Biology 202
2004 Second Web Paper
On Serendip

Irritable bowel syndrome (IBS) is a disorder fraught with controversy. Its cause is unclear and its cure for all those who suffer with the syndrome is yet to be determined. Yet, it cannot be ignored due to the fact that it affects 10% to 17% of the population (1) (2) and billions of dollars go to physicians' visits, prescriptions and lost workdays every year because of IBS. (3) Diagnosis for IBS mostly involves eliminating an organic cause for the symptoms. The symptoms of IBS include relief after defecation, diarrhea or constipation. (1) Once enough testing has been done to decrease the likelihood that some other infection or disease is not the cause of symptoms, IBS is diagnosed.

As there is no known outward cause for the disorder, it must involve the body itself. This is apparent through the current modes of treatment. The treatments include avoiding foods that may aggravate symptoms, taking tricyclic antidepressants and hypnotherapy. (3) Avoiding certain foods may be related to individual's allergies towards those foods, which may have a genetic link. Also tricyclic antidepressants that reduce constipation such as Tegaserod or reduce diarrhea such as Alosteron have been proven effective in certain trials.(1) (3) The literature shows, however, that hypnotherapy is the most effective form of treatment for those diagnosed with IBS. (1) (2) (3) (4) (5) (6)

The fact that hypnotherapy shows positive results may be related to the high co morbidity of IBS and stress in patients.(1) Stomach discomfort is a common symptom of nervousness and anxiety. The author can recall many instances when she was in a stressful situation, such as before an interview or before presenting a project in class and feelings of an upset stomach would arise. It is through such examples that one becomes aware of how close the connection between thoughts and physical responses are. The upset stomach was a direct result of the nervousness. She could only get rid of that symptom but reassuring herself and decreasing the number of worrisome thoughts. The reduction of anxiety reduced the discomfort in the bowels.

Those with IBS may have a hypersensitivity to this symptom of stress. (6) Just as some feel hungry when nervous, while others loose their appetite, people with IBS may have more severe bowel problems connected to stress. It is unclear as to whether this is true in all IBS patients, especially those who do not see a doctor for treatment. However, for those with stress related or stress induced IBS, hypnotherapy has proven to be an effective means of treatment. (6)

Research on hypnosis has reduced much of the mystery surrounding the process. As Galovski and Blanchard (2) report, all participants in their study accepted hypnosis as a satisfactory treatment option for IBS. This overall acceptance may be generalized to the comfort level of the United States as a whole with regards to hypnosis. Today there are standardized ways to hypnotize an individual, with many free scripts and instructions available both in print and on the internet. (7) The basic theme underlying most of these ways to induce hypnosis are attaining a relaxed state. Generally the person stares at a fixed point and listens to the hypnotist (either an actual person or a recording) recite a script, which induces relaxation. (7) (9)

The Stanford Hypnotic Susceptibility Scale (8) is a way to determine how deeply a person can be hypnotized. There are 12 items or tasks the hypnotist asks the person under hypnosis to perform. One example is the hypnotist tells the person that they have no sense of smell. If the person were very susceptible to suggestion under hypnosis he or she would not react to a putrid smell. Someone who is not as easily influenced under hypnosis would draw back from the source of the smell. (9) The more times a person under hypnosis reacts in line with the given suggestion the more hypnotizable the person is. A person who is very hypnotizable would score a 12, meaning they acted in accordance with every suggestion. A person who is not at all susceptible to hypnosis would score a zero. The general population scores in the range of 5 to 7. (9)

Hypnotherapy is used as a way to make people more aware of their bodies so that they may have better control over their general functioning. Hypnosis has been studied in acute pain management and has been shown to reduce perceived pain in moderately and highly hypnotizable people. (10) It has also been used to relieve chronic pain such as that experienced by cancer patients by improving distraction techniques such as visualization. (6) (11) The person focuses attention away from pain and on to pleasant images thus reducing the experience of pain.

Hypnotherapy for sufferers of IBS seems to have the least effect on those that have symptoms related to diarrhea. (2) (5) This may be due to the types of suggestions given to patients under hypnosis. For example, in the study conducted by Galovski and Blanchard imagery such as easily flowing water equated with digestion and intestinal function was used. (2) This sort of imagery would be useful if the patient had symptoms of constipation, however for someone suffering from diarrhea their digestive tract functions too much like this image. Listening to suggestions like that would not show a reduction of symptoms and could potentially exacerbate the problem.

One study showed that most of the physiological effects of IBS remained, despite self-reports of improved symptoms during and after hypnotherapy. (5) This result is in line with other studies that looked at perceived distress on the body during hypnosis. (10) (12) Hilgard (10) showed that acute pain thresholds could increase under hypnosis but that the physiological responses to stimuli, such as heart rate, are similar to those not under hypnosis and experiencing the same painful stimuli.

Likewise, Williamson et. al. (12) carried out an experiment involving bicyclists and perceived physical effort. They found that hypnotized bicyclists had increased blood pressure and heart rate when they were cycling under the suggestion of going up an incline. However, under the suggestion that they were going down a hill their blood pressure and heart rate were the same as under the suggestion that they were going on a flat surface. Under all three conditions their speed and work done was the same. The participants reported that their perception of the work done was less while going down hill, but their physiological responses did not reflect that. (12) Here are examples of perceived pain or distress on the body being less than physical indicators would suggest.

This might indicate that in IBS, hypnosis may not cure all, most, or any of the actual symptoms but rather reduce or eliminate the perceived discomfort and pain associated with it. This conclusion would correspond with findings that those with IBS are hypersensitive to pain in the bowels. It would also be consistent with the high levels of co morbidity of IBS and anxiety disorders. (2) (3) One is then left wondering if the hypnotherapy is just treating the anxiety disorder. And if symptoms do actually remit were they just caused by the anxiety? If they were, did the person really have IBS or just an anxiety disorder with physical symptoms?

References

1) Talley, N. J. & Spiller, R. (2002). Irritable bowel syndrome: a little understood organic bowel disease? [Electronic version]. The Lancet, 360, 555-564.

2) Galovski, T. E. & Blandchard, E. B. (1998). Treatment of irritable bowel syndrome with hypnotherapy [Electronic version]. Applied Psychophysiology and Biofeedback, 23, 219-232.

3) Farthing, M. J. G (1995). Irritable bowel, irritable body, or irritable brain? [Electronic version]. British Medical Journal, 310 (6973), 171-176.

4) Houghton, L. A., Calvert, E. L., Jackson, N. A., Cooper, P., & Whorwell, P. J. (2002). Visceral sensation and emotion: a study using hypnosis [Electronic version]. Gut, 51 (5), 701-704.

5) Nash, M. R. (2004). Salient findings: pivotal reviews and research on hypnosis, soma and cognition. The International Journal of Clinical and Experimental Hypnosis, 52 (1), 82-88.

6) Vickers, A. & Zollman, C. (1999). Hypnosis and relaxation therapies [Electronic version]. British Medical Journal, 319, 1346-1349.

7)Hypnosis Script Library - Suite 101.com, free scripts to induce hypnosis

8) Weitzenhoffer, A. M., & Hilgard, E. R. (1959). Stanford hypnotic susceptibility scale, forms A and B. Palo Alto, CA: Consulting Psychologists Press.

9) Nash, M. R. (1997). The truth and the hype of hypnosis [Electronic version]. Scientific American. 277, 47-55.

10) Hilgard, E. R. (1967). A quantitative study of pain and its reduction through hypnotic suggestion [Electronic version]. Proceedings of the National Academy of Sciences of the United States of America, 57 (6), 1581-1586.

11) Reed, W. H., Montgomery, G. H., & DuHamel, K. N. (2001). Behavioral intervention for cancer treatment side effects [Electronic version]. Journal of the National Cancer Institute, 93 (11), 810-823.

12) Williamson, J. W., McColl, R., Mathews, D., Mitchell, J. H., Raven, P. B., & Morgan, W. P. (2001). Hypnotic manipulation of effort sense during dynamic exercise: cardiovascular responses and brain activation [Electronic version]. Journal of Applied Physiology, 90, 1392-1399.


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