An RCT of hypnotherapy for management of irritable bowel syndrome – right intervention, wrong outcome?

Roberts LM¹, Wilson S¹, Greenfield S¹, Singh S²

¹Department of Primary Care, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK

²Department of Gastroenterology, Good Hope Hospital, Birmingham, UK

Background

Gut-directed hypnotherapy (GDH) has been demonstrated to be successful in alleviating irritable bowel syndrome (IBS) symptoms within a specialist centre. This trial aimed to evaluate effectiveness in the primary care management of IBS.

Objective

To report on a recent RCT evaluating hypnotherapy in the management of IBS, highlighting issues for future CAM research.

Materials and methods

One hundred and one patients with IBS were recruited within primary care and diagnosis was confirmed by a gastroenterologist. Eighty patients were deemed eligible for randomisation. Control patients received the usual management from their GP. Intervention patients also received five sessions of GDH. The main outcome measures were disease-specific symptoms and quality-of-life scores collected 3, 6 and 12 months post-randomisation. Qualitative data were collected from hypnotherapy patients.

Results

Between-group comparisons demonstrate a significant difference in symptoms at 3 months, with greater pain reduction in the hypnotherapy group (32.6 vs. 46.9, P = 0.017). There was no corresponding difference in quality of life. Differences did not persist beyond 3 months. Qualitative reports from hypnotherapy patients revealed that most (81.8%, 27/33) reported definate improvement and almost all (90.9%, 30/33) stated they would recommend GDH to others. Qualitative data suggested benefits in panic reduction, enhanced feeling of symptom control and general well-being.

Conclusion

Conventional validated outcome measures did not demonstrate improvement in quality of life, although patients who received hypnotherapy reported this. There is a suggestion that hypnotherapy (and possibly other CAM treatments) accrue benefit in ways not detected by conventional trial outcome measures. Future studies should therefore aim to incorporate generic measures and qualitative reporting.

Acknowledgement

The hypnotherapy RCT was funded by a grant from Good Hope Hospital R&D.

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