Researchers Study Bowel Disorder

Monday, November 19th 2001, 12:00 am
By: News On 6

ALBANY, N.Y. (AP) _ Dawn Barsky always suspected that her bowel problems were triggered by stress. Now she knows how to ease her symptoms by changing the way she thinks and acts when faced with daily challenges.

``What it boils down to is, we have certain core beliefs that cause the fight-or-flight response, and that triggers the bowel symptoms,'' Barsky said.

Barsky is one of about 140 people who have participated in an ongoing clinical study of the effectiveness of cognitive-behavioral therapy for irritable bowel syndrome. The study is being done at sites in Albany and Buffalo.

Psychologist Edward Blanchard, director of the Center for Stress and Anxiety Disorders in Albany, was awarded a $1.98 million grant by the National Institutes of Health in 1999 to conduct the three-year study.

The center, affiliated with the State University at Albany, has been studying non-drug treatments for irritable bowel syndrome, or IBS, for almost 15 years. Several small-scale studies found cognitive-behavioral therapy fairly effective in easing symptoms, Blanchard said.

``Not everybody responds,'' he said. ``From these studies, we hope eventually to have a profile of who's a good candidate for this type of treatment and who is not.''

In the current study, 240 patients will be treated _ about half of them at the Albany center and half at the University of Buffalo. Each center has seen about 70 people so far.

``The point of the treatment is to have them take a step back, look at their lives and how IBS is interfering with it, and change their behavior so they can have as much of a normal life as possible,'' said Laurie Keefer, a doctoral candidate in clinical psychology who assesses potential participants.

The current study also will evaluate whether other trained psychologists get the same results with patients when they use the manual developed at the Albany clinic.

Irritable bowel syndrome, sometimes called spastic colitis, afflicts about 35 million Americans and is second only to the common cold as a cause of worker absenteeism, according to the International Foundation for Functional Gastrointestinal Disorders. Seventy-five percent of sufferers are women.

The syndrome is characterized by abdominal discomfort or pain, bloating, urgent bathroom needs, and diarrhea or constipation _ or alternating bouts of both. Diagnosis is made after similar conditions, such as Chrohn's Disease and ulcerative colitis, have been ruled out.

A patient's symptoms may vary, and may subside or worsen at various times over the years. Since the cause of IBS is not known, and symptoms are so variable, treatment is tricky.

Treatment strategies often involve stress management and dietary changes. Patients are advised to use fiber supplements such as Metamucil and to identify and avoid foods that trigger their symptoms.

Various medications, including pain relievers, antispasmodics, antidiarrheal agents, and antidepressants, may be prescribed. Medications help some patients but not others, Blanchard said.

The cognitive-behavioral approach used in the study involves 10 weekly sessions in small groups led by a therapist. Patients are directed to keep a journal to record patterns of negative, self-defeating reactions to stress, and then taught ways to change those patterns, Blanchard said.

Barsky, a 46-year-old medical technologist in Saratoga Springs, said she learned that her greatest source of stress arose from her core belief, ``I'm not good enough.'' She found that her perfectionism was constantly unleashing a torrent of self-recrimination.

``If I made a mistake, I'd have this running commentary in my head: 'Oh, you idiot! How could you be so stupid,''' Barsky said. ``I always knew I did that, but I didn't realize the extent of it.''

Barsky learned to change her internal message to something gentler, such as ``I made a mistake.''

The therapist also encouraged her to directly confront a supervisor at work rather than silently blaming herself for the conflicts they were having. ``That was extremely stressful to do, but it did lead to some inroads in our relationship in the office,'' she said.

Barsky's main symptom is severe constipation, and sometimes upper abdominal pain, she said. The symptoms improved after she quit a previous, highly stressful job. They worsened again when she was stressed out about her son's college applications last winter.

``One night, I had extreme upper abdominal pain. I thought I was dying. I couldn't even catch my breath,'' Barsky said. That incident was part of the reason she volunteered for the IBS study, she said.

Was the program a success?

``Absolutely,'' Barsky said. ``Just the information gained, the self awareness. I know it's helped my tension headaches.''

``Stress is the biggest element in this,'' said 65-year-old James Estramonte, who was in Barsky's therapy group. ``I'm the type of person who has stress and doesn't even recognize it. They made me aware of it.''

Estramonte and his wife make hand-painted lamps in Greenwich, 30 miles north of Albany. The program helped him see that by setting high production goals, he was creating stress needlessly.

``Now instead of telling myself I have to build 40 lamp parts today, I'll say I'll do what I can,'' Estramonte said.

The therapy didn't cure his constipation, but helped him find ways to avoid worsening the symptoms, he said.

``It's not as if you take a thought pill to stop your stomach from aching,'' Blanchard said. ``This is about making general changes to ward off symptoms.''