Irritable bowel syndrome (IBS) is a complex and prevalent functional gastrointestinal disorder that is treated with limited effectiveness by standard medical care. Hypnosis treatment is, along with cognitive-behavioral therapy, the psychological therapy best researched as an intervention for IBS. Eleven studies, including 5 controlled studies, have assessed the therapeutic effects of hypnosis for IBS. Although this literature has significant limitations, such as small sample sizes and lack of parallel comparisons with other treatments, this body of research consistently shows hypnosis to have a substantial therapeutic impact on IBS, even for patients unresponsive to standard medical interventions. The median response rate to hypnosis treatment is 87%, bowel symptoms can generally be expected to improve by about half, psychological symptoms and life functioning improve after treatment, and therapeutic gains are well maintained for most patients for years after the end of treatment.

University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA. William_Whitehead@med.unc.edu

Irritable bowel syndrome (IBS) is a very common condition in the Western part of the world, and it accounts for a large proportion of the workload of a gastroenterologist. Unfortunately, the pathogenesis and pathophysiology of the syndrome are incompletely understood, and the treatment options are limited. However, hypnotherapy is one treatment option that has proven to be very useful in IBS. The mechanisms of action explaining why hypnosis is effective for IBS are not altogether known, but recent studies have shed some light on this issue. These studies, and what can be learned from them about how hypnosis impacts IBS, are reviewed in this article. Hypnosis may affect IBS partly through changes in colorectal sensitivity and improvement in psychological factors. The effects on GI motility and the autonomic nervous system are less clear and need further evaluation.

Dept of Internal Medicine, Sahlgrenska University Hospital, Goteborg, Sweden. magnus.simren@medicine.gu.se

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.

Division of Digestive Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. opalsson@med.unc.edu

This modest clinical pilot study was intended to provide preliminary data on the effects of hypnotic inductions tailored to an irritable bowel syndrome patient at each session compared to Palsson's manualized protocol. Patients (N = 8) who had not previously responded to any form of treatment were assigned randomly to either a tailored or manualized induction condition. Other than pretesting for hypnotizability, the procedure followed for the manualized group (n = 4) was exactly as prescribed by O. Palsson (1998). The identical procedure was used for the other 4 patients except that the inductions were individualized. All 8 patients showed favorable responses to treatment immediately posttreatment and at 10-month follow-up. Only the tailored group showed no incapacitating pain at posttreatment but greater emotional stress than the manualized group. The tailored group continued to improve and showed better results than the manualized group at 10 months, and the posttreatment emotional distress was significantly attenuated.

Washington State University, Pullman, Washington 99164, USA. arreed_barabasz@wsu.edu

To assess the association between complementary and alternative medicine (CAM) use, preventive care practices, and use of conventional medical services among adults with diabetes. RESEARCH DESIGN AND METHODS: We analyzed data on 2,474 adults with diabetes. We created an overall CAM-use category based on use of any of the following: diets, herbs, chiropractic care, yoga, relaxation, acupuncture, ayuverda, biofeedback, chelation, energy healing, Reiki therapy, hypnosis, massage, naturopathy, and homeopathy. We used multiple logistic regression to assess the effect of CAM use on preventive care practices (receipt of influenza and pneumonia vaccines) and use of conventional medical services (number of primary care and emergency department visits). STATA was used for statistical analysis to account for the complex survey design. RESULTS: A total of 48% of adults with diabetes used some form of CAM. CAM use was independently associated with receipt of pneumonia vaccination (odds ratio 1.56 [95% CI 1.26-1.94]) but not significantly associated with receipt of influenza vaccination (1.17 [0.92-1.48]). CAM use was independently associated with visiting the emergency department (1.34 [1.06-1.70]), having six or more primary care visits (1.44 [1.14-1.83]), and having eight or more primary care visits (1.66 [1.22-2.25]). CONCLUSIONS: In contrast to the findings of previous studies, CAM use appears to be associated with increased likelihood of receipt of preventive care services and increased emergency department and primary care visits. CAM use may not be a barrier to use of conventional medical services in adults with diabetes.

Department of Medicine, Division of General Internal Medicine, Medical University of South Carolina, 135 Cannon St., Suite 403, Charleston, South Carolina 29425, USA.

Source identification tests provide a stringent method for testing the suggestibility of memory because they reduce response bias and experimental demand characteristics. Using the techniques and materials of Maria Zaragoza and her colleagues, we investigated how state anxiety affects the ability of undergraduates to identify correctly the source of misleading post-event information. The results showed that individuals high in state anxiety were less likely to make source misattributions of misleading information, indicating lower levels of suggestibility. This effect was strengthened when forgotten or non-recognised misleading items (for which a source identification task is not possible) were excluded from the analysis. Confidence in the correct attribution of misleading post-event information to its source was significantly less than confidence in source misattributions. Participants who were high in state anxiety tended to be less confident than those lower in state anxiety when they correctly identified the source of both misleading post-event information and non-misled items. The implications of these findings are discussed, drawing on the literature on anxiety and cognition as well as suggestibility.

Department of Psychology, London South Bank University, UK. ridleyam@lsbu.ac.uk

The aim of this study was to systematically review and critically appraise the evidence on the effectiveness of hypnosis for procedure-related pain and distress in pediatric cancer patients. A comprehensive search of major biomedical and specialist complementary and alternative medicine databases was conducted. Citations were included from the databases' inception to March 2005. Efforts were made to identify unpublished and ongoing research. Controlled trials were appraised using predefined criteria. Clinical commentaries were obtained for each study. Seven randomized controlled clinical trials and one controlled clinical trial were found. Studies report positive results, including statistically significant reductions in pain and anxiety/distress, but a number of methodological limitations were identified. Systematic searching and appraisal has demonstrated that hypnosis has potential as a clinically valuable intervention for procedure-related pain and distress in pediatric cancer patients. Further research into the effectiveness and acceptability of hypnosis for pediatric cancer patients is recommended.

Faculty of Health and Social Work, Portland Square, University of Plymouth, Drake Circus, Plymouth, Devon PL4 8AA, United Kingdom. janet.richardson@plymouth.ac.uk

The aim of this study was to systematically review and critically appraise the evidence on the effectiveness of hypnosis for procedure-related pain and distress in pediatric cancer patients. A comprehensive search of major biomedical and specialist complementary and alternative medicine databases was conducted. Citations were included from the databases' inception to March 2005. Efforts were made to identify unpublished and ongoing research. Controlled trials were appraised using predefined criteria. Clinical commentaries were obtained for each study. Seven randomized controlled clinical trials and one controlled clinical trial were found. Studies report positive results, including statistically significant reductions in pain and anxiety/distress, but a number of methodological limitations were identified. Systematic searching and appraisal has demonstrated that hypnosis has potential as a clinically valuable intervention for procedure-related pain and distress in pediatric cancer patients. Further research into the effectiveness and acceptability of hypnosis for pediatric cancer patients is recommended.

Faculty of Health and Social Work, Portland Square, University of Plymouth, Drake Circus, Plymouth, Devon PL4 8AA, United Kingdom. janet.richardson@plymouth.ac.uk