Randomised controlled trial of brief intervention with biofeedback and hypnotherapy in patients

Abstract

Irritable bowel syndrome (IBS) is a common disorder associated with profoundly impaired quality of life and emotional distress. The management of refractory IBS symptoms remains challenging and non-pharmacological therapeutic approaches have been shown to be effective. We compared brief interventions with biofeedback and hypnotherapy in women referred by their GP with refractory IBS symptoms. Patients were randomised to one of two treatment groups, biofeedback or hypnotherapy, delivered as three one-hour sessions over 12 weeks. Symptom assessments were undertaken using validated, self-administered questionnaires. Two of the 128 consecutive IBS patients suitable for the study declined to consider nonpharmacological therapy and 29 patients did not attend beyond the first session. Of the 97 patients randomised into the study, 21 failed to attend the therapy session; 15 of 76 patients who attended for therapy dropped out before week 12 post-therapy. The mean (SD) change in IBS symptom severity score 12 weeks post-treatment in the biofeedback group was -116.8 (99.3) and in the hypnotherapy group -58.0 (101.1), a statistically significant difference between groups (difference=-58.8, 95% confidence interval [CI] for difference [-111.6, -6.1], p=0.029). In 61 patients with refractory IBS, biofeedback and hypnotherapy were equally effective at improving IBS symptom severity scores, total non-gastrointestinal symptom scores and anxiety and depression ratings during 24 weeks follow-up. Biofeedback may prove to be the more cost-effective option as it requires less expertise.

A Biofeedback-Assisted Stress Management Program for Patients with Irritable Bowel Syndrome: a Randomised Controlled Trial

“…With regard to health locus of control (HLC), it has been supported that high levels of external HLC may be a partial mediator of the stress-illness relationship because of the more passive coping strategies enforced by individuals (Artemiadis et al, 2012;Hutner and Locke, 1984). Our study provides further evidence on the reciprocal relationship between control attributions and development and/or exacerbation of IBS (Koloski et Concerning biofeedback, our results are in line with the results of previous studies using the particular method to relieve patients for IBS symptoms (Leahy et al, 1998;Dobbin et al, 2013;Tremback et al, 2009). However, since no other study has used the exact same combination of relaxation techniques and assessment tools, it is quite precarious to compare these findings to other research.…”

“…Both hypothalamus-pituitary axis (HPA) and autonomic nervous system (ANS) over-activity have been recognised to exacerbate IBS symptoms, attesting the mediating role of stress-related neuroendocrine mechanisms on IBS pathophysiology ( North et al, 2004 ). Although few studies have been published on endocrine abnormalities in IBS patients, it has been shown by several studies that alterations in autonomic function can prompt visceral hypersensitivity and changes in gastrointestinal motility ( Dobbin et al, 2013 ; Elsenbruch and Orr, 2001 ). More specifically, the stress-induced activation of the sympathetic autonomic system signals an increased secretion of catecholamines ( i.e.…”

“…EMG, HRV, thermal biofeedback etc.) as non-specific relaxation methods in order to alleviate the effects of stress in people with IBS ( Blanchard and Schwarz, 1987 ; Dobbin et al, 2013 ; Whitehead, 1992 ). The goal of biofeedback training, in general, is to help patients gain control over biological functions and reactions that are usually unaware of, so that they can self-regulate, decrease sympathetic activity and optimise their health ( Chiarioni and Whitehead, 2008 ).…”

Gut-directed guided affective imagery as an adjunct to dietary modification in irritable bowel syndrome

“…Mosner et al (2013) showed that hypnotherapy is superior to medical treatment for the relief of IBS symptoms and for improvement in psychological well-being. Dobbin et al (2013) randomized patients to receive treatment with either biofeedback or hypnotherapy, and found that they were equally effective in improving IBS symptoms as well as anxiety and depression. There is evidence that the beneficial effects of hypnotherapy may persist for up to 5 years (Vlieger et al, 2012).…”

Effect of attention bias modification on event‐related potentials in patients with irritable bowel syndrome: A preliminary brain function and psycho‐behavioral study

“…Psychotherapies such as relaxation-directed hypnotherapy, 14,15 general hypnotherapy, [16][17][18] autogenic training, 19,20 and gut-directed hypnotherapy 21,22 improve IBS-related psychological abnormalities. Non-hypnosis approaches such as cognitive-behavioral therapy (CBT), 23,24 mindfulness, 25,26 biofeedback, 27,28 and psychology education 29,30 also produce psychological improvements in IBS. Clinically, each intervention element of hypnosis and non-hypnosis is a single element of psychotherapy that can be used to improve QOL in patients with IBS.…”