Review Article | Published:

Complementary and alternative medicine for IBS in adults: mind–body interventions

Nature Clinical Practice Gastroenterology & Hepatology volume 5, pages 624636 (2008) | Download Citation

Subjects

Abstract

Standard treatment for IBS focuses on the management or alleviation of the predominant gastrointestinal presenting symptoms, such as diarrhea or constipation, often using pharmacological therapy. For many patients, this approach is unsatisfactory, and patients frequently seek the advice of complementary and alternative medicine (CAM) practitioners in order to explore other treatment options. CAM practices include a broad range of modalities, and mind–body interventions hold particular promise as treatment modalities for IBS because psychological factors could have an important role in IBS symptomatology and quality of life. Psychological stressors are postulated to result in gastrointestinal symptoms through alteration of intestinal function mediated by the autonomic nervous system, hypothalamic–pituitary–adrenal axis and immune system. Hypnotherapy has the strongest supportive evidence as a beneficial mind–body intervention for IBS. Clinical studies of hypnotherapy have uniformly shown improvement of gastrointestinal symptoms, anxiety, depression and quality of life in patients with IBS. Mindfulness meditation remains unstudied for IBS, but is theoretically attractive as a stress-reduction technique. There is a suggestion that relaxation therapy or multimodal therapy (a combination of relaxation therapy, education and psychotherapy) is beneficial for IBS. The most generally accepted psychological mind–body intervention is cognitive behavioral therapy, and clinical trials support the beneficial effects of cognitive behavioral therapy in patients with IBS.

Key points

  • 21–51% of individuals with IBS use complementary and alternative medicine practices

  • Mind–body treatments might improve IBS symptomatology by modulation of the stress response, as described in the biopsychosocial model of medicine

  • Hypnotherapy is an evidence-based treatment for IBS—several trials show improvement of gastrointestinal symptoms, quality of life and reduced medical resource utilization in patients with IBS after hypnotherapy

  • Home-study hypnotherapy programs for IBS remain poorly studied

  • Several studies suggest that patients with IBS benefit more from cognitive behavioral therapy than routine medical care; however, long-term follow-up studies are needed

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

References

  1. 1.

    et al. (1997) Irritable bowel syndrome: a technical review for practice guideline development. Gastroenterology 112: 2120–2137

  2. 2.

    et al. (2003) The economic consequences of irritable bowel syndrome: a US employer perspective. Arch Intern Med 163: 929–935

  3. 3.

    et al. (1995) Medical costs in community subjects with irritable-bowel-syndrome. Gastroenterology 109: 1736–1741

  4. 4.

    and (1991) Irritable-bowel-syndrome in office-based practice in the United States. Gastroenterology 100: 998–1005

  5. 5.

    et al. (2004) Quality of life in managed care patients with irritable bowel syndrome. Manag Care Interface 17: 24–28

  6. 6.

    et al. (1997) Differences between individuals with self-reported irritable bowel syndrome (IBS) and IBS-like symptoms. Dig Dis Sci 42: 2585–2590

  7. 7.

    et al. (2004) Suicidal ideation in patients with irritable bowel syndrome. Clin Gastroenterol Hepatol 2: 1064–1068

  8. 8.

    et al. (2001) Irritable bowel syndrome: toward a cost-effective management approach. Am J Manag Care 7: S268–S275

  9. 9.

    et al. (1997) Irritable bowel syndrome: The view from general practice. Eur J Gastroenterol Hepatol 9: 689–692

  10. 10.

    et al. (2004) Usual medical care for irritable bowel syndrome. Aliment Pharmacol Ther 20: 1305–1315

  11. 11.

    et al. (2003) Predictors of conventional and alternative health care seeking for irritable bowel syndrome and functional dyspepsia. Aliment Pharmacol Ther 17: 841–851

  12. 12.

    et al. (2005) The incidence of self-prescribed oral complementary and alternative medicine use by patients with gastrointestinal diseases. J Clin Gastroenterol 39: 138–141

  13. 13.

    Institute of Medicine (2005) Committee on the use of complementary and alternative medicine by the American public. Complementary and alternative medicine in the United States. Washington D.C.: National Academics Press

  14. 14.

    et al. (2004) Effect of acute physical and psychological stress on gut autonomic innervation in irritable bowel syndrome. Gastroenterology 127: 1695–1703

  15. 15.

    et al. (1992) Effects of stressful life events on bowel symptoms: subjects with irritable bowel syndrome compared with subjects without bowel dysfunction. Gut 33: 825–830

  16. 16.

    et al. (1998) Functional gastrointestinal disorders: psychological, social, and somatic features. Gut 42: 414–420

  17. 17.

    et al. (2008) The role of stress in symptom exacerbation among IBS patients. J Psychosom Res 64: 119–128

  18. 18.

    and (2004) Irritable bowel syndrome: a model of the brain-gut interactions. Med Sci Monit 10: RA55–RA62

  19. 19.

    et al. (2006) Neuroimaging of the brain-gut axis: From basic understanding to treatment of functional GI disorders. Gastroenterology 131: 1925–1942

  20. 20.

    (2000) The neurobiology of stress and gastrointestinal disease. Gut 47: 861–869

  21. 21.

    et al. (2001) Selective recall of gastrointestinal-sensation words: evidence for a cognitive-behavioral contribution to irritable bowel syndrome. Am J Gastroenterol 96: 1133–1138

  22. 22.

    et al. (1993) Selective affective biasing in recognition memory in the irritable bowel syndrome. Gut 34: 1230–1233

  23. 23.

    (2005) Review article: the history of hypnotherapy and its role in the irritable bowel syndrome. Aliment Pharmacol Ther 22: 1061–1067

  24. 24.

    and (2002) The growing case for hypnosis as adjunctive therapy for functional gastrointestinal disorders. Gastroenterology 123: 2132–2135

  25. 25.

    et al. (2002) Hypnosis treatment for severe irritable bowel syndrome: Investigation of mechanism and effects on symptoms. Dig Dis Sci 47: 2605–2614

  26. 26.

    et al. (1990) Changes in rectal sensitivity after hypnotherapy in patients with irritable bowel syndrome. Gut 31: 896–898

  27. 27.

    et al. (1999) Gut focused hypnotherapy normalizes rectal hypersensitivity in patients with irritable bowel syndrome (IBS). Gastroenterology 116: A1009

  28. 28.

    (2006) Hypnosis for irritable bowel syndrome: The quest for the mechanism of action. Int J Clin Exp Hypn 54: 65–84

  29. 29.

    et al. (1992) Physiological effects of emotion: Assessment via hypnosis. Lancet 340: 69–72

  30. 30.

    et al. Hypnotherapy for treatment of irritable bowel syndrome. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD005110. 10.1002/14651858.CD005110.pub2

  31. 31.

    et al. (1984) Controlled trial of hypnotherapy in the treatment of severe refractory irritable-bowel syndrome. Lancet 2: 1232–1234

  32. 32.

    et al. (1987) Hypnotherapy in severe irritable-bowel syndrome—further experience. Gut 28: 423–425

  33. 33.

    (2006) Standardized hypnosis treatment for irritable bowel syndrome: The North Carolina protocol. Int J Clin Exp Hypn 54: 51–64

  34. 34.

    et al. (2003) Long term benefits of hypnotherapy for irritable bowel syndrome. Gut 52: 1623–1629

  35. 35.

    et al. (2002) Hypnotherapy in irritable bowel syndrome: a large-scale audit of a clinical service with examination of factors influencing responsiveness. Am J Gastroenterol 97: 954–961

  36. 36.

    et al. (1996) Symptomatology, quality of life and economic features of irritable bowel syndrome—the effect of hypnotherapy. Aliment Pharmacol Ther 10: 91–95

  37. 37.

    and (1998) The treatment of irritable bowel syndrome with hypnotherapy. Appl Psychophysiol Biofeedback 23: 219–232

  38. 38.

    (2006) Gut-directed hypnotherapy: The Manchester approach for treatment of irritable bowel syndrome. Intl J Clin Exp Hypn 54: 27–50

  39. 39.

    et al. (2006) Hypnosis home treatment for irritable bowel syndrome: A pilot study. Int J Clin Exp Hypn 54: 85–99

  40. 40.

    et al. (1989) Individual and group hypnotherapy in treatment of refractory irritable bowel syndrome. Lancet 1: 424–425

  41. 41.

    IBShypnosis.com []

  42. 42.

    et al. (1999) The role of psychological and biological factors in postinfective gut dysfunction. Gut 44: 400–406

  43. 43.

    (2003) Mindfulness training as a clinical intervention: a conceptual and empirical review. Clinical Psychology: Science and Practice 10: 125–143

  44. 44.

    (2002) Commentary on Majumdar et al.: mindfulness meditation and health. J Alternative & Complementary Medicine 8: 731–735

  45. 45.

    et al. (1995) Three-year follow-up and clinical implications of a mindfulness meditation-based stress reduction intervention in the treatment of anxiety disorders. Gen Hosp Psychiatry 17: 192–200

  46. 46.

    (2002) What do we really know about mindfulness-based stress reduction? Psychosom Med 64: 71–83

  47. 47.

    Center for mindfulness in medicine, health care, and society []

  48. 48.

    et al. (1987) Four-year follow-up of a meditation-based program for the self-regulation of chronic pain: Treatment outcomes and compliance. Clin J Pain 2: 159–173

  49. 49.

    et al. (2004) Mindfulness-based stress reduction and health benefits. A meta-analysis. J Psychosom Res 57: 35–43

  50. 50.

    et al. (2004) Mindfulness meditation to reduce symptoms after organ transplant: a pilot study. Adv Mind Body Med 20: 20–29

  51. 51.

    et al. (1999) The long-term combined effects of medical treatment and a mindfulness-based behavioral program for the multidisciplinary management of chronic pain in west Texas. Pain Digest 9: 103–112

  52. 52.

    and (1988) Compliance with an outpatient stress reduction program: rates and predictors of program completion. J Behav Med 11: 333–352

  53. 53.

    and (1993) Stress Reduction. In Healing and the Mind, 145–155 (Ed Flowers BS) New York: Doubleday

  54. 54.

    et al. (2004) Depression and abdominal pain in IBS patients: The mediating role of catastrophizing. Psychosom Med 66: 435–441

  55. 55.

    et al. (1997) Evidence for two distinct perceptual alterations in irritable bowel syndrome. Gut 41: 505–512

  56. 56.

    et al. (2000) Differences in somatic perception in female patients with irritable bowel syndrome with and without fibromyalgia. Pain 84: 297–307

  57. 57.

    et al. (2004) The Visceral Sensitivity Index: development and validation of a gastrointestinal symptom-specific anxiety scale. Aliment Pharmacol Ther 20: 89–97

  58. 58.

    and (2003) The benefits of being present: mindfulness and its role in psychological well-being. J Pers Soc Psychol 84: 822–848

  59. 59.

    et al. (2006) Using self-report assessment methods to explore facets of mindfulness. Assessment 13: 27–45

  60. 60.

    et al. (1997) Trauma and the gut: interactions between stressful experience and intestinal function. Gut 40: 704–709

  61. 61.

    (1951) Experimental studies on the irritable colon. Am J Med 10: 60–67

  62. 62.

    et al. (2003) Prevalence of irritable bowel syndrome among university students: the roles of worry, neuroticism, anxiety sensitivity and visceral anxiety. J Psychosom Res 55: 501–505

  63. 63.

    et al. (2005) Gastrointestinal-specific anxiety: further validation of the visceral sensitivity index. Gastroenterology 128: A67

  64. 64.

    et al. (2000) The impact of irritable bowel syndrome on health-related quality of life. Gastroenterology 119: 654–660

  65. 65.

    et al. (2004) Clinical determinants of health-related quality of life in patients with irritable bowel syndrome. Arch Intern Med 164: 1773–1780

  66. 66.

    (1997) Stress reduction through mindfulness meditation. Effects on psychological symptomatology, sense of control, and spiritual experiences. Psychother Psychosom 66: 97–106

  67. 67.

    et al. (2005) A randomized, controlled trial of mindfulness-based art therapy (MBAT) for women with cancer. Psychooncology 14: 1–11

  68. 68.

    et al. (1998) Effects of mindfulness-based stress reduction on medical and premedical students. J Behav Med 21: 581–599

  69. 69.

    et al. (2001) Evaluation of a wellness-based mindfulness stress reduction intervention: a controlled trial. Am J Health Promot 15: 422–432

  70. 70.

    et al. (2000) A randomized, wait-list controlled clinical trial: the effect of a mindfulness meditation-based stress reduction program on mood and symptoms of stress in cancer outpatients. Psychosom Med 62: 613–622

  71. 71.

    et al. (2003) Alterations in brain and immune function produced by mindfulness meditation. Psychosom Med 65: 564–570

  72. 72.

    et al. (2003) Mindfulness meditation, anxiety reduction, and heart disease: a pilot study. Fam Community Health 26: 25–33

  73. 73.

    et al. (2004) The effects of mindfulness-based stress reduction on nurse stress and burnout: a quantitative and qualitative study. Holist Nurs Pract 18: 302–308

  74. 74.

    and (2004) Mindfulness-based cognitive therapy for depression: replication and exploration of differential relapse prevention effects. J Consult Clin Psychol 72: 31–40

  75. 75.

    et al. (2000) Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. J Consult Clin Psychol 68: 615–623

  76. 76.

    and (2002) A one year follow-up of relaxation response meditation as a treatment for irritable bowel syndrome. Behav Res Ther 40: 541–546

  77. 77.

    and (1985) A comparison of psychological and medical treatment of the irritable bowel syndrome. Brit J Clin Psychol 24: 215–216

  78. 78.

    et al. (1993) Relaxation training as a treatment for irritable bowel syndrome. Biofeedback Self Regul 18: 125–132

  79. 79.

    and (1989) A controlled behavioural treatment study of irritable bowel syndrome. Behav Ther 20: 509–523

  80. 80.

    et al. (1986) Behavioral treatment of irritable bowel syndrome: a 1-year follow-up study. Biofeedback Self Regul 11: 189–198

  81. 81.

    et al. (1988) A multi-component treatment for irritable bowel syndrome. Behav Ther 19: 67–73

  82. 82.

    and (1987) A multi-component treatment for irritable bowel syndrome. Behav Ther 18: 70–83

  83. 83.

    et al. (1991) A controlled trial of psychological treatment for the irritable bowel syndrome. Gastroenterology 100: 450–457

  84. 84.

    et al. (1990) Behaviorally treated irritable bowel syndrome patients: A four-year follow-up. Behav Res Ther 28: 331–335

  85. 85.

    et al. (1992) Two controlled evaluations of multicomponent psychological treatment of irritable bowel syndrome. Behav Res Ther 30: 175–189

  86. 86.

    et al. (2000) The combination of medical treatment plus multicomponent behavioral therapy is superior to medicla treatment alone in the therapy of irritable bowel syndrome. Am J Gastroenterol 95: 981–994

  87. 87.

    and (1988) Bowel sound biofeedback as a treatment for irritable bowel syndrome. Biofeedback Self Regul 13: 169–179

  88. 88.

    and (1989) A 1- and 2-year follow-up study of bowel sound biofeedback as a treatment for irritable bowel syndrome. Biofeedback Self Regul 14: 333–338

  89. 89.

    (2005) Cognitive behaviour therapy for irritable bowel syndrome. Eur J Gastroenterol Hepatol 17: 11–14

  90. 90.

    (1995) Perceived limitations of standard cognitive therapy: A reconsideration of efforts to revise Beck's theory and therapy. J Cognit Psychother 9: 153–172

  91. 91.

    (2005) Cognitive-behavioral treatment of irritable bowel syndrome. CNS Spectrums 10: 883–890

  92. 92.

    (2005) A critical review of cognitive, behavioral, and cognitive-behavioral therapies for irritable bowel syndrome. J Cognit Psychother 19: 101–123

  93. 93.

    and (1994) Cognitive therapy for irritable bowel syndrome. J Consult Clin Psychol 62: 576–582

  94. 94.

    and (1995) A controlled comparison of cognitive therapy and self-help support groups in the treatment of irritable bowel syndrome. J Consult and Clin Psychol 63: 779–786

  95. 95.

    et al. (2003) A randomized controlled trial of cognitive behavior therapy, relaxation training, and routine clinical care for the irritable bowel syndrome. Am J Gastroenterol 98: 2209–2218

  96. 96.

    et al. (2003) Cognitive-behavioral therapy versus education and desipramine versus placebo for moderate to severe functional bowel disorders. Gastroenterology 125: 19–31

  97. 97.

    et al. (2007) Preliminary study of a self-administered treatment for irritable bowel syndrome: comparison to a wait list control group. Appl Psychophysiol Biofeedback 32: 111–119

  98. 98.

    et al. (2007) A controlled evaluation of group cognitive therapy in the treatment of irritable bowel syndrome. Behav Res Ther 45: 633–648

  99. 99.

    et al. (2006) Prediction of treatment outcome among patients with irritable bowel syndrome treated with group cognitive therapy. Behav Res Ther 44: 317–337

  100. 100.

    et al. (1991) Stress management for irritable bowel syndrome: a controlled trial. Digestion 50: 36–42

  101. 101.

    et al. (1991) Behavioural psychotherapy in the treatment of irritable bowel syndrome. J Psychosom Res 35: 461–469

Download references

Author information

Affiliations

  1. DJ Kearney is Associate Professor of Medicine, Gastroenterology Section, University of Washington School of Medicine and Director of Endoscopy for VA Puget Sound Health Care System, Seattle, WA.

    • David J Kearney
  2. J Brown-Chang is Senior Fellow in Gastroenterology, Gastroenterology Section, University of Washington School of Medicine, Seattle, WA, USA.

    • Janelle Brown-Chang

Authors

  1. Search for David J Kearney in:

  2. Search for Janelle Brown-Chang in:

Competing interests

The authors declare no competing financial interests.

Corresponding author

Correspondence to David J Kearney.

About this article

Publication history

Received

Accepted

Published

DOI

https://doi.org/10.1038/ncpgasthep1257

Further reading