Randomised clinical trial: individual versus group hypnotherapy for irritable bowel syndrome

Jenny Lövdahl, Hans Törnblom, Gisela Ringström, Olafur S Palsson, Magnus Simrén, Jenny Lövdahl, Hans Törnblom, Gisela Ringström, Olafur S Palsson, Magnus Simrén

Abstract

Background: Gut-directed hypnotherapy improves symptoms for patients with irritable bowel syndrome (IBS). Group hypnotherapy, as well as hypnotherapy administered by nurses, can increase treatment availability, but there are few comparisons between individual and group-based hypnotherapy.

Aim: We aimed to evaluate and compare the effectiveness of nurse-administered hypnotherapy for IBS delivered individually or in groups.

Methods: IBS patients were randomised to individual or group hypnotherapy (8 sessions, 12 weeks). The primary endpoint was changes in severity of IBS symptoms. A responder was defined as reduction of IBS severity scoring system (IBS-SSS) ≥50 points at the end of treatment compared to baseline. The effects on extracolonic and psychological symptoms, and quality of life were also assessed. Symptoms were also followed up 6 months after treatment start.

Results: A total of 119 patients were randomised (61 individual, 58 group hypnotherapy). Patients reported improvements in IBS symptoms (IBS-SSS) (individual: 332 (273-401) (median, IQR), versus 216 (140-308), (p < 0.0001), group: 315 (239-382), versus 217 (149-314), (p < 0.0001)), with no differences between the groups (p = 0.16). Extracolonic symptoms, psychological symptoms and quality of life also improved, without clear differences between the groups. Sixty-nine percent of the individual hypnotherapy patients were responders after treatment versus 57% of the group hypnotherapy patients (p = 0.25). Symptom improvements were also seen at follow-up.

Conclusions: Nurse-administered gut-directed hypnotherapy, delivered individually or in groups, relieves IBS symptoms, improves psychological symptoms and quality of life. Group hypnotherapy can be an efficacious alternative, enabling more patients to benefit from the treatment (ClinicalTrials.gov ID no of study: NCT03432078).

© 2022 The Authors. Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd.

Figures

FIGURE 1
FIGURE 1
Timeline illustrates the visits of the treatment period as well as follow‐up, and the patient reported outcome measures assessed at specific time points. †IBS‐SSS, IBS Severity Scoring System, ‡HAD, Hospital Anxiety and Depression scale, §VSI, Visceral Sensitivity Index, ¶IBSQoL, Irritable Bowel Syndrome Quality of Life questionnaire
FIGURE 2
FIGURE 2
Flow chart demonstrating the number of patients during different phases of the study
FIGURE 3
FIGURE 3
Severity of gastrointestinal symptoms before (baseline) and after (visit 8) hypnotherapy treatment assessed with the IBS severity scoring system (IBS‐SSS) (median, IQR). ****p < 0.0001
FIGURE 4
FIGURE 4
Severity of gastrointestinal symptoms (IBS‐SSS; median, IQR), before (baseline), every second week during hypnotherapy, and after treatment (visit 8). A) individual hypnotherapy, B) group hypnotherapy. A mixed between‐within subjects ANOVA demonstrated a significant effect of the hypnotherapy treatment (p < 0.001), but with no differences between the groups (p = 0.83). ****p < 0.0001 vs. baseline
FIGURE 5
FIGURE 5
VAS change in each of the five components of the IBS‐SSS after treatment, compared to baseline. ITT, median (IQR)
FIGURE 6
FIGURE 6
Proportion of responders and non‐responders after hypnotherapy (visit 8), who were responders and non‐responders at mid‐treatment (visit 5). Responder = ≥50 p reduction in IBS‐SSS at visit 8 vs baseline. *p < 0.05

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Source: PubMed

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