Randomized Efficacy Trial of Two Psychotherapies for Depression in Youth With Inflammatory Bowel Disease

Abstract

Objective Pediatric inflammatory bowel disease (IBD) is associated with high rates of depression. This study compared the efficacy of cognitive behavioral therapy (CBT) to supportive non-directive therapy (SNDT) in treating youth with comorbid IBD and depression. Method Depressed youth (51% female; ages 9–17 years; mean age 14.3 years) with Crohn’s disease (n=161) or ulcerative colitis (n=56) were randomly assigned to a 3-month course of CBT or SNDT. The primary outcome was comparative reduction in depressive symptom severity; secondary outcomes were depression remission, increase in depression response, and improved health-related adjustment and IBD activity. Results 178 participants (82%) completed the 3-month intervention. Both psychotherapies resulted in significant reductions in total Children’s Depression Rating Scale Revised score (37.3% for CBT and 31.9% for SNDT), but the difference between the two treatments was not significant (p=0.16). There were large pre-post effect sizes for each treatment (d=1.31 for CBT and d=1.30 for SNDT). Over 65% of youth had a complete remission of depression at 3 months with no difference between CBT and SNDT (67.8% and 63.2%, respectively). Compared to SNDT, CBT showed a greater reduction in IBD activity (p=0.04) but no greater improvement on the Clinical Global Assessment Scale (p=0.06) and health-related quality of life (the IMPACT-III scale) (p=0.07). Conclusion This is the first randomized controlled study to suggest improvements in depression severity, global functioning, quality of life, and disease activity in a physically ill pediatric cohort treated with psychotherapy. Clinical trial registration information—Reducing Depressive Symptoms in Physically Ill Youth; URL: http://clinicaltrials.gov/; NCT00534911.

Family-Based Interpersonal Psychotherapy for Depressed Preadolescents: Examining Efficacy and Potential Treatment Mechanisms

“…Although parents did not participate in sessions, they were invited to join the first 10 minutes of each session to check in about their preadolescents’ symptoms. CCT has been successfully employed as a manualized comparison treatment in efficacy studies of youth depression 20,30 .…”

“…Two CBT treatment protocols, Taking ACTION 18 and Primary and Secondary Control Enhancement Training (PASCET) 19 , have demonstrated promise in effectively treating children with elevated depressive symptoms as compared to waitlist control groups, but have not been compared to active treatments. However, a recent efficacy trial found no differences between PASCET and supportive therapy in reducing depressive symptoms in preadolescents with irritable bowel disorder 20 .…”

Pediatric inflammatory bowel disease and depression

“…(57) Similar CBT approaches have also been shown to improve pain and sleep disturbances in other pediatric populations. (58, 59) Additional promising psychosocial interventions for youth with IBD include hypnotherapy(60) and mindfulness-based techniques(61) which both can improve mood, pain and HRQoL.…”

Effects of a Cognitive Behavioral Therapy Intervention Trial to Improve Disease Outcomes in Children with Inflammatory Bowel Disease

“…A 2014 study by the same group included 178 depressed youth age 9-17 with active IBD who received 3 months of either CBT (teaching coping skills) or supportive nondirective therapy (SNDT; empathic listening and reflecting by the therapist in response to content raised by the patient). 24 The intervention was a 12-session intervention spanning three months. Results showed significantly greater reduction in disease activity for the CBT group vs. the SNDT group.…”