The Use of Clinical Hypnotherapy in the treatment of IBS and Stress
CAM Magazine – January 2007
The Use of Clinical Hypnotherapy in the treatment of IBS and Stress
by Michael Mahoney, Clinical Hypnotherapist, Guardian Medical Centre, Warrington, Cheshire
What is the human common denominator? Stress. Just hearing the term itself can create it. As health care providers, how can we address this facet of human existence in relation to real physical symptoms and medical diagnosis? For some conditions, the term has almost become synonymous with etiology. Physicians and medical health care providers are recognising a paradigm shift to holistic care and as such may refer their patients to complementary specialists for treatment to address the stress component. As a clinical hypnotherapist in practice, I have found that stress can be intrinsic to many physical disorders.
Stress can be caused by various factors in an individual’s life that are either real or perceived, but it can become a duality in that stress, no matter the source, can create havoc for an individual’s health, or a health condition may itself create stress, thus making the condition worse, and thus either prevent or prolong recovery.
A prevalent case in point is the functional gastrointestinal disorder that affects about one in five individuals known as irritable bowel syndrome or IBS. This disorder is characterized primarily by pain manifested with abnormal bowel motility as well as other symptoms. IBS should always be diagnosed by a physician rather than patient self-diagnosis.
Research shows that the IBS patient’s health-related quality of life is not always necessarily related to their specific gastrointestinal symptoms and that physicians should take into account global symptom severity, address anxiety, and eliminate factors contributing to chronic stress in patients with IBS. 1
The brain-gut connection points to intricate links between the nervous system and the digestive system. Stress does not cause IBS, but stressful messages along the brain-gut axis contribute to the symptoms and make them worse.
As pointed out in a recent publication: “While not all persons with IBS exhibit psychological distress, it may be present in some patients with IBS, particularly in those with more severe symptoms. On the other hand, the symptoms of IBS can sometimes be so bothersome and affect daily activities so much that the patient understandably develops emotional distress. Because various forms of emotional stress are important in the development and management of IBS, the understanding of the mind and body's responses called upon during stress may provide insight on the underlying cause of IBS and open the door to new and more effective treatment.” 2
It also may be noted in another study, that “amongst many factors, anxiety and fear generated by IBS symptoms themselves are sufficient in many patients to maintain the stress responsiveness in a chronically enhanced state.”3
There is also a psychological element in the patient’s thought patterns that creates the expectation of difficult IBS days. Running out worries causes anxiety and added stress, which in turn creates a negative physical response. The annoying thing is, it's part of being human, it's a response which we don't have to even try to do, it all happens automatically.
To understand the clinical hypnotherapy processes a bit more, we have to understand stress is not 'out there', stress is how we respond internally to real or perceived external demands. What is a stressful event for one, can be invigorating or relaxing event for another.
Every thought has a physical response. Along with the more every day concerns of, getting to work on time, the IBS patient worries about embarrassing accidents, and making sure they have access to facilities. Every thought produces a physical reaction, good or bad.
Hypnotherapy processes can guide the patient to choose to learn new coping strategies. In the first session of protocol for IBS, time is spent topping up the emotional reserves, making sure individuals can complete the journey. Patients that come to my practice all go through the same thing; in short, they have to be able to have the internal emotional resource to deal with everyday living, as well as changing their thoughts towards IBS. Because IBS has affected the lives of sufferers so deeply, to try and deal with the IBS before we are prepared would lead to a tougher journey. So taking the time to build up the emotional batteries and lay a solid foundation is time well spent. The individual has to learn how to rebuild this internal energy. Many patients feel drained emotionally, life issues and responsibilities continue to deplete inner emotional strength, leading in some cases to anxiety or even some forms of depression, all sources of extreme stress. Before the sufferer even thinks of working through the IBS, or other conditions, after perhaps years of pain and discomfort, of being told by various medical professionals that there is nothing that can be done, even after intrusive and sometimes painful examinations, a new base level needs to be set. Work and family relationships can be eroded and strained, social life and love life can be virtually non-existent, concentration and recall, may be almost impossible compared to how it used to be, confidence and self esteem of the individual is often very low, and the ability to see things in perspective is greatly reduced. It is essential that clinical hypnotherapy protocols address these areas first, or failure of treatment is certain.
In thinking about stress, it helps too if the patient considers that the only important moment of our lives is the current moment. We are living now, not in the past (although we can change emotions attached to memories to make the past more comfortable for us), but we don't want to worry about future events or problems that might never come.
Am additional factor is the fear that current feelings of the patient is going to last forever. For severe refractory IBS sufferers, I found that these patients had a higher failure expectation after years of frustration and unsuccessful treatment resolution and that they often presented with more co-morbid emotional, psychological and physical symptomology and poor QOL, in addition to "basic" IBS symptoms. This finding led me to believe that in many cases, if IBS is not initially treated on the psychological level, the condition usually escalates into a multi-faceted condition. Treatment took longer due to the many levels needing to be addressed, with stress factors contributing as a major component. The various symptoms of IBS and its related stress facets require different types of imagery and suggestions. As a specialist in this area of IBS, sufferers have the need for understanding, and an empathetic approach. Sufferers who consider hypnotherapy currently tend to do so as a ‘last resort’ rather than a first approach after diagnosis.
Stressful life-event scores are significantly higher in IBS patients than in normal controls.4 Patients who have had long-term suffering with IBS who worry and think about their symptoms intensify them.5
Hypnotherapy patients who are feeling much better are changing the way they think, as well as their outlook on life and its events, and consequently, their IBS symptoms abate as well. Patients may not be able to pinpoint exactly when things started to get better, but they do, and they do so because very gently the subconscious mind, which controls the digestive system, begins to realize, that these thought patterns of IBS are no longer needed, the individual as a whole is reminded that it existed without IBS, and can do so again, simply and gently by changing the thought processes, that kept stress and anxiety, guilt etc. in control.
Research has shown that symptom improvement in IBS with hypnotherapy is associated with cognitive change.6
The IBS method of hypnotherapy I developed is gut-specific, and termed “on-going progressive session induction.” This method was created upon the basis that as a patient responds and improves, something new must continue to happen in therapy to help the patient achieve further results. Experience has shown that if the process remains the same, the patient is more likely to become stalled at some stage of the treatment. Particularly, the sounds and words used in therapy initially, when IBS symptoms are present, can become associated with this negative state of health and mind. These same sounds and words should not continue to be used throughout the therapy because the negative associations can then become anchored onto the healing methods, which will eventually limit the progress of the patient.
The IBS method of hypnotherapy allows the patient to continue to progress throughout the entire course of treatment, and beyond. As patients learn new ways of thinking, they have more internal resources available to use in overwriting their previous negative beliefs. This then leads to further progress, more free mental resources, more progress, and the resultant reduction of IBS symptoms. Hypnotherapy works on the basis that everyone is continuously developing in one way or another, as every day involves learning, making decisions, experiencing emotions, etc. The IBS method of treatment takes advantage of this development and encourages it by changing the sessions and mental suggestions in ways that help carry the patient continuously forward.
This approach is based on the belief that everyone throughout their lives has to keep looking for ways of moving forward, and that continuous personal development should be second nature to us all. As change is a natural part of life, we should view it as an opportunity and not a threat. The IBS method reduces the subconscious negative perceptions of change, allowing the embrace of new thoughts and beliefs, with the resultant improvement in IBS symptoms.
Hypnotherapy and similar cognitive approaches may be useful in protecting IBS patients against the effects of allostatic load, or the wear and tear, of stress. 7
In treating the IBS patient, it is important that the therapist understands the frustration, fear, and pain this disorder causes. Tied to this is the anger that stems from sometimes being treated dismissively by health professionals who deny the serious impact of IBS, and its related intrinsic stress and who simply refuse to listen to those who offer new avenues of help. Patients many times come to me out of desperation, relating a feeling of being battered, ignored, disbelieved, and sometimes their condition minimized. So in addition to IBS symptoms, the patient now is dealing with all manner of psychological problems, many times inflicted by those who they sought out for help, and many times inflicted by themselves, or family members, who are less than understanding, or are frustrated in their ability to help. Compassion and understanding constitute a big component of the hypnotherapy process. If the therapist cannot relate to the patient’s depletion of self worth and trust of the process, success will be unlikely. Words of compassion may not be enough, but empathy and compassion in voice and manner towards the patient will go a long way to providing a healing atmosphere and teach the patient that they are worth the time needed to take part in their own healing. Once the patient can feel the empathy, or a safe haven in the therapy setting, if you will, the foundation can be set, some of the stressors lifted – especially those stressors of no hope, or that nothing can be done. The idea of hope of symptom alleviation or even elimination in itself, can lift a big portion of the stress factor in the patient’s life. The ideation of hope creates a new thought or cognition – thereby changing thought patterns. These newly formed initial positive thought patterns break the mind-gut connection and produce even more new thought patterns. Once these take hold, self-healing can begin and progress.
In conclusion, when conducted correctly, progressive hypnotherapy sessions can increase self-esteem, confidence, and allow the sufferer to begin a journey of self improvement and management, by changing negative thoughts and feelings for positive ones and thereby equip themselves emotionally to move away from the stress, symptoms and thoughts of IBS and other conditions. Clinical hypnotherapy may be something to consider to offer to patients with IBS and other stress-related conditions, to provide hope of symptom and emotional improvement. Clinical hypnotherapy can provide that one extra modality of treatment that may mean all the difference to the patient’s health and quality of life.
1. Spiegel BM, Gralnek IM, Bolus R, Chang L, Dulai GS, Mayer EA, Naliboff B. Clinical determinants of health-related quality of life in patients with irritable bowel syndrome. Arch Intern Med. 2004 Sep 13;164(16):1773-80.
2. Martinez V, Taché Y. Stress and Irritable Bowel Syndrome: Unraveling the Code, giresearch.org and also CRF1 receptors as a therapeutic target for irritable bowel syndrome. Current Pharmaceutical Design, 2006, 12, 4071-4088.
3. Mayer E. The Neurobiology Basis of Mind Body Medicine, IFFGD, 2000.
4.Pinto C, Lele MV, Joglekar AS, Panwar VS, Dhavale HS. Stressful life-events, anxiety, depression and coping in patients of irritable bowel syndrome. Department of Psychiatry, BYL Nair Hospital and TN Medical College, Mumbai-8.
5. Lackner JM, Quigley BM. Pain catastrophizing mediates the relationship between worry and pain suffering in patients with irritable bowel syndrome. Department of Medicine, Behavioral Medicine Clinic, School of Medicine, University at Buffalo, SUNY, ECMC, 462 Grider Street, Buffalo, NY 14215, USA.
6. Gonsalkorale WM, Toner BB, Whorwell PJ. Cognitive change in patients undergoing hypnotherapy for irritable bowel syndrome. J Psychosom Res. 2004 Mar;56(3):271-8.
7. Emeran A. Mayer, M.D., UCLA Mind Body Collaborative Research Center, UCLA School of Medicine, California The Neurobiology of Stress and Emotions. Participate/Digestive Health Matters, Winter 2001.
Michael Mahoney is a clinical hypnotherapist in private practice at the Guardian Medical Centre in Cheshire England and is a member of the Primary Care Society for Gastroenterology, the Hypnotherapy Association, The British Council of Hypnotist Examiners, as well as the International Foundation for Functional Gastrointestinal Disorders, the European Association for Cancer Education and the International Functional Brain-Gut Research Group. He treats patients through NHS, non-NHS and BUPA. He has research and patient trials experience showing success rates of 85% - 95% IBS symptom reduction using his Ongoing Progressive Session Induction Method (OPSIM). In 2003 he was named first in the Independent on Sunday ‘Top Brass Section’ of leading hypnotherapists in the UK. His hypnotherapy practice sponsored the UK’s first IBS Awareness evening at Liverpool University in 1997. For further information about Michael’s CPD IBS Workshops for hypnotherapists in practice, contact him at (44) (0)1925629899 Inquiries regarding therapy and training services and program titles may be found at www.ibs-register.co.uk and www.IBSCDS.com and www.healthyaudio.com.
