Gut-focused hypnotherapy for Functional Gastrointestinal Disorders: Evidence-base, practical aspects, and the Manchester Protocol

Abstract

Background: Despite their high prevalence and advances in the field of neurogastroenterology, there remain few effective treatment options for functional gastrointestinal disorders (FGIDs). It is recognized that approximately 25% of sufferers will have symptoms refractory to existing therapies, causing significant adverse effects on quality of life and increased healthcare utilization and morbidity. Gut-focused hypnotherapy, when delivered by trained therapists, has been shown to be highly effective in severe refractory FGIDs. However, hypnotherapy continues to be surrounded by much misunderstanding and skepticism.

Purpose: The purpose of this review is to provide a contemporary overview of the principles of gut-focused hypnotherapy, its effects on gut-brain interactions, and the evidence-base for its efficacy in severe FGIDs. As supplementary material, we have included a hypnotherapy protocol, providing the reader with an insight into the practical aspects of delivery, and as a guide, an example of a script of a gut-focused hypnotherapy session.

Keywords: functional gastrointestinal disorders; hypnotherapy; irritable bowel syndrome.

Figure 1

Examples of illustrations and visual imagery to represent functional gastrointestinal symptoms to enhance the hypnotherapy experience (Reproduced and adapted with permission from Carruthers HR, Morris J, Tarrier N, Whorwell PJ. Reactivity to images in health and irritable bowel syndrome. Aliment Pharmacol Ther 2010; 31:131–142)

Figure 2

Hypnotherapy induced changes in pain‐related brain activation in the Anterior Cingulate Cortex (ACC) seen on Positron Emission Topography. Hypnotic suggestions of low unpleasantness of pain evoke less activity in ACC compared to highly unpleasant hypnotic suggestions of pain (Reproduced with permission from Rainville P, Duncan GH, Price DD, Carrier Bt, Bushnell MC. Pain Affect Encoded in Human Anterior Cingulate But Not Somatosensory Cortex. Science 1997; 277:968–971)

Figure 3

Hypnotherapy restores a normal pattern of brain activity evoked by high‐intensity rectal distension in IBS patients (Reproduced with permission from Lowén, A. ME, et al Effect of hypnotherapy and educational intervention on brain response to visceral stimulus in the irritable bowel syndrome. Alimentary Pharmacology & Therapeutics 2013; 37:1184–1197)

Figure 4

IBS Symptom Severity Scores before and after gut‐focused hypnotherapy in the largest cohort to date (n = 1,000) (Reproduced with permission from Miller V, Carruthers HR, Morris J, Hasan SS, Archbold S, Whorwell PJ. Hypnotherapy for irritable bowel syndrome: an audit of one thousand adult patients. Aliment Pharmacol Ther 2015; 41:844–855)

Figure 5

Short‐ and long‐term benefits of gut‐focused hypnotherapy in non‐cardiac chest pain compared to supportive therapy (Reproduced with permission from Miller V, Jones H, Whorwell PJ. Hypnotherapy for non‐cardiac chest pain: long‐term follow‐up. Gut 2007; 56:1643)

Figure 6

The efficacy of gut‐focused hypnotherapy compared to medical therapy and supportive care in Functional Dyspepsia (Reproduced with permission from Calvert EL, Houghton LA, Cooper P, Morris J, Whorwell PJ. Long‐term improvement in functional dyspepsia using hypnotherapy. Gastroenterology 2002; 123:1778–1785)