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Ulcerative ColitisNCT00553163

Hypnotherapy for Prevention of Relapse in Ulcerative Colitis: a Randomised, Single-blind, Controlled Clinical Trial

A study testing Gut focussed hypnotherapy in people with Ulcerative Colitis, run by Queen Mary University of London at 3 sites in United Kingdom.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

There is increasing evidence that worsening of ulcerative colitis (UC) can be provoked by psychological stresses. When this protocol was devised, there had been no proper scientific studies to find out whether stress reduction can improve the course of UC. Read more about this study

Who is it for?
Ages 16 to 75 years
Conditions the study is for
Ulcerative Colitis
What is being tested?
Gut focussed hypnotherapy
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
26 participants
Where
3 sitesUnited Kingdom
Study dates
Oct 2007to Apr 2010
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 16 to 75 years
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Who may be able to join

  • Inactive UC
  • Age 16-75 years
  • Minimum 1 year on Azathioprine or Mercaptopurine.
  • Simple Colitis Activity Index (SCCAI) score <3
  • Baron's sigmoidoscopic score <2 .
  • In remission for at least 3 months
  • No change to other maintenance therapy (including 5ASA) for at least 4 months

Who cannot join

  • Use of prednisolone orally or topically, or of topical 5ASA for at least 3 months Antibiotics, warfarin, anti-diarrhoeal drugs, non-steroidal anti-inflammatory drugs (NSAIDs), aspirin > 75 mg/day
  • Herbal remedies
  • Alcohol or drug abuse
  • Pregnancy or breast feeding
  • Female of child-bearing age not taking adequate contraception
  • Participation in another drug trial in the previous three months
  • Serious liver, renal, cardiac, respiratory, endocrine, neurological or psychiatric illness
  • Already use relaxation techniques or computerized feedback

Trial locations and contacts

3 sites in 1 country.

United Kingdom3 sites
  • Barts and The Royal London NHS Trust/Queen Mary University London/

    London, E1 1BB

  • University College Hospital London

    London, NW1 2BU

  • Guy's and St Thomas' NHS Trust

    London, SE1 7EH

Other trials in United Kingdom

About this study

There is increasing evidence that worsening of ulcerative colitis (UC) can be provoked by psychological stresses. When this protocol was devised, there had been no proper scientific studies to find out whether stress reduction can improve the course of UC. Hypnotherapy is a technique by which a practitioner induces a temporary trance-like state in patients: while they are in this state, the practitioner uses suggestion to induce relaxation as well as beneficial modification of the way in which the patient experiences the gut working. In previous studies in our lab, we have shown that a single 50 minute session of hypnosis can reduce special indicators of inflammation both in the blood-stream and in the lining of the lower bowel (rectum). Furthermore, in earlier work by others, hypnosis had been shown to be effective in the treatment of patients with irritable bowel syndrome, duodenal ulcer and indigestion unassociated with ulcers.

Many patients with UC need to take the immunosuppressive drug, azathioprine, in addition to a 5ASA drug, to keep their disease under control. While azathioprine is usually effective in maintaining remission of UC, it does require regular drug checks and carries the risk of possible side-effects. We undertook a study of hypnotherapy to see whether it can prevent relapse (worsening) of UC in patients who normally need to take azathioprine to keep their UC inactive. To do this, we planned to ask 66 patients who agreed to participate in the trial to stop their azathioprine. They were then to be allocated to receive either gut-focussed hypnotherapy (44 patients) or, as a control, non-emotive educational sessions (22 patients) once a month for 3 months, with intervening self-hypnosis daily in the active arm. The numbers of patients in each group who developed relapse of their UC in a year were recorded. We diagnosed relapse from patients' diaries recording diarrhoea and bleeding, and by sigmoidoscopy.

It was hoped that this clinical trial would identify a new drug-free way of reducing the chances of relapse in patients with UC.

Read the detailed description

SCIENTIFIC ABSTRACT There is increasing evidence that relapse of ulcerative colitis (UC) can be provoked by psychological stress. When this study was planned, there were no proper scientific studies to find out whether stress reduction can improve the course of UC. Hypnotherapy is a technique by which a practitioner induces a temporary trance-like state in patients: while they are in this state, the practitioner uses suggestion to induce relaxation as well as beneficial modification of the way in which the patient experiences the gut working. In previous studies in our lab, we had shown that a single session of hypnosis can reduce measures of inflammation at both systemic and rectal mucosal levels. Thus, 50 min of gut-focussed hypnosis reduced serum interleukin-6 (IL6) and non-killer (NK) cell numbers in circulating blood, as well as rectal mucosal release of interleukin-13 (IL13), substance P and histamine. Furthermore, in earlier work by others, hypnosis had been shown to be effective in the treatment of patients with irritable bowel syndrome, duodenal ulcer and indigestion unassociated with ulcers.

Many patients with UC need to take the immunosuppressive, azathioprine, in addition to a 5ASA, to keep their disease in remission. While azathioprine is usually effective in maintaining remission of UC, it does require regular drug checks and carries the risk of possible side-effects. We undertook a study of hypnotherapy to see whether it could prevent relapse of UC in patients who normally need to take azathioprine to keep their UC inactive. To do this, we planned to ask 66 patients who agreed to participate in the trial to stop their azathioprine. They were then to be allocated to receive either gut-focussed hypnotherapy (44 patients) or, as a control, non-emotive educational sessions (22 patients) once a month for 3 months, with intervening self-hypnosis daily in the active arm. We then recorded relapse rates in each group at 1 year. We diagnosed relapse from patients' diaries recording the Simple Clinical Activity Index, and by Baron score >1 at sigmoidoscopy.

It was hoped that this clinical trial would identify a new drug-free way of reducing the chances of relapse in patients with UC withdrawing from treatment with azathioprine.

Being tested
Gut focussed hypnotherapy, Control educational sessions
Keywords
Hypnotherapy, Prevention of relapse, ulcerative colitis
Medical subject headings
Colitis, Ulcerative

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Gut focussed hypnotherapyBehavioural

    Gut focussed hypnotherapy

  • Control educational sessionsBehavioural

    Control educational sessions

Study groups in NCT00553163
Study groupRoleWhat they receive
Gut-focussed hypnotherapy (GFH).Active comparatorGut-focussed hypnotherapy (GFH).
Receives: Behavioral: Gut focussed hypnotherapy
Educational sessionsSham comparatorRegular sessions to learn about UC from research nurse
Receives: Behavioral: Control educational sessions

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Relapse at 1 Year

    The number of patients suffering a relapse was compared between the two treatment groups, and was the primary outcome parameter of this study.

    Measured: 1 year

Secondary outcomes (4)
  1. Inflammatory Bowel Disease Questionnaire (IBDQ) at Week 13

    IBDQ (standard measure of IBD patients' Quality of life (QoL) (Irvine et al 1982 approx). The IBDQ is a validated and reliable tool to measure of health-related quality of life in adult patients with IBD. The questionnaire consists of 32 questions scored in four domains: bowel symptoms, emotional health, systemic systems and social function. Scores range from 1 (poorest QoL) to 7 (best QoL). Higher scores indicate better QoL. Lowest score 7, highest score 224.

    Measured: 13 weeks

  2. Hospital Anxiety and Depression Score-Anxiety, (HADSA) at Week 13

    Measure of anxiety, HADS Hospital anxiety and depression scale. HADS questionnaire consists of a 14 question validated questionnaire, developed to measure anxiety and depression in the hospital setting. Each item is answered by the patient on a four point (0-3) response category so the possible scores range from 0 (minimum) to 21 (maximum) for anxiety and 0 (minimum) to 21 (maximum) for depression. Higher scores indicate worse outcome,

    Measured: 13 weeks

  3. Hospital Anxiety and Depression Score-Depression (HADSD)

    Measure of depression. Each item is answered by the patient on a four point (0-3) response category so the possible scores range from 0 to 21 for anxiety and 0 to 21 for depression. Each item is answered by the patient on a four point (0-3) response category so the possible scores range from 0 (minimum) to 21 (maximum) for anxiety and (minimum) to 21 (maximum) for depression. Higher scores worse outcome.

    Measured: 13 weeks

  4. Perceived Stress Questionnaire-Recent (PSQ-R)

    Measure of recent psychological stress. THE PSQ R consists of a 30 question questionnaires: recent, in which the statements used apply to the last month in which used statements apply to the last two years (Appendix 1.3). The score for both recent and general stress levels were stated as the PSQ index ranging from 0 (non-stressed) to 0.99 (highly stressed). Higher scores indicate worse outcome.

    Measured: 13 weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted5 Nov 2007 (estimated)
  2. Study startOct 2007
  3. Primary completionApr 2010
  4. Study completionApr 2010

Why it stopped: Unable to recruit sufficient numbers of patinets in the time available

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Investigator
Enrolment
26 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT00553163
Sponsor's protocol ID
BMRP proposal no IBD 0213
Status last verified
Nov 2013
First submitted
2 Nov 2007
Last updated
28 Jun 2019
Data monitoring committee
Yes
Individual data sharing
No

Publications

  • Mawdsley JE, Rampton DS. Psychological stress in IBD: new insights into pathogenic and therapeutic implications. Gut. 2005 Oct;54(10):1481-91. doi: 10.1136/gut.2005.064261.

    PubMed 16162953
  • Bitton A, Sewitch MJ, Peppercorn MA, deB Edwardes MD, Shah S, Ransil B, Locke SE. Psychosocial determinants of relapse in ulcerative colitis: a longitudinal study. Am J Gastroenterol. 2003 Oct;98(10):2203-8. doi: 10.1111/j.1572-0241.2003.07717.x.

    PubMed 14572569
  • Levenstein S, Prantera C, Varvo V, Scribano ML, Andreoli A, Luzi C, Arca M, Berto E, Milite G, Marcheggiano A. Stress and exacerbation in ulcerative colitis: a prospective study of patients enrolled in remission. Am J Gastroenterol. 2000 May;95(5):1213-20. doi: 10.1111/j.1572-0241.2000.02012.x.

    PubMed 10811330
  • Garrett VD, Brantley PJ, Jones GN, McKnight GT. The relation between daily stress and Crohn's disease. J Behav Med. 1991 Feb;14(1):87-96. doi: 10.1007/BF00844770.

    PubMed 2038047
  • Greene BR, Blanchard EB, Wan CK. Long-term monitoring of psychosocial stress and symptomatology in inflammatory bowel disease. Behav Res Ther. 1994 Feb;32(2):217-26. doi: 10.1016/0005-7967(94)90114-7.

    PubMed 8155059
  • Mawdsley JE, Macey MG, Feakins RM, Langmead L, Rampton DS. The effect of acute psychologic stress on systemic and rectal mucosal measures of inflammation in ulcerative colitis. Gastroenterology. 2006 Aug;131(2):410-9. doi: 10.1053/j.gastro.2006.05.017.

    PubMed 16890594
  • Farhadi A, Keshavarzian A, Van de Kar LD, Jakate S, Domm A, Zhang L, Shaikh M, Banan A, Fields JZ. Heightened responses to stressors in patients with inflammatory bowel disease. Am J Gastroenterol. 2005 Aug;100(8):1796-804. doi: 10.1111/j.1572-0241.2005.50071.x.

    PubMed 16086717
  • Ewer TC, Stewart DE. Improvement in bronchial hyper-responsiveness in patients with moderate asthma after treatment with a hypnotic technique: a randomised controlled trial. Br Med J (Clin Res Ed). 1986 Nov 1;293(6555):1129-32. doi: 10.1136/bmj.293.6555.1129.

    PubMed 3094804
  • Langewitz W, Izakovic J, Wyler J, Schindler C, Kiss A, Bircher AJ. Effect of self-hypnosis on hay fever symptoms - a randomised controlled intervention study. Psychother Psychosom. 2005;74(3):165-72. doi: 10.1159/000084001.

    PubMed 15832067
  • Friedman H, Taub HA. The use of hypnosis and biofeedback procedures for essential hypertension. Int J Clin Exp Hypn. 1977 Oct;25(4):335-47. doi: 10.1080/00207147708415989. No abstract available.

    PubMed 892940
  • Horne DJ, White AE, Varigos GA. A preliminary study of psychological therapy in the management of atopic eczema. Br J Med Psychol. 1989 Sep;62(3):241-8. doi: 10.1111/j.2044-8341.1989.tb02832.x.

    PubMed 2675960
  • Shertzer CL, Lookingbill DP. Effects of relaxation therapy and hypnotizability in chronic urticaria. Arch Dermatol. 1987 Jul;123(7):913-6.

    PubMed 3300566
  • Whorwell PJ, Prior A, Faragher EB. Controlled trial of hypnotherapy in the treatment of severe refractory irritable-bowel syndrome. Lancet. 1984 Dec 1;2(8414):1232-4. doi: 10.1016/s0140-6736(84)92793-4.

    PubMed 6150275
  • Gonsalkorale WM, Houghton LA, Whorwell PJ. Hypnotherapy in irritable bowel syndrome: a large-scale audit of a clinical service with examination of factors influencing responsiveness. Am J Gastroenterol. 2002 Apr;97(4):954-61. doi: 10.1111/j.1572-0241.2002.05615.x.

    PubMed 12003432
  • Zijlstra FJ, van den Berg-de Lange I, Huygen FJ, Klein J. Anti-inflammatory actions of acupuncture. Mediators Inflamm. 2003 Apr;12(2):59-69. doi: 10.1080/0962935031000114943.

    PubMed 12775355

Questions about this trial

What is this clinical trial studying?

A study testing Gut focussed hypnotherapy in people with Ulcerative Colitis, run by Queen Mary University of London at 3 sites in United Kingdom.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 7 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: stopped early, as of the sponsor's last update on 28 Jun 2019. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 3 sites in United Kingdom. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 28 Jun 2019). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Relapse at 1 Year (time frame: 1 year). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT00553163, which also lists 44 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 28 Jun 2019.

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