Resilience in Irritable Bowel Syndrome and Gut-focused Hypnotherapy
Condition: Irritable Bowel Syndrome
MeSH terms: Irritable Bowel Syndrome; Syndrome
Study type: Interventional

Summary: 
      Background:

      Resilience refers to a class of variables highly relevant for wellbeing and coping with
      stress, trauma, and chronic adversity. Despite its significance for health, resilience is
      hardly examined empirically and suffers from poor conceptual integration. Irritable bowel
      syndrome (IBS) is a functional disorder with altered psychological stress reactivity and
      brain-gut-microbiota axis, which causes high chronic strain. Gut-focused hypnotherapy (GHT)
      is a standardized treatment for IBS targeting at resilience. An increase of resilience by GHT
      has been hypothesized but requires further investigation.

      Aims of the study were construct validation and development of an integrational measure of
      different resilience domains by dimensional reduction, and investigation of change in
      resilience in IBS patients by GHT.

      N=74 Gastroenterology outpatients with Irritable Bowel Syndrome (Rome III criteria) were
      examined in 7 resilience domains, quality of life, psychological distress and symptom
      severity. n=53 of these participate in 7 to 10 Gut-directed Hypnotherapy group sessions
      (Manchester protocol). Post-treatment examinations were performed 10 months after last GHT
      session.
    

Detailed description: 
      Aims of this study were, to measure detailed factors of resilience by adequate psychological
      instruments in a sample of Irritable Bowel Syndrome (IBS) patients and to investigate whether
      they are facets of the same underlying construct. To calculate a composite measure of
      resilience based on obtained insights concerning the structure of resilience. To test the
      hypothesis of a positive relation between resilience and response to therapy. And finally, to
      investigate differences between patients untreated or treated with Gut-directed Hypnotherapy
      in groups cross-sectionally and longitudinally, to test the hypothesis of a presumed increase
      in resilience (using the composite score) with changes in IBS symptoms, quality of life and
      psychological distress in parallel.

      Study location and recruitment:

      N=74 Irritable bowel syndrome patients (diagnosed according to Rome III criteria) aged
      between 18 and 70 and refractory to other therapies were recruited at the Specialized
      outpatient-clinic for Psychosomatics at the Division of Gastroenterology and Hepatology,
      Department for Internal Medicine III, University Hospital of Vienna. Antidepressants or
      anxiolytics and/or ongoing psychotherapy were allowed since severe comorbid psychological
      problems are a common problem in IBS patients. The study protocol was approved by the ethics
      committee of the Medical University of Vienna (ID: 1488/2012). Informed consent in writing
      was given by each participant.

      Study Design and Treatment:

      Cross-sectional comparisons were performed with data of n = 37 GHT treated and n = 37
      untreated patients (control group) post GHT. This data were pooled for dimensional reduction
      of resilience domains. Resilience and IBS severity data from the treatment group were
      assessed post GHT; psychological distress and quality of life were assessed pre and post GHT.
      A fraction of n = 16 of the untreated patients (former control group) subsequently also
      received GHT treatment. Pre and post GHT data of these patients were collected and then used
      for longitudinal comparisons, along with the pre and post GHT data on psychological distress
      and quality of life of the primary treatment group. In total, N= 74 patients were examined,
      in total 53 (= 37 + 16) of which underwent GHT. Post treatment examinations were performed 10
      months after last GHT session. The GHT protocol used was the Manchester protocol of GHT and
      consisted of 10 weekly sessions (45 min), with six patients per group over a treatment period
      of 12 weeks. GHT was performed at the University Hospital by two experienced physicians
      trained in Manchester (UK).
    

Intervention name(s): Gut-directed Hypnotherapy
Intervention type(s): Behavioral
Intervention description(s): The GHT protocol used was the Manchester protocol of GHT and consisted of 10 weekly sessions (45 min), with six patients per group over a treatment period of 12 weeks. GHT was performed at the University Hospital by two experienced physicians trained in Manchester (UK).
Other intervention name(s): Gut-focused Hypnotherapy
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Basic Science
Keywords: Resilience; Coping; Psychosomatic; Hypnosis; Construct Validation