Mind the Gut: A Q&A with Dr. Alice Sibelli

Meet Dr. Alice Sibelli, a Clinical Lead at Mahana Therapeutics. Alice was one of Mahana’s early hires and worked for 10 years in health psychology before joining the startup world. Her career in academia led her to King’s College London where she helped develop a Cognitive Behavioral Therapy (CBT) program for people with Irritable Bowel Syndrome (IBS). She worked alongside Professors Rona Moss-Morris, Ph.D; Hazel Everitt, Ph.D; and Trudie Chalder. While at King’s College, Alice was involved in all aspects of one of the largest randomized, controlled trials of the program to assess its effectiveness.

This program would later evolve into Mahana’s U.S.-based prescription digital therapeutic called Parallel, the only FDA-authorized treatment to reduce the severity of IBS symptoms within adults. Alice has seen the program take many shapes, including as a mobile app (currently in development) for a U.S. audience.

I sat down with Alice to learn more about her experience shifting from academia to the startup world, the exciting plans for integrating evidence-based treatments like Parallel into IAPT centers and why she believes digital interventions are the future of healthcare.

Tell us about your background and how you came to help develop a Cognitive Behavioral Therapy program for people with Irritable Bowel Syndrome.

I attended three years of med school and during that time was struggling with the medical health model. I couldn’t fully embrace the dualistic nature of it. I soon realized that I was quite fascinated by the connection between physical and mental health. That’s when I started reading more about the role psychologists can have in enhancing both the psychological and physical well-being of people.

Nearly my whole career in health psychology research has been developing online interventions for people with digestive conditions. After finishing my MSc at University of Southampton [in London, United Kingdom], I applied for a research position there. This is where we conducted an exploratory study to assess the effectiveness of a self-management Cognitive Behavioral Therapy program for people with Irritable Bowel Syndrome. I helped develop the program, which was based on a paper manual that was tested by Rona Moss-Morris.

The U.K. has been a pioneer in health psychology. After the exploratory study, we received funding from the National Institute for Health Research (NIHR) here in the U.K. It allowed us to conduct a large study to assess the effectiveness of the same self-management program.

How has the shift from academia to the digital therapeutics startup world been for you?

Overall, it’s been really positive and stimulating. I was nervous about the change; I’m not going to lie about that! But I was also ready for the change. Working in this space is never boring [laughs]. Everything I learned in academia is invaluable. I had the privilege to work with inspiring researchers and mentors, such as Rona Moss-Morris, among many others. I can now transfer those skills and knowledge to fulfill my current role at Mahana.

Startup life is fast-paced and requires more flexibility — something I’m learning how to be better at. My role, as a member of the clinical team, allows me to collaborate cross-functionally with different teams. In a startup, working with other teams happens every day. We speak different languages depending on our backgrounds, but we always find a common ground. In academia, there was a lot more autonomous work.

Startups are also focused on business goals and outcomes. This is something I wasn’t as exposed to in the past and one of the biggest differences between these two worlds. At Mahana, my work not only has meaning but there’s also a shared purpose within the company. I think that’s quite powerful.

What inspired you to make this career shift?

I really wanted to start implementing evidence-based psychological interventions in real-world clinical settings. Filling in the gap between research and practice is something that I personally find very interesting but also complex and challenging.

Digital therapeutics is the perfect field to allow me to achieve this. I’m clearly passionate about digital interventions [laugh]! I love developing them, testing them and enhancing them by working with patients and healthcare professionals. Joining this space was a natural transition.

I was also craving a change — one that would help me shape my professional identity. This was an important factor in making the decision to shift from academia.

What attracted you to Mahana Therapeutics?

I started collaborating with Mahana while I was still working full time at King’s College London. We worked closely together for about a year before I made the leap. It was the perfect opportunity to get to know the Mahana team and vice versa. It helped us understand if it was a good fit.

Mahana proved its dedication to put patients first. And my core values were in tune with Mahana’s. It always feels like we’re working toward something bigger.

You’re currently leading the IAPT (Improving Access to Psychological Therapies) implementation of Parallel, Mahana’s digital CBT for IBS patients, in the U.K. What is IAPT?

This program started in 2008 in England. It provides clinically validated, evidence-based psychological treatments (talking therapies) for people who have different mental health conditions. Because IAPT is part of our National Health Service (NHS), the therapy is free to clients. The treatments are delivered by IAPT healthcare professionals who are trained by UK national training programs as either high-intensity therapists or positive well-being practitioners who deliver lower intensity interventions. These healthcare professionals support clients throughout the entire therapeutic journey, including determining treatment goals together. IAPT uses a step-care model, which means individuals receive treatments tailored to their needs.

There are about 220 IAPT centers throughout England. IAPT originally offered treatments for depression and anxiety. Today, it also offers treatments for long-term conditions like IBS. The aim is to provide integrated and coordinated healthcare for both physical and mental health conditions.

There are two main pathways to access IAPT services. One is through a general practitioner (GP) or family physician who provides a referral to an IAPT center within a person’s zip code. The other is through an online self-referral.

A few years ago, IAPT expanded their mandate to include Long Term Conditions/Medically Unexplained Syndromes (LTC/MUS). What are LTCs and how are they relevant for digital therapeutics?

LTCs are physical health conditions or chronic diseases that don’t have a cure. They require ongoing management via medications, treatments or a combination of both. Common LTCs are diabetes, heart disease, chronic obstructive pulmonary disease, arthritis, kidney disease, asthma and Inflammatory Bowel Disease (IBD).

About 15 million individuals have an LTC in England. And around 30 percent of people who have an LTC also report having a mental health condition, according to the National Health Service (NHS). The NHS wanted to upscale integrated care and make it more available to these individuals.

It isn’t ideal for people with LTCs to receive completely disconnected treatments for their physical condition and their mental health needs. It also creates unnecessary costs for the NHS or other healthcare systems. LTCs are now part of IAPT’s expanded integrated care, which is called person-centered coordinated care. IAPT offers national training in CBT specifically for LTCs for therapists, including training in CBT for IBS. IAPT also monitors clients’ clinical outcomes regularly.

Digital therapeutics for LTCs are extremely relevant because they require ongoing management. There are both humanistic burdens for individuals but also large financial costs for primary and secondary care. Digital therapeutics can help target both of these issues. Digital interventions empower people to manage their own conditions. In that way, they become a part of the solution.

What does access to Parallel via IAPT mean for people who have IBS?

Within IAPT’s expansion, the services are now including a focus on persistent physical symptoms. IBS is included in this category and is a designated condition that IAPT centers support. Parallel is a treatment for physical IBS symptoms. It’s not a treatment for anxiety or depression, though it does offer stress and mood management tools and the clinical evidence shows that the treatment reduces the severity of symptoms whilst also improving mental health and quality of life outcomes.

Access to Parallel within IAPT can give adults with IBS the opportunity to use a clinically validated treatment that’s specifically tailored to their IBS. This is a treatment that’s been researched and developed over 20 years. We’ve shaped the program based on feedback from patients and providers every step of the process.

The updated version of Parallel, led by Mahana, meets IAPT and the National Institute for Health and Care Excellence’s (NICE) very high standards. It was evaluated along with 14 other digital therapy products for use within IAPT centers. Only six products were recommended to gather real-world data, and Parallel was one of them.

You’ve seen the Parallel program evolve from its original version to a more robust web-based program to a mobile-based program for patients in the U.S. What excites you the most about this evolution — especially working on both the U.K. and U.S. products?

Some of the great things about working on Parallel within Mahana are that we have experienced multi-disciplinary teams and access to the latest technology. These factors really allow us to make Parallel more user-friendly and contemporary.

The IAPT version of Parallel is a therapist-guided product. Mahana has spent a lot of time on integrating the therapist dashboards within the patient version of the program. This creates stronger and safer communication links between patients and therapists. For me, this is a key improvement that will have a direct impact on the quality of care that people receive. I’m also excited about the standalone web version [without the therapist integration]. It’s a better user experience and more contemporary compared to the original version.

In terms of the mobile program [for the U.S.], it’s been inspiring to work alongside teams that have the same end goal. I’m so passionate about the shift to mobile. We’re taking the user experience to a whole new level by transforming the same evidence-based, tailored content from web into mobile. The app allows users to engage on a daily basis if they want to. We’ve gotten feedback from people, who have used the web version, that daily interactions is something they wanted to see.

Mobile also allows people to strengthen their autonomy and symptom management. The mobile app doesn’t include the therapist yet we’re shaping the program in such a way that this guidance is seamlessly integrated in other ways. The app is also more sophisticated at rewarding users, celebrating their progress every step of the way and making sure people with IBS don’t feel so alone.

What is the digital-first initiative in the U.K.?

The NHS is committed to using digital technology to improve physical and mental health care in England. This digital-first initiative aims to help people access the support that they need via digital tools.

Let me deconstruct this a little bit. Here in the U.K., general practitioners are the first point of contact for people in the NHS. This might lead to a referral for specialist or a treatment. Digital first means that people would have access to digital tools as the first point of contact instead of the GP. The tools should allow people to reach the right service or treatment, digital or otherwise. Digital first also means people can book and cancel appointments, obtain prescriptions, schedule diagnostic tests and more through the NHS app.

With COVID-19, telehealth has become even more common among practitioners. But that doesn’t mean in-person consultations disappear. The pandemic simply highlighted that we can use technology to properly triage based on someone’s needs and quickly make decisions for the proper next steps.

Why do you believe digital interventions to manage chronic conditions are the future of healthcare in the U.K.?

I mentioned a couple of reasons earlier so let me expand a bit. Digital interventions provide access to great healthcare much faster. People can access digital treatments from wherever they want and around their schedules. This means they spend less time and money traveling to and from appointments. Digital interventions can also provide personalized treatment based on someone’s unique needs. We can use logic and coding to tailor content and feedback to enhance the quality of care someone receives.

Beyond this, nearly all the people I’ve talked to throughout the years have mentioned stigma, shame and embarrassment related to their IBS. I think many of these people deeply value that there’s a safe self-directed digital program for their IBS that can provide support and preserve their privacy.

One of the challenges that we face, though, in terms of accessibility is around deprived areas, which are particularly affected by long-term conditions. Digital interventions do allow for more access, but there’s still more work to be done so everyone has access to the evidence-based care that they deserve.

Learn more about what we’re doing at Mahana Therapeutics, our FDA authorization and our CE Mark certification.