Special Interview with Michael Mahoney "How does hypnosis help IBS, and how did you come to create a self-hypnosis program especially for IBS patients?" When being invited to write about my work and background I was not only flattered, I wondered what readers would want to learn about me. I suspected they would wonder how on earth anyone would come about treating such a condition as Irritable Bowel Syndrome in the first place. Well, to be honest, I was asked to look into treating patients with the condition by the gastroenterologists in my medical centre here in Cheshire, England, who had given up all hope of helping them. These doctors called their IBS patients their "heart-sinks" because every treatment that could be done was done, but to little or no avail. So they came to me. I had to learn about IBS from scratch, and did so, not only through my professional studies but by interviewing patient after patient and learning about their fears, anxieties, horrible episodes of "emergency" diarrhea, panic attacks for the loo, and public accidents of untold embarrassment. I learned about the heartache and frustration of a patient population that had little or no recourse for relief. As a clinical hypnotherapist, I knew that other medical conditions could be treated through this modality, with results running the range of alleviation of a given condition to full recovery. But IBS was a new one, and I was determined to help these patients because their suffering was indeed affecting their quality of life. First, let me digress a bit. Some readers, perhaps unaware of the many studies over the past 20 years using clinical hypnotherapy as medical treatment, may have visions of watches swinging and people clucking like chickens. Clinical hypnotherapy uses the person's own internal resources to bring about symptom reduction and a path towards healing. As humans, we are in and out of this state throughout the day, as it is merely a common state of concentration similar to being very focused - for example, driving home on "auto-pilot" as we sometimes do. Even while hypnotized, the patient, not the therapist, remains in full control. Hypnotherapy induces a state of relaxation while the patient is awake, and allows helpful suggestions such as those aimed at controlling health problems to be directed into the subconscious mind. It is a natural, normal state, and I have been privileged to help people with many problems through this treatment method for nearly 20 years. In 1991, I began working with referred IBS patients at no charge, since I was learning about them and their needs. I spent nearly two years researching IBS. I developed specific IBS hypnotherapy processes for the treatment, incorporating ongoing feedback from the patients while providing my own funding for research and development. When word got out that IBS patients were actually receiving successful treatment, I had people travel long distances to obtain therapy from me; some of them were coming 100 miles or more. Many IBS patients were too sick to easily travel, however, and had a great fear of not being near the bathroom, or they were afraid of having a bowel accident on the way; for them, coming to see me posed a problem. Today, when people ask what kept me working on my IBS program, even when faced with strapped finances and professional peer review, I could only think of those first patients and their desperation. That will be remembered for the rest of my life. Sadly, many (if not most) of the IBS sufferers I saw had to deal with doctors who did not recognize or fully appreciate the emotional impact of IBS - for IBS is far from a purely physical condition. Many readers will be all too familiar with the emotional toll IBS can take, including anxiety, weepiness, some depression, resignation, and disheartenment. I well understood the frustration, fear, and pain that the IBS patient suffers. I also know first-hand the anger that can come from being dismissed by physicians who don't feel that IBS is a "real" condition that causes real suffering, and who simply refuse to listen to those who offer new avenues of help. Patients often reported that dismissal of their concerns served only to make both their emotional and physical symptoms even worse. IBS needs an empathetic approach. Just dealing with the symptoms of Irritable Bowel Syndrome is not enough; the individual has to learn to rebuild internal energy. After years of pain, and being told by various medical professionals that there is nothing that can be done, many sufferers feel emotionally drained. In the IBS Audio Program introduction I explain about our 'emotional pot of energy' and our 'emotional reserves' and how these have to be attended to, in addition to the physical aspects of the condition. Without the emotional will and strength to seek and persevere in finding a solution, recovery is often difficult. This 'emotional energy' has to be recognized, replenished and managed. To move into recovery we have to work at feeling better, learn new ways of coping, and become familiar with the new positive feelings and thoughts. It is then that we are taking part in our healing. I've also found many IBS patients have to deal not only with dismissive doctors, but with family members and those in their lives who more or less disregard their problem. They'll be accused of "faking" it, or told to just "quit obsessing about it", or given some similar off-hand cutting remark. I felt that this was another area to be addressed, so I created a recording called the "IBS Companionï¿½" that speaks of the humiliations, fears, medical evaluation embarrassments and ordeals that an IBS patient must go through, and how the family can help the patient, rather than add to their distressing situation. One of my patients, upon listening to this recording, told me that she cried, as it was the first time she felt validated as a real human being by someone who understood her condition and its impact on her world. IBS had cost her a good deal of her life, and the recording was the first time she felt real empathy. By mid 1997, I incorporated all the new processes, information, and delivery methods I had learned for IBS hypnotherapy onto audio tapes, so patients who were housebound or far away would no longer have to travel. These recorded sessions are today known as the IBS Audio Program 100ï¿½ and are recorded onto CDs. My work using clinical hypnotherapy for IBS has now been entered into the Guild of Health Writers Awards / Foundation of Integrated Medicine, and is considered one of "80 excellent examples of integrated medicine in the United Kingdom." As a member of the Primary Care Society for Gastroenterology (PCSG), I was invited to speak about my work in London, at the annual scientific meeting of the society, to gastro-interested medical professionals from all over the UK. I'm also a member of the International Functional Brain-Gut Research Group, and founder of the UK Register of IBS Therapists. In March of 2003, I had the honor of being given first place in the UK's Top Hypnotherapist listing, in the 'Top Brass' section of the Business pages of the Independent. This was not only a thrill, but brought me to the realization that my work had gained recognition because it dealt with an enormous patient population that was sorely overlooked and desperately needed help. This was not so much a validation for my work as it was a validation to the sufferers like yourselves. If you are still with me and reading this, perhaps you have been suffering with IBS for a long time and have not had the relief you seek, despite medical intervention. If you feel that you would like to learn more about the use of clinical hypnotherapy for the treatment of IBS and how the IBS Audio Program 100ï¿½ may be helpful to you, please feel free to visit my site at: http://www.ibscds.com Many thanks to those of you who have successfully used the IBS Audio Program 100ï¿½ and have shared your kind words with others on the BB. And may I extend many thanks to all of you for letting me share a bit about my program and my work. I wish you all many blessings and joy! ~ Michael Mahoney -------------------------------- Also: Here is an Overview of Published Research To Date on Hypnosis for IBS Over ten peer-reviewed, double blind clinical studies on hypnotherapy for IBS are condensed in this overview. The clinical trials are drawn from Gut, Lancet, Gastroenterology, and other internationally respected medical journals. The study results are consistent and their conclusions are overwhelmingly positive. The overview was conducted by Olafur S. Palsson, Psy.D., who specializes in clinical hypnotherapy research for IBS at the University of North Carolina's Center for Functional GI & Motility Disorders. (There are no links to the full abstracts of these studies, as the overview presents them in condensed form, and the complete overview is given here). Whorwell PJ; Prior A; Colgan SM. Hypnotherapy in severe irritable bowel syndrome: further experience. Gut, 1987 Apr, 28:4, 423-5. This report summed up further experience with 35 patients added to the 15 treated with hypnotherapy in the 1984 Lancet study. For the whole 50 patient group, success rate was 95% for classic IBS cases, but substantially less for IBS patients with atypical symptom picture or significant psychological problems. The report also observed that patients over age 50 seemed to have lower success rate from this treatment. Harvey RF; Hinton RA; Gunary RM; Barry RE. Individual and group hypnotherapy in treatment of refractory irritable bowel syndrome. Lancet, 1989 Feb, 1:8635, 424-5. This study employed a shorter hypnosis treatment course than other studies for IBS, and the success rate was lower, most likely demonstrating that a larger number of sessions is necessary for optimal benefit. Twenty out of 33 patients with refractory irritable bowel syndrome treated with four sessions of hypnotherapy in this study improved. Improvement was maintained at a 3-month treatment. These researchers further found that hypnosis treatment for IBS in groups of up to 8 patients seems as effective as individual therapy. Prior A, Colgan SM, Whorwell PJ. Changes in rectal sensitivity after hypnotherapy in patients with irritable bowel syndrome. Gut 1990;31:896. This study found IBS patients to be less sensitive to pain and other sensations induced via balloon inflation in their gut while they were under hypnosis. Sensitivity to some balloon-induced gut sensations (although not pain sensitivity) was reduced following a course of hypnosis treatment. Houghton LA; Heyman DJ; Whorwell PJ. Symptomatology, quality of life and economic features of irritable bowel syndrome--the effect of hypnotherapy. Aliment Pharmacol Ther, 1996 Feb, 10:1, 91-5. This study compared 25 severe IBS patients treated with hypnosis to 25 patients with similar symptom severity treated with other methods, and demonstrated that in addition to significant improvement in all central IBS symptoms, hypnotherapy recipients had fewer visits to doctors, lost less time from work than the control group and rated their quality of life more improved. Those patients who had been unable to work prior to treatment resumed employment in the hypnotherapy group but not in the control group. The study quantifies the substantial economic benefits and improvement in health-related quality of life which result from hypnotherapy for IBS on top of clinical symptom improvement. Koutsomanis D. Hypnoanalgesia in the irritable bowel syndrome. Gastroenterology 1997, 112, A764. This French study showed less analgesic medication use required and less abdominal pain experienced by a group of 12 IBS patients after a course of 6-8 analgesia-oriented hypnosis sessions followed by 4 sessions of autogenic training. Patients were evaluated at 6-month and 12-month follow-up. Houghton LA, Larder S, Lee R, Gonsalcorale WM, Whelan V, Randles J, Cooper P, Cruikshanks P, Miller V, Whorwell PJ. Gut focused hypnotherapy normalises rectal hypersensitivity in patients with irritable bowel syndrome (IBS). Gastroenterology 1999; 116: A1009. Twenty-three patients each received 12 sessions of hypnotherapy. Significant improvement was seen in the severity and frequency of abdominal pain, bloating and satisfaction with bowel habit. A subset of the treated patients who were found to be unusually pain-sensitive in their intestines prior to treatment (as evidenced by balloon inflation tests) showed normalization of pain sensitivity, and this change correlated with their pain improvement following treatment. Such pain threshold change was not seen for the treated group as a whole. Palsson, OS, Burnett CK, Meyer K, and Whitehead WE. Hypnosis treatment for irritable bowel syndrome. Effects on symptoms, pain threshold and muscle tone. Gastroenterology 1997;112:A803. Seventeen out of 18 patients with severe and treatment-refractory IBS who completed a 7-session standardized course of hypnosis treatment improved substantially. All central symptoms of IBS responded to treatment, including abdominal pain, diarrhea/constipation, and bloating. Psychological well-being also increased after treatment, with overall psychological symptoms, anxiety and somatization markedly decreased. Gut pain thresholds and smooth muscle tone, measured with a barostat and balloon inflation tests, were unchanged following treatment. Vidakovic Vukic M. Hypnotherapy in the treatment of irritable bowel syndrome: methods and results in Amsterdam. Scand J Gastroenterol Suppl, 1999, 230:49-51. Reports results of treatment of 27 patients of gut-directed hypnotherapy tailored to each individual patient. All of the 24 who completed treatment were found to be improve. Galovski TE; Blanchard EB. Appl Psychophysiol Biofeedback, 1998 Dec, 23:4, 219-32. Eleven patients completed hypnotherapy, with improvement reported for all central IBS symptoms, as well as improvement in anxiety. Six of the patients were a waiting-control group for comparison, and did not show such improvement while waiting for treatment. Gonsalkorale WM, Houghton LA, Whorwell PJ. Hypnotherapy in irritable bowel syndrome: a large-scale audit of a clinical service with examination of factors influencing responsiveness. Am J Gastroenterol 2002 Apr;97(4):954-61. This study is notable as the largest case series of IBS patients treated with hypnosis and reported on to date. 250 unselected IBS patients were treated in a clinic in Manchester, England, using 12 sessions of hypnotherapy over a 3-month period plus home practice between sessions. Marked improvement was seen in all IBS symptoms (overall IBS severity was reduced by more than half on the average after treatment), quality of life, and anxiety and depression. All subgroups of patients appeared to do equally well except males with diarrhea, who improved far less than other patients for unknown reason. 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 Nov;47(11):2605-14. Possible physiological and psychological mechanisms of hypnosis treatment for IBS were investigated in two studies. Patients with severe IBS received seven biweekly hypnosis sessions and used hypnosis audiotapes at home. Rectal pain thresholds and smooth muscle tone were measured with a barostat before and after treatment in 18 patients (study I), and treatment changes in heart rate, blood pressure, skin conductance, finger temperature, and forehead electromyographic activity were assessed in 24 patients (study II). Somatization, anxiety, and depression were also measured. All central IBS symptoms improved substantially from treatment in both studies. Rectal pain thresholds, rectal smooth muscle tone, and autonomic functioning (except sweat gland reactivity) were unaffected by hypnosis treatment. However, somatization and psychological distress showed large decreases. In conclusion, hypnosis improves IBS symptoms through reductions in psychological distress and somatization. Improvements were unrelated to changes in the physiological parameters measured. 17 of 18 patients in study 1 and 21 of 24 patients in study 2 were judged substantially improved Improvement was well-maintained at 10-12 month follow up in study 2.