Az alacsony intenzitású, bizonyítottan hatékony kognitív viselkedésterápia Crohn-betegségben

Abstract

Inflammatory bowel disease (Crohn's disease and colitis ulcerosa) is a chronic, long-term condition that causes chronic inflammation in the digestive tract, and shows an increasing incidence and prevalence worldwide. Changes in disease activity over time affect psychological distress which increases the risk of exacerbations. Beside somatic symptoms (such as abdominal pain, diarrhoea and weight loss), psychiatric comorbidity (in particular major depression, anxiety, social phobia) is common in patients with Crohn's disease. This case study illustrates the management and stabilization of a 21-year-old adult male patient with active Crohn's disease and with severe psychiatric comorbidity. The patient was diagnosed with avoidant personality disorder and dysruptive mood dysregulation disorder based on the results of psychodiagnostics (SCID-II structured clinical interview, MMPI personality inventory and disease-specific clinical questionnaires such as Beck Depression Inventory, Beck Hopelessness Scale, Social Cognition Questionnaire, Anger Expression Scale, Cognitive Emotion Regulation Questionnaire, Rosenberg Self-Esteem Scale). The main aim of psychotherapy is to increase the adherence to pharmacotherapy, to promote psychosocial functioning, to improve well-being and to enhance adaptive coping strategies. Low-intensity cognitive-behavioural psychotherapy was used which included psychoeducation, motivational interview, behavioural activation, patient diary, cognitive restructuring, problem-solving training, and family consulting. Twenty-five sessions were held weekly in outpatient form and 3 sessions of crisis intervention after the surgery at the hospital. The efficacy of the treatment was measured by self-reported questionnaires at baseline and at two follow-up sessions which corroborated a very significant decrease in the severity of depression, hopelessness, while emotional regulation and self-esteem became more adaptive. The remission of the above-mentioned psychiatric symptoms resulted in the improvement of the pharmacotherapy adherence and the quality of life. Low-intensity psychosocial interventions are proven to be an effective way of delivering evidence-based psychotherapy. Orv Hetil. 2018; 159(9): 363-369.

Motivational Interviewing as a Strategy to Improve Adherence in IBD Treatment: An Integrative Review Amidst COVID-19 Disruptions

“…Results suggest that the treatment of psychiatric comorbidities improves adherence and quality of life by correcting maladaptive interpretations of the disease. Furthermore, the integration of motivational interviewing into low-intensity psychotherapy emerges as a viable method to achieve these goals [ 51 ]. Finally, the systematic review by Wagoner and Kavookjan (2017) shows that patients with inflammatory bowel disease (IBD) respond positively to motivational interviewing.…”

“…In fact, in the included case report by Antal-Uram et al (2018), the adoption of low-intensity cognitive behavioral therapy, including motivational interviewing, resulted in an increase in therapeutic adherence from 20% to 75%, leading to disease regression and a reduction in the number of medications taken [ 51 ].…”

“…Conditions like depression and anxiety are prevalent among patients with IBD and profoundly affect both adherence to treatment and overall quality of life [ 59 , 60 ]. Therefore, the use of behavioral change strategies is a possible application to manage both psychological and somatic symptoms [ 51 , 61 ]. In particular, it is necessary to tailor the treatment to the needs of the patient [ 51 ].…”

“…Therefore, the use of behavioral change strategies is a possible application to manage both psychological and somatic symptoms [ 51 , 61 ]. In particular, it is necessary to tailor the treatment to the needs of the patient [ 51 ]. In this context, motivational interviewing has shown advantages related to its adaptability and short-term goals that allow for continuous patient follow-up.…”

“…Thus, a total of three scientific papers were included in this Two of these are case reports, while one is a systematic review summarizing the results of four papers, specifically two randomized controlled trials (RCTs) and two quasi-experimental studies. The evaluation of the methodological quality of the included studies identified two works of medium-high quality, whose values are 92% and 51% [33,51], while the remaining one is characterized by a value of 33%, so it was evaluated as low-quality [52].…”