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Hypnotherapy for Ulcerative Colitis and Crohn’s Disease

Alyssa Luck · Mar 14, 2022 · Leave a Comment

Summary: Hypnotherapy is a mind-body therapy that may have therapeutic potential for IBD, although it’s a bit less practical to implement at home compared to other mind-body therapies such as meditation. Thus far, clinical trials in IBS have shown more impressive results than those in IBD, but there is some preliminary evidence that hypnotherapy could help maintain remission in UC patients who are already in remission, and reduce heart rate and inflammatory markers in those with active disease. The precise mechanism of action behind hypnotherapy remains to be elucidated, but the research of Robert Becker into the electrical systems of the body provides some fascinating glimpses into what may be happening to the mind and body in states of hypnosis.

This article is part of the IBD Index. Last updated on March 14, 2022.

Table of Contents
What is hypnotherapy?
Is there evidence for the effectiveness of hypnotherapy in IBD?
How does hypnotherapy work?
Review of the literature

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.

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.

Cross Currents by Robert Becker (2000); p. 90-91

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.

Related

Mind-Body Therapies Crohn's disease, hypnosis, hypnotherapy, IBD, mind-body, ulcerative colitis

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Hi! I’m Alyssa. I like thunderstorms and cats, hate wearing shoes, and enjoy devising extensive research projects for myself in my free time. This is me in Bali with a monkey on my shoulder. And this is my blog, where I muse about health-related topics and document my relentless self-guinea pigging. If you want to know more about me, click here!

alyssa.luck

alyssa.luck
If you've seen "vagus nerve exercises" that have y If you've seen "vagus nerve exercises" that have you moving your eyes or tilting your head, you've probably encountered the work of Stanley Rosenberg. The exercises he created and introduced in his 2017 book now appear in instructional videos all over the internet. 
 
The book itself has much to recommend it: it's accessible, it's practical, it's inspiring. But it has one major flaw: the solid practical and informational content regarding the cranial nerves is framed in terms of the scientifically dubious polyvagal theory. 
 
I particularly enjoyed the book as an introduction to the therapeutic arena of bodywork, of which Rosenberg is a skilled practitioner. His book is full of case reports that demonstrate how immensely powerful extremely subtle movements and physical manipulations can be. These do need to be kept in perspective: it's a small sample size of the most remarkable cases, and the results were achieved within the supportive clinical environment of a skilled practitioner. You can tell from his descriptions how refined his technique is. But nevertheless, it was a paradigm-shifting read for me, and the exercises give you something concrete to play around with. 
 
The book also brought the cranial nerves and the concept of “social engagement” to the fore as arbiters of health. Rosenberg has a solid background in cranial nerve anatomy and shares many interesting tidbits and considerations that you don’t typically hear; for instance, the potential impact of dental and orthodontic work on cranial nerve function.
 
So, is it worth reading? If any of the above piques your interest, go for it! Just read my post on polyvagal theory first – you can use the book to practice separating the wheat (solid informational content) from the chaff (pseudoscientific framing). If nothing else, the book is a nice reminder that genuine healers who get lasting results for their patients do exist.

But if you just want to try the exercises, you can easily find them all on YouTube. 

“You learn techniques to understand principles. When you understand the principles, you will create your own techniques.” -Stanley Rosenberg
I first stumbled upon polyvagal theory during the I first stumbled upon polyvagal theory during the course of my heart rate variability research. I was surprised to encounter it again "in the wild" shortly after, in the book "Accessing the Healing Power of the Vagus Nerve." Before long, I saw it popping up everywhere, (Baader-Meinhof, anyone?) 
 
Digging deeper, I discovered scientific controversy bubbling just beneath the smooth surface of polyvagal theory's popular presentation. Three months later, I posted a 13k word analysis of the topic. 
 
The technical details are far below the level of practicality for the average person, but the way polyvagal theory has propagated outside of academia has some important ramifications for clinical and scientific progress. 
 
In the wake of a wave of health complaints that our current medical model is poorly equipped to treat, it's clearer than ever that a new paradigm is needed. The grassroots push to emphasize diet and lifestyle factors has been a huge step in the right direction, but it's becoming more and more common to see people who have done everything "right" and are still struggling with persistent health complaints that could range anywhere from mildly annoying to debilitating. 
 
What we need is a genuine integration of mind and body in medicine – not the weak lip service that our current paradigm pays to "stress reduction," like the vague suggestion to relax more and maybe try meditation. And if we're going to develop a sophisticated mind-body medicine, we need a sophisticated mind-body science. And if we want a sophisticated mind-body science, we must subject such topics to the same standards of inquiry as we expect from molecular biomedicine. And that means rejecting pseudoscience like polyvagal theory. 
 
Full analysis and references at alyssaluck.com/polyvagal-theory-a-critical-appraisal
To continue my recounting of the health things I'm To continue my recounting of the health things I'm experimenting with, let me tell you about DNRS: the slightly cheesy, arguably outdated “brain rewiring” program that has changed my life. 

I found it because I was looking for ways to “retrain” my nervous system. I watched some success stories. None of the “target” health conditions matched mine, but I went for it anyway. Probably the best decision I’ve ever made for my health. 

The core of DNRS is built on the principles of neuroplasticity. They call it "brain rewiring" because you intentionally take triggers that would normally stimulate a negative response in your body or mind, and associate them repeatedly with neural signals of safety. If that sounds pseudosciencey, I hear ya – one of my goals with future posts is to bring some concreteness and specificity to the topic. I imagine there are lots of people who could benefit from this type of thing who are turned off by the overly abstract or touchy-feely language. 

There are tons of "brain rewiring" programs like DNRS, but they're all built on similar ideas. Most bring in elements of other popular approaches, ranging from the scientifically validated (cognitive behavioral therapy, mindfulness, acceptance and commitment therapy) to the type of new-agey stuff I always scoffed at (shadow work, inner child work, parts work). 

For me, DNRS has provided the perfect framework to finally achieve what meditation experts and therapists and mystics alike are always advocating – the ability to step into the role of “curious observer.” It's given me everything therapy and meditation promised but could never deliver, helping me recognize my own patterns of thought and behavior and consciously redirect unhelpful ones. If this sounds vague, that's because there isn't a single area of my life that hasn't been improved by using this framework. 

I spend far more time in states of joy and peace and gratitude, and less time in states of anxiety or depression or frenzy. Many chronic worries that used to occupy my mind or keep me up at night – whether related to health, relationships, or my future – have disappeared, and the others are on their way out. (Cont. in comments)
Isn’t it crazy how something can be so easy and Isn’t it crazy how something can be so easy and natural for one person, but so hard for another? 

Me doing food: I can totally cook everything I eat from scratch, no prob

Me doing mental health: just doing my hour of daily mindful cognitive gratitudinal journalization

Me doing physical therapy: I can’t do it I don’t have that muscle

I’ve done many hard things in the name of health, but I think they’ve all been the types of hard things that come naturally to me. And frankly, that hasn’t gotten me where I want to be. 

So I’ve decided to finally tackle something that feels very unnatural: developing a real relationship with my muscles and bones, and learning - through experience, not from a book - how they coordinate with each other and how to use them. 

I never really considered my musculoskeletal system a key player in autoimmune or digestive woes, but now I realize it’s naïve to think dysfunction in one part of the body doesn’t affect another. And since this is so obviously my weakest link, it’s high time to make it a priority!

Even though I’ve done strength training in the past, I never dedicated the time and focus to figure out what my body actually needed to function better, and workouts often felt awkward or led to injury. 

I’ve always dreaded PT-type exercises because they felt simultaneously like “not enough” and also SO HARD, especially when there’s no way to confirm whether I’m doing them “right” (my nightmare). 

But I’m pretty sure the fact that targeted “mind-muscle” work is so hard for me means it’s what I need the most. (That’s how that works, right?)

Anyway, I’m happy to report that I’m finally through both the initial phase of being a giant baby because I have to do something I’m bad at, AND the second phase of neurotically worrying about doing it “wrong.” And hopefully I’m on my way to better posture, improved breathing, and greater strength! 

Super thankful to have people in my life who remind me to have fun and stay curious, when my natural disposition is to write a 27-step plan to “fixing” everything “wrong” with me. And to remind me that it is, in fact, a JOY to be a novice at something (as @_john_the_savage_ would say).
"If your nervous system is balanced, your heart is "If your nervous system is balanced, your heart is constantly being told to beat slower by your parasympathetic system, and beat faster by your sympathetic system. This causes a fluctuation in your heart rate: HRV." (whoop.com) 
 
This statement is a formidable example of one of the biggest misconceptions about heart rate variability (HRV). 
 
HRV is highest during rest or sleep, when sympathetic input is lowest. If HRV was the result of an autonomic “tug-of-war,” why would it be greatest when one of the contenders has entirely dropped the rope? 
 
Part of the misunderstanding may stem from failure to recognize that the heart has an intrinsic rate, well above the resting heart rate maintained by the vagus nerve. Varying vagal impulses create HRV without any sympathetic input at all. 
 
There are many other common misconceptions, such as the notion that HRV metrics measure autonomic tone, or that HRV itself is a metric with one interpretation. 
 
Such misconceptions aren’t only found in layscience – they also pervade academic and clinical literature. For instance, you’ll see LF used as a measurement of “sympathetic tone” and LF/HF as a measurement of “sympathovagal balance,” even though it’s been clear for decades that those interpretations are not physiologically accurate.
 
This post (and the associated article at alyssaluck.com/hrv101) can be thought of as “foundations for understanding HRV research.” And it provides a good example not only of the insufficiency of “sound-byte” science, but also of real science in action. 
 
The unfortunate reality is that we can’t always take researchers’ conclusions at face value. Few have the time to adequately assess a field before adopting one of their metrics, and once a misinterpretation has taken root it can easily become an accepted fact that propagates through repetition, becoming more entrenched with each published paper.
 
Thankfully the ramifications in this case are not very serious - misdirection of experimental design and analysis, and many false statements, but no dire consequences. Nevertheless, it’s a good reminder that science is a human institution, and it never hurts to question oft-repeated “facts.”
My latest diet experiment: the bean protocol! This My latest diet experiment: the bean protocol! This was one of the changes I made immediately prior to my drastic increase in HRV. 

Brief background: the bean protocol entails eating lots of soluble fiber (particularly beans) as a way to support detox. It rests on the assumption that most chronic health issues are the result of fat-soluble environmental toxins, excess hormones, and other fat-soluble things being recirculated in the body rather than eliminated. 

There is some scientific merit to this: the liver does eliminate many toxins and other compounds through the bile, these things can be subject to reabsorption via enterohepatic recirculation, and certain types of fibers do interrupt this process by binding bile, preventing reabsorption and allowing excretion in the feces.

That said, there are many unanswered questions that would need to be answered for me to be on board with that as the sole or even primary explanation for the anecdotal success of those on the protocol. I think there are almost certainly other mechanisms at play, and I doubt things work exactly as proponents of the protocol describe. 

But at the end of the day, what matters is not mechanisms, but practical outcome. And whatever the reason, it works for many! It seems especially popular and effective for hormonal issues and acne, but the preeminent bean spokesperson @uniquehammond cured her severe Crohn’s with it. 

For me, I experienced better digestion and clearer skin, among other benefits (like not having to wear deodorant). On the less-good side, I lost weight I didn't need to lose, had cold hands and feet, and developed some dry patches on my skin. 

(The dry patches [and perhaps weight loss] were probably because I kept fat too low – mostly because their favored fat source, nuts, is a no-go for me.)

I'm continuing to experiment, hoping to find a balance that lets me reclaim the benefits (which I lost after returning to my normal eating pattern) while avoiding the pitfalls. I’ll share any exciting developments, and will eventually dig into the science behind it too. 

For info about what the protocol entails, you can visit alyssaluck.com/the-bean-protocol-for-ibd!
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