404 Irritable Bowel Syndrome
conventional medical care, to either individual psychotherapy
(n50) or the control condition (n51). Patients were as-
sessed by blinded assessors at pretreatment, three months after
treatment began (posttreatment), and at a 12-month follow-up.
The assessor ratings showed signi“cantly greater im-
provement for the treated patients than the controls in re-
duction of abdominal pain and reduction of other somatic
symptoms at the end of treatment. At the one-year follow-up,
the assessor ratings showed treatment was superior to the
control condition on reduction of abdominal pain and so-
matic symptoms, and on improvement in bowel dysfunction.
Both groups were rated signi“cantly less anxious and
depressed at end of treatment and at follow-up.
In the second RCT of psychodynamic psychotherapy
(Guthrie et al., 1991), IBS patients who failed to respond to
routine medical care were randomly assigned to individual
psychodynamic psychotherapy plus home practice of relax-
ation (n 53) or a wait list condition (n 49). Evaluation
was by means of blinded assessor ratings and patient symp-
tom diaries. After the posttreatment evaluation, 33 of the
controls were crossed over to treatment while 10 who had
improved were merely followed.
The assessor ratings showed greater improvement at end
of treatment for the psychotherapy group versus the symptom
monitoring controls on abdominal pain and diarrhea as well
as on reductions in anxiety and depression; the patients rat-
ings showed the same GI symptom results plus greater in
bloating. The one-year follow-up data were based solely on
patient global ratings. They showed that, of patients treated
initially, 68% rated themselves as •betterŽ or •much better.Ž
Among the treated controls, 64% gave similar ratings.
Although we cannot directly compare the content of the
treatments, it seems clear that they are similar and have led to
signi“cantly greater improvement than controls on abdomi-
nal pain and bowel functioning. They thus yield comparable
positive results which appear to hold up well over a one-year
follow-up.
Hypnotherapy
The “rst RCT of hypnotherapy for IBS (Whorwell, Prior, &
Faragher, 1984) appeared shortly after the Svedlund et al.
(1983) trial described earlier. The hypnotherapy treatment
was aimed at general relaxation and gaining control of
intestinal motility along with some attention to ego strength-
ening. Patients also received an audiotape for daily home
practice of autohypnosis. In the “rst study, 30 IBS patients
who had been refractory to standard medical care were ran-
domized to seven hypnotherapy sessions over three months
(n15) or to supportive psychotherapy (seven sessions by
the same therapist) and continued medical care (n15).
Evaluation was by means of patient symptom diary and
blinded assessor ratings.
Results showed dramatic improvement in abdominal pain,
bloating, dysfunctional bowel habit, and general well-being for
the hypnotherapy condition; all patients were clinically im-
proved. Active treatment was superior to the control on all mea-
sures. An 18-month follow-up (Whorwell, Prior, & Colgan,
1987) of the treated sample revealed very good maintenance of
improvement. Two patients had minor relapses at about one
year and responded to a single session of hypnotherapy.
The results were essentially replicated (Houghton,
Heyman, & Whorwell, 1996) in a comparison of 25 cases
treated with hypnotherapy to 25 other cases awaiting
treatment. The protocol was now described as 12 sessions.
Treated patients improved more than controls on abdomi-
nal pain, bowel dysfunction, bloating, and general sense of
well-being. Importantly, those patients treated with hyp-
notherapy missed fewer work days (X2) than the controls
(X17).
An independent replication of these results was reported
by Harvey, Hinton, Gunary, and Barry (1989) who compared
individually administered hypnotherapy to group hypnother-
apy. There were equivalent signi“cant improvements in both
conditions with 61% of participants improved or symptom
free at three months posttreatment.
In our center, Galovski and Blanchard (1998) also repli-
cated Whorwell•s results (using his hypnotherapy protocol)
in a comparison of immediate treatment to symptom
monitoring and delayed treatment. A composite symptom
reduction score, based on patient GI symptom diaries, was
signi“cantly greater (52%) for treated patients versus con-
trols (32% [symptom worsening]). For the whole treated
sample, there were signi“cant reductions in abdominal pain,
constipation, and trait anxiety.
With the continued positive results from Whorwell•s
clinic plus two independent replications, including one in the
United States, it seems clear that hypnotherapy is a highly
viable treatment for IBS.Cognitive and Behavioral TreatmentsThe most active research approach to the psychological treat-
ment of IBS by far has been the evaluation of various
cognitive and behavioral treatments. Most studies have used
a combination of treatment procedures in multicomponent
treatment packages; however, a few have used only a single
component such as relaxation training. Our own work,
with the exception of the hypnotherapy study of Galovski and
Blanchard (1998) described earlier, can be subsumed under
this approach. This research, including our studies from
Albany, is summarized chronologically in Table 17.1.