Hypnosis, mindfulness meditation, and cognitive-behavioral therapy (CBT) have proven effective in reducing symptoms associated with functional digestive disorders. These psychology-based approaches have shown particular benefits in irritable bowel syndrome (IBS). A presentation at the Francophone Days of Hepatology, Gastroenterology, and Digestive Oncology 2024 discussed these alternative therapies.
While medication is often ineffective in this indication, behavioral therapies offer an interesting option. "It is important to inform patients about alternative treatments and guide them toward those with the best evidence of efficacy," emphasized Pauline Jouët, MD, PhD, of the department of hepato-gastroenterology at Louis Mourier Hospital in Colombes, France, during her presentation.
Hypnosis Leading the Way
Among functional digestive disorders, IBS is the most common. Due to hypersensitivity of the colon, with or without intestinal motility disorder, it manifests as abdominal pain, constipation, diarrhea, or bloating. This disorder, which can progress in episodes, often significantly affects the patient's quality of life.
The first behavioral therapy to yield promising results in this indication is hypnosis. This approach can help normalize visceral sensitivity and appears to affect intestinal contractions, said Jouët. "It also has an effect on abnormal brain activations in response to painful rectal stimulation."
Hypnosis, when tailored to focus on the digestive system, is now recommended for this indication. "The patient is brought into a specific state of consciousness between wakefulness and sleep, which increases receptivity to suggestion to facilitate psychological and physiological therapeutic changes."
Its benefits were demonstrated in a British study that included more than 1000 patients with IBS that was refractory to medical treatment. After 3 months of weekly hypnosis sessions, 76% of patients experienced symptom improvement, including a significant reduction in pain and bloating.
Encouraging Self-Hypnosis
These patients also reported improved quality of life. In addition to promoting better bowel movements, the study shows that hypnosis can have a beneficial effect on anxiety and sleep disorders. These effects can be maintained in the long term through self-hypnosis practice, as other studies suggest.
In addition to IBS, hypnosis has also proven effective in managing dyspepsia, a digestive disorder characterized by chronic stomach pain and discomfort. A small, randomized study reported a greater reduction in symptoms among patients treated with hypnosis compared with those treated with medication.
Hypnosis treatment can be conducted in individual or group sessions, either in person or remotely via video conferencing. The practitioner must be trained in this approach. Sessions last between 30 and 60 minutes and cost approximately 50 euros.
Studies have assessed the effect of 6-12 sessions spaced 1-2 weeks apart. Considering the cost and limited number of trained practitioners, "it is advisable to undergo a few sessions initially to check for improvement and then encourage patients to practice self-hypnosis to try to reproduce the feeling of well-being," said Jouët.
To help patients find a specialist trained in these disorders, the Association of Patients with Irritable Bowel Syndrome provides access to its network of hypnosis practitioners through its website, she added. This site can provide access to individual or group sessions (in person or via video).
CBT for Anxiety
Another recommended therapy is CBT, which has shown good results in managing anxiety and stress triggered by IBS symptoms. "The idea is to correct inappropriate reactions that arise in response to stress," said Jouët.
Conducted by a psychologist, psychiatrist, or even a gastroenterologist specially trained in the field, sessions aim to explain to the patient the impact of anxiety on symptoms and provide tools to control stress, especially during painful episodes.
A recent Japanese study demonstrated the benefits of CBT in more than 100 patients with moderate to severe IBS refractory to medical treatment. They were randomized to receive, in addition to standard treatment, weekly 90-minute CBT sessions for 10 weeks or be placed on a waiting list (which functioned as a control condition).
At 13 weeks, patients receiving CBT had a decrease in IBS Symptom Severity Score of 115.8 points compared with 29.7 points in the control group. The quality-of-life score was reduced by 20.1 points in the CBT group and 0.2 points in the control group. Benefits were maintained at 27 weeks.
A meta-analysis of nine randomized controlled trials involving 610 patients confirmed the effectiveness of CBT sessions in managing IBS.
The results show a 40% reduction in symptoms compared with the control group (relative risk = 0.60). According to the analysis, "four patients need to be treated with CBT to achieve significant improvement in one patient," said Jouët.
Mindfulness Meditation
Mindfulness meditation has also proven effective in this indication. "The practice of meditation involves focusing on the present moment and taking a step back from one's sensations and thoughts," said Jouët. The goal is to implement adaptation strategies to symptoms to mitigate their effects.
Sessions also aim to provide patients with tools to establish a regular meditation practice. A recent study reported a reduction in symptoms related to the disease in 76% of patients with IBS after 6 months of daily meditation sessions.
Consisting of eight 2-hour group sessions per week combined with daily individual practice, the Mindfulness-Based Stress Reduction meditation course remains costly. To avoid spending nearly 500 euros, the practitioner recommends directing patients toward less expensive or even free mobile applications.
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