A Positive Psychology Intervention for Irritable Bowel Syndrome

Massachusetts General Hospital, Boston MA

Investigators

Abstract

PROJECT SUMMARY/ABSTRACT Irritable bowel syndrome (IBS) is a disorder of gut-brain interaction (DGBI) that affects up to 39 million U.S. adults and is associated with substantial psychiatric comorbidity, healthcare costs, and impaired health-related quality of life. Conceptualized as a biopsychosocial stress-sensitive disorder, treatment of IBS often includes the use of behavioral interventions. Existing behavioral interventions for IBS, however, face important limitations, including reduced scalability, low acceptability, limited mechanistic understanding, and limited attention to the promotion of positive psychological constructs (e.g., resilience), which are deficient in patients with IBS and independently linked to fewer IBS symptoms and superior health outcomes. Positive psychological interventions (PPIs), comprised of simple-to-perform exercises (e.g., using perseverance), have potential to improve IBS symptoms and address the limitations of existing interventions, but, aside from our preliminary work, have not previously been explored in IBS. This 5-year K23 Patient-Oriented Research Career Development award addresses this research gap by: (1) examining the feasibility, acceptability, and preliminary efficacy of an optimized 9-week phone-based PPI for IBS, entitled, “WISH,” compared to a time- and attention-matched educational control in a pilot NIH Stage 1B randomized controlled trial (N=50); (2) exploring candidate gut-brain mechanisms (i.e., changes in autonomic function, interoception, and stress- mediated gene expression) by which WISH might impact IBS symptoms; and (3) identifying potential facilitators and barriers to implementation of WISH and other behavioral interventions in diverse gastroenterology (GI) clinical practice settings. This innovative project represents the first examination of a PPI for IBS as well as exploration of its potential gut-brain mechanisms, and, consistent with the NIH stage model, incorporates implementation science principles early in behavioral treatment development. The corresponding training plan will support Dr. Elizabeth Madva in becoming an independent GI psychiatrist-investigator and developer of scalable, well-accepted, and mechanistically targeted behavioral interventions, from pilot testing to implementation, for individuals with DGBI. Training in three key areas will support Dr. Madva’s transition to research independence: (1) clinical trial design, control condition development, and related biostatistical analyses to evaluate behavioral interventions for DGBI; (2) the study of gut-brain mechanisms of behavioral interventions; and (3) implementation science. A multidisciplinary mentorship team with complementary expertise will oversee Dr. Madva’s training: Dr. Jeff Huffman (primary mentor); Drs. Braden Kuo, Laurie Keefer, and Stephen Bartels (co-mentors); and Drs. Brian Healy, Roberta Sclocco, Sami Amr, and Christopher Celano (significant contributors). The proposed project and training will inform preparation of an R01 application to conduct an NIH Stage 2 efficacy trial to examine the true efficacy and mechanisms of this novel PPI for IBS.