This article is part of the IBD Index. Last updated on March 14, 2022.
What is Hypnotherapy?
In the treatment of digestive disorders including IBD, a specific method of hypnotherapy called “gut-directed hypnotherapy” is typically used. From the literature, it appears that a technique called the “Manchester approach” is favored, but exactly what that means continues to elude me behind various journal paywalls.
One 2015 review article states that “typically, hypnosis involves an introduction where suggestions for imaginative experiences are presented. A hypnotic induction will then follow, with the aim of allowing the subject to enter an altered consciousness or trance state. Once in the trance state, suggestions for changes in subjective experience, alterations in perception, sensation, emotion, thought or behaviour are presented. In gut-directed, as opposed to standard hypnotherapy, suggestions are made for the control and normalisation of gastrointestinal function (normally on a repetitive basis) and metaphors are used for bringing about improvement.” (Source)
They then provide a table of common gut-directed suggestions and metaphors, which frankly seem pretty basic (including suggestions like “There will be no more pain, no more bloating and no more discomfort,” and metaphors like the flow of a river or healing energy flowing from their hands).
The most recent RCT conducted testing hypnotherapy in IBD describes the protocol they used in detail, as follows:
In the first session, therapists took a full history, explained gut-directed hypnotherapy, introduced the mind–body connection, performed breathing exercises while the patients were instructed to imagine a warm healing feeling flowing from the hands into the abdomen, and introduced progressive relaxation according to the method of Jacobson. Patients were asked to listen to one of the digital audio recordings or to practise self-hypnosis once a day. Furthermore, patients were instructed to practise conscious breathing exercises several times throughout the day. In the second session, ‘the safe/favourite place exercise’ was introduced that focused on relaxation, increased self-control, and enhanced sleep and energy. Patients were instructed to visualize a colour that symbolized health. In the third session, ‘the hot air balloon exercise’ was introduced. This exercise focused on the reduction of stress and worry and the promotion of calm, comfortable and confident feelings. During the fourth session, the exercise ‘the beach without worries’ was introduced which promoted calm, comfortable and confident feelings, and included visualizations of a healthy gut and a healthy immune system. During the fifth session, ‘the slide’ exercise was introduced. During hypnosis, the patient received suggestions of going down a slide, which was used to promote a reduction of stress, worry and pain and to introduce a calm, comfortable and confident feeling. During this exercise, the gut was also imagined as a slide. In the final session, an evaluation of the past weeks was made. Furthermore, an exercise was performed consisting of elements of the previous sessions. Patients were instructed to continue listening to the hypnosis exercises daily.Hoekman et al, 2021
As summarized in the review of the literature below, that RCT did not demonstrate benefit over standard medical care, and in fact observed lower than expected response rates in both the experimental hypnotherapy and control groups.
Is There Evidence for the Effectiveness of Hypnotherapy in IBD?
Hypnotherapy has not been extensively studied in IBD, but its success in treating functional GI disorders like IBS has resulted in increased interest.
The most recent RCT published in 2021 was done in patients experiencing functional GI symptoms despite their IBD being in remission, and as just mentioned, no benefit was observed above standard medical care. (Source) Interestingly, that same research group has found benefit of hypnotherapy in IBS patients; the authors take this as an indication that the “IBS-like” symptoms experienced by many patients with IBD in remission might not be quite as “IBS-like” in nature as we thought.
The results of two earlier trials were slightly less disappointing: Keefer et al in 2014 found that UC patients in remission who underwent hypnotherapy treatment maintained remission an average of 78 days longer than control patients, and a significantly higher percentage were still in remission after one year (68%, vs 40% of control patients). (Source) And Mawdsley et al in 2008 found that one session of gut-directed hypnotherapy in patients with active UC measurably reduced heart rate and certain inflammatory markers like IL-6. (Source) It sounds like they did include a “control group” of sorts, with several UC patients undergoing a “control procedure,” but as this experiment was not mentioned as an RCT in any of the review articles published later, I assume the design was not randomized.
Overall, the evidence is somewhat promising, but sparse. In fact, the review articles may actually outnumber the actual experiments thus far, which is never a good state of affairs. See the review of the literature section at the end of this article for a list of all the relevant studies I could find concerning hypnotherapy and IBD.
How Does Hypnotherapy Work?
What’s funny is that the 2015 review article from Peters et al includes a section called “mechanism of action,” then proceeds to describe nothing of the sort. What they actually do is describe associations found in the literature between hypnotherapy and various symptoms or pathologies associated with gut disorders, such as gut motility and visceral sensitivity. I hope they realize saying that gut-directed hypnotherapy “has an effect” on gut motility is not, in fact, providing a mechanism of action. (How? How does it have an effect?? I love how some researchers simply step over questions they don’t know the answers to.)
In lieu of anything helpful in the literature (at least that I can find), I’d like to quote a few sections from the book Cross Currents by Robert O Becker:
Even today, there are prominent psychologists who insist that hypnosis simply does not exist, that it is nothing more than an intense desire on the part of the subject to please the hypnotist. Because hypnosis appeared to be a rather odd state of consciousness, and because I had a good way to measure consciousness with DC potentials, we decided to do a little experiment in this “fringe area” of science.Cross Currents by Robert Becker (2000); p. 90-91
What we discovered was much more important than we had expected. We found that we could reliably determine whether a subject was truly hypnotized or was simply trying to please Dr. Friedman. In true hypnosis, the DC potential from the front to the back of the head (which is actually a measure of the brain’s midline DC current) undergoes a drop in strength similar to the drop that occurs during very deep sleep. If the subject was only trying to please us, he or she was mentally active, and the DC potential went up in strength.
One of the most interesting aspects of hypnosis is its ability to produce anesthesia. It is possible to give a truly hypnotized patient the suggestion that a part of the body is numb, cold, and unfeeling, and to then perform minor surgery on that part without the patient’s perceiving pain. We had already shown that general anesthesia in human patients is produced by a fall in the normal DC electrical current across the brain, which then seems to produce similar declines in the DC potentials in the remainder of the body. We had also shown that local anesthesia, produced by blocking the nerve to a single part of the body, results in a drop of the DC current to zero in that area alone…The theory that we developed was that if the local anesthesia produced by hypnosis is real, it should be accompanied by a similar drop in the DC current in the anesthetized area. If this occurred, its meaning would be far more significant than substantiating that the anesthesia of hypnosis was real. It would mean that the conscious mind, under hypnosis, could control the level of activity of the DC control system. The implications of this for energy medicine would be enormous.
Dr. Becker then goes on to describe the experiments by which they proved that theory correct, emphasizing the significance of this finding: it proved that in certain states of consciousness, we have conscious control over our DC system, which is the hypothesized control system for growth and healing. Cross Currents was published in 2000, so is quite out of date, and sadly this line of inquiry seems to have largely died out since Becker’s death.
If this area of research is of interest to you, I highly recommend Becker’s book The Body Electric – it’s an absolutely fascinating read that illuminates many unpleasant truths about the workings of our scientific and academic institutions, and also details some of his original research into the electrical systems of the body and the potentially staggering implications for medicine and healing.
Review of the Literature
My review of the literature was significantly hindered by not having full-text access to The American Journal of Clinical Hypnosis, where many of these papers were published, but we hope the abstracts of these papers do not lead us significantly astray!
Hoekman et al. Hypnotherapy for Irritable Bowel Syndrome-Type Symptoms in Patients with Quiescent Inflammatory Bowel Disease: A Randomized, Controlled Trial. 2021. J Crohns Colitis.
- Included 70 IBD patients in remission who still had functional GI symptoms, randomized to either receive hypnotherapy or standard medical treatment
- The primary outcome was at least a 50% reduction in symptom severity; found no difference between groups in achievement of that outcome, with about a 30% response rate in each (which was lower than expected in both groups; the authors speculate on reasons for this in the discussion section)
- Of note, this same research group has found significant benefit of hypnotherapy over standard medical treatment in IBS subjects
Mawdsley et al. The effect of hypnosis on systemic and rectal mucosal measures of inflammation in ulcerative colitis. 2008. Am J Gastroenterol.
- Seventeen patients with active UC underwent a 50-min session of gut-focused hypnotherapy.
- Eight patients with active UC underwent a control procedure.
- Hypnosis decreased pulse by a median 7 beats per minute (bpm) (P= 0.0008); it also reduced the median serum IL-6 concentration by 53% (P= 0.001), but had no effect on the other systemic variables assessed. Hypnosis reduced rectal mucosal release of SP by a median 81% (P= 0.001), histamine by 35% (P= 0.002) and IL-13 by 53% (P= 0.003), and also, blood flow by 18% (P= 0.0004).
- The control protocol had no effect on any of the variables assessed.
Peters, et al. Review article: gut-directed hypnotherapy in the management of irritable bowel syndrome and inflammatory bowel disease. 2015. Aliment Pharmacol Ther.
- Conclusions: Despite the limitations of study design, evidence is mounting that gut-directed hypnotherapy has durable efficacy in patients with IBS and possibly IBD without apparent safety issues.
Szigethy, Eva. Hypnotherapy for Inflammatory Bowel Disease Across the Lifespan. 2015. Am J Clin Hypn. (Review article)
- This review article covers the existing literature in hypnotherapy in IBD, as well as evidence for hypnotherapy in functional GI disorders like IBS
- Conclusions: Collectively, the strongest evidence of use of hypnotherapy is its association with reduced IBD-related inflammation and improved health-related quality of life with mixed results in terms of its effects on psychological and pain outcomes in adults with IBD. Studies of hypnotherapy for FGID symptoms show consistently more positive results.
Moser, Gabriele. The role of hypnotherapy for the treatment of inflammatory bowel diseases. 2014. Expert Rev Gastroenterol Hepatol. (Review article)
- Conclusion: Few experimental studies and case reports have been published for IBD; GHT increases the health-related quality of life and reduces symptoms. Additionally, GHT seems to have an immune-modulating effect and is able to augment clinical remission in patients with quiescent ulcerative colitis.
Keefer et al. Gut-directed hypnotherapy significantly augments clinical remission in quiescent ulcerative colitis. 2014. Aliment Pharmacol Ther.
- Fifty four patients were randomized at a single site to 7 sessions of gut-directed hypnotherapy (N = 26) or attention control (CON; N = 29) and followed for 1 year.
- One-way ANOVA comparing hypnotherapy and control subjects on number of days to clinical relapse favored the hypnotherapy condition by 78 days.
- Chi square analysis comparing the groups on proportion maintaining remission at 1 year was also significant, with 68% of hypnotherapy and 40% of control patients maintaining remission for 1 year.
- Interim findings reported here: The Potential Role of a Self-Management Intervention for Ulcerative Colitis: A Brief Report From the Ulcerative Colitis Hypnotherapy Trial
Shaoul et al. Hypnosis as an adjuvant treatment for children with inflammatory bowel disease. 2009. J Dev Behav Pediatr.
- The hypnosis therapy was performed on 6 children aged 10 to 17 years 5 with Crohn disease and 1 with ulcerative colitis.
- All patients had received conventional treatment for at least 6 months. Hypnosis was offered to patients in whom additional drug therapy or surgery was considered;.
- Patients had between 4 and 12 sessions lasting 45 to 60 minutes for a period of up to 3 months.
- No changes in other treatment modalities occurred during the therapy.
- Most clinical symptoms resolved under the therapy and inflammatory markers decreased.
Emami et al. Hypnotherapy as an adjuvant for the management of inflammatory bowel disease: a case report. 2009. Am J Clin Hypn. (Case report)
- Case report of two young females with Crohn’s disease, one in remission and one with active disease.
- Both underwent 12 weekly one-hour hypnosis sessions, including gut-directed, ego-strengthening, and post-hypnotic suggestions and immune-directed imaginations.
- The patient who was already in remission experienced improvements in symptoms, psychological state, and quality of life, but the patient with active disease did not, although she did report that the greatest benefit was in improving coping and psychological state.
Miller, Vivien and Whorwell, Peter J. Treatment of inflammatory bowel disease: a role for hypnotherapy? 2008. Int J Clin Exp Hypn.
- Fifteen patients with severe or very severe inflammatory bowel disease on corticosteroids but not responding to medication received 12 sessions of “gut-focused hypnotherapy” and were followed up for a mean duration of 5.4 years.
- Two patients (13.4%) failed to respond and required surgery.
- At follow-up for the remaining 13 patients, 4 (26.6%) were in complete remission, 8 (53.3%) had mild severity, and 1 (6.7%) was moderately severe.
- No control group.
Keefer, Laurie and Keshavarzian, Ali. Feasibility and acceptability of gut-directed hypnosis on inflammatory bowel disease: a brief communication. 2007. Int J Clin Exp Hypn. (Case series)
- Case series of 8 white female patients with inactive IBD. Quality of life improvements observed.
- No control group.