Nurse-administered gut-directed hypnotherapy for irritable bowel syndrome: new strategies to increase accessibility

Abstract

Irritable bowel syndrome (IBS) is one of the disorders of gut-brain interaction (DGBI), and characterized by altered bowel habits and abdominal pain. IBS negatively affects daily functioning, and psychological comorbidities are common. Gut-directed hypnotherapy is an effective brain-gut behavioral therapy that has been shown to reduce symptom burden and psychological distress related to IBS. However, treatment availability is limited, primarily due to a shortage of adequately trained therapists. This thesis aimed to evaluate effects of nurse-delivered gut-directed hypnotherapy for IBS, and to examine strategies to increase accessibility. In Study I, nurse-administered hypnotherapy was demonstrated to be effective, alleviating both IBS and extracolonic symptoms. The treatment also improved GI-specific and general anxiety, and depressive symptoms. Female participants responded more favorably to the intervention. Study II compared the efficacy of individual versus group hypnotherapy. Results indicated that group-based delivery showed similar positive effects on IBS and extracolonic symptoms, psychological outcomes and quality of life. Study III investigated long-term effects of the treatment and demonstrated that the beneficial symptom changes were sustained for up to two years following treatment. A slightly better treatment response over time was observed among participants who received individual hypnotherapy. Stronger treatment effects were also noted in individuals with a high symptom burden before the intervention, and in younger patients. In Study IV, efficacy and acceptability of group-based gut-directed hypnotherapy via live video sessions were evaluated. Treatment outcomes were comparable to those observed in on-site group hypnotherapy, and most study participants reported that they would have preferred remote delivery if given the option. In conclusion, this thesis demonstrates that nurse-delivered gut-directed hypnotherapy is effective for IBS and often produces long-lasting symptom improvements, not only regarding IBS symptoms but also for extracolonic symptoms, psychological distress and quality of life. Group-based hypnotherapy, administered either on-site or online, are similarly effective compared to individual hypnotherapy and enhance treatment accessibility.