Photo by Mlenny; ©2007 Endeavors.

Click to read photo caption.

It’s Friday at six o’clock, and you can finally relax. Only the easy drive home remains. The roads are familiar and your car seems to almost drive itself, allowing you to daydream about your beach vacation — the sun, the sand, the soothing sound of waves. And then you turn into your driveway, unable to remember most of the drive home. Now you’re spooked. How did you make it home alive? Did your mind just wander a bit? Maybe. But maybe something else happened. You might’ve hypnotized yourself.

Sound weird? Well, it happens all the time. It’s called road hypnosis — a confluence of circumstances that allows the conscious mind to space out and the subconscious mind to take over. Drivers snap out of it if something disrupts them — an animal darting across the road, for instance. Usually, people slip out of road hypnosis as easily as they slipped into it. It just kind of happens.

“People think hypnosis is like sleep,” Carolina psychologist Olafur Palsson says. “But it’s not. It’s a very active state. If there was a therapist in the car talking to you, he could do something therapeutic.”

Like what?

Therapists have used hypnosis to help people quit smoking or reduce anxiety before surgery. Hypnosis has helped people feel less pain and bleed less during oral surgery, and then recover more quickly. It can even drastically reduce pain during childbirth.

And at UNC, Palsson researches how hypnosis helps patients with irritable bowel syndrome (IBS), a common but complex gastrointestinal malady with symptoms that include severe bloating, diarrhea, constipation, changes in bowel habits, and abdominal pain — the disorder’s cardinal symptom.

More than bellyaching

Between thirty million and forty million Americans have IBS, and many of them find no long-term relief in conventional treatments such as laxatives or antidiarrheals. Some people take over-the-counter pain medication or use hot-water bottles on their abdomen for temporary relief. Depending on the patient, pain sometimes comes and goes or is relieved by defecation. Other times, pain persists no matter what, which is one reason why IBS patients wind up visiting doctors twice as often as the average person. The syndrome is responsible for approximately $21 billion in annual health-care costs, and in a 2002 study, Carolina gastroenterologist Douglas Drossman found that people with IBS miss three times as many workdays as typical employees. In the most severe cases, patients have to take a job that they can work from home, or even drop out of school. When British gastroenterologist Peter Whorwell studied patients’ emotional states, he found that 38 percent of patients who had not benefited from typical treatments had contemplated suicide.

Whorwell, the first gastroenterologist to use hypnosis for IBS, says that nothing else he tried back in the early 1980s helped his IBS patients.

“I had two options,” he says. “Give up on patients or try something completely different. I thought it would be worth trying hypnotherapy.”

Four things have to happen to induce hypnosis and for it to be effective for IBS patients. They have to narrow their visual focus onto one thing, say, a spot on the ceiling (or the road ahead). Next, they have to become physically and emotionally relaxed. “Being ill at ease or anxious prevents a hypnotic state,” Palsson says. Third, they have to be open to hypnosis, and willing to just let things happen. If they don’t want to be hypnotized, they probably won’t be, and if they want to control how things will go, then hypnosis probably won’t work. Finally, they have to engage their imagination, using all the senses, such as smell and sound, while conjuring a picture of a calm, vivid scene.

A therapist uses verbal cues to guide patients through these four steps, and then gives patients suggestions to help them feel better. Toward the end of one of Palsson’s scripts for treating IBS, he tells patients: “Allow the relaxed and healthy feeling of the beach to fill your body as you continue to relax. Out on the beach on a beautiful day you are far away from all your troubles and cares. So far away from all discomfort.”

Then he links that beach scene to feelings inside the body.

“You may feel inside like nothing can disturb your deep comfort, like nothing can upset you inside or cause you discomfort or pain, that no troubles can get to you and that all discomfort disappears from your life. After you wake up from this state, you will most likely notice that you are carrying a deep sense of calm and comfort inside of you. In the next few days, you may notice that bowel sensations that would have been uncomfortable before do not bother you any longer. They bother you no more than the little sounds of small waves washing ashore with a steady rhythm when you are relaxing perfectly comfortably on a sunny beach.”

And this works?

Whorwell’s initial research showed that seven to twelve hypnosis sessions helped 71 percent of his patients feel substantially better — that is, they felt so much better that severe symptoms were turned into mild ones or went away completely, and IBS no longer affected their lifestyles or their psychological well-being for years.

Whorwell has used hypnosis with slightly better results ever since, and his findings have been substantiated by Palsson and his UNC co-investigators, who are the only team in the United States that’s researching hypnosis as an IBS treatment.

So how does it work?

Palsson says that patients under hypnosis are much more receptive to suggestions and don’t critique or shoot down ideas.

“So for IBS, we’re suggesting to patients that things should be experienced differently,” Palsson says. “Discomfort is noticed less and less. Instead, you pay attention to the positive and interesting things. So you are shifting attention away from bowel sensations that are uncomfortable.”

But if mere suggestions can alleviate pain, does that mean IBS is a psychological problem? Not exactly. Experts say that stress and anxiety can make IBS worse, but they don’t cause IBS. And according to Palsson’s research, hypnotic suggestions also change the way the gastrointestinal (GI) tract actually works. Pain goes away, and bowel habits improve. Figuring out why hasn’t been easy.

According to Palsson, two-thirds of IBS patients have an abnormally low threshold for pain in their bowel and have hyperactive smooth muscles in the GI tract. Patients also experience stronger intestinal contractions after eating food, Palsson says, and then they feel uncomfortable pressure on bowel walls. “So we thought maybe hypnosis reduces the pain sensitivity of the gut, or perhaps relaxes the smooth muscle of the gut.”

In one trial, Palsson and his colleagues measured patients’ pain sensitivity using a computer-controlled pump that inflated a balloon to certain pressures inside the gut. He tracked the pressure level to determine each patient’s pain threshold before and after hypnosis treatment, and found that patients’ pain sensitivity remained the same. Yet their clinical symptoms improved substantially after several hypnosis sessions.

Then he measured bowel muscle tone.

“We expected to see muscle relaxation after hypnosis, but we didn’t find any change there either,” Palsson says. Yet more than 80 percent of the patients improved markedly.

“Keep in mind that all these patients had tried many treatments that failed,” he says. “That’s what’s so exciting about this. A very benign treatment with no negative side effects, just using your imagination and concentration in a guided way, helps the great majority of patients who had not improved with regular medical care.”

Palsson then studied the nervous system’s role in GI function after hypnosis, but found no change in autonomic functions, such as heart rate, blood pressure, skin temperature, or skeletal muscle tension. He found only a slight difference in sweat gland activity. But again, more than 80 percent of patients showed dramatic improvement.

That leaves the mind-body connection. Brain imaging studies have shown that IBS patients are more prone than control subjects to process signals from the gut in brain centers that handle emotional and threatening information. Control subjects showed brain activity in another area of the brain that typically handles signals from the bowel. Drossman suggests that hypnosis might activate the pain-inhibition pathway from the brain through the spinal cord to the bowel, which has just as many nerves as the spinal cord.

But how the mind does this is still a mystery. So Palsson reminds patients that extremely nervous or anxious people feel butterflies in their bellies. Some folks blush when embarrassed. And a stressed person might get an upset stomach or even aggravate an ulcer.

“Almost everyone has experienced this mind-body relationship,” Palsson says. “But the idea that you can actually retune the way the brain controls your GI tract through hypnosis is a bit of a tough sell.”

But IBS patients who find no relief elsewhere often don’t mind trying something different, especially since hypnosis helps patients more than anything else, including cognitive behavior therapy and antidepressant medications. (See “Controlling the Pain,” right.)

Getting the word out

The problem is that patients, doctors, and specialists might not know about hypnosis for IBS treatment, or they might not consider it a viable option.

“The uptake hasn’t been very rapid,” says William Whitehead, who, along with Drossman, is co-director of UNC’s Center for Functional GI and Motility Disorders. “To some extent it’s prejudice against hypnosis. But also, gastroenterologists see themselves as dealing with physical diseases that can be investigated” — not the mind.

Palsson says, “As you can imagine, gastroenterology as a profession deals with the other end of the body, so to speak.”

The other problem is that doctors need specialized training to use hypnotherapy, and many patients and doctors don’t live near major academic medical centers that might use it. And complicating this, Whitehead says, is that hypnotherapists are usually not very knowledgeable about IBS, so they might feel uncomfortable receiving referrals from doctors who are trying to get help for IBS patients.

To address these problems, Palsson created the North Carolina Protocol, a seven-session hypnosis program based on the scripts he reads to patients during research trials. The protocol is free, but the UNC team shares it only with licensed health professionals trained in hypnosis. Palsson has also trained therapists nationwide. More than three hundred therapists use the protocol in the United States, including eleven North Carolina therapists, and it’s also used in seven other countries.

Sheryll Daniel, a clinical psychologist in Raleigh, has used Palsson’s protocol for about five years, and she says that hypnosis helped all of her patients. After seven sessions, some people felt fully cured. Others felt occasional mild bloating or pain, but nothing like the extreme symptoms they had experienced before hypnosis.

“I had one patient who had IBS for forty years,” she says. “Medication had helped her for a little while, but nothing helped long-term. But after seven hypnosis sessions, she felt much better.”

Palsson also created a series of compact discs that patients can listen to at home, although he found that this kind of treatment doesn’t work quite as well as seeing a therapist.

Like acupuncture, hypnosis has been around for thousands of years and is on the cusp of gaining traction as a mainstream treatment for physical ailments. (See Endeavors, Spring 2006, “Will your pain get the point?”)

“For centuries, we’ve separated the body from the mind when dealing with human beings, and I think that is fundamentally wrong,” Palsson says. “We’ve deprived ourselves of healing methods that are very effective and had been used widely before.”

Hypnosis, or focusing attention through various means, he says, is one of three ancient healing methods.

“Medicine, in a way, is the modern equivalent of herbal remedies,” Palsson says. “But another method is using the correct psychological state for healing. And we’re only starting to make full use of it again.”