Comparison of Digitally Delivered Gut-Directed Hypnotherapy Program With an Active Control for Irritable Bowel Syndrome

Abstract

INTRODUCTION: Gut-directed hypnotherapy (GDH) treats irritable bowel syndrome (IBS), but its accessibility is limited. This problem may be overcome by digital delivery. The aim of this study was to perform a randomized control trial comparing the efficacy of a digitally delivered program with and without GDH in IBS. METHODS: Adults with IBS were randomized to a 42-session daily digital program with the GDH Program (Nerva) or without (Active Control). Questionnaires were completed to assess gastrointestinal symptoms through IBS Symptom Severity Scale (IBS-SSS), quality of life, and psychological symptoms (Depression Anxiety and Stress Scale-21) at regular intervals during the program and 6 months following the conclusion on the intervention. The primary end point was the proportion of participants with ≥50-point decrease in IBS-SSS between the interventions at the end of the program. RESULTS: Of 240/244 randomized participants, 121 received GDH Program—the median age 38 (range 20–65) years, 90% female, IBS-SSS 321 (interquartile range 273–367)—and 119 Active Control—36 (21–65), 91% female, IBS-SSS 303 (255–360). At program completion, 81% met the primary end point with GDH Program vs 63% Active Control (P = 0.002). IBS-SSS was median 208 (interquartile range 154–265) with GDH and 244 (190–308) with control (P = 0.004), 30% reduction in pain was reported by 71% compared with 35% (P < 0.001), and IBS quality of life improved by 14 (6–25) compared with 7 (1–15), respectively (P < 0.001). Psychological status improved similarly in both groups. DISCUSSION: A digitally delivered GDH Program provided to patients with IBS was superior to the active control, with greater improvement in both gastrointestinal symptoms and quality of life and provides an equitable alternative to face-to-face behavioral strategies.