When the Stomach loses the Head

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1 When the Stomach loses the Head Creative dealing with Irritable Bowel Syndrome (IBS) The V European Congress of Ericksonian Hypnosis and Psychotherapy Krakow June 12-15, 2014 Brigitta Loretan-Meier Master of Science UZH Psychology/Bodypsychotherapy FSP, Zürich, Switzerland

3 Therapy Project Central-Praxis ZH Gastroenterologist + Psychotherapeut IBS Patient IBS Patient Gastroenterologist Psychotherapeut

4 IBS a case for at least two experts Irritable bowel syndrome - what a load! Expectations and needs of clients Diagnosis of IBS feeling powerless and/or relief On the one hand on the other hand

5 Irritable Bowel Syndrome IBS Chronic physical discomfort without there being an organic illness Discomfort from physiological processes or physical illness which are insufficiently explainable Classification F 45, 32 somatoform autonomic dysfunction

6 Irritable Bowel Syndrome heterogeneous group of patients Food intolerances / allergies: 50-70% Other functional disorders: 20-80% Affective disorders: 20-80% Chronic inflammatory bowel disease in remission: 20-40% Coeliacs disease in remission: 20-30%

8 Me and my Symptoms

9 The worst thing about my symptoms is not the physical suffering but that the symptoms take all my self-confidence! Everything to do with food is stressful! With stomach ache, flatulence and constipation, it takes the enjoyment out of life.

10 Key Causes of IBS disorders current opinion in gastroenterology, there are three main factors : 1. psychosocial factors (life events, trauma, stress as a trigger) 2. changed motility (prior gastroenteritis GI infections, genetics) 3. changed sensibility (visceral hypersensitivity, lactose intolerance) Others: general lifestyle, including eating habits Impact of symptoms: personality factors may play a role in expression of IBS symptoms, always on the go, poor coping styles, irritable beliefs, rigid rules, external locus of control, low self-esteem and confidence, relationship, work, etc.

11 IBS Degrees of Severity IBS non-patient: Discomfort with no impact on everyday life and no desire for treatment Mild: occasional or mild impact on everyday life with desire for treatment Moderate: Sustained or moderate impact on everyday life with desire for treatment and various pre-treatments Severe: Severe and sustained impact on everyday life and a great number of (frustrating) pre-treatments

12 IBS and Psychological Condition Fundamental considerations/ my experiences IBS PC IBS PC IBS > < PC

14 Case Study- Course of Therapy Client, 35 years of age, lives with girlfriend, social network intact, professionally successful Complains about extreme discomfort in the bowels Anxiety and nervousness 2001, first full examination of stomach, IBS diagnosed Different forms of therapy slightly improve the situation temporarily Pharmatherapeutical treatment insufficient

15 Description of Symptoms Physical state Feeling sick when getting up Tenesmus, barely leaves the house Vegetative stress symptoms outbreaks of sweating, shaking on the way to work Mental state Depressed and resigned, has already done and read a lot but nothing helps Feels completely at the mercy of the symptoms Despite understanding at work, it is still bothersome Big inner pressure and uncertainty Self-doubt and frustration

16 Therapy aim of the client To get rid of the stress To get a better perception of the body Aim of the therapist Stabilise Increase well-being and quality of life

17 Therapeutic Approach Solving every problem begins with believing that change is possible Start where minimal changes are possible and noticeable

18 Treatment options for IBS No treatment Change eating habits Medication Psychological methods Complementary methods Combinations Psychotherapy /clinical hypnosis

20 Information / Causes of IBS Changes to the sensitivity in the intestines Changes to intestinal motility Change to central nervous stimulus process Intestinal brain Vegetative nervous system Emotions and symptoms of IBS (vicious circle) Functional disorders (e.g. migraines)

21 Belly-brain?

22 Extent of stomach pain Extent of flatulence Extent of stool problems Extent of psychological discomfort Impact on daily life Own control over bowel function Extent of stomach pain Extent of flatulence Extent of stool problems Extent of psychological discomfort Impact on daily life Own control over bowel function Extent of stomach pain Extent of flatulence Extent of stool problems Extent of psychological discomfort Impact on daily life Own control over bowel function Extent of stomach pain Extent of flatulence Extent of stool problems Extent of psychological discomfort Impact on daily life Own control over bowel function none none none none very severe very severe very severe very severe IBS Questionnaire Datum: BM bowel movement :) well-being DI diarrhoea :I affected CO constipation :( sick FL flatulence

23 Stress response and vegetative nervous system Slowing down of gastric emptying Speeding up of intestinal emptying Faster heart rate Increased muscle tension

24 (Translation) M.E.Schwab ETH Zürich/2009

26 Gut-directed Hypnosis Session 1, medical history and information 7-12 sessions of minutes over 3 months - Session 1-2: quiet and general increasing of selfesteem - Sessions 3-12: suggestion relating to the bowels Symptoms diary Daily, independent practice (self-management) Häuser 2010

28 Research Findings Many controlled studies exist in which a highly significant reduction in anxiety, depression and gastro-intestinal symptoms is proven in the corresponding psychotherapeutic setting - with hypnotherapeutic interventions -

29 230 patients from primary care 4 hours of therapy within 6 weeks Significant improvement in scores (pain, anxiety, depression) (Brann et al, York, UK, 2007) The high response rate with hypnotherapy can be explained from the design Psychological aspects of IBS problems (anxiety, depression) are the focus of attention The hypnotherapy approach is centred on the individual Hypnosis influences the affective and the sensory aspects of the pain

30 Role of the Psychotherapist To recognise the development deficits Quality of relationships through a genuine closeness Trust Impartial attitude Wide repertoire of experience and knowledge Principle of confidence Intuitive comprehension

31 Summary / Result Hypnosis and control Resource management Relationship level social competence Body perception body confidence Tools to establish self-regulation self-hypnosis Increasing self-esteem Psychodynamics

32 Future s - mu - sick

33 Thank you for your attention

Case Study: Personalized self-hypnosis method for Irritable bowel syndrome

Case Study: Personalized self-hypnosis method for Irritable bowel syndrome Article by Koo Kian Yong Master of Science in Clinical Psychology, Texila American University, Malaysia Email: newmindcentre@gmail.com