Overview of Published Research To Date on Hypnosis for IBSBy Olafur S. Palsson, Psy.D.

Whorwell PJ; Prior A; Colgan SM. Hypnotherapy in severe irritable bowel syndrome: further experience. Gut, 1987 Apr, 28:4, 423-5. This report summed up further experience with 35 patients added to the 15 treated with hypnotherapy in the 1984 Lancet study. For the whole 50 patient group, success rate was 95% for classic IBS cases, but substantially less for IBS patients with atypical symptom picture or significant psychological problems. The report also observed that patients over age 50 seemed to have lower success rate from this treatment.

Harvey RF; Hinton RA; Gunary RM; Barry RE. Individual and group hypnotherapy in treatment of refractory irritable bowel syndrome. Lancet, 1989 Feb, 1:8635, 424-5. This study employed a shorter hypnosis treatment course than other studies for IBS, and the success rate was lower, most likely demonstrating that a larger number of sessions is necessary for optimal benefit. Twenty out of 33 patients with refractory irritable bowel syndrome treated with four sessions of hypnotherapy in this study improved. Improvement was maintained at a 3-month treatment. These researchers further found that hypnosis treatment for IBS in groups of up to 8 patients seems as effective as individual therap

Prior A, Colgan SM, Whorwell PJ. Changes in rectal sensitivity after hypnotherapy in patients with irritable bowel syndrome. Gut 1990;31:896. This study found IBS patients to be less sensitive to pain and other sensations induced via balloon inflation in their gut while they were under hypnosis. Sensitivity to some balloon-induced gut sensations (although not pain sensitivity) was reduced following a course of hypnosis treatment.

Houghton LA; Heyman DJ; Whorwell PJ. Symptomatology, quality of life and economic features of irritable bowel syndrome--the effect of hypnotherapy. Aliment Pharmacol Ther, 1996 Feb, 10:1, 91-5. This study compared 25 severe IBS patients treated with hypnosis to 25 patients with similar symptom severity treated with other methods, and demonstrated that in addition to significant improvement in all central IBS symptoms, hypnotherapy recipients had fewer visits to doctors, lost less time from work than the control group and rated their quality of life more improved. Those patients who had been unable to work prior to treatment resumed employment in the hypnotherapy group but not in the control group. The study quantifies the substantial economic benefits and improvement in health-related quality of life which result from hypnotherapy for IBS on top of clinical symptom improvement.

Koutsomanis D. Hypnoanalgesia in the irritable bowel syndrome. Gastroenterology 1997, 112, A764. This French study showed less analgesic medication use required and less abdominal pain experienced by a group of 12 IBS patients after a course of 6-8 analgesia-oriented hypnosis sessions followed by 4 sessions of autogenic training. Patients were evaluated at 6-month and 12-month follow-up.

Houghton LA, Larder S, Lee R, Gonsalcorale WM, Whelan V, Randles J, Cooper P, Cruikshanks P, Miller V, Whorwell PJ. Gut focused hypnotherapy normalises rectal hypersensitivity in patients with irritable bowel syndrome (IBS). Gastroenterology 1999; 116: A1009. Twenty-three patients each received 12 sessions of hypnotherapy. Significant improvement was seen in the severity and frequency of abdominal pain, bloating and satisfaction with bowel habit. A subset of the treated patients who were found to be unusually pain-sensitive in their intestines prior to treatment (as evidenced by balloon inflation tests) showed normalization of pain sensitivity, and this change correlated with their pain improvement following treatment. Such pain threshold change was not seen for the treated group as a whole.

Vidakovic Vukic M. Hypnotherapy in the treatment of irritable bowel syndrome: methods and results in Amsterdam. Scand J Gastroenterol Suppl, 1999, 230:49-51.Reports results of treatment of 27patients of gut-directed hypnotherapy tailored to each individual patient. All of the 24 who completed treatment were found to be improve.

Galovski TE; Blanchard EB. Appl Psychophysiol Biofeedback, 1998 Dec, 23:4, 219-32. Eleven patients completed hypnotherapy, with improvement reported for all central IBS symptoms, as well as improvement in anxiety. Six of the patients were a waiting-control group for comparison, and did not show such improvement while waiting for treatment.

This study is notable as the largest case series of IBS patients treated with hypnosis and reported on to date. 250 unselected IBS patients were treated in a clinic in Manchester, England, using 12 sessions of hypnotherapy over a 3-month period plus home practice between sessions. Marked improvement was seen in all IBS symptoms (overall IBS severity was reduced by more than half on the average after treatment), quality of life, and anxiety and depression. All subgroups of patients appeared to do equally well except males with diarrhea, who improved far less than other patients for unknown reason.

Hypnotherapy in irritable bowel syndrome: a large-scale audit of a clinical service with examination of factors influencing responsiveness.

Gonsalkorale WM, Houghton LA, Whorwell PJ.

Department of Medicine, University Hospital of South Manchester, United Kingdom.

OBJECTIVES: Hypnotherapy has been shown to be effective in the treatment of irritable bowel syndrome in a number of previous research studies. This has led to the establishment of the first unit in the United Kingdom staffed by six therapists that provides this treatment as a clinical service. This study presents an audit on the first 250 unselected patients treated, and these large numbers have also allowed analysis of data in terms of a variety of other factors, such as gender and bowel habit type, that might affect outcome. METHODS: Patients underwent 12 sessions of hypnotherapy over a 3-month period and were required to practice techniques in between sessions. At the beginning and end of the course of treatment, patients completed questionnaires to score bowel and extracolonic symptoms, quality of life, and anxiety and depression, allowing comparisons to be made. RESULTS: Marked improvement was seen in all symptom measures, quality of life, and anxiety and depression (all ps < 0.001), in keeping with previous studies. All subgroups of patients appeared to do equally well, with the notable exception of males with diarrhea, who improved far less than other patients (p < 0.001). No factors, such as anxiety and depression or other prehypnotherapy variables, could explain this lack of improvement. CONCLUSIONS: This study clearly demonstrates that hypnotherapy remains an extremely effective treatment for irritable bowel syndrome and should prove more cost-effective as new, more expensive drugs come on to the market. It may be less useful in males with diarrhea-predominant bowel habit, a finding that may have pathophysiological implications.

BACKGROUND & AIMS: We have shown hypnotherapy (HT) to be effective in irritable bowel syndrome, with long-term improvements in symptomatology and quality of life (QOL). This study aimed to assess the efficacy of HT in functional dyspepsia (FD). METHODS: A total of 126 FD patients were randomized to HT, supportive therapy plus placebo medication, or medical treatment for 16 weeks. Percentage change in symptomatology from baseline was assessed after the 16-week treatment phase (short-term) and after 56 weeks (long-term) with 26 HT, 24 supportive therapy, and 29 medical treatment patients completing all phases of the study. QOL was measured as a secondary outcome. RESULTS: Short-term symptom scores improved more in the HT group (median, 59%) than in the supportive (41%; P = 0.01) or medical treatment (33%; P = 0.057) groups. HT also benefited QOL (42%) compared with either supportive therapy (10% [P < 0.001]) or medical treatment (11% [P < 0.001]). Long-term, HT significantly improved symptoms (73%) compared with supportive therapy (34% [P < 0.02]) or medical treatment (43% [P < 0.01]). QOL improved significantly more with HT (44%) than with medical treatment (20% [P < 0.001]). QOL did improve in the supportive therapy (43%) group, but 5 of these patients commenced taking antidepressants during follow-up. A total of 90% of the patients in the medical treatment group and 82% of the patients in the supportive therapy group commenced medication during follow-up, whereas none in the HT group did so (P < 0.001). Those in the HT group visited their general practitioner or gastroenterologist significantly less (median, 1) than did those in the supportive therapy (median, 4) and medical treatment (median, 4) groups during follow-up (P < 0.001). CONCLUSIONS: HT is highly effective in the long-term management of FD. Furthermore, the dramatic reduction in medication use and consultation rate provide major economic advantages.

Despite the fact that the use of antidepressants and other psychologic strategies may seem intuitive in the setting of moderate to severe functional bowel disease, conclusive data from well-designed trials have been lacking.

In this setting, Drossman and colleagues have conducted the largest randomized trial to evaluate the effectiveness of desipramine, a tricyclic antidepressant, as well as cognitive-behavioral therapy vs their control conditions (placebo and education, respectively) in women with moderate to severe functional bowel disorders. Additionally, these investigators assessed the clinical benefits of the active treatment regimens (desipramine or cognitive-behavioral therapy) in clinically meaningful patient subgroups (ie, with/without history of depression; with/without history of sexual or physical abuse; predominant diarrhea; predominant constipation; moderate vs severe disease).

This randomized, comparator-controlled, multicenter trial involved 431 adult women from the University of North Carolina and the University of Toronto who had moderate to severe symptoms of functional bowel disorders. Subjects received either psychologic (cognitive-behavioral therapy vs education) or antidepressant (desipramine vs placebo) therapy for a period of 12 weeks. Assessment of physiologic, clinical, and psychosocial parameters were conducted before and after end of therapy.

Overall, results suggest that the active psychologic treatment (ie, cognitive-behavioral therapy) was effective for women with functional bowel disorders, including irritable bowel syndrome, whereas the active antidepressant treatment (desipramine) appeared to only be effective in the management of those patients who were adherent (ie, able to stay on their medication). Specifically, by intention-to-treat analysis, cognitive-behavioral therapy was found to be significantly more effective than its placebo condition (education; P = .0001; responder rate, 70% vs 37%, respectively; number needed to treat [NNT], 3.1). By contrast, desipramine did not demonstrate significant efficacy vs placebo in the intention-to-treat analysis (P = .016; responder rate, 60% vs 47%, respectively; NNT, 8.1) but did show a statistically significant benefit in the per-protocol analysis (P = .01; responder rate, 73% vs 49%, respectively; NNT, 5.2). The latter was especially significant when subjects with nondetectable blood levels of desipramine were excluded.

Results of subgroup analyses demonstrated that cognitive-behavioral therapy had benefit over its control condition for all subgroups except those patients with depression. By contrast, subgroup analyses indicated that active antidepressant therapy (desipramine) was more beneficial than placebo for women with moderate vs severe symptoms, a history of abuse, without comorbid depression, and with predominant diarrhea.

The investigators highlighted several limitations associated with this study that should be considered. First, at least moderate side effects were observed in up to 25% of subjects taking desipramine, and thus some participants may have become unblinded. However, it should be noted that similar side effects occurred in up to 15% of participants receiving placebo as well. Additionally, dropouts occurred in 23% of patients allocated to treatment; therefore, data that anticipated treatment responses were "imputed" for several of these individuals. Finally, the fact that all patients fulfilling Rome I or II criteria for functional bowel disorders were included also warrants some consideration. Overall, however, as the study authors emphasize, these findings may be generalized to any patient who fulfills the selection criteria used in this trial, who is treated by their standardized psychologic protocol, or who is compliant in taking desipramine as prescribed.

Thus for women with moderate to severe functional bowel disorders, cognitive-behavioral therapy is effective and desipramine may be effective when taken adequately. It is important to note, however, that certain clinical subgroups are more or less amenable to these relative treatments.

Palsson and colleagues[17] previously reported positive results associated with the use of hypnosis in patients with IBS. It was found that hypnosis (45 minutes every other week for 12 weeks as well as self-hypnosis techniques) improved both IBS symptoms (pain, bloating, and disturbed defecation) and psychologic parameters (somatization and anxiety scores). However, the real-world effectiveness of hypnotherapy presupposes motivated patients and ready access to an appropriately trained therapist.

During this year's meeting of the American College of Gastroenterology, Palsson and colleagues[18] expanded on their previous work by reporting the results of a 3-month home hypnosis program for patients with IBS. The study authors compared the improvement (in multiple symptom parameters) of 19 patients with IBS treated with self-hypnosis (conducted via audio compact disc instruction) with 57 age-, sex-, and symptom severity-matched controls treated with standard medical therapy. Fifty-three percent of the hypnosis patients had improvement in overall IBS symptoms compared with 26% of the controls (10 of 19 vs 15 of 57; P < .05). Quality of life was also significantly improved among patients who underwent hypnosis, and these treatment differences were shown to persist at 6 months. These investigators also found that patients exhibiting greater degrees of anxiety were less likely to respond to hypnotherapy, suggesting that other methods of therapy may be more useful in this subset of patients with IBS."

Department of Medicine, University Hospital of South Manchester, Manchester, UK.

BACKGROUND: and aims: There is now good evidence from several sources that hypnotherapy can relieve the symptoms of irritable bowel syndrome in the short term. However, there is no long term data on its benefits and this information is essential before the technique can be widely recommended. This study aimed to answer this question.

PATIENTS AND METHODS: 204 patients prospectively completed questionnaires scoring symptoms, quality of life, anxiety, and depression before, immediately after, and up to six years following hypnotherapy. All subjects also subjectively assessed the effects of hypnotherapy retrospectively in order to define their "responder status".

RESULTS: 71% of patients initially responded to therapy. Of these, 81% maintained their improvement over time while the majority of the remaining 19% claimed that deterioration of symptoms had only been slight. With respect to symptom scores, all items at follow up were significantly improved on pre-hypnotherapy levels (p<0.001) and showed little change from post-hypnotherapy values. There were no significant differences in the symptom scores between patients assessed at 1, 2, 3, 4, or 5+ years following treatment. Quality of life and anxiety or depression scores were similarly still significantly improved at follow up (p<0.001) but did show some deterioration. Patients also reported a reduction in consultation rates and medication use following the completion of hypnotherapy.

CONCLUSION: This study demonstrates that the beneficial effects of hypnotherapy appear to last at least five years. Thus it is a viable therapeutic option for the treatment of irritable bowel syndrome.

We think of the seat of the soul as the brain, in concert with the rest of the nervous system. The Dalai Lama speaks of a "luminous consciousness" that transcends death and which he thinks might not have brain correlates, but we believe even this must be realised neurally.

So an interesting question for neuroscientists is how do the brains of Buddhist practitioners or indeed any other wise, happy and virtuous people light up? How are the qualities of happiness, serenity and loving kindness that arise from the Buddhist practice of mindful meditation reflected in the brain? How does that subjective experience manifest itself?

Neuroscience is beginning to provide answers. Using scanning techniques such as PET and functional MRI, we can study the brain in action. We now know that two main areas are implicated in emotions, mood and temperament. The amygdala twin almond-shaped organs in the forebrain and its adjacent structures are part of our quick triggering machinery that deals with fear, anxiety and surprise. It is likely that these structures are also involved in other basic emotions such as anger. The second area comprises the prefrontal lobes, recently evolved structures lying just behind the forehead. These have long been known to play a major role in foresight, planning and self-control, but are now crucially implicated in emotion, mood and temperament.

With this knowledge in hand, a few prominent neuroscientists have begun to study the brains of Buddhists. The preliminary findings are tantalising. Richard Davidson at the Laboratory for Affective Neuroscience at the University of Wisconsin at Madison has found that the left prefrontal lobes of experienced Buddhist practitioners light up consistently (rather than just during meditation). This is significant, because persistent activity in the left prefrontal lobes indicates positive emotions and good mood, whereas persistent activity in the right prefrontal lobes indicates negative emotion. The first Buddhist practitioner studied by Davidson showed more left prefrontal lobe activity than anyone he had ever studied before.

We can now hypothesise with some confidence that those apparently happy, calm Buddhist souls one regularly comes across in places such as Dharamsala, India the Dalai Lama 's home really are happy. Behind those calm exteriors lie persistently frisky left prefrontal lobes. If these findings are widely confirmed, they will be of great importance.

Buddhists are not born happy. It is not reasonable to suppose that Tibetan Buddhists are such a homogeneous biological group that they are, uniquely among humans, born with a "happiness gene" that activates the left prefrontal cortex. The most reasonable hypothesis is that there is something about conscientious Buddhist practice that results in the kind of happiness we all seek.

What about the effect of Buddhist practice on the amygdala and other subcortical forebrain circuitry? This circuitry, you will recall, is involved in relatively automatic emotional and behavioural responses.

Now, thanks to important work by Joseph LeDoux at New York University, we know that a person can be conditioned via their amygdala and thalamus to be scared of things that really aren 't worth being scared of. We also know that it is extremely hard to override what the amygdala "thinks" and "feels" simply by conscious rational thought.

That said, there is some fascinating early work that suggests Buddhist mindfulness practice might tame the amygdala. Paul Ekman of the University of California San Francisco Medical Center, a renowned researcher on basic Darwinian emotions, is, like Davidson, in the early stages of studying Buddhist practitioners. So far, he has found that experienced meditators don 't get nearly as flustered, shocked or surprised as ordinary people by unpredictable sounds, even those as loud as gunshots. And Buddhists often profess to experience less anger than most people.

I believe research like this will eventually allow us to answer the question of whether Buddhist training can change the way the brain responds most importantly with negative emotions to certain environmental triggers. Antidepressants are currently the favoured method for alleviating negative emotions, but no antidepressant makes a person happy.

On the other hand, Buddhist meditation and mindfulness, which were developed 2500 years before Prozac, can lead to profound happiness, and its practitioners are deeply in touch with their glowing left prefrontal cortex and their becalmed amygdala.

In 1984, Whorwell et al.1 in Manchester, England, published a small but well-designed placebo-controlled trial of hypnosis as a treatment of irritable bowel syndrome (IBS). They randomized 30 patients with severe, refractory IBS to either 7 sessions of hypnotherapy or the same amount of psychotherapy plus placebo pills. The results indicated that hypnosis treatment had specific (nonplacebo) effects that substantially improved the central IBS symptoms of all the patients in that group (who showed far greater improvement than the control group). In a follow-up article,2 the investigators reported that clinical improvement was maintained in all the hypnotherapy patients during a 2-year posttreatment period.

A dozen other hypnosis studies on IBS, by the same group3–6 and by other investigators in several countries,7–14 have followed this initial trial. The additional studies have largely confirmed the high efficacy of hypnosis in IBS treatment, although the 100% response rate in the first study has generally not been equaled. This body of research has made hypnosis the most investigated psychologic treatment of IBS. In that regard, it is rivaled only by cognitive-behavioral therapy, which also shows a high success rate and substantial impact on IBS symptoms in some trials.15,16

Although some of these studies have been small and inadequate in design, hypnotherapy has emerged from the cumulative experience of this work not only as effective in improving the gastrointestinal (GI) symptoms that define IBS but also as a potent way to counter the quality of life impairment, disability, and excess health care costs associated with the disorder.3,4 This is most recently shown by the largest systematic assessment to date (250 consecutive patients) of the therapeutic impact of this treatment, reported in 2002 by the Manchester group.3 Based on the more than 50% average reduction in IBS severity, substantial reduction in anxiety and depression, significantly reduced health care costs and improved quality of life noted in this report, and good maintenance of symptom improvement beyond 2 years after treatment, it might be argued that hypnotherapy is more effective than any other single treatment modality for severe IBS.

In the present issue of GASTROENTEROLOGY, the Manchester group again presents a controlled trial of hypnotherapy,17 this time targeting functional dyspepsia (FD). The design closely parallels the group's 1984 controlled trial1 for IBS. As in that study, patients were randomized to either hypnotherapy or to an equal amount of supportive psychotherapy combined with placebo medication. However, the present study added a second side-by-side control group of patients randomized to standard medical treatment.

The hypnosis intervention used in this study is also largely identical in form and in content to what the Manchester group has used for many years for IBS, with some relatively small modifications to address FD symptoms.

The impact on FD from the hypnotherapy reported in their article closely mirrors the benefits of hypnosis seen for IBS. The mean reductions in symptoms were about the same as for IBS3 (59%) and continued to improve after treatment, reaching a remarkable average of 73% reduction in severity at 1-year follow-up (in contrast with the comparison groups). Greater decreases in medication use and improvement of quality of life after hypnotherapy were noted in this trial. As in the treatment of IBS, the therapeutic effects are generally well preserved at long-term follow-up.

Although replication of this first therapeutic trial for FD is needed, it expands considerably our knowledge of the potential for hypnotherapy as a treatment of functional GI problems. FD and IBS jointly account for more than half of the workload of gastroenterologists.18 Up to half of these patients are dissatisfied with standard treatment,19 which highlights a considerable unmet need for adjunctive or complementary treatments that can improve efficacy and patient satisfaction. With the present FD hypnotherapy study indicating that this treatment method may be as effective for FD as it is for IBS, it is becoming increasingly hard to ignore the notion that the skills of the hypnotherapist should be made routinely available to patients with functional GI disorders. The evidence consistently argues that wide availability of hypnotherapy would make management of these disorders more effective and would add broad benefits in improved emotional well-being and functional status of these patient groups. It might also produce large savings in cost of care for health care systems because of reduction in medication use and health care visits.

These potential advantages of hypnotherapy as adjunct in the management of IBS and FD raise the question whether it would be possible to implement routine adjunctive hypnosis management in mainstream care for GI disorders. The short answer is that, although feasible, it would, at least in the United States, require overcoming substantial practical and systemic obstacles.

Psychologic treatment is currently used only rarely as a therapeutic modality for functional GI patients, offered to less than 10% of all patients in primary care and gastroenterology clinics. Furthermore, this option is probably exercised mostly with patients who either present with significant psychologic symptoms or have not responded to conventional treatment. Many health maintenance organizations dissuade primary care physicians from routinely making outside referrals for psychologic treatment of functional GI disorders because of the higher up-front cost of such care. Reimbursement for psychologic treatment of functional GI disorders is furthermore limited or nonexistent in many insurance plans. All of these aspects of the health care system would have to be addressed and corrected to make hypnosis for FD and IBS widely available.

Perhaps an even more serious hindrance to widespread application of hypnotherapy for functional GI disorders is the limited availability of suitably trained and experienced clinicians. Only a very small proportion of physicians and nursing staff have the training or experience to administer hypnotherapy. Because of time pressures on physicians, such work may be impractical, especially in primary care settings, in which a series of 30-minute sessions with any one patient is likely to seem an unattainable luxury. Close collaborative ties with hypnotherapists do not exist in most medical settings. In the United States, mental health professionals, many of whom have little knowledge of functional GI disorders and therefore are often reluctant to undertake treatment of these disorders, practice much of clinical hypnosis.

Finally, popular perception of hypnosis, which even today carries an unfortunate and erroneous legacy of mystery and coercive influence over people from popular media and stage shows, may make some patients and physicians less receptive to considering this treatment option.

In light of the growing evidence of the value of hypnotherapy in enhancing care for functional GI disorders, it would seem timely to make a concerted effort to examine ways to remove these barriers and facilitate the availability of such treatment; for example, by providing systematic training to health professionals specifically in hypnotherapy for functional GI disorders, integrating hypnotherapy services, and enhancing reimbursement and referral patterns for such treatment.

The Manchester group, the pioneers in the domain of GI hypnosis, represents 1 model of how hypnotherapy can be effectively integrated with clinical gastroenterology. They have established a unit dedicated to medical hypnotherapy, working hand-in-hand with the gastroenterology service, and using 6 hypnotherapists who treat a large numbers of functional GI patients with hypnotherapy.

Apart from practical hindrances that continue to keep hypnotherapy from broad use for GI disorders, a number of important research questions remain unanswered about such treatment:

The mechanism of the impact of hypnosis on functional GI disorders remains obscure. Unlike pharmaceutic agents for IBS and FD, which have a clearly delineated mechanism of action, it is largely unknown how hypnotherapy produces its effects on GI symptoms. It is well documented that hypnosis can modulate GI functioning. The hypnotic state seems by its own virtue to increase oro-cecal transit time20 and quiet colonic motility.21 Experimental application of specific hypnotic suggestions and imagery can also have demonstrable effects on gastric secretion22 and transit time.20 Tests performed during hypnosis show decreased perception of discomfort in patients with IBS6 and FD.23 However, the research to date on posttreatment changes associated with hypnotherapy have provided very little evidence5,6,10,11 that overall changes in physiologic parameters such as pain thresholds, muscle tone, or autonomic functioning are central to the therapeutic effect, with the possible exception of increased pain thresholds for the most pain-sensitive subgroup of patients.5 Further work is needed to elucidate the main mechanism of action that produces improvement in GI symptoms. Side-by-side comparisons with other psychologic treatments are still lacking. Various other psychologic treatments have also been reported to have a positive impact on IBS symptoms, including cognitive-behavioral therapy,15,16 interpersonal therapy,24 stress-management training,25,26 and psychodynamic therapy.27 It remains uncertain at this time whether hypnotherapy is superior to these alternative psychologic treatments because no side-by-side comparative studies have been conducted. Combined effects with medications are unknown. To date, the research on hypnotherapy for FD has exclusively tested it as a monotherapy. The combination of this psychologic treatment with medications such as antidepressants and the 5-hydroxytryptamine modulating agents for IBS seems in order, if this type of treatment is to be considered as an adjunctive therapy in medical care. Such combination trials are also important because experience from non-GI trials of combined psychologic therapy and pharmacotherapy for headache28 and depression,29 for example, suggests that such a combined pharmacologic–psychologic approach is superior to either intervention alone. It is unknown whether hypnotherapy for FD and IBS can be administered in an automated home-treatment format. Hypnosis is unlike most other psychologic treatments because it is largely a one-way talk therapy with very limited interactivity. For this reason, it can be used without a live therapist, and this is commonly done in the form of audiotaped home practice sessions that patients use between clinic visits. The availability and affordability of this therapy would be vastly increased if the same kind of face-to-face hypnosis treatment found effective for FD and IBS would also help patients when administered exclusively in a home-treatment audio format. No data have been presented to date to make it possible to conclude whether this is feasible.

In conclusion, although some of the studies to date on hypnotherapy for functional GI disorders have been small and lacking in methodological rigor, and many research questions remain unanswered, the cumulative and consistent evidence for efficacy of hypnotherapy for these disorders seems to warrant serious consideration of its use as a regular adjunct in primary care and gastroenterology treatment of patients with FD and IBS.

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