Treatments · Mind and gut
Gut-directed hypnotherapy
What ACG 2021, BSG 2021 and NICE say about gut-directed hypnotherapy for IBS, with the studies, trials, news, and stories we have tagged to it.
What the guidelines say
| Body | Position | Strength and evidence | Source |
|---|---|---|---|
| ACG 2021 | Suggests that gut-directed psychotherapies be used to treat global IBS symptoms. | Conditional recommendationVery low quality of evidence | PubMed |
| BSG 2021 | Gut-directed hypnotherapy may be an efficacious treatment for global symptoms in IBS; psychological therapies should be considered when symptoms have not improved after 12 months of drug treatment, or earlier if accessible locally and based on patient preference. | Strong recommendationLow quality of evidence | PubMed |
| NICE | Referral for psychological interventions (cognitive behavioural therapy, hypnotherapy, or psychological therapy) should be considered for people with IBS who do not respond to pharmacological treatments after 12 months and who develop a continuing symptom profile (refractory IBS). | Not graded | Source |
Gut-directed hypnotherapy is a course of hypnosis sessions (six in the largest trial) that use relaxation and imagery aimed specifically at gut function and the perception of gut sensations. It is one of the “brain-gut behaviour therapies” and is meant to change how the nervous system processes signals from the bowel rather than to address mood PMID 33903147.
A 2020 network meta-analysis of 41 randomised trials (4,072 participants) found gut-directed hypnotherapy among the therapies with the largest evidence base, with a relative risk of remaining symptomatic of 0.67 after treatment, while cautioning that trial risk of bias was high and effects were likely overestimated PMID 32276950. The largest single trial, IMAGINE (354 Dutch patients from primary and secondary care), gave six sessions of individual or group hypnotherapy versus supportive education: adequate relief at three months was 40.8% with individual, 33.2% with group, and 16.7% with the control, and group delivery was non-inferior to individual PMID 30473202. A small three-arm trial found hypnotherapy’s effect on gut symptoms similar to a low FODMAP diet at six weeks, with better effects on anxiety and depression scores and no added benefit from combining the two PMID 27397586.
Delivery format is an active research question because trained therapists are scarce. A UK service audit reported 65% of patients responding to hypnotherapy delivered over Skype versus 76% face to face PMID 30702396. In a 2023 randomised trial of a self-administered smartphone program (362 patients treated), the primary endpoint of abdominal pain response after treatment did not differ from a digital muscle-relaxation comparator (30.4% vs 27.1%), although responder rates during treatment favoured hypnotherapy PMID 37391055.
Points clinicians commonly raise: trials cannot blind participants to a psychological treatment, which is one reason guideline evidence grades are low PMID 32276950; it is usually offered alongside, not instead of, diet and medication; and app-based programs have less evidence than therapist-delivered courses PMID 37391055.
Talk to a clinician before starting or stopping anything.
References
- 1Lacy BE, Pimentel M, Brenner DM, et al. ACG Clinical Guideline: Management of Irritable Bowel Syndrome. Am J Gastroenterol. 2021. PMID 33315591
- 2Vasant DH, Paine PA, Black CJ, et al. British Society of Gastroenterology guidelines on the management of irritable bowel syndrome. Gut. 2021. PMID 33903147
TreatIBS is an informational site and does not provide medical advice. The research summarized here may not apply to your situation. Talk with a clinician before starting, stopping, or changing any treatment.
Studies
Recent PubMed entries tagged to Hypnotherapy.
Trials
Registered interventional studies tagged to this approach.
Pain in Pediatric Patients - Internet Interventions for Disorders of Gut-brain Interaction
Gut-directed hypnotherapy, Cognitive-behavioral therapy
News
Headlines that mention this approach, linked to the original.
No news items mention Hypnotherapy yet.
Stories
Public accounts from people who tried it, labeled as individual experience.
Alex Robb: six weeks of group CBT for toilet-related fear with IBS
Reported that group CBT with graded exposure changed how he read the urge to go, from needing a toilet immediately to a signal he could wait on, and that he no longer plans his days around toilet access.
Ten years of IBS-D: David (IBSWithWatson) on diet, nortriptyline, therapy and hypnotherapy
Reported that no single change resolved his IBS-D; combining identified food triggers, short-term symptom medication, nortriptyline, therapy, hypnotherapy and gradually facing avoided situations left him able to work, travel and socialise, with flare-ups still occurring.
Critiques
Single-study critiques that cover this approach.
Gut-directed hypnotherapy for IBS: the IMAGINE trial and the diet comparison
IMAGINE randomised 354 Dutch IBS patients to individual, group, or educational control. Hypnotherapy roughly doubled adequate relief at 3 and 12 months, and group delivery held its own. A look at the evidence.