Intended for healthcare professionals

Rapid response to:

Primary Care

Cognitive behaviour therapy in addition to antispasmodic treatment for irritable bowel syndrome in primary care: randomised controlled trial

BMJ 2005; 331 doi: (Published 18 August 2005) Cite this as: BMJ 2005;331:435

Rapid Response:

C.B.T and Hypnotherapy to treat refractory Irritable bowel syndrome

C.B.T. to treat irritable bowel syndrome along with antispasmodics is
found to be helpful 1.This is understandable as digestive system mirrors
the mind. A recent meta-analysis has established that hypnosis enhances
the efficacy of both psychodynamic and cognitive behavioural therapies.2 A
cmbination of hypnotherapy and C.B.T along with drug treatment might
accelerate the symptom controll of refractory irritable bowel syndrome.

Five published randomised controlled trials have examined the effects
of hypnotherapy in people with refractory irritable bowel syndrome.3-7 In
one such trial involving 30 patients who had been unsuccessfully treated
to any therapy, and having severe irritable bowel syndrome, it was found
that after three months of treatment ( seven 30 minute sessions at
increasing intervals over 3 months along with a tape for daily self
hypnosis), the reductions in mean weekly overall symptom scores and
improvement in well-being were greater in the hypnotherapy group than in
the control group. A follow up study of the 15 patients in the
hypnotherapy group over a mean of 18 months found that all patients had
remained in remission. 8

Irvin Kirsch considers hypnotherapy an empirically validated, non-
deceptive placebo and the effects are mediated by response expectancies 9.
This is probably one of the several psychological mechanisms that explain
the working of hypnosis. Mainstream psychiatry is still highly sceptical
about the efficacy of hypnosis in clinical psychiatry 10.If cognitive
therapy is useful
in deprogramming the cognitive distortions, hypnotherapy can be
effective in reprogramming the cognition. Self-hypnosis is to be
discouraged until cognitive reprogramming has been achieved,
as this can reinforce the existing cognitive disturbances.

Cognitive therapy has to be revised to accommodate the hypnotic
techniques. It is analogous to the shift from Newtonian to Quantum
mechanics, as Newtonian laws were only good approximations. In its early
days the cognitive science laboratory began to provide a new range of
experimentally based assessment techniques 11, which may yet provide new
insights into psychopathology. Just as there was a detectable
‘psychoanalytic drift’ in the practice of cognitive therapy in the
eighties 12, now there is a ‘hypnotherapeutic drift’ in the educational
circles of cognitive science. But hypnosis is not a penacea or a
substitute for physical and various other psychotherapeutic treatment

1.Tonny Kennedy, Roger Jones, Simon Darnley, Paul Seed,
Simon Wessely, Trudie Chalder. Cognitive behavioural
therapy in addition to antispasmodic treatment for irritable
bowel syndrome in primary care: randomised controlled trial.
BMJ 2005: 435, DOI;10.1136/BMJ.38545.505764.06

2.Kirsch, I. & Lynn, S.J. The altered state of hypnosis: Changes
in the theoretical landscape. American Psychologist 1995; 50, 846-858.

3.Whorwell PJ et al. Controlled trial of hypnotherapy in the
treatment of severe refractory irritable bowel syndrome. Lancet 1984; 2

4.Forbes A et al. Hypnotherapy and therapeutic audiotape: effective
in previously unsuccessfully treated irritable bowel syndrome?. Int J
Colorectal Dis 2000; 15:328-34

5.Galovski TE, Blanchard EB. The treatment of irritable bowel
syndrome with hypnotherapy. App Psychophysical Biofeedback 1998; 23.219-32

6. Palsson OS et al. Hypnosis treatment for severe irritable bowel
syndrome. Investigation of mechanism and effect on symptoms. Dig Dis Sci
2002; 47: 2605-14.

7.Harvey RF et al. Individual and group hypnotherapy in treatment of
refractory irritable bowel syndrome. Lancet 1989; 1 (8635):424-5.

8.Whorwell PJ et al. Hypnotherapy in severe irritable bowel syndrome:
further experience. Gut 1987; 28:423-5.

9.Kirsch, Irvine. Hypnosis in Psychotherapy: Efficacy and
mechanisms. Contemporary hypnosis 1996;13. 109-114.

10. Gelder Michael, Dennis Gath and Richard Mayor (1990). Oxford
Textbook of Psychiatry. Oxford Medical Publications - Oxford

11.William J.M.G, Watts F.N., Macleod C and Mathews A (1988).
Cognitive Psychology and Emotional Disorder, Chichester. John Wiley &

12.Power M.J. Cognitive therapy an outline of
theory,practice and problems. British Journal of
Psychotherapy 1989; 5, 544-556.

Competing interests:
None declared

Competing interests: No competing interests

24 August 2005
James Paul Pandarakalam
consultant psychiatrist, 5 Boroughs Partnership NHS Trust
St Helens North CMHT, Peasley Cross Resource Centre, St Helens, Merseyside WA 9 3DA