A Randomized Controlled Trial of Mindfulness-Based Stress Reduction to Prevent Flare-Up in Patients with Inactive Ulcerative Colitis

Abstract

Background/Aims: The primary therapeutic goals in ulcerative colitis (UC) are to maintain excellent quality of life (QOL) by treating flare-ups when they occur, and preventing flare-ups. Since stress can trigger UC flare-ups, we investigated the efficacy of mindfulness-based stress reduction (MBSR) to reduce flare-ups and improve QOL. Methods: Patients with moderately severe UC, in remission, were randomized to MBSR or time/attention control. Primary outcome was disease status. Secondary outcomes were changes in markers of inflammation and disease activity, markers of stress and psychological assessments. Results: 55 subjects were randomized. Absence of flares, time to flare and severity of flare over 1 year were similar between the two groups. However, post hoc analysis showed that MBSR decreased the proportion of participants with at least one flare-up among those with top tertile urinary cortisol and baseline perceived stress (30 vs. 70%; p < 0.001). MBSR patients who flared demonstrated significantly lower stress at the last visit compared to flared patients in the control group (p = 0.04). Furthermore, MBSR prevented a drop in the Inflammatory Bowel Disease Quality of Life Questionnaire during flare (p < 0.01). Conclusion: MBSR did not affect the rate or severity of flare-ups in UC patients in remission. However, MBSR might be effective for those with high stress reactivity (high perceived stress and urinary cortisol) during remission. MBSR appears to improve QOL in UC patients by minimizing the negative impact of flare-ups on QOL. Further studies are needed to identify a subset of patients for whom MBSR could alter disease course.

Effect of psychological therapy on disease activity, psychological comorbidity, and quality of life in inflammatory bowel disease: a systematic review and meta-analysis

“…Of these, a further 32 were excluded for various reasons leaving 14 studies eligible for data extraction. [23][24][25][26][27][28][29][30][31][32][33][40][41][42] Agreement between reviewers for eligibility assessment was excellent (Kappa statistic = 0.91). Detailed study characteristics are provided in Table 1, and risk of bias across all studies is reported in page 1 of the webappendix.…”

“…[23][24][25][26][27][28][29]32,33,[40][41][42] . Four of these presented data in patients with CD, 25,32,40,42 four in patients with UC, 27,28,40,41 and five in patients with IBD. 23,24,26,29,33 Results from all analyses in patients with quiescent IBD are summarised in Table 2.…”

“…One study included CD patients, 42 three studies included UC patients, 27,28,41 and two included patients with IBD. 24, 29 Overall, 159 (57.4%) of 277 patients treated with psychological therapy experienced a relapse of disease activity, compared with 127 (52.7%) of 241 patients in the control group.…”

“…Six RCTs assessed impact on disease activity indices in CD, 23,24,26,32,33,40 and seven in UC. 23,24,26,27,33,40,41 . There was no significant difference in disease activity indices among those treated with psychological therapy, compared with those in the control group, at the final point of follow-up (SMD = -0.03; 95% CI -0.20 to 0.14) (Figure 3), with no evidence of heterogeneity between studies (I 2 = 0%, P = 0.87).…”

“…22 However, the authors included quasirandomised and non-randomised studies in their analysis and there have been numerous additional studies published in the intervening years. [23][24][25][26][27][28][29][30][31][32][33] We therefore aimed to re-examine the efficacy of psychological therapies in IBD, with particular emphasis on their effects on disease activity indices, psychological wellbeing, including anxiety, depression, and perceived stress, and quality of life.…”