One of Laurie Keefer's patients was afraid to be a bridesmaid in a friend's wedding, others worried about traveling with the boss or even going to parties in peoples' homes.
The patients have ulcerative colitis, a nasty gastrointestinal disease that flares without warning and makes it vital for them to find a bathroom fast. The disease is often diagnosed when people are in their late 20s and early 30s. The flare-up is like having a severe stomach bug that can drag on for weeks. It ruins vacation plans, causes lengthy absences from work and generally messes up peoples' lives at a time when they are trying to build careers and meet a romantic partner or marry.
But some of Keefer's patients are less fearful these days and starting to embrace activities they once avoided. They've been taking part in a new National Institutes of Health (NIH) funded research study to test whether hypnotherapy can extend the time between their flare-ups. Currently, the treatments for ulcerative colitis, an inflammatory bowel disease, include a fistful of pills -- up to a cumbersome 12 a day that reduce the risk of flares but that many forget to take, as well as steroids or surgery to remove their colon.
In an early look at the data for the ongoing study, Keefer, a clinical health psychologist and an assistant professor of medicine at the Northwestern University Feinberg School of Medicine, is finding that treatment with hypnotherapy enabled some subjects' to socialize more and get involved in activities such as eating at restaurants, exercising and road trips. Some subjects feel less impaired by their disease and are better at remembering to take their pills.
The patient who was afraid to stand up at a friend's wedding is now going to be a bridesmaid. The patient who was nervous about getting on a plane with the boss is now taking business trips with him.
The study will be enrolling a total of 80 patients over three years and will track the progress of each patient for one year. Thus far, 27 subjects have enrolled in the study and completed the required eight weeks of hypnotherapy sessions. As a part of the study, subjects also listen to special relaxation tapes up to five times per week.
While it's too early in the study to know if the hypnotherapy has prolonged their remissions, only two of 12 subjects who have participated in the study for a full year have experienced a relapse, whereas based on their history, all 12 subjects would have been expected to have had two or more relapses within the year.
"These numbers are encouraging because the study specifically targets individuals who flare a couple times a year," Keefer said. Subjects are also expected to take their routine maintenance medication during the trial.
Keefer presented her findings recently at the Crohn's & Colitis Foundation of America's 13th Annual Medical Symposium and 14th Annual Patient and Family Conference in Chicago.
The goal of the trial is to see if hypnotherapy can help subjects learn to manage their stress and develop a sense of control over their health, explained Keefer, who is director of the Center for Psychosocial Research in Intestinal Bowel Disease at Northwestern's Feinberg School.
"Managing stress is really important for managing inflammatory bowel disease," Keefer said. "We see young adults about to get married, pregnant women, people worried about losing their jobs in this difficult economy. The body doesn't differentiate between good stress and bad stress. When people are under stress, their disease flares up."
In the experimental hypnosis sessions, Keefer suggests to subjects that they closely monitor their stress and be aware of how it's affecting them. "If they're not getting enough sleep, part of the hypnosis is encouraging them to know this is a trigger and make an effort to take naps and take it easier, " she said. "I also tell them your body can detect slight changes in stress and can adapt easily and not be affected."
The key issue is how confident subjects feel in their ability to manage their disease. "There is quite a bit of data in a variety of diseases that shows people who have a higher sense of control over their health feel better and have fewer symptoms than people who don't," Keefer said. "This is a proactive approach."
Keefer said the trial is one of the few NIH-funded behavioral studies for inflammatory bowel disease, which affects between 250,000 to 500,000 people in the U.S.
Her preliminary data on the overall quality of life for 27 subjects after eight weeks of hypnotherapy showed that 80 percent of them reported an increased belief that they could affect and manage their disease versus 50 percent of subjects in standard care (no hypnotherapy.) In addition, subjects reported a 76 percent increase in the quality of their lives (the improvements were most notable in their bowel symptoms) compared to a 25 percent increase for standard care. In another measure, 73 percent of the subjects experienced a general improvement in their health and well being compared to a 25 percent increase for standard care.
"The preliminary results on the improved quality of life for the 27 subjects in this ongoing study (aiming for a total of 80 subjects) look positive so far," Keefer said.
Once the eight weeks of hypnotherapy are completed, subjects are expected to listen to the relaxation tapes or practice relaxation twice a week to maintain the benefits. They are also encouraged to "step up their practice" of relaxation tapes if they think they are at risk for a flare, Keefer said.
Currently the treatment for the disease is a maintenance medication called 5-ASA. "The problem is most people forget to take the full dose," Keefer said. If that doesn't work steroids are often the next treatment, but long-term use can cause joint problems and other side effects such as anxiety and insomnia. When doctors try to taper the patient off steroids, symptoms tend to flare again.