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UB clinic studies brain-stomach link

By Scott Scanlon

Refresh Editor

Are you the kind of person who loses it when you’re caught in traffic?

Are you pretty good at solving problems but really bad when the problem is beyond your control to fix?

Do you internalize your frustrations – so much so that it has led to ongoing problems in your gastrointestinal tract?

Take heart, all you Type A personalities who answered yes to all of those questions. Jeffrey M. Lackner feels your pain, and he has spent the last decade searching for better treatment options for what bugs you.

Lackner, 51, a Denver native and “health psychologist,” is director of the University at Buffalo Behavioral Medicine Clinic, part of the University at Buffalo School of Medicine.

“The clinic,” he says, “is really designed to understand the relationship between behavior and chronic medical conditions, particularly painful ones: GI disease, low back pain, noncardiac chest pain, benign headache.”

Lackner and clinic associates have spent the last 10 years, with support of the National Institutes of Health, studying how best to treat Irritable Bowel Syndrome, a chronic condition that afflicts up to 50 million Americans.

The clinic, along with Northwestern University, is on the front end of one of the largest clinic trials ever involving IBS treatment options. Those 18 and over interested in participating can call 898-4458. It’s free and you can be compensated for your time. You must agree to be followed for a year.

Q. I’ve had people tell me, ‘I had IBS 10 years ago and I’m horrified it’s going to flare up again.’ What is this disease marked by?

A. The symptoms can come and go over a long period of time. It’s like any chronic illness, like epilepsy, or hypertension, or asthma or arthritis, problems that don’t lend themselves to a simple fix.

The goal is to help patients manage it better, whether it’s through dietary changes or medications or learning very practical, concrete skills to gain control.

We know physiologically that there is this two-way street between the brain and the gut. We know that when those brain-gut interactions are dis-regulated, problems can arise that can involve abdominal pain, cramping, diarrhea, constipation or both. We also know because those neuroconnections are a two-way street, you can actually recalibrate those connections by teaching patients different ways of thinking and behaving.

Q. If somebody has struggled with this, do you have a couple of suggestions?

A. One thing we’re interested in is understanding how patients process information and what role that plays in increasing symptoms. We know that patients with IBS have a tendency to worry more intensely. When that happens, symptoms can flare up. So the goal is being able to kind of learn how to gain control of that process so it works for them, instead of working against them.

Q. Are we talking about meditation? Breathing exercises?

A. One set of skills is designed to teach people to break down physical tension and we do teach people very practical muscle relaxation skills, and the other is to reduce the mental tension that can disrupt brain-gut interactions, and that’s why they’re learning more about IBS or gaining control over worry or problem solving more effectively.

Q. What behavior are we talking about and what are the more effective ways of dealing with IBS?

A. Somebody who has a Type A personality, that can really be very effective in certain situations. That Type A personality might not be useful if you’re caught in a traffic jam late for a meeting, because your body might only respond in a way that aggravates your symptoms. So being able to help patients understand how stressful events impact the way we think, which sets in motion a cascade of physical, emotional and behavioral reactions, is really important, and then using that information to be able to unlearn habits that get the best of patients.

One of our treatments emphasizes problem solving, which is kind of ironic because our patients are very good at problem solving. But where they sometimes struggle is in knowing where to solve problems and where to step back and say, “Hold it, there’s only so much I can do to solve this problem. So getting a patient to be more flexible in adopting a problem-solving response is a really important skill that is part of one of our treatments.

But in another part of our treatment we emphasize the importance of learning more about symptoms, information and support, which is also very effective.