The Efficacy and Methodological Challenges of Psychotherapy for Adults with Inflammatory Bowel Disease

Abstract

Adults with inflammatory bowel disease (IBD) are at a greater risk of anxiety and depression and impaired quality of life (QoL) compared with healthy controls and other chronic physical illness groups. Consequently, the development and evaluation of well-defined and theoretically robust psychotherapeutic interventions for adults with IBD are desirable. To date, interventions have, for the most part, used multiple cross-theoretical approaches. Published reviews are heterogeneous in terms both of categorization of psychotherapeutic approaches and also of conclusions relating to efficacy. A recent Cochrane meta-analysis of randomized controlled trials found no evidence for the efficacy of these interventions in adults, as in a number of previous reviews, ideologically disparate interventions (e.g., psychodynamic and cognitive behavioral) were grouped together. We aimed to extend the currently available literature on psychological intervention in IBD by: evaluating the efficacy of specific strategies (i.e., stress management, psychodynamic, cognitive behavioral therapy, or hypnosis) in improving psychological symptoms and QoL, including all controlled and noncontrolled studies, and explicating the methodological problems in published trials. Sixteen studies (5 stress management, 4 psychodynamic, 5 cognitive behavioral therapy, and 2 hypnosis) were evaluated. Interventions predominantly based on stress management showed only modest benefits for IBD or mental health symptoms or QoL. Cognitive behavioral therapy studies showed generally consistent benefits in terms of anxiety and depression symptoms, but inconsistent outcomes regarding IBD symptoms. Psychodynamically informed interventions reduced depressive and anxiety symptoms, but not IBD severity. Both hypnosis studies, albeit using different methods, seemed to have a more positive impact on disease severity than mental health symptoms or QoL. Our results suggest that while further well-designed and evaluated interventions are needed, psychological input can make a positive contribution to best practice multidisciplinary treatment of adults with IBD.

Utilization and efficacy of internet-based eHealth technology in gastroenterology: a systematic review

“…adolescent somatic symptoms, parent irrational cognitions, and protective responses to pain/IBD symptoms). These findings are consistent with face-toface/group-based interventions targeting GI symptoms and mental health (see reviews: Zijdenbos et al [32], Timmer et al [33], and Knowles et al [15]), in that it can be argued that individuals who experience mental distress along with their physical health condition are likely to benefit from a focused psychological intervention. It is, however, too early to identify if targeted eHealth psychological interventions may be more beneficial for different illness cohorts (i.e.…”

“…stress, disease status, medication type and changes). It also evaluates differences between completers and non-completers Adapted from Knowles et al [15]. Hunt et al [18] First IBS online study, involving patient-therapist communication.…”

“…Effect sizes are used where available to compare treatment effectiveness. Critical appraisal was conducted based on gastroenterology-specific recommendations adapted from Knowles et al [15] (see Table II). …”

A systematic review of the psychological correlates of adjustment outcomes in adults with inflammatory bowel disease

“…The authors combined stress management, psychodynamic psychotherapy and cognitive behaviour therapy (CBT) studies as "psychotherapy" in the meta-analysis, therefore any differential efficacy between these theoretically distinct approaches could not be evaluated. When considered independently, a more recent review found promising evidence that CBT improved mental health in patients with IBD, both immediately following the intervention and at 6 months follow up (Knowles et al, 2013). …”

A Controlled Study of a Group Mindfulness Intervention for Individuals Living With Inflammatory Bowel Disease

“…22 Responding to the links between psychological distress, IBD and QoL, several psychological strategies have been trialed, including stress management, psychodynamic and cognitivebehavioral interventions; for reviews of this literature, see Refs. 23-26. In the most recent systematic review of psychological interventions in IBD, Knowles et al 27 concluded that while some interventions, particularly cognitive-behavioral therapy, have provided evidence for improving psychological well-being, there is limited evidence for their beneficial impact on QoL or disease activity. Knowles et al 27 argued that future psychologically oriented IBD interventional trials should address previous methodological limitations (e.g., lacking control groups, accounting for dropouts, and missing data) and also explore other potentially useful treatment modalities, particularly those involving mindfulness.…”