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Initial consultation

Initial consultation. Patient: seeking/not seeking HT Stage hypnosis Not a psychological treatment Not probing for psychological problems Hidden memories No regression Forward looking Loss of control - more control Boundaries. Therapy. First session (tutorial, no HT)

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Initial consultation

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  1. Initial consultation • Patient: seeking/not seeking HT • Stage hypnosis • Not a psychological treatment • Not probing for psychological problems • Hidden memories • No regression • Forward looking • Loss of control - more control • Boundaries

  2. Therapy First session (tutorial, no HT) IBS multifactorial extra intestinal symptoms over-reactive gut motility sensitivity symptoms of the individual HT prejudices must practice/musical instrument depth not essential Chevreuls pendulum medication Start symptom diary

  3. Laminate muscle activity before hypnotherapy after hypnotherapy

  4. Laminate gut less sensitive gut more sensitive after hypnotherapy before hypnotherapy

  5. Second session standard hypnosis test for visualisation ego strengthening symptom diary practice with tape/disc Third session as above

  6. Fourth session gut focused hand on abdomen visualise river practice with gut focused tape/disc Subsequent sessions gut focused extra-intestinal symptoms avoid other issues symptom diary (compare with start) practice

  7. Problem patients (1) Sceptical (no problem) Not wanting to improve Negative Patient/therapist interaction Too eager Passive First relapse

  8. Problem patients (2) Regular meetings Unusual reactions New information Suicidal ideation New symptoms Education

  9. Suicide dataSuicidal ideation in primary, secondary,tertiary care IBS and IBD patients • primary care secondary care tertiary care active • group (pIBS) group (sIBS) group (tIBS) IBD • Mean age 43.1 49.2 51.1 45.8 • Suicidal thoughts concerning • disease % 4 16 38 15 • Attempted suicide because of • disease % 0 0 5 1 • Mean anxiety score 8.3 9.7 10.6 8.7 • Mean depression score 4.1 6.3 8.3 5.6 • Symptoms rated as severe % 21 57 70 40 • Substantial interference with life % 11 54 71 41 • Treatment considered adequate % 65 48 36 64 Clin Gastro Hepatol 2004 (in press)

  10. Suicide dataSuicidal ideation in primary, secondary,tertiary care IBS and IBD patients • primary care secondary care tertiary care active • group (pIBS) group (sIBS) group (tIBS) IBD • Mean age 43.1 49.2 51.1 45.8 • Suicidal thoughts concerning • disease % 4 16 38 15 • Attempted suicide because of • disease % 0 0 5 1 • Mean anxiety score 8.3 9.7 10.6 8.7 • Mean depression score 4.1 6.3 8.3 5.6 • Symptoms rated as severe % 21 57 70 40 • Substantial interference with life % 11 54 71 41 • Treatment considered adequate % 65 48 36 64 Clin Gastro Hepatol 2004 (in press)

  11. Suicide dataSuicidal ideation in primary, secondary,tertiary care IBS and IBD patients • primary care secondary care tertiary care active • group (pIBS) group (sIBS) group (tIBS) IBD • Mean age 43.1 49.2 51.1 45.8 • Suicidal thoughts concerning • disease % 4 16 38 15 • Attempted suicide because of • disease % 0 0 5 1 • Mean anxiety score 8.3 9.7 10.6 8.7 • Mean depression score 4.1 6.3 8.3 5.6 • Symptoms rated as severe % 21 57 70 40 • Substantial interference with life % 11 54 71 41 • Treatment considered adequate % 65 48 36 64 Clin Gastro Hepatol 2004 (in press)

  12. Suicide dataSuicidal ideation in primary, secondary,tertiary care IBS and IBD patients • primary care secondary care tertiary care active • group (pIBS) group (sIBS) group (tIBS) IBD • Mean age 43.1 49.2 51.1 45.8 • Suicidal thoughts concerning • disease % 4 16 38 15 • Attempted suicide because of • disease % 0 0 5 1 • Mean anxiety score 8.3 9.7 10.6 8.7 • Mean depression score 4.1 6.3 8.3 5.6 • Symptoms rated as severe % 21 57 70 40 • Substantial interference with life % 11 54 71 41 • Treatment considered adequate % 65 48 36 64 Clin Gastro Hepatol 2004 (in press)

  13. Problem patients (2) Regular meetings Unusual reactions New information Suicidal ideation New symptoms Education

  14. Other strategies patient Different images Care: nice for you - ? nice for patient with words phobias non prescriptive Assertive approach therapist

  15. Concomitant Medications Antispasmodics Antidiarrhoeals Antidepressants Laxatives

  16. Audit Symptom scores HAD scores QOL scores Aliment Pharm Ther 1997;11:395-402

  17. Key components (1) Calm, peaceful, relaxed Mind becoming stronger More positive, less negative Overcome anything Hand on tummy (correlates) No symptoms …(repetitive) Triplets

  18. Key components (2) Determined to get better You’re in control of gut, not gut in control of you Tummy source of pleasure Set backs will not stop progress Everything in harmony Every system working naturally

  19. Key components (3) Gut cannot be upset by anything Think of gut as river Road to recovery When wake up - continued improvement Reinforce with tape or disc Wake up

  20. IBS referral Investigation positive diagnosis Dietary advice (fibre, other foods, cephalic phase) Antispasmodics (laxatives & antidiarrhoeals) adequate response no response follow up hypnotherapy adequate response no response yearly follow up regular follow up IgG exclusion, pain control

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