Cognitive-behavioural therapy has no effect on disease activity but improves quality of life in subgroups of patients with inflammatory bowel disease: a pilot 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

Background: Studies have demonstrated usefulness of cognitive-behavioural therapy (CBT) in managing distress in inflammatory bowel disease (IBD); however, few have focused on IBD course. The present trial aimed to investigate whether adding CBT to standard treatment prolongs remission in IBD in comparison to standard therapy alone.

Methods: A 2-arm parallel pragmatic randomised controlled trial (+CBT - standard care plus either face-to-face (F2F) or online CBT over 10 weeks versus standard care alone (SC)) was conducted with adult patients in remission. IBD remission at 12 months since baseline was the primary outcome measure while the secondary outcome measures were mental health status and quality of life (QoL). Linear mixed-effect models were used to compare groups on outcome variables while controlling for baseline.

Results: Participants were 174 patients with IBD (90 +CBT, 84 SC). There was no difference in remission rates between groups, with similar numbers flaring at 12 months. Groups did not differ in anxiety, depression or coping at 6 or 12 months (p >0.05). When only participants classified as 'in need' (young, high baseline IBD activity, recently diagnosed; poor mental health) were examined in the post-hoc analysis (n = 74, 34 CBT and 40 controls), CBT significantly improved mental QoL (p = .034, d = .56) at 6 months. Online CBT group had a higher score on Precontemplation than the F2F group, which is consistent with less developed coping with IBD in the cCBT group (p = .045).

Conclusions: Future studies should direct psychological interventions to patients 'in need' and attempt to recruit larger samples to compensate for significant attrition when using online CBT.

Trial registration: The protocol was registered on 21/10/2009 with the Australian New Zealand Clinical Trials Registry (ID: ACTRN12609000913279).

Figures

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

References

    1. Ghia JE, Blennerhassett P, Collins SM. Impaired parasympathetic function increases susceptibility to inflammatory bowel disease in a mouse model of depression. J Clin Invest. 2008;118(6):2209–18.
    1. Bernstein CN, Singh S, Graff LA, Walker JR, Miller N, Cheang M. A prospective population-based study of triggers of symptomatic flares in IBD. Am J Gastroenterol. 2011;105(9):1994–2002. doi: 10.1038/ajg.2010.140.
    1. Camara RJ, Ziegler R, Begre S, Schoepfer AM, von Kanel R, Swiss Inflammatory Bowel Disease Cohort Study group The role of psychological stress in inflammatory bowel disease: quality assessment of methods of 18 prospective studies and suggestions for future research. Digestion. 2009;80(2):129–39. doi: 10.1159/000226087.
    1. Maunder RG, Levenstein S. The role of stress in the development and clinical course of inflammatory bowel disease: epidemiological evidence. Curr Mol Med. 2008;8(4):247–52. doi: 10.2174/156652408784533832.
    1. Graff LA, Walker JR, Bernstein CN. Depression and anxiety in inflammatory bowel disease: a review of comorbidity and management. Inflamm Bowel Dis. 2009;15(7):1105–18. doi: 10.1002/ibd.20873.
    1. Ford AC, Talley NJ, Schoenfeld PS, Quigley EM, Moayyedi P. Efficacy of antidepressants and psychological therapies in irritable bowel syndrome: systematic review and meta-analysis. Gut. 2009;58(3):367–78. doi: 10.1136/gut.2008.163162.
    1. von Wietersheim J, Kessler H. Psychotherapy with chronic inflammatory bowel disease patients: a review. Inflamm Bowel Dis. 2006;12(12):1175–84. doi: 10.1097/01.mib.0000236925.87502.e0.
    1. Timmer A, Preiss JC, Motschall E, Rucker G, Jantschek G, Moser G. Psychological interventions for treatment of inflammatory bowel disease. Cochrane Database Syst Rev. 2011;2:CD006913.
    1. Knowles SR, Monshat K, Castle DJ. The efficacy and methodological challenges of psychotherapy for adults with inflammatory bowel disease: a review. Inflamm Bowel Dis. 2013;19(12):2704–15. doi: 10.1097/MIB.0b013e318296ae5a.
    1. McCombie AM, Mulder RT, Gearry RB. Psychotherapy for inflammatory bowel disease: a review and update. J Crohns Colitis. 2013;7(12):935–49. doi: 10.1016/j.crohns.2013.02.004.
    1. Lichtenstein GR, Hanauer SB, Kane SV, Present DH. Crohn’s is not a 6-week disease: lifelong management of mild to moderate Crohn’s disease. Inflamm Bowel Dis. 2004;10(Suppl 2):S2–10. doi: 10.1097/00054725-200407002-00002.
    1. Mittermaier C, Dejaco C, Waldhoer T, Oefferlbauer-Ernst A, Miehsler W, Beier M, et al. Impact of depressive mood on relapse in patients with inflammatory bowel disease: a prospective 18-month follow-up study. Psychosom Med. 2004;66(1):79–84. doi: 10.1097/01.PSY.0000106907.24881.F2.
    1. Hofmann SG, Smits JA. Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. J Clin Psychiatry. 2008;69(4):621–32. doi: 10.4088/JCP.v69n0415.
    1. Pragmatic trials []
    1. Mikocka-Walus AA, Gordon AL, Stewart BJ, Andrews JM. The role of antidepressants in the management of inflammatory bowel disease (IBD): a short report on a clinical case-note audit. J Psychosom Res. 2012;72(2):165–7. doi: 10.1016/j.jpsychores.2011.06.006.
    1. Better access to mental health care: fact sheet for patients []
    1. Bee PE, Bower P, Lovell K, Gilbody S, Richards D, Gask L, et al. Psychotherapy mediated by remote communication technologies: a meta-analytic review. BMC Psychiatry. 2008;8:60. doi: 10.1186/1471-244X-8-60.
    1. Kaltenthaler E, Brazier J, De Nigris E, Tumur I, Ferriter M, Beverley C, et al. Computerised cognitive behaviour therapy for depression and anxiety update: a systematic review and economic evaluation. Health Technol Assess. 2006;10(33):iii. doi: 10.3310/hta10330.
    1. Bernstein KI, Promislow S, Carr R, Rawsthorne P, Walker JR, Bernstein CN. Information needs and preferences of recently diagnosed patients with inflammatory bowel disease. Inflamm Bowel Dis. 2011;17(2):590–8. doi: 10.1002/ibd.21363.
    1. Bai A, Ma AG, Yong M, Weiss CR, Ma Y, Guan Q, Bernstein CN, Peng Z. AMPK agonist downregulates innate and adaptive immune responses in TNBS-induced murine acute and relapsing colitis. Biochem Pharmacol. 2010;80(11):1708–1717. doi: 10.1016/j.bcp.2010.08.009.
    1. Baumgart DC, Bernstein CN, Abbas Z, Colombel JF, Day AS, D’Haens G, et al. IBD around the world: comparing the epidemiology, diagnosis, and treatment: proceedings of the world digestive health Day 2010 - inflammatory bowel disease task force meeting. Inflamm Bowel Dis. 2011;17(2):639–44. doi: 10.1002/ibd.21409.
    1. Singh H, Penfold RB, De Coster C, Au W, Bernstein CN, Moffatt M. Predictors of serious complications associated with lower gastrointestinal endoscopy in a major city-wide health region. Can J Gastroenterol. 2010;24(7):425–430. doi: 10.1155/2010/714591.
    1. Singh H, Nugent Z, Demers AA, Kliewer EV, Mahmud SM, Bernstein CN. The reduction in colorectal cancer mortality after colonoscopy varies by site of the cancer. Gastroenterology. 2010;139(4):1128–1137. doi: 10.1053/j.gastro.2010.06.052.
    1. Bernstein CN. Anti-tumor necrosis factor therapy in Crohn's disease: more information and more questions about the long term. Clin Gastroenterol Hepatol. 2010;8(7):556–558. doi: 10.1016/j.cgh.2010.04.014.
    1. Best WR, Becktel JM, Singleton JW, Kern F., Jr Development of a Crohn’s disease activity index. National cooperative Crohn’s disease study. Gastroenterology. 1976;70(3):439–44.
    1. Walmsley RS, Ayres RC, Pounder RE, Allan RN. A simple clinical colitis activity index. Gut. 1998;43(1):29–32. doi: 10.1136/gut.43.1.29.
    1. Jenkinson C, Coulter A, Wright L. Short form 36 (SF36) health survey questionnaire: normative data for adults of working age. BMJ. 1993;306(6890):1437–40. doi: 10.1136/bmj.306.6890.1437.
    1. Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36), I. Conceptual framework and item selection. Med Care. 1992;30(6):473–83. doi: 10.1097/00005650-199206000-00002.
    1. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361–70. doi: 10.1111/j.1600-0447.1983.tb09716.x.
    1. Spielberger CD. Manual for the state-trait anxiety inventory. Palo Alto, CA: Consulting Psychologists Press; 1983.
    1. Carver CS. You want to measure coping but your protocol’s too long: consider the brief COPE. Int J Behav Med. 1997;4(1):92–100. doi: 10.1207/s15327558ijbm0401_6.
    1. Holmes TH, Rahe RH. The social readjustment rating scale. J Psychosom Res. 1967;11(2):213–8. doi: 10.1016/0022-3999(67)90010-4.
    1. Carr JL, Moffett JA, Sharp DM, Haines DR. Is the Pain Stages of Change Questionnaire (PSOCQ) a useful tool for predicting participation in a self-management programme? Further evidence of validity, on a sample of UK pain clinic patients. BMC Musculoskelet Disord. 2006;7:101. doi: 10.1186/1471-2474-7-101.
    1. Duncan A, Wilson C, Cole SR, Mikocka-Walus A, Turnbull D, Young GP. Demographic associations with stage of readiness to screen for colorectal cancer. Health Promot J Austr. 2009;20(1):7–12.
    1. Prochaska JO, DiClemente CC. The transtheoretical approach: towards a systematic eclectic framework. Homewood, IL: Dow Jones Irwin; 1984.
    1. Diaz Sibaja MA, Comeche Moreno MI, Mas Hesse B. Protocolized cognitive-behavioural group therapy for inflammatory bowel disease. Rev Esp Enferm Dig. 2007;99(10):593–8. doi: 10.4321/S1130-01082007001000006.
    1. Mussell M, Bocker U, Nagel N, Olbrich R, Singer MV. Reducing psychological distress in patients with inflammatory bowel disease by cognitive-behavioural treatment: exploratory study of effectiveness. Scand J Gastroenterol. 2003;38(7):755–62. doi: 10.1080/00365520310003110.
    1. Schwarz SP, Blanchard EB. Evaluation of a psychological treatment for inflammatory bowel disease. Behav Res Ther. 1991;29(2):167–77. doi: 10.1016/0005-7967(91)90045-5.
    1. Szigethy E, Carpenter J, Baum E, Kenney E, Baptista-Neto L, Beardslee WR, et al. Case study: longitudinal treatment of adolescents with depression and inflammatory bowel disease. J Am Acad Child Adolesc Psychiatry. 2006;45(4):396–400. doi: 10.1097/01.chi.0000198591.45949.a4.
    1. Szigethy E, Kenney E, Carpenter J, Hardy DM, Fairclough D, Bousvaros A, et al. Cognitive-behavioral therapy for adolescents with inflammatory bowel disease and subsyndromal depression. J Am Acad Child Adolesc Psychiatry. 2007;46(10):1290–8. doi: 10.1097/chi.0b013e3180f6341f.
    1. Butler AC, Chapman JE, Forman EM, Beck AT. The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clin Psychol Rev. 2006;26(1):17–31. doi: 10.1016/j.cpr.2005.07.003.
    1. Keller W, Pritsch M, Von Wietersheim J, Scheib P, Osborn W, Balck F, et al. Effect of psychotherapy and relaxation on the psychosocial and somatic course of Crohn’s disease: main results of the German Prospective Multicenter Psychotherapy Treatment study on Crohn’s Disease. J Psychosom Res. 2004;56(6):687–96. doi: 10.1016/S0022-3999(03)00122-3.
    1. Keefer L, Taft TH, Kiebles JL, Martinovich Z, Barrett TA, Palsson OS. Gut-directed hypnotherapy significantly augments clinical remission in quiescent ulcerative colitis. Aliment Pharmacol Ther. 2013;38(7):761–71. doi: 10.1111/apt.12449.
    1. Miehsler W, Weichselberger M, Offerlbauer-Ernst A, Dejaco C, Reinisch W, Vogelsang H, et al. Which patients with IBD need psychological interventions? A controlled study. Inflamm Bowel Dis. 2008;14(9):1273–80. doi: 10.1002/ibd.20462.
    1. Waller R, Gilbody S. Barriers to the uptake of computerized cognitive behavioural therapy: a. Psychol Med. 2009;39(5):705–12. doi: 10.1017/S0033291708004224.

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