A Cross-Institution Protocol for Virtual, Transdiagnostic, Group Gut-Directed Hypnotherapy
abstract
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Access this abstract now Full Text Available for ClinicalKey SubscribersGut-directed hypnotherapy (GDH) is an evidence-based intervention for numerous gastrointestinal (GI) conditions. Although much of the literature focuses on its use for refractory irritable bowel syndrome (IBS), research also supports its use across other disorders of gut-brain interaction (DGBI) and for sustaining remission in ulcerative colitis. GDH involves a verbally guided induction of a “trance-like” state, followed by autogenic (ie, self-generated) relaxation, visualization, and suggestions for alterations in gut-related sensations and perceptions as well as cognitive, behavioral, and emotional responses. Historically, the most widely used protocol for GDH has been Olafur Palsson’s North Carolina protocol. This scripted protocol was originally designed for IBS and has since been adapted to other DGBIs. The protocol involves a hypnosis-trained clinician delivering a course of 7 biweekly GDH sessions, traditionally individually and in person. Patients receive a self-hypnosis audio recording to practice at home at least 5 times per week.
In recent years, various factors have contributed to a growing demand for GDH. The overall prevalence of GI conditions is increasing, with ∼40% of the worldwide population experiencing a DGBI. There is also greater recognition of the biopsychosocial model in DGBIs, the importance of psychologists in the care of patients with GI conditions, and increasing demand for behavioral health services as a whole. Recently, researchers have demonstrated not only that hypnosis can be delivered effectively in groups, but that redesigning GI behavioral health programs to include more group treatment options can improve the timeliness of treatment delivery and increase the number of patients served. The COVID-19 pandemic also motivated providers to create novel ways to increase access to treatment; to support these changes, we demonstrated that virtual, transdiagnostic GDH groups are feasible and acceptable to patients.
In particular, adaptation of the North Carolina protocol to a virtual (ie, telehealth based), transdiagnostic group format involved numerous changes, made iteratively, across several years of clinical practice. Herein, we present changes to the original protocol that we have tested and successfully implemented at 4 GI behavioral health programs within academic medical centers. We also present the specific rationale behind each of these changes (Table 1) and describe several practices that one might consider in the development of a virtual, transdiagnostic GDH group.
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A Cross-Institution Protocol for Virtual, Transdiagnostic, Group Gut-Directed Hypnotherapy
Gastroenterology 2024 May 01;166(5)918-920.e2, JK Salwen-Deremer, J Gerson, KN Tomasino, MR Craven, AU Pandit, OS PalssonFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Gut-directed hypnotherapy (GDH) is an evidence-based treatment for IBS, and preliminary research supports its use across the spectrum of disorders of gut–brain interaction (DGBI), including functional dyspepsia and functional esophageal conditions. There has been growing interest in GDH treatment by both patients and providers over the past decade owing to an increased awareness of the important role of brain–gut processes contributing to DGBI. The field of psychogastroenterology is rapidly expanding; however, access to GI psychology services such as GDH remains limited.
The authors of the current paper outline their approach for delivering group-based GDH at four large academic medical centers. They describe adaptations to an evidence-based GDH protocol for IBS that allows for telehealth-based delivery applied across gastrointestinal conditions and symptoms (“transdiagnostic”). The primary aim of this approach is to improve access to care at their institutions where there are typically long wait times for services. This protocol provides a helpful model for expanding GDH treatment to reach a larger number of patients and provides practical tools (eg, screening questionnaire) for clinicians wishing to implement similar models of care in their practice.
As this group-based, transdiagnostic GDH treatment modality becomes more widely available, further research is needed to examine its efficacy compared with that of traditional, individualized treatment. Although research has demonstrated effectiveness of in-person group-based GDH for IBS, no studies to date have reported on the effectiveness of a virtual, transdiagnostic approach. It will be important to understand whether we sacrifice effectiveness by adapting the treatment so that it can be applied more broadly (eg, using transdiagnostic hypnotherapy suggestions vs diagnostic-specific suggestions).
Overall, this approach is encouraging and an important step forward in improving access to GDH, an effective nonpharmacological treatment option for patients with DGBI.