Hypnotherapy equals low FODMAP diet for IBS – Australian Study

The findings agrees with data from other clinical trials and support the value of hypnotherapy for treating IBS. The results have implications for clinical practice and primary care in Australia and the United States where rates of functional gastrointestinal disorders are high.

What is Irritable Bowel Syndrome?

Irritable bowel syndrome (IBS), also sometimes called 'spastic colon', is a functional gastrointestinal disorder. Common symptoms ofIBS include bloating, abdominal pain, cramping, and constipation or diarrhea, and may significantly impact quality of life. The ROME III criteria are used to diagnose IBS.

Irritable bowel syndrome is a challenge to treat. As there is no cure, treatment aims to relieve gastrointestinal symptoms. IBS differs from inflammatory bowel disease and other disorders that cause abdominal pain in that there is no structural problem with the gut.

Doctors have a few options for treating IBS. The low FODMAP diet that eliminates triggers of irritable bowel syndrome (fermentableoligosaccharides, disaccharides, monosaccharides, and polyols). This elimination diet is considered the 'gold standard' for treating irritable bowel syndrome and was developed by Dr. Sue Shepherd of Monash University. Medication treatments for IBS include laxatives, antispasmodics, and antidepressants. However, medication has been shown as less effective than dietary interventions.

IBS may also be treated with psychotherapies. Hypnotherapy has been shown to remedy health problems and improve wellbeing for a range of conditions, including symptoms of irritable bowel syndrome. It is believed to act upon the brain-gut axis and has been used in clinical practice to treat irritable bowel syndrome in the UK, United States, and Australia.

The Australian Study

Dr. Simone Peters and her team at Monash University compared hypnotherapy to the low-FODMAP diet for irritable bowel syndrome. She hypothesized that quality of life and symptoms of IBS would improve in both groups. However, hypnotherapy was expected to have a smaller effect in the treatment of irritable bowel syndrome than the diet since it is a form of psychological therapy.

The results were surprising. Hypnotherapy had the same effect as the dietary intervention for alleviating gastrointestinal symptoms. In both treatment groups, 70% of patients improved in quality of life and a range of individual symptoms of IBS such as bloating, diarrhea, constipation cramping, and abdominal pain.

The study at a glance:

• The study was a randomized controlled trial in Melbourne, Australia.
• Hypnotherapy reduced symptoms of IBS in 70% of patients
• Compared to the low-FODMAP diet
• Both treatments had the same effect on GI symptoms

Study design

Dr. Peters and her team conducted a randomized controlled trial over 6 weeks. 74 patients with moderate irritable bowel syndrome were randomly assigned to one of three treatment groups:

• Hypnotherapy: 25 patients received six weekly 1-hour sessions by a trained hypnotherapist. Audio recordings of hypnotherapy were provided, and patients were asked to listen to them daily.
• Diet: 24 patients strictly followed the low-FODMAP diet, eliminating food compounds known to cause IBS such as fermentable oligosaccharides, disaccharides, monosaccharides, polyols, fructose, and other short-chain carbohydrates associated with malabsorption. A qualified dietitian provided instruction, and adherence monitored by regular phone calls.
• Both: 25 patients received both of the above treatments.

Measurements taken

The researchers took six measures of IBS symptoms, rated on a100-point scale. These were self-reported by IBS patients at the start of the trial, 6 weeks later and 6 months follow-up. These were:

• Abdominal Pain
• Bloating
• Wind
• Nausea
• Satisfaction with stool consistency
• Overall symptoms
• Psychological scores for depression and anxiety were also measured.

Results of the Study

Hypnotherapy improved all six measures of IBS symptoms (abdominal pain, bloating, wind, nausea, satisfaction with stool consistency, overall symptoms). This effect was equal to the improvement from the low-FODMAP diet. In both groups, 70% of patients improved in overall and individual GI symptoms after 6 weeks. This benefit was maintained six months after treatment.

Combining treatment of dietary intervention and hypnotherapy did not benefit patients more than individual treatments. This was surprising since the two treatments were believed to act via different mechanisms, and so effects were expected to add to one another.

The graph below shows these findings. All symptoms can be observed to decrease from the start of the experiment (baseline) to six weeks and remain low six months after treatment. No differences were demonstrated between groups. This is shown in the significant overlap between graphs.

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The study also found hypnotherapy was associated with psychological benefits. Patients were less anxious and depressed in this group, but not in the low-FODMAP group.

Explanation of Results

The results showed that hypnotherapy is an effective treatment for IBS. The study also demonstrates that this effect is clinically significant, equal to that of the low FODMAP diet.  

The finding that all three groups produced similar results is surprising. Hypnotherapy was expected to benefit IBS symptoms to a lesser degree than diet, since the treatment mode is psychological. The Australian researchers proposed four possible reasons to explain these findings:

• All three treatments worked by the placebo effect, meaning treatments acted solely through the patient’s belief in them. This is a possibility since no placebo control was available in this study although the low FODMAP diet has previously been compared to a placebo.
• The benefit of treatment was limited by the ceiling effect, in which there is a maximum proportion of IBS patients that respond to treatment.
• Both treatments act via the same mechanism, despite different modes of entry.
• The two therapies negatively impact one another, limiting the effect of combined treatment.

How strong is the evidence?

As a randomized controlled trial – the ‘gold standard’ of proof in medicine⸺the evidence generated from Dr. Peters’ trial is robust.Reasonable measures were taken by Dr. Peters and her team to eliminate sources of bias. Although the trial was relatively small with 74 patients and the period of hypnosis short at six weeks, the data was conclusive in statistical terms. Future studies with larger cohorts may confirm findings, but the present results should be accepted.

Results of similar studies

The Australian study consolidates findings from the UK that show hypnotherapy is effective. Research from the Manchester group in the UK of 1000 patients found 76% of patients treated with hypnotherapy improved symptom severity by almost half. Several other studies have reported reductions in IBS symptoms of between 25% to 75% with gut-directed hypnotherapy.here is a growing body of literature supporting hypnotherapy for IBS.

Does this mean IBS is all in the mind?

The result that hypnotherapy treats IBS does not suggest the disorder is a simply ‘functional’ disorder of the mind. Rather, it suggest that IBS is a biopsychosocial condition in which the mind-body connection can play a role in lessening symptoms.

In fact, Dr. Peters’ study showed that psychological benefits from hypnotherapy did not correlate directly with improvements to IBS symptoms. This implies that hypnotherapy did more than just affect the mind; it exerted a physiological effect on the GI tract that lessened symptoms of IBS.

How Hypnotherapy Works

The science of gut-directed hypnotherapy is new and unfolding, and the precise mechanism for how this therapy might relieve IBS is not known. However, there are several theories for how the effect might occur. Hypnotherapy may act by:

• Reducing pain sensitivity in the gut
• Reducing physiological arousal
• Relaxing smooth muscle in the intestine
• Increasing motility (the speed of which food moves through the gut)
• Lowering the psychological trait of somatization (body sensation-focused distress)

How can this study help you?

If you have IBS, this study brings good news. It demonstrates hypnotherapy is a powerful treatment and that gastrointestinal symptom can be treated without needing to change what you eat. A six-week course of hypnotherapy improved symptoms in 70% of patients regardless of hypnotic susceptibility. For patients who have struggled with dietary treatments or found little benefit, hypnotherapy should be considered a clinically effective alternative.

Hypnotherapy or diet – which should I choose?

The low-FODMAP diet and gut-directed hypnotherapy are both likely to reduce IBS symptoms in most patients. The choice of therapy should come down to budget, the availability of hypnotherapists in your local area, and dietary preferences. When choosing a treatment, it is essential first to consult a doctor to confirm the IBS diagnosis. Below is a summary of the pros and cons of each procedure:

Low-FODMAP diet

Pros

• Reduces IBS symptoms in 70% of patients.
• Empowering  for patients, as the focus is on food and diet.
• Well researched.

Cons

• Nutritionally inadequate. Studies have found calcium deficiency in some patients.Lack of fiber is  also a concern.
• Gut bacteria (and the ‘microbiome’)  may be negatively affected by the lack of prebiotic effects of FODMAPs.
• Eating  disorders may arise from obsessive focus on food, such as orthorexia nervosa.

Gut-directed Hypnotherapy

Pros

• Reduces IBS symptoms in 70% of patients. Effective regardless of the hypnotic status of the patient.
• Additional psychological benefits, including improving associated anxiety & depression.
• Exceptionally safe.
• Accessible via an app, such as Nerva.
• App-based treatment is lower cost than in-person.

Cons

• Few therapists are trained in gut-directed techniques.
• A financial burden is associated with sessions.
• Time commitment is required.

How can I access gut-directed hypnotherapy?

Gut-directed hypnotherapy is a relatively new IBS treatment and availability may be subject to location. Fortunately, there is evidence that app-based hypnotherapy is comparable to in-person treatment. Nerva was created with Dr Peters, leader of this Monash study.

The Wrap Up

The present clinical trial contributes to the growing body of work showing hypnotherapy is effective and may help to normalize this therapy in clinical practice. Patients with IBS in Australia, the United States and worldwide can expect better relief of GI symptoms through the expansion of hypnotherapy clinics. The health benefits of hypnotherapy are likely to be investigated in many more clinical trials in the future.