Brain Response to Expectation and Delivery of Rectal Distensions Before and After Hypnotherapy and Education Intervention in Irritable Bowel Syndrome (IBS) : an fMRI Study

• Aim & MethodsWe aimed to determine the effect of standardized hypnosis treatment (HYP) on symptom outcomes and brain activity compared to an education intervention (EDU). Twenty-seven women with IBS were evaluated before and after treatment with hypnotherapy (n=17) or educational intervention (n=10). Behavioural treatment outcomes were determined by Severity Scoring System (IBS-SSS). A decrease of 50 points in SSS score was considered clinically significant treatment response. Blood oxygenated level dependent (BOLD) signal were acquired by using a 1.5 T magnetic resonance scanner during expectation and delivery of large rectal distension (45 mmHg). Group comparisons of treatment effects were performed within the general linear model in SPM8. Region of interest analyses were performed with significance threshold of p<0.05, family-wise error corrected.ResultsThere were no group differences in baseline SSS scores. Clinically significant change in SSS was observed in HYP (82%, n=14) and EDU (60%, n=6). Mean improvement in SSS was 108 (range -277 to 29) in HYP and 62 (range -250 to 79) in EDU (ns). During cued expectation of rectal distension, HYP was associated with significantly decreased activation in the left dorsal and ventral anterior insula, left mid insula, left ventrolateral prefrontal cortex (vlPFC) and left dorsolateral prefrontal cortex (dlPFC). Respectively, the EDU group showed less BOLD activity in the left ventral anterior insula after treatment. No significant treatment effect on brain response to the 45 mmHg distension was observed.ConclusionWhile both treatments improve IBS symptoms, the standardized hypnosis treatment has a more widespread central effect compared to education. The brain effects are seen during the expectation of rectal discomfort, but not during the experience of aversive rectal distensions. These findings are consistent with a HYP-induced reduction in pain expectation, rather than pain perception

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