Acceptance commitment therapy (ACT) for psychological distress associated with inflammatory bowel disease (IBD): protocol for a feasibility trial of the ACTforIBD programme

Abstract

IntroductionInflammatory bowel disease (IBD) involves an abnormal immune response to healthy gut bacteria. When a person develops IBD, their susceptibility to anxiety and/or depression increases. The ACTforIBD programme, specifically designed for people with IBD and comorbid psychological distress, draws on acceptance and commitment therapy (ACT), which promotes acceptance of situations that cannot be solved such as persistent physical symptoms. There are no ACT trials for IBD using an active control group or a telemedicine approach, which is important to improve accessibility, particularly in the context of the ongoing COVID-19 pandemic. The ACTforIBD programme is administered online with a 4-hour therapist involvement per participant only; if successful it can be widely implemented to improve the well-being of many individuals with IBD.Methods and analysisOur team have codesigned with consumers the ACTforIBD programme, an 8-week intervention of 1-hour sessions, with the first three sessions and the last session delivered one-to-one by a psychologist, and the other sessions self-directed online. This study aims to evaluate the feasibility and preliminary efficacy of ACTforIBD to reduce psychological distress in patients with IBD. Using a randomised controlled trial, 25 participants will be randomised to ACTforIBD, and 25 patients to an active control condition.Ethics and disseminationThis protocol has been approved by Deakin University Research Ethics Committee in September 2021 (Ref. 2021-263) and the New Zealand Central Health and Disability Ethics Committee in December 2021 (Ref. 2021 EXP 11384). The results of this research will be published in peer-reviewed journals and shared with various stakeholders, including community members, policy-makers and researchers, through local and international conferences.Trial registration numberACTRN12621001316897.

Feasibility, Acceptability, and Preliminary Efficacy of Acceptance Commitment Therapy for Adults Living With Inflammatory Bowel Disease and Distress

“…The protocol for this trial, as well as its aims, are outlined in a previous publication. 19 This trial aims to evaluate the feasibility and acceptability of the ACTforIBD program as well as evaluate its preliminary efficacy in reducing symptoms of depression and anxiety and improving HRQoL in people living with IBD. This trial was registered prospectively in Australia and New Zealand (registration number: ACTRN12621001316897 ).…”

Telemedicine in inflammatory bowel diseases: A new brick in the medicine of the future?

“…It is increasingly emerging that the gut-brain axis plays a role in the pathogenesis of IBD as it affects the course of the disease, such that bidirectional communication with a mutual influence between the brain and gut is realised[ 93 ]. The bidirectionality in the gut-brain axis is one of its gnoseological pillars, in that the prevalence of anxiety-depressive disorders reaches about 30% in patients in remission and increases to about 70% in patients with active IBD[ 94 ]. During the COVID-19 pandemic, it was also observed in Italy that, during the first lockdown, there were particularly high rates of anxiety, depression, and poor sleep quality in patients with IBD in remission[ 95 ].…”

“…During the COVID-19 pandemic, it was also observed in Italy that, during the first lockdown, there were particularly high rates of anxiety, depression, and poor sleep quality in patients with IBD in remission[ 95 ]. Nonetheless, anxiety-depressive disorders may also influence the frequency of disease flare-ups in patients with IBD, potentially leading to an increased frequency of flare-ups, an often more aggressive presentation, increased rates of hospital readmission, and an increased risk of surgical intervention[ 94 ]. However, this issue is not always adequately addressed in managing IBD and often takes a back seat.…”

“…Some of these projects are currently underway. One example is the randomised trial by Evans et al [ 94 ] known as the "ACTforIBD" program. The latter is based on acceptance-commitment therapy ( i.e., a technique specifically for patients with IBD and concomitant psychopathological comorbidities) to address unresolved problems related to chronic IBD.…”

The 2023 Impact of Inflammatory Bowel Disease in Canada: Mental Health and Inflammatory Bowel Disease

“…While ACT has shown some promise of improved stress and quality of life in people with chronic diseases and similar efficacy as standard CBT ( 84 , 85 ), there has been little application with IBD to date. An RCT in adults who had mild or quiescent IBD demonstrated significant stress reduction compared to a treatment as usual control group ( 86 ), and further feasibility studies are underway ( 87 , 88 ). However, efficacy for anxiety, depression, resilience, or IBD clinical outcomes has yet to be examined.…”