Research (various)

Below are hypnosis research abstracts related to various health issues.

Some of the abstracts come from PubMed.gov, which is on the website of the NIH (National Institutes of Health). If you’re a research fan, it’s a great site with advanced search options. If you have any questions about how hypnosis helps people with health conditions, feel free to contact me.

Hypnosis for Asthma—a Controlled Trial
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1912142
Br Med J 1968; 4 doi: http://dx.doi.org/10.1136/bmj.4.5623.71 (Published 12 October 1968)
Cite this as: Br Med J 1968;4:71

A Report to the Research Committee of the British Tuberculosis Association

Abstract
An investigation of hypnosis in asthma was made among patients aged 10 to 60 years with paroxysmal attacks of wheezing or tight chest capable of relief by bronchodilators. One group of patients was given hypnosis monthly and used autohypnosis daily for one year. Comparisons were made with a control group prescribed a specially devised set of breathing exercises aimed at progressive relaxation.

Treatment was randomly allocated and patients were treated by physicians in nine centres. Results were assessed by daily diary recordings of wheezing and the use of bronchodilators, and by monthly recordings of F.E.V.1 and vital capacity. At the end of the year independent clinical assessments were made by physicians unaware of the patients’ treatment.

There were 252 patients (127 hypnosis and 125 controls) accepted for analysis, but a number of them did not continue the prescribed treatment for the whole year: 28 hypnosis and 22 control patients failed to co-operate, left the district, or had family problems; one hypnosis and one control patient died. Seven hypnosis and 17 control patients were withdrawn as treatment failures, the difference between the two groups being statistically significant.

As judged by analyses based on the daily “score” of wheezing recorded in patients’ diaries, by the number of times bronchodilators were used, and by independent clinical assessors, both treatment groups showed some improvement.

Among men the assessments of wheezing score and use of bronchodilators showed similar improvement in the two treatment groups; among women, however, those treated by hypnosis showed improvement similar to that observed in the men, but those given breathing exercises made much less progress, the difference between the two treatment groups reaching statistical significance. Changes in F.E.V.1 and V.C. between the control and hypnosis groups were closely similar.

Independent clinical assessors considered the asthma to be “much better” in 59% of the hypnosis group and in 43% of the control group, the difference being significant There was little difference between the sexes. Physicians with previous experience of hypnosis obtained significantly better results than did those without such experience.

Hypnosis for symptom management in women with breast cancer: a pilot study.
http://www.ncbi.nlm.nih.gov/pubmed/22443523
Int J Clin Exp Hypn. 2012;60(2):135-59. doi: 10.1080/00207144.2012.648057.
Jensen MP, Gralow JR, Braden A, Gertz KJ, Fann JR, Syrjala KL.
University of Washington School of Medicine, Seattle, WA 98104, USA.

Abstract
Eight women who were in treatment for breast cancer (n = 4) or breast cancer survivors (n = 4), presenting with 1 or more of 4 symptoms (chronic pain, fatigue, hot flashes, and sleep difficulties), were given 4 to 5 sessions of self-hypnosis training for symptom management.

Analyses revealed (a) significant pre- to posttreatment decreases in pain intensity, fatigue, and sleep problems and (b) that pain intensity continued to decrease from posttreatment to 6-month follow-up. Although there was a slight increase in fatigue severity and sleep problems from posttreatment to 6-month follow-up, the follow-up scores did not return to pretreatment levels.

The findings provide initial support for using hypnosis to manage symptoms in women who are breast cancer survivors. Clinical trials evaluating hypnosis efficacy over and above other treatments are warranted.

A hypnotherapy intervention for the treatment of anxiety in patients with cancer receiving palliative care.
http://www.ncbi.nlm.nih.gov/pubmed/22399044
Int J Palliat Nurs. 2012 Feb;18(2):69-75.
Plaskota M, Lucas C, Evans R, Cook K, Pizzoferro K, Saini T.
Princess Alice Hospice, Esher, Surrey, UK.

Abstract
This pilot study aimed to assess the benefits of hypnotherapy in the management of anxiety and other symptoms, including depression and sleep disturbance, in palliative care patients with cancer.

Eleven hospice patients received four sessions of hypnotherapy and completed the Hospital Anxiety and Depression Scale, the Edmonton Symptom Assessment System, and the Verran and Snyder-Halpern Scale at set time points. Wrist actigraphy also provided an objective assessment of sleep quality.

After the second hypnotherapy session there was a statistically significant reduction in mean anxiety and symptom severity, but not in depression or sleep disturbance. After the fourth session there was a statistically significant reduction in all four patient-reported measures but not in actigraphy.

These results offer evidence that hypnotherapy can reduce anxiety in palliative care patients, as well as improving sleep and the severity of psychological and physical symptoms. Further studies are needed to explore whether the observed benefits were a direct result of the hypnotherapy and how the intervention could most benefit this patient population.

Control of Respiratory Motion by Hypnosis Intervention during Radiotherapy of Lung Cancer I.
http://www.ncbi.nlm.nih.gov/pubmed/24093100
Biomed Res Int. 2013;2013:574934. doi: 10.1155/2013/574934. Epub 2013 Sep 4.
Li R, Deng J, Xie Y.
Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences
1068 Xueyuan Anenue, Shenzhen University Town, Shenzhen 518055, China.

Abstract
The uncertain position of lung tumor during radiotherapy compromises the treatment effect. To effectively control respiratory motion during radiotherapy of lung cancer without any side effects, a novel control scheme, hypnosis, has been introduced in lung cancer treatment.

In order to verify the suggested method, six volunteers were selected with a wide range of distribution of age, weight, and chest circumference. A set of experiments have been conducted for each volunteer, under the guidance of the professional hypnotist.

All the experiments were repeated in the same environmental condition. The amplitude of respiration has been recorded under the normal state and hypnosis, respectively.

Experimental results show that the respiration motion of volunteers in hypnosis has smaller and more stable amplitudes than in normal state. That implies that the hypnosis intervention can be an alternative way for respiratory control, which can effectively reduce the respiratory amplitude and increase the stability of respiratory cycle. The proposed method will find useful application in image-guided radiotherapy.

From mental power to muscle power–gaining strength by using the mind.
http://www.ncbi.nlm.nih.gov/pubmed/14998709
Neuropsychologia. 2004;42(7):944-56.
Ranganathan VK, Siemionow V, Liu JZ, Sahgal V, Yue GH.

Abstract
The purposes of this project were to determine mental training-induced strength gains (without performing physical exercises) in the little finger abductor as well as in the elbow flexor muscles, which are frequently used during daily living, and to quantify cortical signals that mediate maximal voluntary contractions (MVCs) of the two muscle groups.

Thirty young, healthy volunteers participated in the study. The first group (N = 8) was trained to perform “mental contractions” of little finger abduction (ABD); the second group (N = 8) performed mental contractions of elbow (ELB) flexion; and the third group (N = 8) was not trained but participated in all measurements and served as a control group.

Finally, six volunteers performed training of physical maximal finger abductions. Training lasted for 12 weeks (15 min per day, 5 days per week). At the end of training, we found that the ABD group had increased their finger abduction strength by 35% (P < 0.005) and the ELB group augmented their elbow flexion strength by 13.5% (P < 0.001).

The physical training group increased the finger abduction strength by 53% (P < 0.01). The control group showed no significant changes in strength for either finger abduction or elbow flexion tasks.

The improvement in muscle strength for trained groups was accompanied by significant increases in electroencephalogram-derived cortical potential, a measure previously shown to be directly related to control of voluntary muscle contractions.

We conclude that the mental training employed by this study enhances the cortical output signal, which drives the muscles to a higher activation level and increases strength.

Hypnosis integrated in burn care: impact on the healthcare team’s stress.
[Article in French]
http://www.ncbi.nlm.nih.gov/pubmed/24073477
Rev Med Suisse. 2013 Sep 11;9(397):1646-9.
Bertholet O, Davadant M, Cromec I, Berger MM.
Faculté de biologie et de médecine UNIL, Lausanne.

Abstract
Hypnosis for burn care was introduced in 2004 in the CHUV burn center showing great benefit for burned patients. Whereas advantages of hypnosis for the patient are well established, the impact on the medical staff remains poorly assessed.

This manuscript reviews current attested benefits of hypnosis for patients, specially for burned patients. The results of a recent study assessing the impact of hypnosis on the staffs level of stress caused by burn treatment, will also be introduced.

The effects of hypnosis on anxiety, depression, fatigue, and sleepiness in people undergoing hemodialysis: a clinical report.
http://www.ncbi.nlm.nih.gov/pubmed/23957264
Int J Clin Exp Hypn. 2013;61(4):475-83. doi: 10.1080/00207144.2013.810485.
Untas A, Chauveau P, Dupré-Goudable C, Kolko A, Lakdja F, Cazenave N.
Laboratoire de Psychopathologie et Processus de Santé EA 4057, Université Paris Descartes, Sorbonne Paris City, Boulogne-Billancourt, France.

Abstract
This study investigated the effect of hypnosis on anxiety, depression, fatigue, and sleepiness in hemodialysis patients. Twenty-nine patients participated in the 15-day study. A single hypnosis session was performed on Day 8.

Anxiety, depression, fatigue, and sleepiness were measured at baseline, on Day 8, and on Day 15 (HADS, MFI, ESS). Daily fatigue was also measured numerically.
Anxiety, depression, and sleepiness significantly decreased after hypnosis. Weekly measures of fatigue remained stable; however, daily fatigue decreased.

Systematic review: the effectiveness of hypnotherapy in the management of irritable bowel syndrome.
http://www.ncbi.nlm.nih.gov/pubmed/16918880
Aliment Pharmacol Ther. 2006 Sep 1;24(5):769-80.
Wilson S, Maddison T, Roberts L, Greenfield S, Singh S; Birmingham IBS Research Group.
Division of Primary Care, Public & Occupational Health, Department of Primary Care and General Practice, University of Birmingham, Edgbaston, Birmingham, UK.

Abstract

AIM:
To systematically review the literature evaluating hypnotherapy in the management of irritable bowel syndrome (IBS).

METHODS:
Electronic databases were searched (Cochrane Library, Medline, CINAHL, AMED, Embase, PsycINFO, CISCOM, TRIP and the Social Science Citation index), bibliographic references scanned and main authors contacted.

No restrictions were placed on language or publication year. Eligible studies involved adults with IBS using single-component hypnotherapy. All studies, except single case or expert opinion, were sought and all patient-related outcomes eligible.

RESULTS:
Out of 299 unique references identified, 20 studies (18 trials of which four were randomized, two controlled and 12 uncontrolled) and two case series were eligible. These tended to demonstrate hypnotherapy as being effective in the management of IBS. Numbers of patients included were small. Only one trial scored more than four out of eight on internal validity.

CONCLUSION:
The published evidence suggests that hypnotherapy is effective in the management of IBS. Over half of the trials (10 of 18) indicated a significant benefit.

A randomized placebo-controlled trial of high internal validity is necessary to establish the effectiveness of hypnotherapy in the management of IBS. Until such a trial is undertaken, this form of treatment should be restricted to specialist centres caring for the more severe forms of the disorder.

Nurse-led hypnotherapy: an innovative approach to Irritable Bowel Syndrome.
http://www.ncbi.nlm.nih.gov/pubmed/23890461
Bremner H.
Complement Ther Clin Pract. 2013 Aug;19(3):147-52. doi: 10.1016/j.ctcp.2013.01.001.
Epub 2013 Mar 23.
178 Attingham Drive, Dudley DY1 3HY, UK.

Abstract

INTRODUCTION:
Irritable Bowel Syndrome (IBS) is a common, chronic functional illness, which can greatly reduce patients’ quality of life, and consumes healthcare resources. Standard treatments include dietary changes and medication, though these are often ineffective.

RESEARCH:
Clinical studies of hypnotherapy demonstrate improvement in symptoms and quality of life in over 80% of subjects with intractable IBS. Our experience of a nurse-led hypnotherapy service for IBS in a community setting provides evidence of comparable efficacy for symptom control, improved quality of life, reduced dependence on medication and improved general health measures. We address the challenges of setting up and maintaining the service in a changing healthcare environment.

CONCLUSION:
This model of care could act as a template for providers of gastroenterology and functional disease services wishing to provide IBS care.

Case reports: Designing and delivering a hypnotherapy service for irritable bowel syndrome in primary care
http://fg.bmj.com/content/3/3/210.abstract
Frontline Gastroenterol 2012;3:210-215 doi:10.1136/flgastro-2011-100095
Helen Bremner
Community Clinical Nurse Hypnotherapist, Sandwell Primary Care Trust, Kingston House, 438 High Street, West Bromwich, B70 9LD, UK.
Contributors Dr Nigel Trudgill reviewed previous drafts of the manuscript and suggested the use of the Wilcoxon signed rank test for data analysis.

Abstract
Evidence-based guidelines recommend hypnotherapy as a treatment option for intractable irritable bowel syndrome (IBS). However, few National Health Service (NHS) hypnotherapy services are in place. We report the experiences and results from the only NHS-funded primary care service for IBS hypnotherapy in England (as identified by a telephone audit of 151 Primary Care Trusts (PCT) in England in February 2011).

The service was delivered by a full-time nurse hypnotherapist, commissioned and funded by a PCT. In 18 months, 119 patients have been seen. Validated scoring tools showed improvement in quality of life and symptom severity scores, with improvement in all domains following therapy.

This case study illustrates both the clinical effectiveness of hypnotherapy in the treatment of IBS delivered by a nurse hypnotherapist and some of the challenges faced when setting up this service. This paper summarises aspects of a model of care that could act as a template for service providers wishing to deliver hypnotherapy for IBS.

Long-term effects of hypnotherapy in patients with refractory irritable bowel syndrome
http://informahealthcare.com/doi/abs/10.3109/00365521.2012.658858
Scandinavian Journal of Gastroenterology, April 2012, Vol. 47, No. 4 , Pages 414-421 (doi:10.3109/00365521.2012.658858)
Perjohan Lindfors(1,3,4), Peter Unge(6), Henry Nyhlin(5), Brjánn Ljótsson(7), Einar S. Björnsson(1), Hasse Abrahamsson(1) & Magnus Simrén(1,2)

1 Department of Internal medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
2 University of Gothenburg, Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
3 Department of Gastroenterology, Sabbatsbergs Hospital, Stockholm, Sweden
4 Department of Gastroenterology, Gävle county Hospital, Gävle, Sweden
5 Department of Gastroenterology, Karolinska University Hospital, Stockholm, Sweden
6 Department of Gastroenterology, Örebro University Hospital, Sweden
7 Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden

Abstract

Objective
Gut-directed hypnotherapy is considered to be an effective treatment in irritable bowel syndrome (IBS) but few studies report the long-term effects.
This retrospective study aims to evaluate the long-term perceived efficacy of gut-directed hypnotherapy given outside highly specialized hypnotherapy centers.

Methods
208 patients, who all had received gut-directed hypnotherapy, were retrospectively evaluated. The Subjective Assessment Questionnaire (SAQ) was used to measure changes in IBS symptoms, and patients were classified as responders and non-responders.

Patients were also asked to report changes in health-care seeking, use of drugs for IBS symptoms, use of alternative non-pharmacological treatments, and if they still actively used hypnotherapy.

Results
Immediately after hypnotherapy, 103 of 208 patients (49%) were responders and 75 of these (73%) had improved further at the follow-up 2–7 years after hypnotherapy (mean 4 years).

A majority of the responders still used hypnotherapy on a regular basis at follow-up (73%), and the responders reported a greater reduction in health-care seeking than non-responders. A total of 87% of all patients reported that they considered gut-directed hypnotherapy to be worthwhile, and this differed between responders and non-responders (100% vs. 74%; p < 0.0001).

Conclusion
This long-term follow-up study indicates that gut-directed hypnotherapy in refractory IBS is an effective treatment option with long-lasting effects, also when given outside highly specialized hypnotherapy centers. Apart from the clinical benefits, the reduction in health-care utilization has the potential to reduce the health-care costs.

Long-term follow-up of gut-directed hypnotherapy vs. standard care in children with functional abdominal pain or irritable bowel syndrome.
http://www.ncbi.nlm.nih.gov/pubmed/22310221
Am J Gastroenterol. 2012 Apr;107(4):627-31. doi: 10.1038/ajg.2011.487. Epub 2012 Feb 7.
Vlieger AM, Rutten JM, Govers AM, Frankenhuis C, Benninga MA.
Department of Pediatrics, St Antonius Hospital, Nieuwegein, The Netherlands.

Abstract

OBJECTIVES:
We previously showed that gut-directed hypnotherapy (HT) is highly effective in the treatment of children with functional abdominal pain (FAP) and irritable bowel syndrome (IBS). Aim of this follow-up study was to investigate the long-term effects of HT vs. standard medical treatment plus supportive therapy (SMT).

METHODS:
All 52 participants of our previous randomized controlled trial (RCT) were invited to complete a standardized abdominal pain diary, on which pain frequency and pain intensity were scored. Furthermore, the Children’s Somatization Inventory (CSI) and a general quality of life (QOL) questionnaire were filled out. Clinical remission was defined as > 80% improvement in pain scores compared with baseline.

RESULTS:
All 27 HT patients and 22 out of 25 SMT patients participated in this study. Two patients of the SMT group were lost to follow-up and one refused to participate. After a mean duration of 4.8 years follow-up (3.4-6.7), HT was still highly superior to conventional therapy with 68 vs. 20% of the patients in remission after treatment (P = 0.005).

Pain intensity and pain frequency scores at follow-up were 2.8 and 2.3, respectively, in the HT group compared with 7.3 and 7.1 in the SMT group (P < 0.01). Also, somatization scores were lower in the HT group (15.2 vs. 22.8; P = 0.04). No differences were found in QOL, doctors’ visits, and missed days of school or work between the two groups.

CONCLUSIONS:
The beneficial effects of gut-directed HT are long lasting in children with FAP or IBS with two thirds still in remission almost 5 years after treatment, making it a highly valuable therapeutic option.

Effects of gut-directed hypnotherapy on IBS in different clinical settings-results from two randomized, controlled trials.
http://www.ncbi.nlm.nih.gov/pubmed/21971535
Am J Gastroenterol. 2012 Feb;107(2):276-85. doi: 10.1038/ajg.2011.340. Epub 2011 Oct 4.
Lindfors P, Unge P, Arvidsson P, Nyhlin H, Björnsson E, Abrahamsson H, Simrén M.
Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

Abstract

OBJECTIVES:
Gut-directed hypnotherapy has been found to be effective in irritable bowel syndrome (IBS). However, randomized, controlled studies are rare and few have been performed outside highly specialized research centers. The objective of this study was to study the effect of gut-directed hypnotherapy in IBS in different clinical settings outside the traditional research units.

METHODS:
The study population included IBS patients refractory to standard management. In study 1, patients were randomized to receive gut-directed hypnotherapy (12 sessions, 1 h/week) in psychology private practices or supportive therapy, whereas patients were randomized to receive gut-directed hypnotherapy in a small county hospital or to serve as waiting list controls in study 2. Gastrointestinal symptom severity and quality of life were evaluated at baseline, at 3 months follow-up and after 1 year.

RESULTS:
We randomized 138 IBS patients refractory to standard management, 90 in study 1 and 48 in study 2. In both the studies, IBS-related symptoms were improved at 3 months in the gut-directed hypnotherapy groups (P<0.05), but not in the control groups (ns). In study 1, a significantly greater improvement of IBS-related symptom severity could be detected in the gut-directed hypnotherapy group than in the control group (P<0.05), and a trend in the same direction was seen in study 2 (P=0.17). The results seen at 3 months were sustained up to 1 year.

CONCLUSIONS:
Gut-directed hypnotherapy is an effective treatment alternative for patients with refractory IBS, but the effectiveness is lower when the therapy is given outside the highly specialized research centers.

Boosting human learning by hypnosis.
http://www.ncbi.nlm.nih.gov/pubmed/22459017
Cereb Cortex. 2013 Apr;23(4):801-5. doi: 10.1093/cercor/bhs068. Epub 2012 Mar 29.
Nemeth D, Janacsek K, Polner B, Kovacs ZA.
Institute of Psychology, School of Medicine, University of Szeged, Szeged 6722, Hungary.

Abstract

Human learning and memory depend on multiple cognitive systems related to dissociable brain structures. These systems interact not only in cooperative but also sometimes competitive ways in optimizing performance. Previous studies showed that manipulations reducing the engagement of frontal lobe-mediated explicit attentional processes could lead to improved performance in striatum-related procedural learning. In our study, hypnosis was used as a tool to reduce the competition between these 2 systems.

We compared learning in hypnosis and in the alert state and found that hypnosis boosted striatum-dependent sequence learning. Since frontal lobe-dependent processes are primarily affected by hypnosis, this finding could be attributed to the disruption of the explicit attentional processes.

Our result sheds light not only on the competitive nature of brain systems in cognitive processes but also could have important implications for training and rehabilitation programs, especially for developing new methods to improve human learning and memory performance.

Suggestion in the treatment of depression.

http://www.ncbi.nlm.nih.gov/pubmed/23488249
Am J Clin Hypn. 2013 Jan;55(3):221-9.
Kirsch I, Low CB.
University of Plymouth, Plymouth, United Kingdom.

Abstract
Meta-analyses consistently reveal that most of the response to antidepressant treatment can be obtained by placebo, and the difference between response to the drug and the response to any treatment is not clinically significant for most individuals diagnosed with major depressive disorder. Furthermore, the best predictor of antidepressant efficacy is the response to placebo during the so-called placebo run-in period.

It can also be shown that a significant portion of the placebo effect is expectancy. These data thus indicate that suggestion is a central factor in treating depression. Therefore, the use of hypnosis, which is based on suggestion, as a treatment adjunct can be expected to enhance treatment outcome.

Controlled outcome studies of child clinical hypnosis.
http://www.ncbi.nlm.nih.gov/pubmed/24165457
Acta Biomed. 2013 Sep 1;84(2):94-7.
Adinolfi B, Gava N.
Milton Erickson Institute, Torino, Italy.

Abstract

Background
Hypnosis is defined as “as an interaction in which the hypnotist uses suggested scenarios (“suggestions”) to encourage a person’s focus of attention to shift towards inner experiences”.

Aim of the work
The focus of this review is to summarize the findings of controlled outcome studies investigating the potential of clinical hypnosis in pediatric populations. We will examine the following themes: anesthesia, acute and chronic pain, chemotherapy-related distress, along with other specific medical issues.

Results
Hypnosis is an effective method to reduce pain and anxiety before, during and after the administration of anesthetics, during local dental treatments, invasive medical procedures and in burn children.

Hypnosis can be successfully used to manage recurrent headaches, abdominal pain, irritable bowel syndrome and chemotherapy-related distress. Hypnosis has an important role in managing symptoms and improving the quality of life of children suffering from asthma and cystic fibrosis and in facilitating the treatment of insomnia in school-age children.

Finally, hypnosis can be effectively used for the treatment of some habitual disorders such as nocturnal enuresis and dermatologic conditions, including atopic dermatitis and chronic eczema.

Conclusions
Clinical hypnosis seems to be a useful, cheap and side-effects free tool to manage fear, pain and several kinds of stressful experiences in pediatric populations. Children who receive self-hypnosis trainings achieve significantly greater improvements in their physical health, quality of life, and self-esteem.

Psychological treatments in functional gastrointestinal disorders: a primer for the gastroenterologist.
http://www.ncbi.nlm.nih.gov/pubmed/18801190
Clin Gastroenterol Hepatol. 2013 Mar;11(3):208-16; quiz e22-3. doi: 10.1016/j.cgh.2012.10.031. Epub 2012 Oct 24.
Palsson OS, Whitehead WE.
Center for Functional Gastrointestinal and Motility Disorders, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7080, USA.

Abstract
The functional gastrointestinal disorders (FGIDs) often show inadequate response to usual medical care. Psychological treatments can help improve functional gastrointestinal disorder patient outcomes, and such treatment should be considered for patients who have moderate or severe symptoms after 3-6 months of medical care and those whose symptoms are clearly exacerbated by stress or emotional symptoms.

Effective psychological treatments, which are based on multiple randomized controlled trials, include cognitive behavioral therapy and hypnosis for irritable bowel syndrome and pediatric functional abdominal pain, cognitive behavioral therapy for functional chest pain, and biofeedback for dyssynergic constipation in adults.

Successful referral by the gastroenterologist for psychological treatment is facilitated by educating the patient about the rationale for such treatment, reassurance about the diagnosis and continuation of medical care, firm doctor-patient therapeutic alliance, and identification of and communication with an appropriate psychological services provider.

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