Research studies on hypnotherapy for Irritable Bowel Syndrome

This study conducted a systematic review to assess the quality of existing literature on psychological treatments for irritable bowel syndrome and to quantify the evidence for their efficacy. Three independent reviewers (two from England, one from the United States) coded the quality of 32 studies, 17 of which provided data suitable for meta-analysis. Meta-analysis of efficacy data (50% reduction of symptoms) gave an odds ratio of 12 (95% confidence interval = 5.56-25.96) and a number needed to treat of 2. Psychological treatments are, as a class of interventions, effective in reducing symptoms compared with a pooled group of control conditions. Questions regarding the relative superiority of specific psychological treatments and influence of active versus nonspecific treatment effects remain unanswered. Gastroenterology & Hepatology Vol 20 Issue 11-12 Meta-analysis: the treatment of irritable bowel syndrome D. Lesbros-Pantoflickova, P. Michetti, M. Fried, C. Beglinger, A. L. Blum LINK TO FULL REPORT Summary The stated purpose of this study was to evaluate therapies available for the treatment of irritable bowel syndrome, and provide consensus recommendations for their use, a total of 51 double-blind clinical trials using bulking agents, prokinetics, antispasmodics, alosetron, tegaserod and antidepressants were selected. The quality of studies was assessed using 5-point scale. Meta-analyses were performed on all studies, and on ‘high-quality studies. 17/01/2016 13:48 Research studies on hypnotherapy for Irritable Bowel Syndrome Page 27 of 67 file:///Volumes/Small%20External/rwd025ra-RD35-Athletic/RD35-Athletic/ibs-pdf.htm NB The authors were critical of the quality of many of the trials, including psychotherapy, Their report on psychotherapy for instance stated: 1. Mechanism of action: Psychological factors such as stressful or traumatic life events are reported by up to 60% of IBS patients, and are associated with the first onset of symptoms or with symptom exacerbation. Harmful events such as abuse, neglect or loss of a parent have been described in IBS patients and, to a certain degree, also in animals models.The aggregation of IBS in families of patients with IBS might also be due to learned responses which are transmitted in early childhood.3 These responses may imply a tendency towards anxiety, depression and somatization. Thus, it has been suggested that reducing the severity of psychological distress by will alleviate the symptoms of IBS. Psychotherapy, such as cognitive-behavioural therapy,dynamic/interpersonal psychotherapy, hypnotherapy, and stress management may reduce autonomic arousal and anxiety and thus reduce the frequency and severity of symptoms. There are a number of pathophysiological studies directly evaluating the effect of psychotherapy on GI motility or visceral sensitivity. Most of these studies are related to hypnotherapy. Some controlled studies with IBS patients reported reductions in fasting colonic motility or improvements in abnormal sensory perception in IBS patients with hypnotherapy compared with no treatment or supportive psychotherapy. However, others failed to find such an effect and attributed the improvement of IBS symptoms to reduction in psychological distress and somatization by psychotherapy. 2. Clinical evidence: There have been numerous trials of psychological treatment in IBS. Many suffer of methodological inadequacies. The main problem of these studies are the absence of a true control group and lack of adequate blinding, leading to a bias assessment. For example, hypnotherapy was reported to improve IBS symptoms compared with supportive psychotherapy, symptom-monitoring waitlist condition or no treatment. However, some measures such as the therapist contact time or degree of attention to symptoms are lower with these therapeutic procedures than with hypnotherapy. Thus, given the generous placebo response that accompanies trials of functional bowel disorders, the absence of adequate control groups may account for the favourable effect obtained with psychotherapy. Accordingly, in a adequately controlled trial in IBS subjects comparing cognitive behaviour and relaxation therapy to standard care alone showed a reduction in anxiety, depression, social functioning scale and bowel symptoms, with, however, no difference between the three approaches. In addition, similar therapies have been successfully used in organic 17/01/2016 13:48 Research studies on hypnotherapy for Irritable Bowel Syndrome Page 28 of 67 file:///Volumes/Small%20External/rwd025ra-RD35-Athletic/RD35-Athletic/ibs-pdf.htm disorders such as breast cancer. Thus, this type of therapy might simply modify illness behaviour, thus improving the handling of the disorder by the patient. Moreover, while some therapies such as cognitive behaviour therapy, appear efficacious in IBS patients, they are not costeffective.212 In conclusion, the role for psychotherapy in IBS has not been established.