UB psychologist: Behavioral treatment of irritable bowel syndrome provides significant relief across a wide range of IBS symptoms
By Chris Motola
Q: You’ve been researching a very unusual way to treat irritable bowel syndrome (IBS).
A: We’ve been working on developing treatments for IBS for the last 20 years. It’s funded by the National Institutes of Health. IBS is one of the most common gastrointestinal disorders and is a major source of quality of life impairments. And that quality of life impairment is aggravated by the lack of satisfactory dietary and medical treatments. As we’ve gotten to know more about how the brain and gut interact, we’ve learned that the brain not only can be a source of symptoms, but we can actually teach patients to gain control over and reducing their symptoms. The challenge has always been the accessibility of these treatments. There aren’t a lot of people who provide what’s called cognitive behavioral therapy for 10 to 20 weeks. In another study we found a very brief, home-based treatment was effective. We wanted to see if those results stood up with a larger group of patients. The results were very promising.
Q: What is IBS, exactly, symptoms notwithstanding?
A: I’m not sure we really know exactly what’s going on. It seems to be a problem with the way the brain and the gut communicate. When they’re working in tandem, patients don’t complain of symptoms, but if there’s any alteration of the brain-gut axis, it can influence some of the physical properties that underlay IBS, like motility and intestinal secretion.
Q: What do these techniques look like?
A: The strategies we focus on emphasize teaching skills that help patients process information more effectively. And that can include worry control, flexible problem solving, muscle relaxation training, being able to monitor their symptoms and staying ahead of flare-ups. And those are pretty effective at dampening the extent to which stress interrupts the brain-gut interaction.
Q: Are there problem foods, or is it more a matter of how what you eat makes you feel?
A: Our view is that there are a number of factors that can affect the way the brain and gut communicate. Hormonal factors are one. Diet is another. Stress is another. Diet is not really a big part of our treatment because when our work began there wasn’t a definitive diet that worked. There’ve been a lot of diets tried since, but I’m not sure we can teach them anything new in that area that they haven’t already tried.
Q: Are most IBS patients good candidates for this treatment?
A: Our response rate was about 50 – 60 percent, with those patients experiencing a significant reduction in symptoms. I think the people we see have fairly severe symptoms. If people are looking for a cure or fix from a medical point of view, they’d be disappointed with a behavioral approach, but the truth is they’d probably be disappointed with a dietary or medical approach because there’s no cure or fix to be had. I think the type of treatment we have provides significant relief across a wide range of IBS symptoms, unlike medications which are very specific to patients with specific types of bowel problems.
Q: Do you think this is indicative of their being a strong behavioral component to other chronic conditions?
A: I think the more we learn about the complexity of these pain disorders, I think therapeutic benefit of behavioral treatments will be more apparent. And I don’t mean in terms of coping with having a disease, but in getting to the core aspects of the illness itself.
Q: Do you think it’s fair to call these diseases at least partially psychosomatic, or is that too loaded a term?
A: Psychosomatic seems to suggest that it’s a physical manifestation of a psychiatric problem. IBS is a real medical problem that is more complicated than just saying it’s in their head.
Q: How much monitoring do patients need?
A: We saw these people only for four hours. Most of the treatment was done at home. Our follow-up data suggests that people in our treatments were able to retain their gains long after treatment, so people seem to be able to sustain it.
Q: As a researcher, how do you get this knowledge into the hands of patient-facing medical doctors and professionals?
A: I think you do it one patient at a time. I think you try to work with them and emphasize that our approach is to round things out, not to compete with physicians and dietitians. What we’re trying to do is target a mechanism that is beyond their reach.
Q: Where do you see this research headed from here?
A: The next big step forward would probably be to make it a more portable treatment. I think that could come in the form of a digital platform or an app that could help people who don’t live near a research center studying this.
Name: Jeffrey M. Lackner, PsyD
Position: Director of Behavioral Medicine Clinic at University of Buffalo
Hometown: Denver, Colo.
Education: Emory University; Rutgers University; College of William and Mary
Affiliations: University of Buffalo Jacobs School of Medicine and Biomedical Sciences
Family: Wife, two children
Hobbies: Music, reading, photography, travel
In the News
Psychologist Jeffrey Lackner, associate professor in the department of medicine at UB, is renowned for his research into innovative treatments for irritable bowel syndrome. In 2008 Lackner received $8.5 million from the National Institutes of Health (NIH) to conduct a seven-year, multi-site clinical trial of a program he developed. The program concluded in 2016. The trial was the largest to date and one of the largest behavioral trials funded by the NIH. Results showed that one-third of patients with IBS who undergo the treatment achieve significant relief within four weeks.