Clinical Review Clinical review

Psychological approach to managing irritable bowel syndrome

BMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39199.679236.AE (Published 24 May 2007) Cite this as: BMJ 2007;334:1105

Hypnotherapy for IBS.

I.B.S. is considered as a brain-gut dysfunctional syndrome by
hypnotherapists and several studies have impressively documented the value
of hypnotherapy for this condition. Gastrointestinal conditions seem to be
stress –related illnesses. These conditions are associated with the
possible involvement of several other emotional factors such as repressed
hostility and anger that may be responsive to hypnotherapy 1. Whorwell’s
study group noticed long term (mean 18months) follow up response rates on
50 patients with 95% success with classical cases, 43% with atypical
cases, and 60% with cases exhibiting significant psychopathology 2. They
also found that patients over age 50 responded poorly (25% success), but
patients below the age of 50 with classical irritable bowel syndrome were
100% successful.
Even though it is not clear whether IBS is caused by stress, it is certain
this condition is worsened by stress. The mechanism of the working of gut-
directed hypnotherapy is enigmatic but it may change the way the brain
modulates gut activity: under hypnosis gut sensitivity is reduced.

References

1.Walker, B.B. (1983) Treating stomach disorders can we reinstate
regulatory processes? In R. Hozl & W.E. Whitehead (Eds),
Psychopathology of the Gastrointestinal Tract: Experimental & Clinical

Applications. New York; plenum, pp209-233

2.Whrwell, P.J., Prior, A., & Faragher, E.B. (1984) Controlled
trial of hypnotherapy in the treatment of service refractory irritable
bowel syndrome. Lancet, 2, 1232-1233

Competing interests:
None declared

Competing interests: No competing interests

31 May 2007
James Paul Pandarakalam
Consultant psychiatrist
St Helens North CMHT, St Helens WA 9 3DA