Clinical Hypnosis in Pediatric Crohn's Disease

Inflammatory bowel disease (IBD), which includes Crohn's disease (CD) and ulcerative colitis
(UC), is a chronic, immune-mediated disease increasingly prevalent in youth. Patients with
IBD experience pain, fatigue, altered bowel habits, psychological distress, and reduced
quality of life. Regardless of disease activity, persistent pain and psychiatric
comorbidities both have a negative impact on quality of life. Alongside standard
pharmacologic and nutritional therapies, clinical hypnosis is a complementary therapy that
may improve physical and psychosocial outcomes in these patients. Clinical hypnosis consists
of guiding the patient into a relaxed and focused state and providing therapeutic suggestions
to induce desired physiologic and psychologic change. Children and adolescents are excellent
candidates for hypnosis by virtue of their vivid imaginations. Hypnosis is effective in
management of functional abdominal pain, irritable bowel syndrome, anxiety, chronic pain, and
distress related to medical procedures. To date, there are no clinical trials that evaluate
the effects of hypnosis in pediatric patients with IBD, but there is strong conceptual
support for its role in improving pain and psychological distress in these patients. In
addition to genetic, environmental, and microbial influences, a growing body of evidence
supports the role of a dysregulated brain-gut axis and chronic stress in IBD. Animal and
human studies demonstrate the effect of stress on the immune system and gastrointestinal
tract. Studies show that the benefits of hypnosis may extend to its role in increasing vagal
tone and regulating the immune system via the brain-gut axis. Adults with UC receiving a
hypnosis intervention demonstrated improved remission and decreased inflammatory markers.
Case series suggest that children with inflammatory bowel disease benefit from hypnosis, and
it can be safely and easily delivered via audio recordings. Patients with IBD are interested
in integrative therapies to reduce symptoms and improve quality of life, and a
biopsychosocial approach is essential in their care. The addition of hypnosis may improve
outcomes through influence on stress, inflammation, coping, symptom perception, and quality
of life.

The investigators hypothesize that pediatric patients with CD participating in a clinical
hypnosis intervention as an adjunct to standard of care will report improved quality of life
compared to a waitlist control group. The specific aims of the study are as follows: (1) To
implement hypnosis as an adjunctive therapy in adolescents with CD. (2) To evaluate the
impact of hypnosis in CD on measures of quality of life. (3) To evaluate the impact of
hypnosis in CD on pain, depression, anxiety, sleep, and coping.