Positive Health Online

Generally accepted as the foremost authority in the UK on the use of hypnosis to alleviate Irritable Bowel Syndrome (IBS), Professor Peter Whorwell BSc MB BS MD PhD FRCP has carried out numerous clinical trials assessing and reflecting the efficacy of hypnotherapy in the treatment of IBS and has published many papers in this field of research.

Although the fundamental causes of irritable bowel syndrome are not fully understood it occurs when the large bowel ceases to function normally and is either over- or under-active, leading to episodes of diarrhoea interspersed with periods of constipation. Sufferers may also experience additional symptoms including:

• Abdominal contractions, spasms or cramps;
• Bloating & excess wind;
• Nausea and vomiting;
• Indigestion.

The disorder seems be related to, and/or exacerbated by, stress, tension and anxiety rather than resulting from some pathological disorder.

The total prevalence of IBS in the UK is estimated to be 10.5% of the population and was found to vary by gender and age, with women aged 30-39 twice as likely to suffer from IBS as men of the same age.[1]

Sufferers of IBS can find their lives restricted by the ever present need to be close to toilet facilities, and the tension, which arises from the fear of being 'caught out', increases the stress thus aggravating the condition and generating a 'catch 22' situation.

To understand how and why patients and clients respond favourably to the application of hypnosis firstly requires a basic understanding of the nature of hypnosis itself.

Simply put, hypnosis is an altered state of awareness usually brought about, in therapy, through a combination of relaxation and inward focus, or relaxation and distraction. Though the mechanisms by which the subject in a hypnotic state becomes more suggestible may be disputed, the fact that, to a greater or lesser extent, the subject is rendered more suggestible is generally accepted.

In layman's term, during hypnosis, the rational, critical, analytical part of the conscious mind is relegated to the side lines, allowing increased access to the non-critical subconscious which is more likely to accept suggestions; suggestions which the conscious might otherwise ignore. Note, however, that even in the deeper levels of hypnosis, the conscious is never so passive that suggestions, unacceptable to the subject, will be acted upon, but those which are for the recipient's own good, will tend to be more readily accepted than otherwise.

The individual suffering from IBS will be liable to benefit, firstly from the very act of allowing themselves to achieve a level of hypnosis, as the effect of experiencing deep relaxation alone can impact favourably on the condition. The client will be encouraged, between sessions, to continue the practice of hypnosis either by listening to a CD or with self hypnosis.

During the session 'anchors', physical or verbal, can be suggested, the use of which, post hypnotically, will bring about a 'programmed' relaxation response. This can be utilized by the subject if, and when, they become aware of a rising tension or anxiety.

The therapist can also encourage the client to visualize, in a variety of ways, direct or metaphorical, their system functioning in a healthy, gentle fashion, tuning in to their natural body rhythms, just as nature intended.

However, accepting that stress informs the progress of IBS, one might ask why everyone who is stressed does not suffer with IBS. Other functional disorders which can arise as a result of stress, tension and anxiety encompass complaints as diverse as dermatological problems, cardiovascular issues, headaches, migraine and even eating disorders or drug misuse. So why do some people develop one reaction to stress while another develops a completely dissimilar complaint?

Well, having asked the question, I have to say that there is no clear answer! What has become clear to me, however, during the years I have been practising psychoanalytical hypnotherapy, is that the development of one complaint rather than another is often related to something from earlier life experience, either a learned behaviour or a traumatic event.

Whilst suggestion therapy alone can achieve a great deal of relief for sufferers[2] of IBS, assisting the client to understand or recognize why their bowel is the part of the body which is evidencing 'dis-ease' can have quite dramatic effects.

To achieve this end, under hypnosis and utilizing various non-leading interventions, the therapist can support the client as they permit their subconscious to identify a memory or memories, related to the presenting problem. Often 'visiting' past experience, expressing unexpressed emotions or simply reassessing the incident or incidents in the light of hindsight (how often do we wish we had 20-20- vision?) can have a profound effect as the 'bug' in the programme is rendered obsolete.

This form of intervention is probably the most controversial as it is difficult to assess, clinically, the efficacy of hypnoanalytical therapy, for a large number of individuals, as each experience is unique to the client. Why it works may be clear to me, but hard to validate. I can only cite the evidence of my own eyes, as obviously I am not in a position to divulge any client details.

I leave you, however, with the following conclusion reported in the American Journal of Clinical Hypnosis.[3]

"Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by abdominal pain, distension, and an altered bowel habit for which no cause can be found. Despite its prevalence, there remains a significant lack of efficacious medical treatments for IBS to date. In this paper we reviewed a total of 14 published studies (N = 644) on the efficacy of hypnosis in treating IBS (8 with no control group and 6 with a control group). We concluded that hypnosis consistently produces significant results and improves the cardinal symptoms of IBS in the majority of patients, as well as positively affecting non-colonic symptoms. When evaluated according to the efficacy guidelines of the Clinical Psychology Division of American Psychological Association, the use of hypnosis with IBS qualifies for the highest level of acceptance as being both efficacious and specific. In reviewing the research on the mechanism of action as to how hypnosis works to reduce symptoms of IBS, some evidence was found to support both physiological and psychological mechanisms of action." (My emphasis)

Case Study
A lady in her mid years presented with IBS having suffered with it for 12 years, her life becoming increasingly constrained by the condition. She had been active in outdoor pursuits, all of which, one by one, were becoming untenable with the constant need to be aware of where public toilets could be found.

During the first session, after induction, deepening, and rebuilding of self-esteem techniques, I utilized suggestions to the effect that she was regaining control over her normal body functions and encouraged her to imagine that she was experiencing a calmness throughout her digestive tract, with gentle, rhythmic pulsations easing the passages. (There is no need to be too specific; an overall impression of good functioning is the aim.)

I placed a post hypnotic anchor (a signal which is effective after the session has ended) so that if, or when she felt any tension or anxiety over such considerations as reaching a toilet facility in time, she could utilize it, thus programming her subconscious to relax to order. (The efficacy of such anchors will vary from client to client depending on the degree of hypnosis obtained.)

Finally I encouraged the client to imagine that she had moved forward in time, in her mind, to a point in the future where she could sense, see and experience what it would feel like to be free of her complaint and to actually step inside this person and 'try it on' like a new piece of clothing, encouraging her to visualize her taking part in the activities she once enjoyed so much.

Now suggestion therapy can be powerful but, a bit like the Pavlov's dog experiment, over time, de-conditioning can occur if the original cause of the functional disorder remains in the psyche. So for the second session, after initializing hypnosis and encouraging the client once again to visit the future, (so providing a clear blueprint of what it was she wished to achieve) I questioned the subconscious as to whether or not there were any obstacles to her achieving this improved state of affairs.

At this point I wish to note, it is extremely important that the therapist does not 'lead' the client in any way whatsoever and takes care to ensure their language is 'sterile'. Once the client has indicated that something has come to their mind the therapist assists the client to use this 'hook' (whatever it is) to connect them with an associated incident, again very carefully.

Occasionally at this point a client will have an 'Ah ha!' moment, immediately resolving the issue with the benefit of hindsight. On other occasions, the client may have to expel trapped emotions and this can happen in a variety of ways. It is the therapist's job to support the client and to encourage full cathartic venting of whatever needs to be released and in whatever way the client wishes. Thereafter the memory is revisited as many times as required until it has lost any power over the individual and can thus be rendered impotent.

In the case of this particular client she recalled an incident in childhood which occurred while she herself was in the toilet, doing what nature intended. As a result of being provoked by another who was chivvying her to hurry up, she lost her temper and did some damage to the door of the toilet.

Without going into the why's and wherefores this client recognized, with the benefit of hindsight, that she had been so upset by that incident, especially the associated loss of temper, that she had developed into a very emotionally controlled adult.

She was, at the point in her life when she visited me, requiring to call on every ounce of her control not to say, things she wanted to say, to a significant other. It seemed that her IBS was nature's way of providing an escape valve for all the unexpressed annoyance and anger which had built up within her, only in the most impressive way!

Though it may be hard to prove the connection, clinically, a few weeks after this I received a lovely email from my client saying that she couldn't believe that she had let the IBS rule her life for so long and that it had completely cleared up. To this day I don't know what happened when she opened the flood gates of her emotions, but at least she was now in a position to express what she felt, rather than her leaving it to her somatic being.

References
1. Wilson S, Roberts L, Roalfe A et al. Prevalence of irritable bowel syndrome: a community survey. British Journal of General Practice 54: 495-502. 2004.
2. Overview of Published Research To Date on Hypnosis for IBS. Olafur S. Palsson, Psy.D. www.ibshypnosis.com/IBSresearch.html
3. American Journal of Clinical Hypnosis Volume 47, Issue 3. 2005.