Evidence-based study shows how hypnotherapy provides positive outcomes for IBS patients

It is common that Hong Kong people might have experiences of disordered defecation with unknown reason, such as diarrhea and constipation. It is also easy to observe that abdominal discomforts often come along with stress. Emotion disturbance and stress might affect our intestinal functions.

The alarm system of our body has been already turned on and expressed as features of Irritable Bowel Syndrome (IBS). Professor Siu-man Ng, Department of Social Work and Social Administration, The University of Hong Kong, points out that the etiology of IBS is not entirely clear.

The cause might be related to intestinal abnormality, for examples, congenital visceral hypersensitivity and long-term stress. It induces a series of symptoms that triggering by the visceral functional disorder. The global prevalence of IBS is 13.5. It is estimated that the point prevalence of IBS among adults in Hong Kong is about 7%. It is indicated that there is a growing tendency in Asian society.

Apart from medication, concerning the symptom relief of IBS, overseas studies have pointed out that a variety of alternative therapies (including hypnotherapy), show its effectiveness in various level.

Hypnotherapy has given public an impression of "mystery" and "peculiarity". In fact, it is kinds of psychotherapy. There are evidence-based studies proved its effectiveness for IBS but those are overseas studies. What's more, those studies are focused on Traditional Hypnotherapy, in which hypnotic suggestions are mainly provided by counselors in accordance with those established scripts or guidelines.

Regarding Integrative Hypnotherapy (also named as Ericksonian Hypnotherapy), no matter in local context of Hong Kong or overseas, rigorous clinical study is awaited. Integrative hypnotherapy was founded by the psychiatrist, Dr. Milton Erickson, that its hypnotic suggestions will be tailor-made by counselor in reference to individual client's context and uniqueness, e.g., symptom.

In view of the situation mentioned above, Department of Social Work and Social Administration at The University of Hong Kong conducted an evidence-based study on hypnotherapy for IBS in 2017. It aimed at exploring an alternative therapy with full recovery for the persons suffering from IBS.

It adopted a Three-armed randomized control trial, a qualitative research methodology. There were totally 144 subjects with IBS recruited in the study. The inclusion criteria were individuals who (1) were Chinese adults aged between 18 and 60 years, (2) had a diagnosis of IBS according to the Rome III criteria4, and (3) had undergone treatment with IBS-related medication, without effectiveness.

Participants were randomly assigned into either experimental group - 1. Integrative hypnotherapy group (IH), 2. Traditional hypnotherapy group (TH), or control group - educational talk (ET) for receiving the services that lasted for 3 months. The intervention included a series of hypnotherapy groups led by registered social worker with professional hypnotherapy training. It taught the subjects to practice self-hypnosis to tackle the symptoms of IBS. It was a 4-session weekly group. Each session lasted for 3 hours.

Participants were asked to complete a self-report questionnaire at baseline T₀(before intervention), 1 month afterwards T₁(immediately after completion of 4-weekly session intervention), and at a third time, 3-month post-intervention follow-up T₂. This study examined primarily the effectiveness of hypnotherapy on (1) the alleviation of symptom severity, (2) the improvement of quality of life, and, ultimately, (3) the changes in coping responses, for persons with IBS.

The results of the study have been published and will be formally announced in June 2022. The major findings are highlighted as follows,

1.Significant relief on IBS symptoms immediately after completion of hypnotherapy or education talks (lasted a month)
The severity of symptoms was measured through standardized assessment scales. It was found that the symptoms of IBS were greatly improved, both in hypnotherapy groups and educational talks, immediately after the intervention.

2. Persistent improvement after intervention, but phenomenon only found in hypnotherapy groups
The IBS symptoms severity score further reduced three months after completion of the intervention. However, the persistent improvement was found only in hypnotherapy groups; and the amplitude of persistent improvement in integrative hypnotherapy groups was greater than the traditional ones. In contrast, there was bounce back found in educational talks.

3.Significant increase on the mental health score and association between persistence of emotion improvement and hypnotherapy.
The study also showed that SF 12 health related quality of life - mental component score increased significantly, both in hypnotherapy groups and educational talks, right after completion of intervention (lasted a month).

It pointed out that all interventions got immediate effect on mental health improvement. Nevertheless, the persistence of emotion improvement in integrative hypnotherapy groups and traditional hypnotherapy was far more outstanding. In contrast, there was obvious set back in educational talks. It indicated that there was association between hypnotherapy and persistence of emotion improvement.

4.Persistent improvement of coping responses only found in hypnotherapy groups
Regarding coping responses of symptom catastrophizing, SC, both hypnotherapy groups and educational talks got immediate improvement after the intervention. However, concerning the persistent improvement, it was confined in hypnotherapy groups only. It was obviously found that educational talks got no significant change across the study.

The result showed that, concerning the coping responses of symptoms-related social hypervigilance, SSH, including negative thoughts towards symptoms, hidden of symptoms and purchase absolute control, only integrative hypnotherapy groups got both immediate and persistent improvement. The change across the intervention was not obvious in traditional hypnotherapy groups. There was a significant regression across the intervention in educational talks.

Overall, by comparing the results obtained from the study, the major findings were (1)positive outcome significantly demonstrated in hypnotherapy for IBS participants. The integrative approach and traditional approach had shown a variety level of effectiveness in different domains. The existence of emotional-physiological connection of IBS and its mutual influence were highlighted.

(2) The results mentioned above pointed out the immediate and short-term efficiency both on symptom relief and emotion health by information provision for IBS participants. However, (3) by sole information provision that without emotion support and adjustment of coping responses, it was resulted in the reinforcement of IBS participants' blindly purchasing absolute symptom control without actual help.
(4) The most critical finding concerning hypnotherapy for IBS was its immediate and long-term effecton (a) symptom alleviation, (b) emotion hidden behind, and (c) coping responses. In view of it, our research study had realized that utilization of hypnotherapy facilitated the persistent improvement of IBS.