I was interested to read this post from Dr Simone Peters from Monash University, which confirmed that gut-directed hypnotherapy is effective in 70 to 80% of people with IBS. Dr Peter Whorwell showed the same thing way back in 1984, further demonstrating that, with ‘top-ups’, this result could be maintained for the longer term.
Seventy to eighty per cent seems a ‘magic’ figure. The same percentage of people respond to a low FODMAP diet. And in the nineteen eighties, about 70 to 80% of people with IBS responded to a high fibre diet.
Unlike Dr Peters, I doubt that gut directed hypnotherapy has multiple potential actions on the brain gut axis, I suspect that it has one major action on the autonomic nervous system, which then has multiple effects throughout the body. Hypnotherapy calms the autonomic nervous system down by encouraging focused attention within a safe environment. This would rectify dysregulation throughout the body, abolishing or reducing symptoms. To put it into the context of my last few posts, it would reinforce the actions of the ventral vagal complex by applying the vagal brake on stress induced reactions of alarm and helplessness. The focused eye contact, the modulated voice of the therapist, the safe environment, the calming of areas of tension throughout the body through body scanning and progressive muscular relaxation, would all suppress activity in the sympathetic nervous system and dorsal vagal complex. Such actions resemble the ways mothers calm their infants or friends and lovers reassure each other. Other effects, such as reductions in gut sensitivity and regulation of gut motility would then follow.
But what does that say about the effect of the low FODMAP diet? Are we to conclude that both treatments reduce gut sensation and reflex action but in different ways – hypnotherapy restoring a sense of security which reduces gut sensitivity and motility, the low FODMAP diet reducing the stimulation of the sensitive gut? Or do both therapies convey a sense of being listened to and cared for, restoring a sense of body confidence? Dietitians, both in Australia and in the UK, insist that the low FODMAP diet can only be delivered and supervised by FODMAP trained dietitians, indicating that this is a special treatment requiring specialist knowledge and ability. Hypnotherapy has always conveyed a sense of control by somebody with special mental powers. Both enhance the healing effect or what has been unfairly derided as ‘the placebo effect’.
Surely the point is that both hypnotherapy and a low FODMAP diet work. In open studies, which approximate to normal practice, they are at least 70% effective. Other treatments that capture the public imagination have similar beneficial effects. Drugs never achieve that kind of response rate. So, should health professionals worry overmuch that they cannot ‘prove’ efficacy by double blind randomized placebo-controlled trials? Can they not accept that it is impossible to design ‘sham’ treatments for treatments that rely on recruiting the patients’ belief for their effectiveness? Should they acknowledge the credibility of open studies? Is not about time that their reliance on proving that a certain treatment is marginally superior to an inactive placebo is abandoned in favour of a more pragmatic and positive approach that enhances the healing effect? I think that is a strong argument, especially for unexplained illnesses where there is no diagnostic marker and which rely on the symptom response to assess effectiveness.
The major concern is that such treatments do not harm patients. In that respect, hypnotherapy has an excellent safety record, the low FODMAP diet carries some concerns about nutritional deficiency and depletion of the microbiome and drugs can have multiple unwanted effects throughout the body; while they can be life-saving in extreme circumstances, they always carry a risk of untoward side effects, particularly for ‘highly sensitive people’.
Health professionals should also be concerned that treatments, for which efficacy cannot be proven, do not exploit patients. But we are ‘currently’ living in what professes to be a free-market economy. Most treatments for IBS are available from local pharmacists, private health practitioners or on-line. Although independent charities like The IBS Network do their best to inform people and help guide them through the myriad of treatment options, it is up to the individual to choose what they believe is best,
Nevertheless, we are a gullible species, easily persuaded by charisma, promise and fear, as recent plebiscites on both sides of the Atlantic have so clearly demonstrated.