Hypnotherapy has shown promising results in international studies for treatment of DGBI.
Gut-directed hypnotherapy for children is based on relaxation and imagery and sensation
exercises with a focus on gastrointestinal symptoms ("directed daydreams", which both
divert and provide a pleasant feeling in the body, which the child can use when the
symptoms come). The aim is to both improve awareness of and increase control over the
symptoms. Hypnotherapy is a safe treatment that has been shown to have minimal side
effects. The research group in the Netherlands with whom investigators collaborate in
this project has shown a significantly better effect in short and long term with
hypnotherapy than with conventional medical treatment for children and adolescents with
DGBI. Hypnotherapy via home-based self-exercises with audio files is proven as effective
as individual therapy performed face-to-face by a therapist.
Preliminary results/ backround work: Collaboration with the Dutch group started, the
treatment manual for gut-directed hypnotherapy has been translated into Swedish and has
undergone cultural validation by experienced child psychologists and has been recorded in
audiobook quality. The study website (where the families have access to the treatments
and measure the outcomes) has been created. Comprehensive patient information material
has been created about DGBI and hypnotherapy, which consists of both texts, films, and
audio to reach all patient types (Fig 1a-b). The pilot study is ongoing since Sep 2023.
Aim: To test the practical aspects concerning patient recruitment, information about
treatment, the treatment itself, measurement of outcome, required power for the main
outcome. The lessons learned will help investigators to fine-tune the protocol and give
the planned large RCT optimal conditions.
Study population: 30 patients (8-17 years, of which approximately half are 13-17 years)
from Sachsska Children's Hospital's Gastrointestinal Clinic and Pediatric and Adolescent
Medical Clinics in Stockholm, who are diagnosed with DGBI following Rome IV criteria.
Before inclusion, the families meet with a study physician and a study nurse for an
assessment of inclusion and exclusion criteria, for information about the study, and
review of treatment principles.
Exposure: Gut-directed hypnotherapy exercises 5 times/week, for 12 weeks, delivered via
audio files on the study's website (files can also be downloaded to mobile phone).
Outcome: At the beginning and end of the treatment and every third week during the
treatment, the patients and parents will fill in self-assessments in the form of
internationally validated questionnaires for symptom severity, quality of life, school
absence etc, via an internet platform with identification control (which we have worked
with in many previous projects). Improvement by >30% on the primary outcome measure is
defined as clinically significant, based on international recommendations.
Power: In several previous pilot studies, 30 patients have been sufficient to obtain
meaningfully tight confidence intervals for the outcome measures and to be able to
conclude for future RCTs. However, no formal power analysis is relevant without a
comparison group.