Hypnotherapy for Pediatric IBS: Comparing Self-Administered, in-Office Therapy

The efficiency of self-administered hypnotherapy is equivalent to that of in-office hypnotherapy in relieving pediatric irritable bowel syndrome (IBS) or functional abdominal pain (FAP), according to results of a randomized clinical trial recently published in JAMA Pediatrics.¹

IBS or FAP are diagnosed in 13.5% of children.² Pharmacotherapy is largely ineffective for abdominal pain-related functional gastrointestinal disorders, but data suggest some patients may benefit from psychological interventions like hypnotherapy.³ Access to hypnotherapy for children is often hampered by inadequate insurance coverage and a lack of qualified experts. In an effort to facilitate access to hypnotherapy, researchers at Emma Children’s Hospital in Amsterdam, The Netherlands, recorded a hypnotherapy program on CD, designed for at-home use.

A total of 250 children (mean age, 13; n = 126 with IBS; n = 124 with FAP), were recruited between July 2011 and June 2013 for this multi-center randomized controlled trial. Baseline characteristics were similar in the hypnotherapy CD group (n=126) and the in-office hypnotherapy group (n=124).

Children randomly assigned to in-office hypnotherapy attended 6 sessions with a qualified hypnotherapist over 3 months. Each session lasted between 50 and 60 minutes. The hypnotherapy exercises consisted primarily of “gut-directed” visualization exercises that emphasized relaxation, controlling abdominal pain and gut function, and ego strengthening.⁴ The children were advised to practice the exercises regularly at home. To reduce the possibility of any one hypnotherapist biasing results, the study employed 11 hypnotherapists.

The 5 pre-recorded exercises on the hypnotherapy CD were identical to the exercises used in the in-office sessions. For the first hypnotherapy exercise, a research nurse visited each child in the hypnotherapy CD group to provide instructions. The nurse verified that the children understood the exercise and instructed them to listen to the CD at least 5 times per week over the next 3 months. To encourage adherence, the nurse followed-up the visit with phone calls 4 and 8 weeks later. Adherence was high, with children listening to the CD a mean of 5.7 times per week (standard deviation, 1.4).

The primary endpoint was treatment success, which was considered a reduction of at least 50% in baseline scores for pain frequency and intensity. Outcomes were measured at 3 months, 6 months, and 12 months after the start of the intervention.

After 3 months, 46 children (37%) in the hypnotherapy CD group were considered to have been treated successfully compared with 62 children (50%) in the in-office hypnotherapy  group. Success rates improved over time: at 6 months, 64 children (51%) in the hypnotherapy CD group and 81 children (65%) in the in-office hypnotherapy group met the criteria for treatment success. At 12 months, 78 children (62%) in the hypnotherapy CD group achieved treatment success vs 88 (71%) in the in-office hypnotherapy group. Directly after treatment, 83% of children in the in-office hypnotherapy  group described their relief as adequate compared with 70% in the hypnotherapy CD group. At 1 year, the percentages of satisfied children increased to 87% in the in-office group and 76% in the CD group. No correlation between probability of treatment success and age, diagnosis, expectations of the child or parents, or hypnotic susceptibility in either cohort was found. Depression and anxiety at baseline had no effect on hypnotherapy success.

Although a greater percentage of children in the in-office group achieved treatment success or were satisfied with their outcomes, analyses showed the CD program was noninferior. “This study confirms earlier findings that [hypnotherapy] is highly valuable in treating children with IBS or FAP [syndrome],” the researchers wrote, and recommended hypnotherapy be incorporated into national guidelines for treatment of pediatric IBS or FAP. They suggested home-based hypnotherapy could improve access for children and suggested using a smartphone or tablet application instead of a CD.

Summary and Clinical Applicability

Gut-directed hypnotherapy can provide long-term improvement in the frequency and intensity of pain in children with IBS or FAP. Self-administered hypnotherapy at home is an effective alternative to in-office hypnotherapy and may allow earlier treatment. The authors recommend clinical practice guidelines for IBS and FAP incorporate hypnotherapy.

Limitations

It is possible that attitudes about hypnosis may influence outcomes, although the study found little evidence of expectancy bias. In addition, the natural course of the patient’s illness may have affected treatment success. The nature of the interventions prevented masking, which may be another limitation.

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References

1. Rutten JMTM, Vlieger AM, Frankenhuis C, et al. Home-based hypnotherapy self-exercises vs individual hypnotherapy with a therapist for treatment of pediatric irritable bowel syndrome, functional abdominal pain, or functional abdominal pain syndrome: a randomized clinical trial. JAMA Pediatr. 2017;171(5):470-477.
2. Korterink JJ, Diederen K, Benninga MA, Tabbers MM. Epidemiology of pediatric functional abdominal pain disorders: a meta-analysis. PLoS ONE. 2015;10(5):e0126982.
3. Gulewitsch MD, Müller J, Hautzinger M, Schlarb AA. Brief hypnotherapeutic-behavioral intervention for functional abdominal pain and irritable bowel syndrome in childhood: a randomized controlled trial. Eur J Pediatr. 2013;172(8):1043-1051.
4. Rutten JMTM, Vlieger AM, Frankenhuis C, et al. Gut-directed hypnotherapy in children with irritable bowel syndrome or functional abdominal pain (syndrome): a randomized controlled trial on self exercises at home using CD versus individual therapy by qualified therapists. BMC Pediatr. 2014;14:1140.