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New Developments in Gut Hypnosis Research Using Standardized Protocols
Olafur S. Palsson, PsyD; Laurie Keefer, PhD ; Jennifer L. Kiebles, PhD
The availability of an empirically tested standardized hypnosis protocol for IBS has greatly facilitated hypnosis treatment of this disorder in the U.S. and enabled hundreds of clinicians to offer this evidence-based intervention. Efforts are now under way to address several other gastrointestinal disorders in a similar manner through empirical testing of standardized hypnosis protocols, and this work is likely to greatly increase the use of hypnosis for those other disorders as well in the next few years. In this symposium, the presenters describe these new protocols and the research studies they are conducting on them in the treatment of inflammatory bowel disease, gastroesophageal reflux disease (GERD), heartburn, functional chest pain and globus. Outcomes to date are presented wherever available, including findings from a randomized controlled NIH-funded trial on inflammatory bowel disease and pilot studies on globus and GERD. Additionally, the Nationwide IBS Hypnosis Outcomes Project, where hypnosis outcomes in IBS are systematically collected by numerous clinicians across the U.S. working outside formal research settings, is presented as a practical model for the field for large-scale testing of the ecological validity and determinants of effectiveness of standardized hypnosis protocols.
At the end of this session, individuals will be able to:
Summarize what is currently known about the clinical impact of hypnosis on
inflammatory bowel disease;
Identify three different esophageal or upper gut disorders that have been shown in
r esearch to respond to hypnosis intervention; and
Recognize how clinicians operating in independent settings can build collaborative
research into their clinical services to test hypnosis interventions for particular health
conditions through common adoption of simple assessment and intervention practices.
Presentation 1: Preventive Use of Hypnosis in Inflammatory Bowel Disease: Results from an NIH-funded Randomized Controlled Trial
Laurie Keefer, PhD
In this presentation, data from the NIH-funded Ulcerative Colitis Relapse Prevention Trial (UCRPT) will be presented. Ulcerative Colitis is a chronic, relapsing and remitting gastrointestinal disease with no satisfactory treatment. UCRPT is based on the premise that prevention of disease flare may include targeting behaviors known to increase risk, including stress and poor adherence to maintenance medication. UCRPT is a randomized controlled trial (N = 46) comparing the efficacy of two therapies-gut-directed hypnosis against time/attention control for patients with quiescent UC on rate of flare as well as on self-efficacy, quality of life and patient concerns.
Presentation 2: Hypnosis Interventions for Esophageal Disorders (GERD, Heartburn, and Globus)
Jennifer L. Kiebles, PhD
In this presentation, data from the Northwestern University Esophageal Center's pilot study using hypnotherapy as a treatment for globus sensation will be presented. Globus sensation is a bothersome and difficult symptom to treat. The aims of the pilot study were to evaluate the acceptability and utility of hypnotically-assisted relaxation (HAR) in decreasing the perception of globus sensation and the effect of HAR on interdeglutitive upper esophageal sphincter (UES) pressure. Sixteen subjects with persistent globus sensation unresponsive to therapy for reflux disease and with normal esophageal/laryngeal imaging studies were invited to participate in a 7-session clinical protocol. Ten out of 16 agreed to participate and completed the 7-session protocol. Globus symptom severity varied widely pre-treatment (ESQ median=52.5, range 16-72), and 9 of 10 subjects reported a reduction in globus symptomatology following treatment (median=14.0, range 3-19; p = .007). Group respiratory augmentation and average resting UES pressure were unaffected by HAR (p = .48, .89). This case series suggests that HAR can provide a substantial improvement in globus sensation irrespective of cause, with no effect on UES function. Further, data from a preliminary clinical case-series highlighting hypnotherapy for reflux disease will also be presented.
Presentation 3: The Nationwide IBS Hypnosis Outcomes Project (NIHOP)
Olafur S. Palsson, PsyD
This presentation outlines a nationwide data collection project testing the effectiveness and determinants of treatment response to hypnosis for IBS across numerous clinicians using the same hypnosis protocol. Therapists across the U.S. who provide treatment with the North Carolina hypnosis protocol for IBS use a uniform broad set of validated outcome measures to assess IBS patients at intake and track their progress systematically during treatment and at follow-up by means of internet-mediated methodology. This project may provide a novel and efficient model for large-scale collective research to document clinical outcomes in the field of hypnosis, and also provides participating clinicians with practice support to maximize the quality of care in psychological treatment of IBS.