Effect of hypnotherapy and educational intervention on brain response to visceral stimulus in the irritable bowel syndrome

Authors

  • M. B. O. Lowén,

    1. Department of Clinical and Experimental Medicine/Gastroenterology, Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
    2. Department of Gastroenterology, UHL, County Council of Östergötland, Linköping, Sweden
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  • E. A. Mayer,

    1. Division of Digestive Diseases, Department of Medicine, The Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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  • M. Sjöberg,

    1. Ersta Hospital, Karolinska Institute, Stockholm, Sweden
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  • K. Tillisch,

    1. Division of Digestive Diseases, Department of Medicine, The Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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  • B. Naliboff,

    1. Department of Psychiatry, The Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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  • J. Labus,

    1. Department of Psychiatry, The Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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  • P. Lundberg,

    1. Radiation Physics, Department of Medical and Health Sciences, Faculty of Health Sciences, Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
    2. Department of Radiation Physics UHL, County Council of Östergötland, Linköping, Sweden
    3. Radiology, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden
    4. Department of Radiology UHL, County Council of Östergötland, Linköping, Sweden
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  • M. Ström,

    1. Department of Gastroenterology, UHL, County Council of Östergötland, Linköping, Sweden
    2. Department of Clinical and Experimental Medicine/Gastroenterology, Linköping University, Linköping, Sweden
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  • M. Engström,

    1. Department of Medical and Health Sciences (IMH)/Radiology, Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
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  • S. A. Walter

    Corresponding author
    • Department of Clinical and Experimental Medicine/Gastroenterology, Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
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Correspondence to:

Dr S. A. Walter, Department of Clinical and Experimental Medicine/Gastroenterology, Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.

E-mail: susanna.walter@liu.se

Summary

Background

Gut-directed hypnotherapy can reduce IBS symptoms, but the mechanisms underlying this therapeutic effect remain unknown.

Aim

To determine the effect of hypnotherapy and educational intervention on brain responses to cued rectal distensions in IBS patients.

Methods

Forty-four women with moderate-to-severe IBS and 20 healthy controls (HCs) were included. Blood oxygen level dependent (BOLD) signals were measured by functional Magnetic Resonance Imaging (fMRI) during expectation and delivery of high- (45 mmHg) and low-intensity (15 mmHg) rectal distensions. Twenty-five patients were assigned to hypnotherapy (HYP) and 16 to educational intervention (EDU). Thirty-one patients completed treatments and posttreatment fMRI.

Results

Similar symptom reduction was achieved in both groups. Clinically successful treatment (all responders) was associated with significant BOLD attenuation during high-intensity distension in the dorsal and ventral anterior insula (cluster size 142, P = 0.006, and cluster size 101, P = 0.005 respectively). Moreover HYP responders demonstrated a pre–post treatment BOLD attenuation in posterior insula (cluster sizes 59, P = 0.05) while EDU responders had a BOLD attenuation in prefrontal cortex (cluster size 60, P = 0.05). Pre–post differences for expectation conditions were almost exclusively seen in the HYP group. Following treatment, the brain response to distension was similar to that observed in HCs, suggesting that the treatment had a normalising effect on the central processing abnormality of visceral signals in IBS.

Conclusions

The abnormal processing and enhanced perception of visceral stimuli in IBS can be normalised by psychological interventions. Symptom improvement in the treatment groups may be mediated by different brain mechanisms. Clinical trial number: NCT01815164.

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