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Innovative Cognitive Behavioural Therapy for Irritable Bowel Syndrome: What is it and does it work?

Prof. Jeffrey Lackner

Thursday, 26 September 2024


Irritable bowel syndrome (IBS) is the most common gastrointestinal (GI) disorder, accounts for considerable personal suffering, is costly and largely refractory to medical therapies. Its physical symptoms (abdominal pain with diarrhea or constipation) commonly co-occur with psychological (e. g. GAD, depression) and somatic (e.g., low back pain, headache) complaints. IBS has been variously understood as an intestinal motility disorder or, in the absence of positive diagnostic testing, a product of an untreated psychiatric disorder.  Inadequate empirical support for these models has led to an understanding of IBS as a biopsychosocial (BPS) problem that implicates a person’s biology, cognitive processes and learned behaviors (that influence GI symptoms IBS through their interaction with each other and with the environment. The model suggests several points of intervention in the treatment of IBS.  Clinical trials that have adopted a BPS (Everitt et al, 2018; Lackner et al, 2018) have established CBT as a gold standard psychological treatment, yielding substantial, rapid, broad (e.g., symptom relief, improved mental and physical functioning), and sustained symptom improvement that compares favorably to pharmacological agents.

The event will be equivalent to 2.3/4hrs of CPD.


After a brief overview of the nature of IBS (e.g., definition, diagnostic criteria), this workshop will describe the conceptual underpinnings of CBT for IBS, its rationale, evidence-base, goals as well as technical components and procedures using didactic instruction and detailed case examples from actual patients enrolled in a landmark NIH trial (Lackner, Jaccard, et al., Gastroenterology, 2018) that helped establish CBT’s status as one of the most widely endorsed empirically validated psychological treatment (Black. et al., GUT, 2020).  Attendees will learn practical strategies to trouble shoot around difficult clinical issues (e.g., troubleshooting compliance) to maximize outcomes, engage patients more fully in treatment procedures, and enhance patient (and clinician) satisfaction.

Learning Objectives

1. Understand the nature and symptoms of IBS as well as its economic and personal burden.
2. Explain differences and similarities between CBT for IBS and other behavioral approaches
3. Understand the conceptual basis for CBT for IBS with a focus on actionable cognitive and behavior processes that maintain core gastrointestinal symptoms.
4. Learn how to implement core CBT techniques to improve IBS symptoms and quality of life.
5. Learn the role of non-specific factors (e.g., therapeutic alliance), which ones are most strongly related to positive outcome, and how to use them to optimize outcome.

Training Modalities

Didactic content, vignettes that illustrate clinical procedures introduced, case discussion, Q & A.

Key References

Black, C. J., et al. (2020). Efficacy of psychological therapies for irritable bowel syndrome: systematic review and network meta-analysis. Gut 69(8): 1441-1451.

Everitt HA, Landau S, O’Reilly G, et al. (2019). Assessing telephone-delivered cognitive–behavioural therapy (CBT) and web-delivered CBT versus treatment as usual in irritable bowel syndrome (ACTIB): a multicentre randomised trial. Gut, gutjnl-2018-317805.

Lackner JM. (2020). Skills over pills? A clinical gastroenterologist's primer in cognitive behavioral therapy for irritable bowel syndrome. Expert Rev Gastroenterol Hepatol, 14(7):601-618.

Lackner, J. M., et al. (2018). "Improvement in Gastrointestinal Symptoms After Cognitive Behavior Therapy for Refractory Irritable Bowel Syndrome." Gastroenterology 155(1): 47-57.
Lackner, J. (2009). Minimal Contact CBT for IBS Therapist Manual (to follow).

Laird KT, Tanner-Smith EE, Russell AC, Hollon SD, and Walker LS. (2017). Comparative efficacy of psychological therapies for improving mental health and daily functioning in irritable bowel syndrome: A systematic review and meta-analysis. Clin Psychol Rev, 51:142-152.

Laird KT, Tanner-Smith EE, Russell AC, Hollon SD and Walker LS. (2016). Short-term and Long-term Efficacy of Psychological Therapies for Irritable Bowel Syndrome: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol, 14(7):937-947 e934.

Mayer, E.A., Ryu, H.J. & Bhatt, R.R. (2023). The neurobiology of irritable bowel syndrome. Mol Psychiatry 28, 1451–1465.
Radziwon, C. and J. M. Lackner (2015). "Coping Flexibility, GI Symptoms, and Functional GI Disorders: How Translational Behavioral Medicine Research Can Inform GI Practice." Clin Transl Gastroenterol 6: e117.

Van Oudenhove L, Crowell MD, Drossman DA, Halpert AD, Keefer L, Lackner JM, Murphy TB, Naliboff BD, and Levy RL. (2016). Biopsychosocial Aspects of Functional Gastrointestinal Disorders. Gastroenterology. Feb 18:S0016-5085(16)00218-3.

About the presenter

Jeffey M Lackner is Professor of Medicine and Chief of the Division of Behavioral Medicine in the Department of Medicine at the Jacobs School of Medicine and Biomedical Sciences, University at Buffalo (State University of New York). He is the author of more than 100 peer-reviewed scholarly publications including papers in diverse forums such as Journal of Consulting and Clinical Psychology, Gastroenterology, PAIN, Microbiome, Neurogastroenterology and Motility, Behaviour Research and Therapy, and Annals of Behavioral Medicine. His primary research interests focus on developing low-intensity behavioral self-management treatment for “centralized “pain disorders, characterizing their efficacy profile and durability, the reasons for why and how they work, and the patients for whom they are most (and least) effective. This work has influenced clinical practice guidelines in the US, Asia, Mexico, Europe including NICE Guidelines for IBS. Dr Lackner’s protocol featured is the only behavioral IBS treatment that received “strong” empirical support designation by Division 12 (Society of Clinical Psychology) of the American Psychological Association. In addition to supervising clinicians and teaching trainees, he is a practicing psychologist who maintains an active private practice devoted to providing brief evidence-based treatments for treatment refractory pain disorders.

Who should attend

This event is suitable for mental health practitioners of all disciplines seeking to expand their work into a new clinical area about which they may be unfamiliar as well as more experienced practitioners with a general background in CBT in behavioral pain interventions wanting to refine their skills. It is also suitable for those who would like a refresher course or to review the basics to maintain their skills.

Details coming soon

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