistic = 0.72) or consider using (OR = 0.77, 95% CI = 0.59-1.00, c statistic = 0.64) meditation. Adolescents with more severe disease (OR = 4.17, 95% CI = 1.07-16.29, c statistic = 0.83) were more willing to consider using relaxation in the future. Adolescents with worse HRQOL were more willing to consider using prayer and meditation for future symptom management (P < 0.05). CONCLUSIONS:: Many adolescents with IBD either currently use or would consider using mind-body CAM for symptom management. Inflamm Bowel Dis 2009.

Inflamm Bowel Dis. 2009 Aug 24. Cotton S, Humenay Roberts Y, Tsevat J, Britto MT, Succop P, McGrady ME, Yi MS. Department of Family Medicine, University of Cincinnati College of Medicine.

Hypnotherapy for irritable bowel syndrome--a systematic review



The Irritable bowel syndrome (IBS) is a highly prevalent functional disorder with a remarkable clinical and economic impact. Several pathogenetic factors of IBS are discussed and summarised within a bio-psycho-social model. Data from published hypnotherapeutic interventions with approximately 800 patients show long-lasting symptom relief. The underlying mechanisms of action are not well understood. Nine mechanism studies show influences of hypnosis on colorectal sensitivity, colorectal motility and mental strain (anxiety, depression, maladaptive cognitions). Results are often contradictory and effects of hypnosis on several of the proposed pathogenetic factors are not examined at all. This paper reviews previous studies on hypnotherapy in IBS patients with a focus on symptom relief and mechanisms of action.

Z Gastroenterol. 2009 Nov;47(11):1153-9. Epub 2009 Nov 6. Hefner J, Rilk A, Herbert BM, Zipfel S, Enck P, Martens U. Abteilung Innere Medizin VI, Psychosomatische Medizin und Psychotherapie, Universität Tübingen. jochen.hefner@t-online.de

Using art to help understand the imagery of irritable bowel syndrome



Full Title: Using art to help understand the imagery of irritable bowel syndrome and its response to hypnotherapy

A medical artist asked 109 patients if they had an image of their IBS pre- and posthypnotherapy, making precise watercolor paintings of any images described. Results were related to treatment outcome, symptoms, anxiety, depression, and absorption (hypnotizability); 49% of patients had an image, and a wide variety were recorded and painted. Imagery was significantly associated with gender (p < .05), anxiety (p < .05), noncolonic symptomatology (p < .05), and absorption (p = .001); 57.8% of responders compared with 35.5% of nonresponders to hypnotherapy had an image of their disease (p < .05) before treatment, and color images were associated with better outcomes (p = .05) than monochrome ones. All images changed in responders, often becoming more nonspecific in nature. Inquiring about IBS imagery helps to identify potential responders and nonresponders to hypnotherapy and may also provide insights into how patients think about their illness.

Int J Clin Exp Hypn. 2009 Apr;57(2):162-73. Carruthers HR, Miller V, Morris J, Evans R, Tarrier N, Whorwell PJ. University of Manchester, United Kingdom.

Hypnotherapy for functional gastrointestinal disorders: a review



Patients with functional gastrointestinal disorders, such as irritable bowel syndrome, functional dyspepsia, and noncardiac chest pain, can suffer from a range of severe symptoms that often substantially erode quality of life. Unfortunately, these conditions are notoriously difficult to treat, with many patients failing to improve despite being prescribed a wide variety of conventional medications. As a consequence, the potential benefits of hypnotherapy have been explored with evidence that this approach not only relieves symptoms but also appears to restore many of the putative psychological and physiological abnormalities associated with these conditions toward normal. These observations suggest that this form of treatment has considerable potential in aiding the management of functional gastrointestinal disorders and should be integrated into the ongoing medical care that these patients are receiving.

Int J Clin Exp Hypn. 2009 Jul;57(3):279-92. Miller V, Whorwell PJ. University of Manchester, Manchester, United Kingdom.

Mindfulness for irritable bowel syndrome: protocol development for a controlled clinical trial



BACKGROUND: Irritable bowel syndrome (IBS), a functional bowel disorder with symptoms of abdominal pain and disturbed defecation experienced by 10% of U.S. adults, results in significant disability, impaired quality of life, and health-care burden. Conventional medical care focusing on pharmacological approaches, diet, and lifestyle management has been partially effective in controlling symptoms. Behavioral treatments, such as cognitive-behavioral therapy and hypnosis, are promising. This paper describes an on-going feasibility study to assess the efficacy of mindfulness training, a behavioral treatment involving directing and sustaining attention to present-moment experience, for the treatment of IBS. METHODS/DESIGN: The study design involves randomization of adult women with IBS according to Rome II criteria, to either an eight-week mindfulness training group (based on a Mindfulness-based Stress Reduction [MBSR] format) or a previously validated IBS social-support group as an attention-control condition. The primary hypothesis is that, compared to Support Group participants, those in the Mindfulness Program will demonstrate significant improvement in IBS symptoms as measured by the IBS Symptom Severity Scale [1]. DISCUSSION: 214 individuals have been screened for eligibility, of whom 148 were eligible for the study. Of those, 87 were enrolled, with 21 withdrawing after having given consent. 66 have completed or are in the process of completing the interventions. It is feasible to undertake a rigorous randomized clinical trial of mindfulness training for people with IBS, using a standardized MBSR protocol adapted for those experiencing IBS, compared to a control social-support group previously utilized in IBS studies. TRIAL REGISTRATION: Clinical Trials.gov Identifier: NCT00680693.

BMC Complement Altern Med. 2009 Jul 28. Gaylord SA, Whitehead WE, Coble RS, Faurot KR, Palsson OS, Garland EL, Frey W, Mann JD. Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. susan_gaylord@med.unc.edu

Irritable bowel syndrome: a mild disorder; purely symptomatic treatment.



(1) Patients frequently complain of occasional bowel movement disorders, associated with abdominal pain or discomfort, but they are rarely due to an underlying organ involvement. Even when patients have recurrent symptoms, serious disorders are no more frequent in these patients than in the general population, unless other manifestations, anaemia, or an inflammatory syndrome is also present; (2) There is currently no way of radically modifying the natural course of recurrent irritable bowel syndrome; (3) The effects of antispasmodics on abdominal pain have been tested in about 20 randomised controlled trials. Pinaverium and peppermint essential oil have the best-documented efficacy and only moderate adverse effects. Antispasmodics with marked atropinic effects do not have a favourable risk-benefit balance; (4) Tricylic antidepressants seem to have only modest analgesic effects in this setting. In contrast, their adverse effects are frequent and they have somewhat negative risk-benefit balances. Nor has the efficacy of selective serotonin reuptake inhibitor antidepressants (SSRIs) been demonstrated; (5) Alosetron and tegaserod carry a risk of potentially life-threatening adverse effects and therefore have negative risk-benefit balances; (6) Seeds of plants such as psyllium and ispaghul, as well as raw apples and pears, have a limited impact on constipation and pain. Osmotic laxatives are effective on constipation. Symptomatic treatments for constipation can sometimes aggravate abdominal discomfort; (7) Loperamide has been poorly assessed in patients with recurrent irritable bowel syndrome with diarrhoea. It modestly slows bowel movement but does not relieve pain or abdominal discomfort; (8) Dietary measures have not been tested in comparative trials. Some patients are convinced that certain foods provoke a recurrence of irritable bowel syndrome, but restrictive diets carry a risk of nutritional deficiencies; (9) Various techniques intended to control emotional and psychological disturbances have been proposed, including relaxation, biofeedback, hypnosis, and psychotherapy. The results of clinical trials are not convincing; (10) Oral products containing live bacteria, designed to change the equilibrium of intestinal flora, have been tested in 13 placebo-controlled trials, with inconsistent results. A few cases of septicaemia have been reported; (11) The six available trials of acupuncture (versus sham acupuncture) showed no more than a placebo effect; (12) In practice, patients who have recurrent irritable bowel syndrome but with no other signs of a condition warranting specific treatment should be reassured as to the harmless nature of their disorder if a careful physical examination and basic laboratory tests are negative. The only available treatments have purely symptomatic effects and only limited efficacy. It is best to avoid using all treatments and additional diagnostic investigations that carry a risk of disproportionate adverse effects.

Prescrire Int. 2009 Apr;18(100):75-9.

Feasibility and acceptability of gut-directed hypnosis on inflammatory bowel disease.



Hypnotically assisted treatments have been used to reduce stress, improve gastrointestinal motility, strengthen immune function, and potentially reduce inflammation. Such treatments may also help reduce disease flares and improve quality of life in inflammatory bowel diseases (IBD). The authors report the results of a case series of 8 white female patients with inactive IBD. All participants initiated and completed treatment, supporting the general acceptability of hypnotically assisted treatment among IBD patients. There was a significant improvement in IBD-quality of life scores for the group posttreatment, t(7) = -3.38, p = .01, with a mean improvement in quality of life of 29 points with significant changes in all 4 subscales. No negative effects of treatment were found.

Int J Clin Exp Hypn. 2007 Oct;55(4):457-66. Keefer L, Keshavarzian A. Rush University Medical Center, Chicago, Illinois, USA. laurie.keefer@northwestern.edu

What you need to KNOW to avoid Partially Hydrogenated Oil alias! TRANS FAT



by Robert DeMaria DC, DABCO, FASBE, NHD

Are you ready for another fat article? By now most people in America have been so inundated with news about FAT that there we are actually living in a FAT phobia epidemic. Confusion is everywhere. FAT or OIL is not the ENEMY the kind of oil the consumers are choosing is the problem!! You need to make wise selections. Well meaning FREE LANCE writers are looking for information to attempt to educate the public about staying thin while you eat. The food manufactures are scurrying to find an alternative for the oils they fry and cook with, keeping the taste appealing and the government off their backs while attempting keep the profit margins up for their investors. Read any of the business news papers and you will see huge players in the food industry make announcements on changing their source of cooking oils. Do you know why they are switching? Better educated consumers are demanding healthier ingredients. Education and the access to information have changed the world in which we eat and live.

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Cognitive-behavioral hypnotherapy in the treatment of irritable-bowel-syndrome-induced agoraphobia.



There are a number of clinical reports and a body of research on the effectiveness of hypnotherapy in the treatment of irritable bowel syndrome (IBS). Likewise, there exists research demonstrating the efficacy of cognitive-behavioral therapy (CBT) in the treatment of IBS. However, there is little written about the integration of CBT and hypnotherapy in the treatment of IBS and a lack of clinical information about IBS-induced agoraphobia. This paper describes the etiology and treatment of IBS-induced agoraphobia. Cognitive, behavioral, and hypnotherapeutic techniques are integrated to provide an effective cognitive-behavioral hypnotherapy (CBH) treatment for IBS-induced agoraphobia. This CBH approach for treating IBS-induced agoraphobia is described and clinical data are reported.

Int J Clin Exp Hypn. 2007 Apr;55(2):131-46. Golden WL. williamgolden@optonline.net

Complementary and alternative medicine for treatment of irritable bowel syndrome.



To review the evidence supporting selected complementary and alternative medicine approaches used in the treatment of irritable bowel syndrome (IBS). QUALITY OF EVIDENCE: MEDLINE (from January 1966), EMBASE (from January 1980), and the Cochrane Database of Systematic Reviews were searched until March 2008, combining the terms irritable bowel syndrome or irritable colon with complementary therapies, alternative medicine, acupuncture, fiber, peppermint oil, herbal, traditional, yoga, massage, meditation, mind, relaxation, probiotic, hypnotherapy, psychotherapy, cognitive therapy, or behavior therapy. Results were screened to include only clinical trials, systematic reviews, and meta-analyses. Level I evidence was available for most interventions. MAIN MESSAGE: Soluble fibre improves constipation and global IBS symptoms. Peppermint oil alleviates IBS symptoms, including abdominal pain. Probiotic trials show overall benefit for IBS but there is little evidence supporting the use of any specific strain. Hypnotherapy and cognitive-behavioural therapy are also effective therapeutic options for appropriate patients. Certain herbal formulas are supported by limited evidence, but safety is a potential concern. All interventions are supported by systematic reviews or meta-analyses. CONCLUSION: Several complementary and alternative therapies can be recommended as part of an evidence-based approach to the treatment of IBS; these might provide patients with satisfactory relief and improve the therapeutic alliance.

Can Fam Physician. 2009 Feb;55(2):143-8. Comment in: Can Fam Physician. 2009 Feb;55(2):126-7, 128-9. Shen YH, Nahas R. Department of Family and Community Medicine at University of Ottawa in Ontario.

Hypnotherapy as an adjuvant for the management of inflammatory bowel disease: a case report.



Idiopathic inflammatory bowel diseases (IBDs) significantly affect the quality of life of sufferers. Improved quality of life and patient symptom management may be achieved through integrating psychological/behavioral interventions with pharmacologic treatments. Here is our experience with hypnotherapy as an adjuvant management for an 18-year-old female with Crohn's Disease (CD) in remission (patient I) and a 24-year-old female with CD in active phase (patient II). The patients participated in 12 weekly one-hour sessions of hypnotherapy. Gut-directed, ego-strengthening, and post-hypnotic suggestions and immune-directed imaginations were used. After the hypnotherapy course, symptoms, psychological state, and quality of life improved in patient I, but not patient II (according to questionnaires). After a 6 month follow-up, symptoms and quality of life were the same as at the end of hypnotherapy sessions in both patients. The patients reported the greatest benefit of hypnotherapy was in helping them to cope better with their disease and also in improving their psychological state. Hypnotherapy may improve quality of life of IBD patients in remission and help them to cope better with their disease. Well-designed controlled clinical trials are needed in this field.

Am J Clin Hypn. 2009 Jan;51(3):255-62. Emami MH, Gholamrezaei A, Daneshgar H. Department of Gastroenterology, Isfahan University of Medical Sciences, Isfahan, Iran.

Predictors of the efficacy of methods for psychocorrection in patients with irritable bowel syndrome



Prognostic factors that predict the efficiency of autogenous training and psychopharmacotherapy were detected in 90 women with irritable bowel syndrome and constipation. A multifactor personality questionnaire, Spielberg's state-trait anxiety test, Beck's depression inventory scale, and visual analog scale were used for the purpose of psychodiagnosis. The efficiency of autogenous training was found to be higher in patients with irritable bowel syndrome and mildly or moderately compromised psychological adaptation associated with a moderately elevated level of anxiety. Psychopharmacotherapy proved to be especially efficacious in patients with hypochondriac, depressive, and manifest anxiety disorders. It was found that the pronouncedness of rigidity, tension, fixation-proneness, and the degree of depression could be used as predictors of positive effects of psychopharmacotherapy on stool patterns while hypochondriac trends served as predictors of the alleviation of pain syndrome in patients with irritable bowel syndrome and constipation.

Vopr Kurortol Fizioter Lech Fiz Kult. 2008 Sep-Oct;(5):6-8. A?vazian TA, Za?tsev VP, Pakhomova IV, Gusakova EV.

Treatment of inflammatory bowel disease: a role for hypnotherapy?



Fifteen patients with severe or very severe inflammatory bowel disease on corticosteroids but not responding to medication received 12 sessions of "gut-focused hypnotherapy" and were followed up for a mean duration of 5.4 years with disease severity being graded as remission, mild, moderate, severe, or very severe. Two patients (13.4%) failed to respond and required surgery. At follow-up for the remaining 13 patients, 4 (26.6%) were in complete remission, 8 (53.3%) had mild severity, and 1 (6.7%) was moderately severe. Quality of life became good or excellent in 12 (79.9%). Corticosteroid requirements dramatically declined with 60% of patients stopping them completely and not requiring any during follow-up. Hypnotherapy appears to be a promising adjunctive treatment for inflammatory bowel disease and has steroid sparing effects. Controlled trials to clearly define its role in this disease area are justified.

Int J Clin Exp Hypn. 2008 Jul;56(3):306-17. Miller V, Whorwell PJ. University of Manchester, United Kingdom.

Complementary and alternative medicine for IBS in adults: mind-body interventions.



Standard treatment for IBS focuses on the management or alleviation of the predominant gastrointestinal presenting symptoms, such as diarrhea or constipation, often using pharmacological therapy. For many patients, this approach is unsatisfactory, and patients frequently seek the advice of complementary and alternative medicine (CAM) practitioners in order to explore other treatment options.

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Hypnosis and upper digestive function and disease.



Hypnosis is a therapeutic technique that primarily involves attentive receptive concentration. Even though a small number of health professionals are trained in hypnosis and lingering myths and misconceptions associated with this method have hampered its widespread use to treat medical conditions, hypnotherapy has gained relevance as an effective treatment for irritable bowel syndrome not responsive to standard care. More recently, a few studies have addressed the potential influence of hypnosis on upper digestive function and disease. This paper reviews the efficacy of hypnosis in the modulation of upper digestive motor and secretory function. The present evidence of the effectiveness of hypnotherapy as a treatment for functional and organic diseases of the upper bowel is also summarized, coupled with a discussion of potential mechanisms of its therapeutic action.

World J Gastroenterol. 2008 Nov 7;14(41):6276-84. Chiarioni G, Palsson OS, Whitehead WE. Divisione di Riabilitazione Gastroenterologica dell'Universita di Verona, Azienda Ospedaliera di Verona, Ospedale di Valeggio sul Mincio, 37067 Valeggio sul Mincio (VR), Italy. chiarioni@tin.it.

Efficiency of autogenous training in medical rehabilitation of patients with irritable colon.



It was established that use of autogenous training makes possible to increase efficiency of the therapy, leading to considerable more evident improvement of somatic and psychotic state, decrease of pain syndrome. Predictors of efficiency of autogenous training were marked out. Indications for use the method in medical rehabilitation of patients with irritable colon syndrome with constipation dominance were elaborated.

Vopr Kurortol Fizioter Lech Fiz Kult. 2008 Jan-Feb;(1):24-7. Pakhomova IV, A?vazian TA, Za?tsev VP, Gusakova EV, Molina LP.

There is Hope There is Help



by Debra Mittler, CHt

There is an ever growing epidemic of eating disorders amongst both women and men. Some start as young as six years of age. People who develop eating disorders usually do it to cope with life circumstances. It is an unconscious reaction to develop a sense of control, escape feelings, avoid responsibility or stop the process of life. They "think" these behaviors make them feel better. They usually are not aware of, and are disconnected from the physical and emotional harm they are doing on their mind, body and spirit. These people tend to have low self-esteem and can view themselves with a lot of negativity. Some feel that nothing is ever good enough, (mostly themselves). Generally their thoughts, feelings and behaviors stem from the limiting beliefs they have about themselves and the world.

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Complementary and alternative medicine use and cost in functional bowel disorders.



ABSTRACT: BACKGROUND: Functional Bowel Disorders (FBD) are chronic disorders that are difficult to treat and manage. Many patients and doctors are dissatisfied with the level of improvement in symptoms that can be achieved with standard medical care which may lead them to seek alternatives for care. There are currently no data on the types of Complementary and Alternative Medicine (CAM) used for FBDs other than Irritable Bowel Syndrome (IBS), or on the economic costs of CAM treatments. The aim of this study is to determine prevalence, types and costs of CAM in IBS, functional diarrhea, functional constipation, and functional abdominal pain. METHODS: 1012 Patients with FBD were recruited through a health care maintenance organization and followed for 6 months. Questionnaires were used to ascertain: Utilization and expenditures on CAM, symptom severity (IBS-SS), quality of life (IBS-QoL), psychological distress (BSI) and perceived treatment effectiveness. Costs for conventional medical care were extracted from administrative claims. RESULTS: CAM was used by 35% of patients, at a median yearly cost of $200. The most common CAM types were ginger, massage therapy and yoga. CAM use was associated with female gender, higher education, and anxiety. Satisfaction with physician care and perceived effectiveness of prescription mediation were not associated with CAM use. Physician referral to a CAM provider was uncommon but the majority of patients receiving this recommendation followed their physician's advice. CONCLUSIONS: CAM is used by one-third of FBG patients. CAM use does not seem to be driven by dissatisfaction with conventional care. Physicians should discuss CAM use and effectiveness with their patients and refer patients if appropriate.

van Tilburg MA, Palsson OS, Levy RL, Feld AD, Turner M, Drossman DA, Whitehead WE. BMC Complement Altern Med. 2008 Jul 24;8(1):46.

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