-IBIS-1.7.6-
tx
digestive system
irritable bowel syndrome
Psychospiritual Approaches
metaphors and correlations
Aggressive toilet training may result in individuals who are narrow in outlook, punctual, fastidious, and who suffer from grievous bowel problems. (Harrison, 132.)
Layered deposits of old, confused thoughts clogging the channel of elimination; wallowing in the mire of the past. (Hay, 1984, 175.)
Inflammation: fear; inflamed thinking; seeing red; anger and frustration about conditions in one's life. (Hay, 1984, 170-171.)
Colitis patients (more serious than irritable bowel) are most afraid of living their own lives, realizing their own personalities. Taking up one's own position vis-a-vis others inevitably entails a certain degree of isolation and thus a loss of symbiosis. It is out of this fear of loss that they 'sweat blood' via the intestine, and via the unconscious are sacrificing the symbols of their own life, namely blood and slime. Accepting responsibility is their task of transformation. (Dethlefsen, 137.)
Dysfunctional response to stressors.
(Dancey CP, et al. J Psychosom Res 1998 May;44(5):537-545; Dancey CP, et al. J Psychosom Res. 1995 Oct;39(7):827-832; Houghton LA. Baillieres Best Pract Res Clin Gastroenterol. 1999 Oct;13(3):415-427; Thomson S, Dancey CP. J Pediatr Health Care. 1996 Nov-Dec;10(6):280-285; Waxman D. J R Soc Med 1988 Dec;81(12):718-720.)
Chinese psychophysiology:
Liver ~ Gan is the home of the Hun (Ethereal Soul); it relates to decisiveness, control, and the principle of emergence; maintains smooth flow of Qi and Xue (Blood); controls the contractility of the muscles; and reflects emotional harmony and movement.
» Healthy expressions are kindness, spontaneity, and ease of movement.
» Liver Qi Stagnation reflects and accentuates emotional constraint as the Liver's function of facilitating smooth flow in the body is constricted. Stagnation is associated with frustration, irritability, tension, and feeling stuck. With time this pattern tends to produce a gloomy emotional state of constant resentment, repressed anger or depression, along with tightness in the chest, frequent sighing, abdominal tension or distension, and/or a feeling of a lump in the throat with difficulty in swallowing. (Maciocia, p. 216) Liver Qi Stagnation often combines with Liver Shi (Excess) to "invade" the Stomach and Spleen.
» Liver Shi (Excess) signs include discontent; anger; pain in lumbar region and genitals (Seem, p. 28); muscular tension; excessive sex drive; insomnia; moodiness; excitability; genital diseases; red, tearing eyes; compulsive energy; and bitter taste in the mouth. Chronically suppressed anger can implode and give rise to Fire in the Liver and Gall Bladder with symptoms of irritability, bitter taste, headaches, etc., and a tendency to "invade" the Stomach, Spleen, and Intestines.
Spleen ~ Pi governs digestion and manifests in the muscle tissues; transforms food into Qi and Xue (Blood); governs the Xue (Blood); resolves Dampness and Phlegm; and relates to the ability to assimilate, stabilize, and feel centered and balanced.
» Healthy expressions are fairness, openness, deep thinking, and reminiscence.
» Spleen Xu (Deficiency) signs include slightness (deficient "form"); abundant elimination; morning fatigue; cold, wet feet (Seem, p. 28); abdomen taut and distended like a drum; craving for sweets; flatulence; nausea; mild edema; memory failure; heavy feeling in legs; pale lips; loose stools; muscular weakness; and, indirectly, obesity. Unresolved Spleen Xu (Deficiency) predisposes to Spleen Shi (Excess), particularly accumulation of Dampness and Phlegm, as the Spleen's functioning declines. Spleen Xu (Deficiency) increases the susceptibility to "invasion" by the Liver.
» Spleen Shi (Excess) signs include heaviness (excess "form"); large abdomen; great sighing; sadness; obsessions and nightmares (Seem, p. 28); abdominal pain; irregular appetite; stickiness in the mouth and on lips; red lips; chest congestion; fatigue; and constipation. Dampness and Phlegm Shi (Excess) usually derive from Spleen Yang and/or Qi Xu (Deficiency).
» The excessive use of the mind in thinking, studying, concentrating, and memorizing over a long period of time tends to weaken the Spleen and may lead to Xue Yu (Blood Stasis). This also includes excessive pensiveness and constant brooding. (Maciocia, p. 241) Likewise, inadequate physical exercise and excess consumption of sweet and/or Cold foods will also deplete the Spleen. Environmentally, the Spleen is highly susceptible to attack from external Dampness and Cold.
Large Intestine ~ Da Chang absorbs water; governs transformation and conveyance of waste from food to form stool; is paired with the Lung and relates to strength and sustainability as the Yang aspect of Metal.
» Weakness, dysfunction, and illness associated with sadness, grief, and worry. Worry depletes the Lung Qi which fails to descend and assist the Large Intestine in its functions.
» Healthy expressions are righteousness and courage.
» Large Intestine Shi (Excess) signs include dry mouth; parched lips; hot body (Seem, p. 29); warmth and swelling along the course of the channel; distended abdomen; dizziness; constipation; and yellow-orange urine.
» Stagnation of Qi in the Large Intestine produces spastic abdominal pain and constipation, with small stools alternating with diarrhea.
therapies
imagery:
luminous blue (Chavez)
understanding the worm (Chavez)
Focus on literal images of loops of intestine lying quiet and still. The only movement is the long, slow flex of normal peristalsis as it squeezes along digestive materials. Change harsh colors to cool ones, rough seas becoming tranquil, discordant music to pleasant melodies, calm an angry animal. (Fanning, p. 228)
OR, follow the harsh colors, rough seas, discordant music, etc. and see where it leads patient. DON'T calm the angry animal! (Mindell)
affirmation:
I digest and assimilate all new experiences peacefully and joyously. (Hay, 1984, 170.)
I freely and easily release the old and joyously welcome the new. Letting go is easy. (Hay, 1984, 157.)
I release and dissolve the past. I am a clear thinker. I live in the now in peace and joy. (Hay, 1984, 175.)
(Inflammation) My thinking is peaceful, calm, and centered. I am willing to change all patterns of criticism. I love and approve of myself. (Hay, 1984, 170-171.)
hypnotherapy:
Hypnotherapy has been found to be helpful in several studies.
(Harvey RF. Lancet 1989;i:424-426; Waxman D. J R Soc Med 1988;81:718-720; Houghton LA, et al. Aliment Pharmacol Ther 1996;10:91-1095.)
psychotherapy:
In cases of stomach disorders and digestive complaints, ask some related questions:
» What is it that I am unable or unwilling to swallow? Assimilate? Let go of?
» Is something eating me up inside? What am I feeling so sour about?
» How am I handling my feelings? How am I coping with my aggression?
» To what extent am I avoiding conflicts? Am I longing for the conflict-free time of childhood, when I was secure, loved, and cared for? (Dethlefsen, p. 134)
Those who are prone to inflammations are attempting to avoid conflicts. The following questions may be useful:
» What conflict am I failing to see? hear? feel? move?
» What conflict am I dodging? What is my relationship to it?
» What conflict am I failing to admit to?" (Dethlefsen, p. 108)
process paradigm: (experientially oriented)
What is the symptom preventing me from doing? What is the symptom making me do? (see process interview: digestive system)
related materia medica listings:
the shadow and physical symptoms
converting a symptom to a signal
imagery: precautions
imagery: techniques
affirmations: guidelines and precautions
hypnotherapy
process paradigm
footnotes
Ayres RC, Robertson DA, Naylor K, Smith CL. Stress and oesophageal motility in normal subjects and patients with irritable bowel syndrome. Gut. 1989 Nov;30(11):1540-1543.
Abstract: Patterns of oesophageal motility were recorded in 17 healthy volunteers and 12 patients with the irritable bowel syndrome. Recordings were taken at rest and under stress by hyperventilation, a dichotic hearing challenge and a cold pressor test. In healthy volunteers the dichotic hearing challenge was associated with a significant increase in the mean amplitude of oesophageal peristalsis from 69.9 mmHg to 82.4 mmHg (p less than 0.01) and in the percentage of simultaneous waves from 9.7% to 24.5% (p less than 0.01). The cold pressor test increased the peristaltic amplitude from 69.9 mmHg to 87.1 mmHg (p less than 0.001) and the percentage of simultaneous waves from 9.7% to 34.4% (p less than 0.01). Both manoeuvres were associated with increases in pulse and blood pressure. In patients with irritable bowel syndrome, the resting mean oesophageal peristaltic amplitude was higher than that seen in normal volunteers (95.9 mmHg v 69.9 mmHg p less than 0.05). Changes in oesophageal motility during stress were similar in these patients to those seen in normal subjects although the changes were not significant. This study refutes the hypothesis that symptoms of irritable bowel syndrome and their association with stress are attributable to increased sensitivity of oesophageal motility to disruption by stressful stimuli.
Bentley SJ, Pearson DJ, Rix KJ. Food hypersensitivity in irritable bowel syndrome. Lancet 1983 Aug 6;2(8345):295-297.
Abstract: Food hypersensitivity as a cause of abdominal symptoms was investigated by means of exclusion diets and double-blind food provocation in patients with irritable bowel syndrome. Twenty-seven patients entered the study; nineteen complied with dietary manipulation. Food hypersensitivity as a cause of their presenting symptoms was confirmed by double-blind food provocation in only three patients, who also had evidence of associated atopic disease and positive skin tests to common inhalant allergens. Evidence of minor psychiatric disorder was found in twelve of fourteen patients examined by an independent psychiatrist.
Dancey CP, Fox R, Devins GM. The measurement of irritable bowel syndrome (IBS)-related misconceptions in people with IBS. J Psychosom Res. 1999 Sep;47(3):269-276.
Abstract: Irritable bowel syndrome (IBS) is a common chronic disorder affecting between 15% and 22% of Western populations; core symptoms include abdominal pain and disturbed bowel function. Adjusting to living with IBS may entail considerable coping effort and, because medical treatments are largely ineffective, people with IBS must learn to manage the condition themselves. Self-management programs that include an increased awareness of and information relating to chronic illness have been shown to lead to positive benefits. The present article describes the development of the IBS misconceptions scale, an instrument designed to measure the misconceptions held by people with IBS. The final 17-item questionnaire was able to differentiate between three groups expected to differ in terms of IBS-related misconceptions, and showed good validity and reliability. The IBS-MS may be a useful tool in patient education programs, because it should be sensitive to changes in illness-related knowledge gained during intervention programs, and it is hoped that further research will lend further support to its reliability, validity, and usefulness.
Dancey CP, Taghavi M, Fox RJ. The relationship between daily stress and symptoms of irritable bowel: a time-series approach. J Psychosom Res 1998 May;44(5):537-545.
Abstract: Irritable bowel syndrome (IBS), a chronic disorder that includes symptoms such as abdominal pain and altered bowel habits, affects up to 22% of people in Western populations. The causes of IBS are not well understood, but are believed to be multifactorial. Although stress is widely believed to be implicated, empirical evidence in support of this is lacking, perhaps because a typical between-participants analysis ignores individual differences and therefore may obscure any link. The present study used a within-person, lagged time-series approach to investigate the links between everyday stress and symptomatology in 31 IBS sufferers. Both everyday stress and symptomatology exhibited serial dependence for a statistically significant proportion of sufferers. Multiple regression analysis carried out on same-day and lagged relationships up to and including 4 days found that, for over half the participants, everyday stress and symptoms were related. The best regression model was one in which symptoms were a function of hassles and symptoms on the previous 2 days, and hassles on the same day, fitting the data for 67% of participants. This prospective study confirms other studies that have suggested stress is a significant factor in IBS, and concludes that stress management programs may be both useful and cost-effective in the treatment of IBS.
Dancey CP, Whitehouse A, Painter J, Backhouse S. The relationship between hassles, uplifts and irritable bowel syndrome: a preliminary study. J Psychosom Res. 1995 Oct;39(7):827-832.
Farah DA, Calder I, Benson L, Mackenzie JF. Specific food intolerance: its place as a cause of gastrointestinal symptoms. Gut 1985 Feb;26(2):164-168.
Abstract: Thirteen out of 49 patients suspected of having specific food intolerance after withdrawal and reintroduction of specific foods, were further subjected to double blind placebo controlled food challenges. Only three of these subjects were thus shown to have proven specific food intolerance. Of the remaining 10, nine were strong 'placebo reactors'. The study suggests that a small number of patients with gastrointestinal symptoms have verifiable specific food intolerance but that a greater number have symptoms attributable to psychogenic causes.
Francis CY, Houghton LA. Use of hypnotherapy in gastrointestinal disorders. Eur J Gastroenterol Hepatol. 1996 Jun;8(6):525-529. (Review)
Abstract: Medical history is full of anecdotal reports on the use of hypnosis in the treatment of gastrointestinal and other disorders. Unfortunately, much of the work published to date consists mainly of short case reports or involves small numbers of patients. They have, however, all broadly given the same message: that patients symptoms improve and they cope better with their condition after hypnotherapy. More recently, controlled trials have shown that patients with severe refractory irritable bowel syndrome or relapsing duodenal ulcer disease respond well to hypnotherapy. This article aims to give an overview of the areas in gastroenterology where hypnotherapy has been applied, discussing in particular what progress has been made in the area of irritable bowel syndrome.
Guthrie E, Creed F, Dawson D, Tomenson B. A randomised controlled trial of psychotherapy in patients with refractory irritable bowel syndrome. Br J Psychiatry. 1993 Sep;163:315-321.
Abstract: Patients with chronic, refractory irritable bowel syndrome (n = 102) were entered into a randomised controlled trial of psychotherapy versus supportive listening. Independent physical and psychological assessments were carried out at the beginning and end of the 12-week trial. For women, psychotherapy was found to be superior to supportive listening, in terms of an improvement in both physical and psychological symptoms. There was a similar trend for men, but this did not reach significance. Following completion of the trial, patients in the control group were offered psychotherapy; 33 accepted and following treatment experienced a marked improvement in their symptoms; ten declined. At follow-up one year later, those patients who had received psychotherapy remained well, patients who had dropped out of the trial were unwell with severe symptoms, and most of the controls who declined psychotherapy had relapsed. This study shows that psychotherapy is feasible and effective in the majority of irritable bowel syndrome patients with chronic symptoms unresponsive to medical treatment.
Guthrie E, Creed F, Dawson D, Tomenson BG. AA controlled trial of psychological treatment for the irritable bowel syndrome. Gastroenterology 1991 Feb;100(2):450-457.
Abstract: One hundred two patients with irritable bowel syndrome were studied in a controlled trial of psychological treatment involving psychotherapy, relaxation, and standard medical treatment compared with standard medical treatment alone. Patients were only selected if their symptoms had not improved with standard medical treatment over the previous 6 months. At 3 months, the treatment group showed significantly greater improvement than the controls on both gastroenterologists' and patients' ratings of diarrhea and abdominal pain, but constipation changed little. Good prognostic factors included overt psychiatric symptoms and intermittent pain exacerbated by stress, whereas those with constant abdominal pain were helped little by this treatment. This study has demonstrated that psychological treatment is feasible and effective in two thirds of those patients with irritable bowel syndrome who do not respond to standard medical treatment.
Harvey RF, Hinton RA, Gunary RM, Barry RE. Individual and group hypnotherapy in treatment of refractory irritable bowel syndrome. Lancet 1989 Feb 25;1(8635):424-426.
Abstract: 33 patients with refractory irritable bowel syndrome were treated with four 40-minute sessions of hypnotherapy over 7 weeks. 20 improved, 11 of whom lost almost all their symptoms. Short-term improvement was maintained for 3 months without further formal treatment. Hypnotherapy in groups of up to 8 patients was as effective as individual therapy.
Houghton LA. Sensory dysfunction and the irritable bowel syndrome. Baillieres Best Pract Res Clin Gastroenterol. 1999 Oct;13(3):415-427.
Abstract: Dysfunction of the sensory system of the gut is now generally believed to be important in the pathophysiology of irritable bowel syndrome (IBS). This disturbance may well account for some of the symptoms of the disorder, such as abdominal pain, by virtue of the fact that intra-lumenal events (e.g. contractions) may be 'sensed' more easily. It can be assessed in the laboratory by a variety of techniques, but usually involves measuring the patient's response to distension of any site of the gut, most commonly the rectum. Hypersensitivity is the most frequent finding, but hyposensitivity can also occur--hypersensitivity does not appear to be specific to any particular pattern of bowel habit, but hyposensitivity does tend to be generally only seen in patients with constipation, especially those with the 'no urge' type. Although there is some evidence to support hypersensitivity being related to enhanced vigilance in some patients, other data suggest that there may be a true alteration in sensory processing. The mechanisms underlying this sensory dysfunction remain to be elucidated, but could involve changes in either the enteric, spinal and/or central nervous systems. Finally, factors such as gender, stress, emotion and infection can all influence the sensitivity of the gut and may therefore play a role in IBS.
Houghton LA, Heyman DJ, Whorwell PJ. Symptomatology, quality of life and economic features of irritable bowel syndrome - the effect of hypnotherapy. Aliment Pharmacol Ther 1996 Feb;10(1):91-95.
Abstract: AIMS: The purposes of this study were to quantify the effects of severe irritable bowel syndrome on quality of life and economic functioning, and to assess the impact of hypnotherapy on these features. METHODS: A validated quality of life questionnaire including questions on symptoms, employment and health seeking behaviour was administered to 25 patients treated with hypnotherapy (aged 25-55 years; four male) and to 25 control irritable bowel syndrome patients of comparable severity (aged 21-58 years; two male). Visual analogue scales were used and scores derived to assess the patients' symptoms and satisfaction with each aspect of life. RESULTS: Patients treated with hypnotherapy reported less severe abdominal pain (P < 0.0001), bloating (P < 0.02), bowel habit (P < 0.0001), nausea (P < 0.05), flatulence (P < 0.05), urinary symptoms (P < 0.01), lethargy (P < 0.01), backache (P = 0.05) and dyspareunia (P = 0.05) compared with control patients. Quality of life, such as psychic well being (P < 0.0001), mood (P < 0.001), locus of control (P < 0.05), physical well being (P < 0.001) and work attitude (P < 0.001) were also favourably influenced by hypnotherapy. For those patients in employment, more of the controls were likely to take time off work (79% vs. 32%; p = 0.02) and visit their general practitioner ( 58% vs. 21%; P = 0.056) than those treated with hypnotherapy. Three of four hypnotherapy patients out of work prior to treatment resumed employment compared with none of the six in the control group. CONCLUSION: This study has shown that in addition to relieving the symptoms of irritable bowel syndrome, hypnotherapy profoundly improves the patients' quality of life and reduces absenteeism from work. It therefore appears that, despite being relatively expensive to provide, it could well be a good long-term investment.
Houghton LA, Whorwell PJ. Opening the doors of perception in the irritable bowel syndrome. Gut. 1997 Oct;41(4):567-568.
Thomson S, Dancey CP. Symptoms of irritable bowel in school children: prevalence and psychosocial effects. J Pediatr Health Care. 1996 Nov-Dec;10(6):280-285.
INTRODUCTION: This study was to ascertain the prevalence of symptoms of irritable bowel in a sample of school children 11 to 17 years of age and to determine whether children with such symptoms differed from children without symptoms on various psychosocial questions. METHOD: Eight hundred fifty-one school children completed a 20-item questionnaire consisting of questions related to symptoms of irritable bowel, psychosocial questions, and filler questions. Questions referred to a 1-week time frame to minimize memory distortion. RESULTS: Of the sample, 133 (16.2%) had one or more symptoms of irritable bowel. A significant association was found between bowel symptoms and other factors. Children with symptoms were more likely to report that they felt different from other children (chi 2 analysis = 10.06, p = 0.002), were embarrassed about their health (chi 2 analysis = 16.14, p = 0.0001), and felt their health prevented them from going out with their friends (chi 2 analysis = 4.69 p = 0.03). DISCUSSION: The study suggests that a large number of children have symptoms of irritable bowel and that having such symptoms can have a significant impact on children's lives beyond the immediate physical effects. Because children with symptoms of irritable bowel are likely to come to the attention of health professionals, nurses are in an ideal position to give such children both information and reassurance about their condition.
Waxman D. The irritable bowel: a pathological or a psychological syndrome? J R Soc Med 1988 Dec;81(12):718-720.
Abstract: The irritable bowel syndrome is discussed together with some of its theories, methods of investigation and various treatment regimens. Eight case histories are reported. In each patient, symptoms appeared to be precipitated by situations interpreted by that patient as stressful. A programme of prospective desensitization using hypnosis is described. Where symptoms of depression were additionally present, antidepressant medication was prescribed. This was subsequently phased out as and when indicated. Where patients had been taking antidiarrhoeal or antispasmodic drugs, various stool bulking agents or benzodiazepines, these were also slowly discontinued as treatment progressed. Cases were followed up from 3 months to 12 years. In 2 cases recurrence of symptoms was again successfully treated. There was no recurrence of any of the bowel symptoms in any other patient. The results support the view that the irritable bowel syndrome is psychogenic in origin.