Cognitive-Behavioural Therapy for Inflammatory Bowel Disease: 24-Month Data from a Randomised Controlled Trial

Antonina Mikocka-Walus, Peter Bampton, David Hetzel, Patrick Hughes, Adrian Esterman, Jane M Andrews, Antonina Mikocka-Walus, Peter Bampton, David Hetzel, Patrick Hughes, Adrian Esterman, Jane M Andrews

Abstract

Purpose: There is ongoing controversy on the effectiveness of psychotherapy in inflammatory bowel disease (IBD). In the few small studies, cognitive-behavioural therapy (CBT) has been shown to alleviate symptoms of anxiety or depression. However, there is little research on the impact of CBT on physical outcomes in IBD and no studies on long-term effectiveness of CBT.

Methods: The present two-arm pragmatic randomised controlled trial aimed to establish the impact of CBT on disease course after 24 months of observation. The study compared standard care plus CBT (+CBT) with standard care alone (SC). CBT was delivered over 10 weeks, face-to-face (F2F) or online (cCBT). The data were analysed using linear mixed-effects models.

Results: CBT did not significantly influence disease activity as measured by disease activity indices at 24 months (Crohn's Disease Activity Index (CDAI), p = 0.92; Simple Clinical Colitis Activity Index (SCCAI), p = 0.88) or blood parameters (C-reactive protein (CRP), p < 0.62; haemoglobin (Hb), p = 0.77; platelet, p = 0.64; white cell count (WCC), p = 0.59) nor did CBT significantly affect mental health, coping or quality of life (all p > 0.05).

Conclusions: Therefore, we conclude that CBT does not influence the course of IBD over 24 months. Given the high rate of attrition, particularly in the CBT group, future trials should consider a personalised approach to psychotherapy, perhaps combining online and one-to-one therapist time.

Keywords: Cognitive-behavioural therapy; Disease course; Inflammatory bowel disease.

Conflict of interest statement

Compliance with Ethical Standards All authors declare that they have no competing interests to report. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the Royal Adelaide Hospital and the University of South Australia Research Ethics Committees in August 2009. Informed consent was obtained from all individual participants included in the study. The privacy rights of participants were observed.

Figures

Fig. 1
Fig. 1
CONSORT diagram showing the flow of participants through the study

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