HIGHLIGHTS

    Tens of millions of people in the United States suffer from it, but only a fraction of them seek treatment - and those who do are often diagnosed incorrectly.  Now, thanks to a $1.98 million, four-year grant from the National Institutes of Health, researchers at the University at Albany's Center for Stress and Anxiety Disorders hope to shed more light on Irritable Bowel Syndrome by encouraging more people to come forward for diagnosis and treatment.
    Irritable Bowel Syndrome, or IBS, is typically characterized by such symptoms as abdominal pain, cramping, or tenderness; bloating; and altered bowel habits, according to center director Edward B. Blanchard, who will oversee the study.  However, because such symptoms mimic those of inflammatory bowel disease, ulcerative colitis, or Crohn's disease, those illnesses must be ruled out before a diagnosis can be made and a course of treatment prescribed.  It is estimated that IBS afflicts 8 to 17 percent of the entire U.S. population, or about 21 million to 44 million men and women.
    Blanchard became interested in IBS around 1985, after reading a statistic noting that approximately 98 million workdays were lost in the U.S. each year as a result of stomach pain.  At the time, in fact, stomach pain was the third most frequent reason cited by workers calling in sick; only headaches and back problems were more common medical excuses.  Intrigued by that information, Blanchard and one of his students teamed up with Albany Medical Center's John Balint, M.D., who referred to them four patients for study.  “In many ways, IBS is an ideal problem for clinical psychologists interested in health-related issues,” observed Blanchard, whose past research has revealed that stress and anxiety seem to contribute toward the syndrome.  “It is not a disease; IBS is a functional disorder, which means that there is no physical abnormality found with it.  No scan or blood test can detect it.” 
    For the study, Blanchard and his counterpart at the University at Buffalo's School of Medicine, psychologist Jeff Lackner, Ph.D., will recruit a total of 240 patients over the next three years.  Each subject will invest a total of about four months in the study, completing a series of questionnaires during that period and keeping a diary detailing symptoms for four weeks prior to starting treatment and for two weeks following completion of the program.  In addition, the 120 UAlbany participants will be examined by Howard Malamood, M.D., an Albany Medical Center gastroenterologist, to ensure that there is no underlying structural cause for their symptoms.  After the IBS diagnosis has been confirmed, chief therapist and University at Albany graduate Annette Payne, Ph.D., a Capital Region psychologist who also trained the Albany and Buffalo researchers, will work with patients in small groups for several weeks.  Center for Stress and Anxiety Disorders staff will follow up with study participants three months after they have completed the program, and again nine months later.
    Actual work and follow-up with patients will take place during the first 36 months of the study, Blanchard noted, with the final year devoted to summarizing, recording, and disseminating the results.  The N.I.H.'s National Institute of Diabetes, Digestive and Kidney Diseases is supporting the program with a $1.98 million grant - the largest single award Blanchard has ever received for his research.  The funding was awarded on a competitive basis. 
    Blanchard feels that his research on IBS fits in well with the Center for Stress and Anxiety Disorders' other offerings.  Currently, the center provides a wide range of programs, including the diagnosis and treatment of post-traumatic stress related to automobile accidents, headaches, and aggressive driving.
    Aside from identifying candidates for participation and making clear “which form of therapy” is best for IBS sufferers, Blanchard hopes that the study will show that patients experience relief from their symptoms “for at least a year.”  He added, “I would like to see the results hold up over time, rather than provide temporary relief.”

Capital Region residents who wish to refer themselves for possible participation in Blanchard's study are welcome to contact the Center for Stress and Anxiety Disorders at (518) 442-4025.

    In a suite of offices located in Husted Hall on Western Avenue, receptionist Colleen Wood is busily scheduling the appointments of about 120 clients a week. Doctoral students are calling in daily to check their messages from clients - messages that must be returned within four to five hours. 
    Look in after most people have left their University offices for the day, and the lights will still be on in 167 Husted Hall until 8 p.m. four nights a week. Who are these people and what are they doing? 
    The site is UAlbany's Psychological Services Center, which trains doctoral students under the supervision of faculty from the departments of Psychology and Educational Counseling Psychology. These students counsel clients from the Albany area who seek help coping with anything from marital and family problems to depression, job loss or a death in the family.
    The clients are usually self-referred, and what they find at the center are mental health services at an affordable price.
    “We hold evening hours in order to accommodate families who are pressured for time,” said Director George B. Litchford. Many clients do not have the option of taking the afternoon off from work to keep an appointment.
    “We have videotaping capability so that the doctoral students are closely monitored as we train them to work with clients. Each professor closely supervises about four students,” Litchford said.
    Litchford, a native of Long Island, N.Y., earned a Ph.D. in clinical psychology from UAlbany in 1973. He did postdoctoral work in neuropsychology at the University of Utah-Veterans Administration Hospital in Salt Lake City, and is board-certified in clinical psychology.
    In addition to training future psychologists, the Psychological Services Center serves a population that otherwise may go untreated.
    “A good percentage of the clients we see have limited financial resources in addition to the fact that many individuals do not have health insurance,” Litchford said. The center provides mental health services on a sliding scale of from $10 to $45 per hour. 
    “If you are making $25,000 a year and have two or three children, $10 is a lot of money,” Litchford said. “To pay the $40 to $100 an hour that is the going rate charged by private therapists would be simply out of the question. We are one of the few low-cost outpatient clinics in the region.” Cases requiring a psychiatrist to prescribe medication are referred outside the clinic, or treated in consultation with a psychiatrist. 
    U.S. Surgeon General David Satcher recently reported finding a wide gap between the need for mental health services and their availability. “One in every five Americans experiences a mental disorder in any given year, and half of all Americans have such disorders at some time in their lives, but most of them never seek treatment,” noted a recent New York Times article on the subject.
    At UAlbany, however, operating with a staff of two, mental health services are provided to clients of all ages and at rates that do not exclude those least able to pay. The Psychological Services Center treats 300 clients a year, according to Litchford.
    The key to making this operation a successful and effective community outreach is a long-standing, rotating network of faculty members from the departments of Psychology and Educational and Counseling Psychology. These professors closely supervise about 20 doctoral students a year, consulting with them on cases and offering their expertise. “The faculty from both departments give way beyond what is needed to do. They are extraordinarily generous about contributing and consulting on cases. This makes for a pleasant working atmosphere and a meaningful clinic,” Litchford said. 
    Walk into receptionist Colleen Wood's office and one is likely to run into Edward B. Blanchard, the highly regarded UAlbany psychology professor who recently won a $1.98 million research grant. Other supervising faculty this year are: Allen Israel and Sharon Danoff-Burg of the psychology department; as well as Marilyn Stern, Michael Ellis, and Monroe Bruch of counseling psychology. Faculty are expected to contribute at least 10 hours a week. The doctoral students fill their training practicum requirements at the center. 
    “All the second-year students, approximately 20 yearly, come here for their first clinical experience,” Litchford said. In addition, about six to eight third-, fourth-, and fifth-year students also handle cases. 
“I work with third-, fourth-, and fifth-year students who have full-time assistantships here. They are each here about 20 hours per week, while the practicum students are here 12 hours per week,” Litchford said.
    Lucy Cardella, a Rochester native, is a fourth-year counseling psychology student and senior graduate assistant to the center's director. “It's just an incredible training opportunity for students. We learn how to assist people who have really multidimensional kinds of difficulties, including career concerns, relationship problems, and emotional and behavioral difficulties,” she said.
Cardella said the students learn different modes of treatment, including individual, family, and couples therapy. 
    The center also completes 125 family assessments per year for the Albany County Family Court, and provides psychological services to the Doane Stuart School.
    “The clinic started 20 years ago as part of the doctoral programs in pyschology. It is highly desirable, if not required, to have on-campus clinics, by the American Psychological Association.  In-house clinics are an important criterion for accreditation,” Litchford said. 
    Professor Susan Phillips, chair of the School of Education's Department of Educational Counseling Psychology, said, “The Pyschological Services Center is unique not only in its role in the mental health services that it provides the community, but also in its role as a dedicated training site for two accredited doctoral programs - the Ph.D. in counseling psychology, and the Ph.D. in clinical psychology. Designed to be jointly run and used by these two programs, the center provides excellent opportunities for beginning practicum training, as well as for advanced specialized field experience and for research. These opportunities enhance both programs in terms of quality of training, reputation, and accreditation status.”