Individual or group hypnotherapy associated with relief from IBS

Although hypnotherapy did not improve quality of life, psychological symptoms, cognition, self-efficacy, or irritable bowel syndrome (IBS) symptoms significantly more than an educational support program, it may provide relief to patients by changing their perception of IBS.

Group or individual hypnotherapy appeared to provide some relief to patients with irritable bowel syndrome (IBS), a recent trial found.

The trial was based in 11 hospitals in the Netherlands and included 494 adult patients who were referred from primary or secondary care for psychological treatment of IBS. They were randomized to three groups (with some patients excluded for ineligibility): 142 patients were assigned to six sessions of individual hypnotherapy, 146 patients were assigned to six sessions of group hypnotherapy, and 54 patients were assigned to be controls who received group educational support. The primary outcome was adequate relief of IBS symptoms, with responders defined as patients who reported adequate relief when asked once weekly on three or four occasions in four consecutive weeks. Results were published online by The Lancet Gastroenterology & Hepatology on Nov. 22.

A significant proportion of patients dropped out before study completion: 15% in the individual and group hypnotherapy groups and 20% in the control group. However, an intention-to-treat analysis found that at three months, hypnotherapy was associated with a significantly higher rate of the study's primary outcome: 40.8% (95% CI, 31.7% to 50.5%) in the individual hypnotherapy group, 33.2% (95% CI, 24.3% to 43.5%) in the group hypnotherapy group, and 16.7% (95% CI, 7.6% to 32.6%) in the control group. At 12 months, the rates were 40.8% (95% CI, 31.3% to 51.1%), 49.5% (95% CI, 38.8% to 60.0%), and 22.6% (95% CI, 11.5% to 39.5%), respectively.

The odds ratios favoring hypnotherapy were 2.9 at three months (95% CI, 1.2 to 7.4; P=0.0240) and 2.8 at 12 months (95% CI, 1.2 to 6.7; P=0.0185). Patients in all three groups also showed improvements in quality of life, psychological symptoms, cognition, self-efficacy, and direct and indirect medical costs, with no significant difference between groups. Based on these results, the study authors concluded that hypnotherapy should be considered as a possible treatment for patients with IBS in primary and secondary care and that group hypnotherapy was noninferior to individual hypnotherapy.

The patients' reports of adequate relief were not accompanied by reductions in symptom scores, the authors noted. “The explanation for this finding might be that, in contrast to educational therapy, hypnotherapy improves the perception of IBS symptoms without having a major effect on symptom severity. Thus, the main effect of hypnotherapy might be diminishing the impact of symptoms on patients by changing their mind-set and improving internal coping mechanisms,” they said.

An accompanying comment expressed doubt about the study authors' conclusions, given the lack of difference in secondary outcomes and the low overall efficacy. The limited effect might have been due to the inclusion of only six sessions or lack of specific experience among the hypnotherapists, but in either case, additional research is needed to prove benefit, the comment said.