Gut-directed hypnotherapy in children with irritable bowel syndrome or functional abdominal pain (syndrome): a randomized controlled trial on self exercises at home using CD versus individual therapy by qualified therapists

Juliette M T M Rutten, Arine M Vlieger, Carla Frankenhuis, Elvira K George, Michael Groeneweg, Obbe F Norbruis, Walther Tjon a Ten, Herbert Van Wering, Marcel G W Dijkgraaf, Maruschka P Merkus, Marc A Benninga, Juliette M T M Rutten, Arine M Vlieger, Carla Frankenhuis, Elvira K George, Michael Groeneweg, Obbe F Norbruis, Walther Tjon a Ten, Herbert Van Wering, Marcel G W Dijkgraaf, Maruschka P Merkus, Marc A Benninga

Abstract

Background: Irritable bowel syndrome (IBS) and functional abdominal pain (syndrome) (FAP(S)) are common pediatric disorders, characterized by chronic or recurrent abdominal pain. Treatment is challenging, especially in children with persisting symptoms. Gut-directed hypnotherapy (HT) performed by a therapist has been shown to be effective in these children, but is still unavailable to many children due to costs, a lack of qualified child-hypnotherapists and because it requires a significant investment of time by child and parent(s). Home-based hypnotherapy by means of exercises on CD has been shown effective as well, and has potential benefits, such as lower costs and less time investment. The aim of this randomized controlled trial (RCT) is to compare cost-effectiveness of individual HT performed by a qualified therapist with HT by means of CD recorded self-exercises at home in children with IBS or FAP(S).

Methods/design: 260 children, aged 8-18 years with IBS or FAP(S) according to Rome III criteria are included in this currently conducted RCT with a follow-up period of one year. Children are randomized to either 6 sessions of individual HT given by a qualified therapist over a 3-month period or HT through self-exercises at home with CD for 3 months.The primary outcome is the proportion of patients in which treatment is successful at the end of treatment and after one year follow-up. Treatment success is defined as at least 50% reduction in both abdominal pain frequency and intensity scores. Secondary outcomes include adequate relief, cost-effectiveness and effects of both therapies on depression and anxiety scores, somatization scores, QoL, pain beliefs and coping strategies.

Discussion: If the effectiveness of home-based HT with CD is comparable to, or only slightly lower, than HT by a therapist, this treatment may become an attractive form of therapy in children with IBS or FAP(S), because of its low costs and direct availability.

Trial registration: Dutch Trial Register number NTR2725 (date of registration: 1 February 2011).

References

    1. Rasquin A, Di Lorenzo C, Forbes D, Guiraldes E, Hyams JS, Staiano A, Walker LS. Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology. 2006;130:1527–1537. doi: 10.1053/j.gastro.2005.08.063.
    1. Chitkara DK, Rawat DJ, Talley NJ. The epidemiology of childhood recurrent abdominal pain in Western countries: a systematic review. Am J Gastroenterol. 2005;100:1868–1875. doi: 10.1111/j.1572-0241.2005.41893.x.
    1. Devanarayana NM, Mettananda S, Liyanarachchi C, Nanayakkara N, Mendis N, Perera N, Rajindrajith S. Abdominal pain-predominant functional gastrointestinal diseases in children and adolescents: prevalence, symptomatology, and association with emotional stress. J Pediatr Gastroenterol Nutr. 2011;53:659–665.
    1. Zhou H, Yao M, Cheng G-Y, Chen Y-P, Li D-G. Prevalence and associated factors of functional gastrointestinal disorders and bowel habits in Chinese adolescents: a school-based study. J Pediatr Gastroenterol Nutr. 2011;53:168–173. doi: 10.1097/MPG.0b013e3182125388.
    1. Youssef NN, Murphy TG, Langseder AL, Rosh JR. Quality of life for children with functional abdominal pain: a comparison study of patients’ and parents’ perceptions. Pediatrics. 2006;117:54–59. doi: 10.1542/peds.2005-0114.
    1. Youssef NN, Atienza K, Langseder AL, Strauss RS. Chronic abdominal pain and depressive symptoms: analysis of the national longitudinal study of adolescent health. Clin Gastroenterol Hepatol. 2008;6:329–332. doi: 10.1016/j.cgh.2007.12.019.
    1. Shelby GD, Shirkey KC, Sherman AL, Beck JE, Haman K, Shears AR, Horst SN, Smith CA, Garber J, Walker LS. Functional abdominal pain in childhood and long-term vulnerability to anxiety disorders. Pediatrics. 2013;132:475–482. doi: 10.1542/peds.2012-2191.
    1. Dhroove G, Chogle A, Saps M. A million-dollar work-up for abdominal pain: is it worth it? J Pediatr Gastroenterol Nutr. 2010;51:579–583. doi: 10.1097/MPG.0b013e3181de0639.
    1. Brandt LJ, Chey WD, Foxx-Orenstein AE, Schiller LR, Schoenfeld PS, Spiegel BM, Talley NJ, Quigley EM. American College of Gastroenterology Task Force on Irritable Bowel Syndrome. An evidence-based position statement on the management of irritable bowel syndrome. Am J Gastroenterol. 2009;104(Suppl 1):S1–S35.
    1. Drossman DA. The functional gastrointestinal disorders and the Rome III process. Gastroenterology. 2006;130:1377–1390. doi: 10.1053/j.gastro.2006.03.008.
    1. Di Lorenzo C, Colletti RB, Lehmann HP, Boyle JT, Gerson WT, Hyams JS, Squires RH jr, Walker LS, Kanda PT. Chronic abdominal pain in children: a technical report of the American academy of pediatrics and the North American society for pediatric gastroenterology, hepatology and nutrition AAP subcommittee and NASPGHAN committee on chronic abdominal pain. J Pediatr Gastroenterol Nutr. 2005;40:249–261. doi: 10.1097/.
    1. Weydert JA, Ball TM, Davis MF. Systematic review of treatments for recurrent abdominal pain. Pediatrics. 2003;111:e1–e11. doi: 10.1542/peds.111.1.e1.
    1. Campo JV, Di Lorenzo C, Chiappetta L, Bridge J, Colborn DK, Gartner JC Jr, Gaffney P, Kocoshis S, Brent D. Adult outcomes of pediatric recurrent abdominal pain: do they just grow out of it? Pediatrics. 2001;108:E1. doi: 10.1542/peds.108.1.e1.
    1. Whorwell PJ, Prior A, Faragher EB. Controlled trial of hypnotherapy in the treatment of severe refractory irritable-bowel syndrome. Lancet. 1984;1:1232–1234.
    1. Palsson OS, Turner MJ, Johnson DA, Burnett CK, Whitehead WE. Hypnosis treatment for severe irritable bowel syndrome: investigation of mechanism and effects on symptoms. Dig Dis Sci. 2002;47:2605–2614. doi: 10.1023/A:1020545017390.
    1. Galovski TA, Blanchard EB. The treatment of irritable bowel syndrome with hypnotherapy. Appl Psychophysiol Biofeedback. 1998;23:219–232. doi: 10.1023/A:1022209631047.
    1. Forbes A, MacAuley S, Chiotakakou-Faliakou E. Hypnotherapy and therapeutic audiotape: effective in previously unsuccessfully treated irritable bowel syndrome? Int J Colorectal Dis. 2000;15:328–334. doi: 10.1007/s003840000248.
    1. Lindfors P, Unge P, Arvidsson P, Nyhlin H, Björnsson E, Abrahamsson H, Simrén M. Effects of gut-directed hypnotherapy on IBS in different clinical settings-results from two randomized, controlled trials. Am J Gastroenterol. 2012;107:276–285. doi: 10.1038/ajg.2011.340.
    1. Roberts L, Wilson S, Singh S, Roalfe A, Greenfield S. Gut-directed hypnotherapy for irritable bowel syndrome: piloting a primary care-based randomised controlled trial. Br J Gen Pract. 2006;56:115–121.
    1. Gonsalkorale WM, Miller V, Afzal A, Whorwell PJ. Long term benefits of hypnotherapy for irritable bowel syndrome. Gut. 2003;52:1623–1629. doi: 10.1136/gut.52.11.1623.
    1. Lindfors P, Unge P, Nyhlin H, Ljótsson B, Björnsson ES, Abrahamsson H, Simrén M. Long-term effects of hypnotherapy in patients with refractory irritable bowel syndrome. Scand J Gastroenterol. 2012;47:413–420.
    1. Moser G, Trägner S, Gajowniczek EE, Mikulits A, Michalski M, Kazemi-Shirazi L, Kulnigg-Dabsch S, Führer M, Ponocny-Seliger E, Dejaco C, Miehsler W. Long-term success of GUT-directed group hypnosis for patients with refractory irritable bowel syndrome: a randomized controlled trial. Am J Gastroenterol. 2013;108:602–609. doi: 10.1038/ajg.2013.19.
    1. Weydert JA, Shapiro DE, Acra SA, Monheim CJ, Chambers AS, Ball TM. Evaluation of guided imagery as treatment for recurrent abdominal pain in children: a randomized controlled trial. BMC Pediatr. 2006;6:29. doi: 10.1186/1471-2431-6-29.
    1. Vlieger AM, Menko-Frankenhuis C, Wolfkamp SCS, Tromp E, Benninga MA. Hypnotherapy for children with functional abdominal pain or irritable bowel syndrome: a randomized controlled trial. Gastroenterology. 2007;133:1430–1436. doi: 10.1053/j.gastro.2007.08.072.
    1. Gulewitsch MD, Müller J, Hautzinger M, Schlarb AA. Brief hypnotherapeutic-behavioral intervention for functional abdominal pain and irritable bowel syndrome in childhood: a randomized controlled trial. Eur J Pediatr. 2013;172:1043–1051. doi: 10.1007/s00431-013-1990-y.
    1. Green JP, Barabasz AF, Barrett D, Montgomery GH. Forging Ahead: the 2003 APA Division 30 definition of hypnosis. Int J Clin Exp Hypn. 2005;53:259–264. doi: 10.1080/00207140590961321.
    1. Vlieger AM, Rutten JMTM, Govers AMAP, Frankenhuis C, Benninga MA. Long-term follow-up of gut-directed hypnotherapy vs. standard care in children with functional abdominal pain or irritable bowel syndrome. Am J Gastroenterol. 2012;107:627–631. doi: 10.1038/ajg.2011.487.
    1. Van Tilburg MAL, Chitkara DK, Palsson OS, Turner M, Blois-Martin N, Ulshen M, Whitehead WE. Audio-recorded guided imagery treatment reduces functional abdominal pain in children: a pilot study. Pediatrics. 2009;124:e890–e897. doi: 10.1542/peds.2009-0028.
    1. Zanten Van Veldhuyzen SJ, Talley NJ, Bytzer P, Klein KB, Whorwell PJ, Zinsmeister AR. Design of treatment trials for functional gastrointestinal disorders. Gut. 1999;45(Suppl 2):ii69–ii77.
    1. Gonsalkorale WM. Gut-directed hypnotherapy: the Manchester approach for treatment of irritable bowel syndrome. Int J Clin Exp Hypn. 2006;54:27–50. doi: 10.1080/00207140500323030.
    1. See MC, Birnbaum AH, Schechter CB, Goldenberg MM, Benkov KJ. Double-blind, placebo-controlled trial of famotidine in children with abdominal pain and dyspepsia: global and quantitative assessment. Dig Dis Sci. 2001;46:985–992. doi: 10.1023/A:1010793408132.
    1. Gur RC. Measuring hypnotic susceptibility: a guest editorial. Am J Clin Hypn. 1978-1979;21:64–67.
    1. Morgan AH, Hilgard JR. The Stanford hypnotic clinical scale for children. Am J Clin Hypn. 1978-1979;21:148–169. doi: 10.1080/00029157.1978.10403969.
    1. Muris P, Meesters C, Schouten E. A brief questionnaire of DSM-IV-defined anxiety and depression symptoms among children. Clin Psychol Psychoth. 2002;9:430–442. doi: 10.1002/cpp.347.
    1. Meesters C, Muris P, Ghys A, Reumerman T, Rooijmans M. The Children’s Somatization Inventory: further evidence for its reliability and validity in a pediatric and a community sample of Dutch children and adolescents. J Pediatr Psychol. 2003;28:413–422. doi: 10.1093/jpepsy/jsg031.
    1. Ravens-Sieberer U, Gosch A, Rajmil L, Erhart M, Bruil J, Power M, Duer W, Auquier P, Cloetta B, Czemy L, Mazur J, Czimbalmos A, Tountas Y, Hagquist C, Kilroe J. the KIDSCREEN Group. The KIDSCREEN-52 quality of life measure for children and adolescents: psychometric results from a cross-cultural survey in 13 European countries. Value Health. 2008;11:645–658. doi: 10.1111/j.1524-4733.2007.00291.x.
    1. The KIDSCREEN group. The KIDSCREEN Questionnaires-Quality of Life Questoinnaires for Children and Adolescents Handbook. Lengerich: Pabst Science Publishers; 2006.
    1. Van der Veek SMC, De Haan E, Derkx HHF, Benninga MA, Lindauer RJL, Boer F. PhD Thesis: A Psychosocial Perspective on Pediatric Functional Abdominal Pain: Risk Factors and Treatment. Academic Medical Center, University of Amsterdam; 2012. The Relative Contribution of Parental and children’s Cognitive and Behavioral Reactions to Pediatric Functional Abdominal Pain; pp. 80–94.
    1. Walker L, Smith C, Garber J, Claar R. Testing a model of pain appraisal and coping in children with recurrent abdominal pain. Health Psychol. 2005;24:364–374.
    1. Ayers TA, Sandler IN. Manual for the Children’s Coping Strategies Checklist & How I Coped Under Pressure Scale. [ retrieved June 2010]
    1. De Boo GM, Wicherts J. Assessing cognitive and behavioral coping strategies in children. Cognit Ther Res. 2007;33:1–20.
    1. Feeny D, Furlong W, Torrance GW, Goldsmith CH, Zhu Z, DePauw S, Denton M, Boyle M. Multiattribute and single-attribute utility functions for the health utilities index mark 3 system. Med Care. 2002;40:113–128. doi: 10.1097/00005650-200202000-00006.
    1. Hille ET, Weisglas-Kuperus N, Van Goudoever JB, Jacobusse GW, Ens-Dokkum MB, De Groot L, Wit JM, Geven WB, Kok JH, De Kleine MJ, Kollée LA, Mulder AL, Van Straaten HL, De Vries LS, Van Weissenbruch MM, Verloove-Vanhorick SP. Dutch Collaborative POPS 19 study group. Functional outcomes and participation in young adulthood for very preterm and very low birth weight infants: the Dutch Project on Preterm and Small for Gestational Age Infants at 19 years of age. Pediatrics. 2007;120:e587–e595. doi: 10.1542/peds.2006-2407.
    1. Eiser C, Morse R. The measurement of quality of life in children: past and future perspectives. J Dev Behav Pediatr. 2001;22:248–256.
    1. Tarride J-E, Burke N, Bischof M, Hopkins RB, Goeree L, Campbell K, Xie F, O’Reilly D, Goeree R. A review of health utilities across conditions common in paediatric and adult populations. Health Qual Life Outcomes. 2010;8:12. doi: 10.1186/1477-7525-8-12.
    1. Mangel AW, Hahn BA, Heath AT, Northcutt AR, Kong S, Dukes GE, McSorley D. Adequate relief as an endpoint in clinical trials in irritable bowel syndrome. J Int Med Res. 1998;26:76–81.
    1. Milling LS, Reardon JM, Carosella GM. Mediation and moderation of psychological pain treatments: response expectancies and hypnotic suggestibility. J Consult Clin Psychol. 2006;74:253–262.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться