Treating IBS, Starting in the Head

How cognitive behavioral therapy can alter brain-gut interaction, providing real relief without medical intervention.

illustration of mind body relationship.

People with irritable bowel syndrome (IBS) may try restrictive diets, probiotics, antibiotics or even fecal transplants to treat the worst effects of the common gastrointestinal disorder. Now there’s new promise in a different, much less intensive approach: cognitive behavioral therapy, or CBT.

Although CBT was originally developed to treat depression and anxiety disorders, a special type developed at the University at Buffalo has been shown to provide IBS symptom improvement in even the most severe cases, according to Jeffrey Lackner, professor and chief of Behavioral Medicine in UB’s Jacobs School of Medicine and Biomedical Sciences.

How mind conquers matter

CBT is a psychological treatment that teaches skills for changing faulty or unhelpful ways of thinking. Previous research by Lackner and others has shown that learning-based treatments like CBT can deliver real relief from IBS symptoms, with little or no doctor involvement.

The approach is known to be safe, convenient and low cost, and can spare patients the ordeal of intensive medical interventions. What scientists haven’t understood, however, was the exact mechanism by which the treatment worked.

The role of the microbiome

A recent joint study by Lackner’s team and researchers at UCLA revealed that the therapy has the power to modulate key components of the brain-gut-microbiome axis.

For many patients, stress cranks up IBS by disrupting brain-gut interactions, explained Lackner. These interactions are regulated in part by the gut microbiome. By teaching patients information-processing skills, they are actually addressing the biophysical drivers of treatment-resistant symptoms.

 “The fact that we see patient-reported symptom improvements that correspond with ‘objective’ biological changes in the microbiome and brain function is pretty remarkable,” said Lackner.

Targeted effectiveness

Because the patients in the study who responded to the treatment showed greater baseline connectivity between the central autonomic network and the emotional regulation network, the findings raise the possibility that CBT-responsive IBS patients can be identified in clinical practice using microbial biomarkers.

“This is paradigm-shifting for how we understand the role of the microbiome and therapeutics that can modify its composition,” said Lackner, whose work is motivated by a desire to advance beyond simplistic ways of treating chronic medical conditions, which are neither fully physical nor fully mental. Acknowledging that complexity, he said, allows science to move away from “a one-size-fits-all brand of medicine toward a more personalized medicine approach.”