From the message board of the British Society of Clinical Hypnosis
I was just wondering how many hypnotherapists here have actually treated anyone for refractory IBS? I have. Once.
I ask because two hypnotherapists wrote to me last month about NICE ‘recognising’ hypnotherapy as a ‘psychological intervention’, and the last BSCH newsletter referred to Bill Doult’s excellent blog on the same subject.
Several things strike me as curious about this.
Firstly, why now?
The NICE guidelines were published in February 2008 (not Feb 2010). They say:
“1.2.3 Psychological interventions
1.2.3.1 Referral for psychological interventions (cognitive behavioural therapy [CBT], hypnotherapy and/or psychological therapy) should be considered for people with IBS who do not respond to pharmacological treatments after 12 months and who develop a continuing symptom profile (described as refractory IBS).
1.2.4 Complementary and alternative medicine (CAM )
1.2.4.1 The use of acupuncture should not be encouraged for the treatment of IBS.
1.2.4.2 The use of reflexology should not be encouraged for the treatment of IBS.”*
Secondly, I think we ought to be quite careful how we choose to interpret this.
On the strength of the extract from the guidelines above, I have seen it argued that “… hypnotherapy is not classified as a Complementary Therapy by … the National Institute for Health and Clinical Excellence (NICE)”. Is that really what it says? Surely, the thing it isn’t being classified as is a complementary or alternative “medicine”. Surely we’ve never thought of ourselves as purveyors of medicine, have we? Under “Psychological interventions” it lists CBT, as well as hypnotherapy and psychological therapy. I do not imagine that caused all the cognitive behavioural therapists to go off and proclaim that they are no longer complementary or alternative anything but are now psychological interventionsists. CBT is CBT. It was before February 2008 and it is now. And hypnotherapy is hypnotherapy. Nothing has changed.
Thirdly, so what? I admit it’s speculation only on my part but my guess is that refractory IBS is a tiny, insignificant part of the average hypnotherapist’s caseload. What I’m not guessing at is that no PCT in the country is going to pay for anyone here to treat it. Unless you are, or work for, Prof Whorwell the NHS will not finance the treatment of refractory IBS (for reasons which have been rehearsed elsewhere on this board).
There are some other aspects of the NICE findings that may be of interest to members.
“Hypnotherapy: A deep state of relaxation is achieved through focused attention.”**
Oh well. As the report wasn’t written by hypnotherapists I don’t suppose we can complain too much that they think hypnotherapy is a deep state of relaxation but, apparently, no state of hypnosis. (I know – a lot of hypnotherapists think that too.)
“Psychological interventions: The treatment of any condition by psychological means. This may utilise insight, persuasion, suggestion, reassurance, and instruction so that patients may see themselves and their problems more realistically and have the desire to cope effectively with them. There are many different psychological interventions, these include psychotherapy, biofeedback, cognitive behavioural therapy, family therapy, hypnotherapy, interpersonal therapy and psychodynamic therapy.”**
This looks like woolly thinking to me. Isn’t psychodynamic therapy a subset of psychotherapy? It’s like saying ‘Pets include fish, dogs, cats, poodles, birds, Labradors …’ Of course, patient’s seeing themselves and their problems more realistically is an entirely conscious activity and doesn’t require hypnosis (communication with the non-conscious mind) at all.
“The costs of hypnotherapy were based on the mean number and duration of sessions used in the Whorwell (1984) and Galoviski (1998) studies, weighted by their contribution to the meta-analysis. This gave a mean duration of 3.6 hours of hypnotherapy. As there were only two studies used to estimate the RR, the cost range was based on the range from the various studies included in the clinical effectiveness review (2.2 – 4.9 hours). This gave a total cost for hypnotherapy of £171, (range £105 - £237).”**
So, even if we were going to be paid by the NHS to treat refractory IBS, we’d be paid £171 for 3.6 hours (£47.50/hour) to relieve a condition that 12 months traditional NHS treatment had not helped. I wonder how realistic this is.
In summary then, I suspect that NICE’s acknowledgement of hypnotherapy as a possible long-shot in the treatment of refractory IBS is something of a red herring. One might argue that NICE recognition for anything takes us out of the mumbo-jumbo smoke and mirrors closet and into the professional light. If that were true, however, hypnotherapy would be recognised as a frontline intervention in a whole host of physiological and psychological issues for which NICE ignores hypnotherapy completely.
The question, therefore, isn’t so much ‘what can we do to leverage NICE’s recognition of hypnotherapy as a treatment for refractory IBS?’ but ‘what can we do to get NICE to recognise all the other conditions for which hypnotherapy is a reasonable treatment option?’
Best wishes
Barry Thain
Clinical Hypnotist
* NICE clinical guideline 61 “Irritable bowel syndrome in adults. Diagnosis and management of irritable bowel syndrome in primary care.”
** Clinical practice guideline - Irritable bowel syndrome in adults: Diagnosis and management of irritable bowel syndrome in primary care. National Collaborating Centre for Nursing and Supportive Care, commissioned by National Institute for Health and Clinical Excellence, February 2008
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