Marc%20I.%20Oster,%20Psy.D.,%20ABPH%20American%20School%20of%20Professional%20Psychology%20at%20Argosy%20University%20Schaumburg%20Campus%20999%20Plaza%20Drive,%20Suite%20111%20Schaumburg,%20IL%2060173%20(847)[e-mail]

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Marc I. Oster, Psy.D., ABPHAmerican School of
Professional Psychology at Argosy University
Schaumburg Campus999 Plaza Drive, Suite
111Schaumburg, IL 60173(847) 969-4944moster_at_arg
osy.edu
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Chicago Society of Clinical Hypnosis

• The Use of Hypnosis in the Treatment of Digestion
  and Elimination Problems
• Loyola University Medical Center
• Maywood, IL
• April 24, 2009

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The Use of Hypnosis in the Treatment of Digestion
and Elimination Problems

• 1. To describe a model for the development of
  psychophysical disorders.
• 2. To describe how the term success can be used
  to minimize failure experiences in treatment.

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Types of Evidence useful in the Evaluation of
Complementary Therapies

• Types of Evidence Validation
  Questions
• ________________________________________________
  ________________________________
• Experimental evidence Is the practice
  efficacious when examined experimentally?
• Clinical (practice) evidence Is the
  practice effective when applied clinically?
• Safety evidence Is the
  practice safe?
• Comparative evidence Is it the best
  practice for the problem?
• Summary evidence Is the
  practice known and evaluated?
• Rational evidence Is the
  practice rational, progressing, and
  contributing to medical and scientific
  understanding?
• Demand evidence Do consumers
  and practitioners want the practice?
• Satisfaction evidence Is it
  meeting the expectations of patients and
  practitioners?
• Cost evidence Is the practice inexpensive
  to operate and cost-effective? Is it
  provided by payers?
• Meaning evidence Is the
  practice the right one for the individual?

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Five Risk Factors leading to chronic
stress-related symptomsWickramasekera (1987,
1998)

• 1. Hypnotic ability both high and low
• 2. Habitual Catastrophic Thinking
• 3. Habitual Neuroticism - Sympathetic
  Reactivity/Negative Affectivity
• 4. Major Life Changes and/or Daily Hassles
• 5. Social Support Systems and Coping Skills
• Wickram divides the five factors as follows
• Predisposers (1-3) Triggers (4)
  Buffers (5)______
• Hypnotic Ability Major Life Events
  Support Systems
• Catastrophizing Daily Hassles
  Coping Skills
• Sympathetic Reactivity
• Wickramasekera, I. (1987). Risk factors leading
  to chronic stress-related symptoms. Advances.
  Institute for the Advancement of Health, 4(1),
  9-35.
• Wickramasekera, I. (1998). Secrets kept from the
  mind but not the body or behavior the unsolved
  problems of identifying and treating somatization
  and psychophysical disease. Advances in
  Mind-Body Medicine, 14, 81-132.

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When to use hypnosis

• Symptom reduction or management
• Habit alteration/change
• Increase awareness
• Enhance treatment compliance
• Improve medication utilization
• Exploration
• Ego strengthening
• From Weisberg Clavel (2008) ASCH.

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• LanguageMeaning is in the ear of the beholder

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• 93 message is in something other than words
• 38 Inflection
• 55 Gestures
• 7 Words
• Phil Norma Barretta

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Therapeutic Language

• Patient-centered
• Ego-strengthening
• Positive
• Empathetic
• Suggests change

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• AVOID
• Burning
• Stinging
• Painful
• Hurts
• Bad
• Awful

• USE
• Warm
• Tingly
• Sore
• Scratchy
• Soft
• Gently
• Easily
• Quickly
• Nicely

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• Understanding and Treating Irritable Bowel
  Syndrome
• And Encopresis

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• Irritable Bowel Syndrome or IBS is a functional
  gastrointestinal disorder characterized by
  abdominal pain, bowel function abnormalities in
  frequency and consistency, and sometimes bloating
  or abdominal distention.

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• IBS affects 9-20 of the population.
• IBS is twice as common in women, representing
  about 75-80 of all IBS seen in practice.
• IBS accounts for 3 million doctors visits a year.
• IBS represents 25-50 of all visits to
  gastroenterologists.

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IBS vs. Other Diseases

• IBS prevalence as high as 20
• Diabetes about 3
• Asthma about 4
• Heart disease about 8
• Hypertension about 11

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The Rome Criteria for IBS

• At lease 3 months of continuous or recurrent
  symptoms, and
• Abdominal pain relieved by defecation or
  accompanied by a change in stool frequency (lt3 x
  week or gt3 x day) or consistency, and
• Disturbed defecation at least 25 of the time,
  consisting of two or more of the following
• altered frequency of bowel movements
• altered consistency of stool
• altered stool passage
• passage of mucus
• abdominal distention

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The Psychology of IBS

• Many patients with IBS who consult physicians
  also have depression or anxiety, perfectionism,
  obsessive-compulsiveness, elevated scores on
  tests of social desirability, and other physical
  complaints.
• However, IBS is not a psychological disorder. It
  is a physical disorder that is strongly affected
  by one's emotional state, as well as stress and
  tension.

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The Epidemiology of IBS

• The lifetime prevalence of IBS is about 20.
  Although not a very serious disorder when
  compared to something like schizophrenia, it is a
  major healthcare concern.
• Like many other conditions, but maybe more
  dramatically so, IBS suffers can be divided into
  two groups, those who seek treatment and those
  who do not seek treatment.
• Studies found that of those IBS patients who do
  not consult a physician, 70-80 of all IBS
  patients, were psychologically healthy and
  similar to normal controls on psychological
  testing.
• Those IBS suffers who seek medical treatment
  tended to also be more psychologically distressed
  on psychological tests.

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• One's "suffering" is what determines their
  consultation with a physician.
• In one study, 85 of a sample reported changes in
  their bowel habits secondary to psychological
  stress. Other studies found that figure to be
  closer to 10.
• Some studies report childhood trauma being linked
  to the development of IBS symptoms. Of those
  with functional GI disorders, 53 were sexually
  abused during childhood as compared to 37 of
  those with organic diseases.

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Sexual Abuse and IBS

• IBS patients have been found to be twice as
  likely to report sexual abuse history as healthy
  subjects.

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Stress and IBS

• IBS patients consistently report more stressful
  life events than control subjects.
• More than half of IBS patients report that
  stressful psychological events exacerbate their
  symptoms or precede symptom onset. The stressful
  life events IBS patients report are typically
  commonplace events, but loss of a parent and
  sexual abuse seem particularly common in the
  stressor history of IBS patients.

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Effective Management of IBS

• Do not treat unless you're sure that a diagnosis
  of IBS has been made by a physician,
• Maintain good contact with their primary care
  physician and encourage patients to continue to
  consult their physician on any changes in
  physical symptoms,
• Use brief and time limited treatment of the kinds
  that have been demonstrated to be effective in
  research,
• Make clear to the patient that progress is going
  to be gradual,
• Use improvement in abdominal pain, bowel
  dysfunction, and social and work functioning as
  the chief criteria for improvement with emotional
  well being as secondary criteria.

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Effective Psychological Treatments for IBS

• Brief cognitive therapy
• Brief dynamic therapy
• Brief hypnosis treatment
• Highest success rates reported for cognitive
  therapy, 80 and hypnosis treatment 80-95
  these are the only treatments with replicated
  highly successful outcomes in controlled studies.
  Improvement is maintained at 14year follow-up.
• VOL 57, NO 1 / JANUARY 2008 THE JOURNAL OF
  FAMILY PRACTICE

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Treatment Effectiveness

• When comparing various treatment models,
  treatment duration is usually short, ranging from
  7-10 sessions over 8-13 weeks.
• Common forms of therapy included relaxation
  training, cognitive, dynamic and supportive
  therapy as well as hypnosis. Treatment effects
  are generally well maintained at one-year
  follow-up.
• When comparing insight-oriented therapy,
  hypnotherapy, cognitive-behavioral therapy, and
  biofeedback, all produce notable improvements in
  some symptoms with the best objective reports
  being with hypnotherapy showing 85 improvement
  in patients under age 50 at one-year follow-up,
  followed by cognitive-behavioral therapy alone.

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Treatment Model

• Whorwell (classic approach) vs UNC/Palssons
  Model
• 1. 10 - 20-30min sessions maximum improvement
  usually noted in 4-8 sessions
• 2. hypnosis is directive, "gut-directed" and
  not exploratory
• 3. standard eye-fixation induction and
  suggestions for imagery (to assess
• imagery capacity)
• 4. place hand on abdomen and feel warmth,
  repeat several times
• 5. suggest to relate warmth to the reduction
  of spasm and the ability to alleviate pain and
  distension, bowel habits will normalize as their
  control gradually improves
• 6. if they can visualize, they are asked to
  see a meandering river, then note the
• effect of an obstruction to the flow, such
  as a lock or gate. Observe the effect of the
  opening and closing of the gate
• 7. the river is like their guts and the gate
  is the smooth muscle and they adjust them to a
  comfortable setting
• 8. around the 3rd session, work on
  self-hypnosis, ego-strengthening and confidence
  building
• 9. explain that this method help them to
  control nor cure their problem, thus requiring
  regular practice.

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Whorwell's Results (Stress Medicine, 1987)

• age classic IBS
  atypical IBS
• -------------------------------------------------
  ------------------
• lt50 yrs 93
  33
• gt50 yrs 50
  50
• -------------------------------------------------
  ------------------
• Total 86
  38

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Re-Defining Success

• This might be complete relief of symptoms, or it
  may be slight or temporary relief, or partial
  relief.
• Sometimes, a symptom might even get a little
  worse. Even that is good because any change in
  symptoms implies movement and where there's
  movement, greater change can occur.
• Finally, there may be minimal or no change, but
  you notice a sense of impending change or feel
  hopeful that change is coming.

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Case Examples

• Beths IBS
• Mike the pooper, or not

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Selected Bibliography

• Blanchard, E.B. (1993). Irritable Bowel
  Syndrome. In R.J. Gatchel E.B. Blanchard
  (Eds.) Psychophysiological Disorders Research
  and Clinical Applications. Washington, DC APA.
• Palsson, O.S. (Editor) (2006). Special Issue
  Irritable Bowel Syndrome. IJCEH, 541.
•  
• Palsson, O.S. (1997). Hypnosis treatment for
  Irritable Bowel Syndrome. Gastroenterology, 112,
  A803.
•  
• Whorwell, P.J. (1987). Hypnotherapy in the
  irritable bowel syndrome. Stress Medicine, 3,
  5-7.
•  

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• Whorwell, P.J. Prior, A. Faragher, E.B.
  (December 1, 1984). Controlled trial of
  hypnotherapy in the treatment of severe
  refractory irritable bowel syndrome. The Lancet,
  1232-1233.
•  
• Wickramasekera, I. (1987). Risk factors leading
  to chronic stress-related symptoms. Advances,
  Institute for the Advancement of Health, 4(1),
  9-35.

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Marc I. Oster, Psy.D., ABPH

• Mailing Address
• 1954 First Street, 103
• Highland Park, IL 60035-3104
• Private Practice / Office Address
• Center for Psychological Services, LLC
• 465 Central Ave., Suite 201
• Northfield, IL 60093
• [phone] voicemail
• [phone] cell phone
• marcoster_at_yahoo.com
• www.marcoster.homestead.com