Hypnosis: Bowel dysfunction Brigitte Collins, BSc, MSc, Diploma in Hypnosis What is hypnosis Important to say what it is not: • Not stage hypnosis • Not sleep. • Hypnotist does not take control. • Cannot be stuck in hypnosis. • Sensationalized treatment results have made hypnosis into a magical mystical process. • The more grandiose the more sceptical. • Not merely relaxation. What is hypnosis • Does not constitute a form of treatment or therapy in its own right. • Seen as adjunct and best incorporated into practice. • Hypnosis is treated as a means of helping patients develop powerful personal resources directed towards achieving their therapeutic goals. • Promotes self sufficiency and independence leading to control, resourceful and a self assured patient. What is hypnosis • Definition: It is an interaction between one person the hypnotist and a subject. The hypnotist influences the subjects perceptions, feelings, thinking and behaviour by asking them to concentrate on ideas and images that may evoke the intended effects. (BSCH) • How does it work? How does hypnosis work? • 90% of our brain is the sub conscious mind and handles body functions, emotions and behaviour. • 10% conscious mind and is responsible for logic and reasoning • Sub conscious mind cannot reason. • Since SCM cannot reason it acts upon CM suggestions, filter beliefs and may interact with the environment. How does hypnosis work? • Hypnosis takes hold in the SCM and exerts an automatic influence on behaviours, feelings and thoughts = positive behaviours • Positive ideas conveyed to SCM by suggestion, repetition proceeds to manifest them in to that persons experience = healing Two basic elements • Trance – Frame of mind characterised: – Focused attention on experiences e.g. Ideas and feelings. – Disattention to extraneous stimuli e.g. Become removed from immediate realities. – Absorption in an activity be it images, thoughts and feelings. – Most people have a natural capacity for trance. Two basic elements • Suggestion – Differs from everyday suggestion/instructions. E.g. Numbness. – Hypnotist conveys communication in such a way that directs the subjects imagination to elicit intended alterations in sensations, perceptions, feelings, thoughts and behaviour. – Mind body link, chevreuls pendulum, lemon. – Post hypnotic suggestion. Self hypnosis • • • • Yes! Reinforces self mastery and coping. Encourages active involvement in treatment. Extends treatment beyond the therapists office. (Heap and Aravind 2002) • Rehearse coping strategies. • Manage stress symptoms. • Manage pain. Who can be hypnotised? • All of the population in one way shape or form can be hypnotised (Yapko, 2011 ) • Like any treatment some may respond better than others and some may not. • Scales for measuring hypnotisability. Creative imagination scale. • Can we tell? Evidence for hypnosis • Whorwell (1984) RCT where two groups of 30 patients, one = hypnotherapy and control group = supportive therapy with medication. 3 months later hypnotherapy group saw a greater improvement in bowel habit and wellbeing, pain and bloating when compared to control group. • Palsson et al 2002: Whorwell et al 2005. • Gonsalkorale et al 2003 • Tan et al 2005: Systematic review • Nice guidance (2008) Evidence for hypnosis • Bremner 2012 • Neural changes of the brain and brain activity have been noted during hypnosis. • Process of pain exaggerated in IBS • Hypnosis has shown to influence such activity and therefore change that area of the brain that can overreact. Case study • 48 year old woman • Teaching assistant/ stressful at times • Diagnosed with slow transit constipation/IBS some years later • Using Senna x1-2 or more each day • Suffering with abdominal pain/discomfort, decreased bowel frequency, bowel movement once per week sometimes less, bloating, increase in girth and anxiety regarding symptoms. Case study • Sleep disturbance, prescribed Amitriptylline • Appeared calm on the outside although cauldron bubbling on the inside • Relaxation techniques previously for feeling anxious, worked really well. • Interests: Holidaying in Jamaica, visiting a park Case study • Following assessment hypnotherapy was discussed and how we ourselves can bring about physiological changes. E.g. job interview, exams • Demonstration of lemon and chevreuls pendulum • Discussion on working with anxiety first. Case study • First session incorporated within assessment. • Breathing technique, using calmness and releasing tension, anxiety, worries, concerns • Deepener, progressive muscle relaxation, massage • Special place, steps down to deepen the process. Talked through description, makes this realistic. • Session recorded on phone • Homework: Self hypnosis. Weekly sessions for 6 then monthly. Case study • Session2: Completed self hypnosis each day • Bowels open when arriving home and next day. Using Senna x 1 per day. Other symptoms continued • As previous session. Special place with more description. Felt some numbness in hands. Relaxed much quicker. • Homework: Self hypnosis each day with use of recording Case study • Session 3: Much better. BO each day. Felt more positive. Senna x 1 per day • RB, PMR and gut related hypnotherapy. • Liquid in bottles. Biggest spoon – Bottle 1 = Calm, pale blue – Bottle 2 = Confidence, pale purple – Bottle 3 = Bloating, Bright pink with sparkles – Soothing and cool, flat stomach Self hypnosis: Recording to be done each day and if can manage without recording to use parts of session Case study • Session 4: BO 4 out of 7 days. Bloating decreased. No laxatives • Repeated last session – Could see purple liquid on top of blue liquid and working through gut like gaviscon – Pink liquid went to head. Self hypnosis: Reduce use of recording and do self with the bottles Case study • Session 5: Used liquid bottles a lot, feeling more relaxed about bowels, BO 4 out of 7 days, no bloating, no laxatives • RB, PMR • Own visual imagery of how she visualised bowels. Stool got stuck in the corners of the colon mainly on the left side, stool gathered in the rectum and no messages could get through to brain so no regular bowel movement Case study • Visualised bowel in hypnosis: • Solution was to drink more water which would help stool to get through and therefore pushing stool along faster and so empties in to the rectum more quickly. This was related to a slot machine where there is a prize and she could see a flashing red button that she pressed, which sent messages to the brain. This relaxed the rectum and as a result had a bowel movement. • Self hypnosis: To repeat when having a drink Case study • Session 6: Not feeling so good. Did self hypnosis • Repeated last session • Homework: Self hypnosis with recording and self each day. Case study • Session7: After last session BO each day, no laxatives, complete evacuation, no bloating, feeling very good. No amitriptylline. • Feels that this has had an impact on other things where sleep pattern has improved greatly, more confidence at work, therefore less stressful • Overall well being: Feeling great and extremely well. ‘MORE POWERFUL THAN ANY TABLET’ Conclusion • Hypnosis is best used as part of an integrated approach • Can be costly to provide because of time, although the sustained effects could be offset against a reduction in medication and other healthcare demands (Bremner 2012: Gonsalkorale et al 2003) • Sustained effect has been noted after 5 years.