Effect of Cognitive Behavioral Therapy on Clinical Disease Course in Adolescents and Young Adults With Inflammatory Bowel Disease and Subclinical Anxiety and/or Depression: Results of a Randomized Trial

Abstract

Background Anxiety and depressive symptoms are prevalent in patients with inflammatory bowel disease (IBD) and may negatively influence disease course. Disease activity could be affected positively by treatment of psychological symptoms. We investigated the effect of cognitive behavioral therapy (CBT) on clinical disease course in 10–25-year-old IBD patients experiencing subclinical anxiety and/or depression. Methods In this multicenter parallel group randomized controlled trial, IBD patients were randomized to disease-specific CBT in addition to standard medical care (CBT + care us usual [CAU]) or CAU only. The primary outcome was time to first relapse in the first 12 months. Secondary outcomes were clinical disease activity, fecal calprotectin, and C-reactive protein (CRP). Survival analyses and linear mixed models were performed to compare groups. Results Seventy patients were randomized (CBT+CAU = 37, CAU = 33), with a mean age of 18.3 years (±50% < 18 y, 31.4% male, 51.4% Crohn’s disease, 93% in remission). Time to first relapse did not differ between patients in the CBT+CAU group vs the CAU group (n = 65, P = 0.915). Furthermore, clinical disease activity, fecal calprotectin, and CRP did not significantly change over time between/within both groups. Exploratory analyses in 10–18-year-old patients showed a 9% increase per month of fecal calprotectin and a 7% increase per month of serum CRP in the CAU group, which was not seen in the CAU+CBT group. Conclusions CBT did not influence time to relapse in young IBD patients with subclinical anxiety and/or depression. However, exploratory analyses may suggest a beneficial effect of CBT on inflammatory markers in children.

Do interventions for mood improve inflammatory biomarkers in inflammatory bowel disease?: a systematic review and meta-analysis

“…This left 28 unique RCTs 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 of 1789 participants ( Fig. 1 ).…”

“…Detailed study characteristics are presented in Supplementary Table S4 . 22 arms from 20 studies trialled psychological therapy, 28 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 40 , 41 , 43 , 44 , 46 , 49 , 50 , 51 , 52 , 54 , 55 3 studies trialled antidepressants 42 , 45 , 53 and 6 arms from 5 studies trialled exercise interventions. 29 , 30 , 39 , 47 , 48 Details of intervention format and content, based on TIDieR guidance, are reported in Supplementary Table S5 .…”

“…Across the 17 study groups that investigated faecal calprotectin, 28 , 29 , 32 , 33 , 34 , 36 , 37 , 38 , 39 , 41 , 45 , 48 , 49 , 50 , 52 , 55 levels were significantly lower following interventions treating mood compared with controls (SMD = −0.186, 95% CI: −0.34 to −0.03; z = −2.38; p = 0.018; Fig. 3 ).…”

Impact of the SARS-CoV-2 Delta Variant on the Psychological States and Health-Related Quality of Life in Patients With Crohn’s Disease

“…These results implicated the necessity of offering timely psychological counseling to this high-risk population. Tremendous studies have shown that various psychological therapies could relieve psychological stress as well as alleviate disease activity in IBD patients ( 37 , 38 ). In terms of this issue, many cities in China have opened psychological counseling hotlines during the epidemic, but only a small proportion of the patients are aware of and are willing to turn to it for help (21, 13.73%), suggesting that more attention need to be paid to the publicity of the psychological counseling hotlines.…”

Psychogastroenterology: A Cure, Band-Aid, or Prevention?

“…These are factors that can be addressed by treatment. Cognitive behavioral treatment and hypnosis addressing gut specific cognitions, emotions, and behaviors—rather than stress, anxiety, and depression alone—are effective in reducing symptoms and disability in children with gut disorders [ 28 , 29 , 30 , 31 ]. Most of this evidence refers to gut symptoms that were initially thought to be biologically unexplained and became labeled as functional gastrointestinal symptoms (the healthy gut functions differently) and now are referred to as Disorders of Gut–Brain Interaction [ 3 , 32 ].…”