The Role of Stress in the Development and Clinical Course of Inflammatory Bowel Disease: Epidemiological Evidence

Maunder, Robert G.; Levenstein, Susan

doi:10.2174/156652408784533832

Cited by 164 publications

(135 citation statements)

References 46 publications

(61 reference statements)

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“…There is mounting evidence that ineffective management of stress in this context can negatively impact psychological and physical well-being (Evers et al, 2013;Maunder & Levenstein, 2008). This may be especially true for chronic inflammatory health conditions such as arthritis and inflammatory bowel disease (IBD) as stress can exacerbate inflammatory processes (Cohen et al, 2012).…”

Section: Self-compassion and Coping With Chronic Illnessmentioning

confidence: 99%

Self-Compassion, Stress, and Coping in the Context of Chronic Illness

2015

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A recent review suggested that self-compassion promotes use of adaptive rather than maladaptive coping. Less is known about how self-compassion is linked to stress and coping in the context of a chronic stressor. Across two primarily female chronic illness samples, inflammatory bowel disease (N = 155) and arthritis (N = 164), a model linking self-compassion to lower stress through coping styles and coping efficacy was tested. Path analyses revealed significant indirect effects for adaptive coping styles (active, positive reframing, and acceptance), and negatively for maladaptive coping styles (behavioral disengagement and self-blame) in both samples. Findings suggest that the relative balance of adaptive and maladaptive coping strategies used by self-compassionate people is associated with better coping outcomes in the context of chronic illness.

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Section: Self-compassion and Coping With Chronic Illnessmentioning

confidence: 99%

Self-Compassion, Stress, and Coping in the Context of Chronic Illness

2015

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“…In an RCT of adults with IBD, a Spanish group reported clinically significant reductions in anxiety and depression following a structured cognitive-behavior therapy program that included components such as relaxation training, distraction, and cognitive restructuring [108] . Reviews considering the overall effectiveness of psychological therapies for IBD patients not selected for anxiety or depressive disorders have reached a more modest conclusion: there may be some clinical benefit related to psychological functioning, with little support at this point for a significant direct impact on disease parameters [109][110][111] . These studies incorporated a broad range of treatments (e.g., psychodynamic therapy, supportive therapy, and cognitive behavioral therapies), some of which are not as well supported empirically.…”

Section: Psychotherapeutic Approachmentioning

confidence: 99%

Psychiatric comorbidity in the treatment of patients with inflammatory bowel disease

Filipović¹,

Filipović²

2014

WJG

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Ulcerative colitis and Crohn's disease, commonly known as inflammatory bowel disease (IBD), draw attention from specialists of various disorders, including gastroenterology, psychiatry, and radiology. The involvement of a cortical influence in the brain-gut axis as well as the interaction of the hypothalamic-pituitary-adrenal axis and the peripheral nervous system provide an initial explanation of the psychological symptoms associated with IBD. The involvement of structures the limbic system, such as the anterior cingulate cortex, the prefrontal cortex, and the amygdala, paves the way for the discovery of the mechanisms underlying depression depression, anxiety, alexithymia, personality traits, and other psychological impairments following the onset of IBD. Psychiatric therapy in IBD patients is almost as important as the gastroenterological approach and consists of pharmacological treatment and psychotherapy. Neither of the available psychiatric treatment methods is considered the golden standard because both methods have side effects, and psychotropic medication can provoke the worsening of IBD symptoms. Thus, both approaches must be applied with awareness of the possibility of side effects. We suggest that psychiatrists and gastroenterologists work together to reach a consensus on IBD therapy to ensure success and to reduce side effects and relapse to the lowest possible rates.© 2014 Baishideng Publishing Group Co., Limited. All rights reserved.Key words: Inflammatory bowel disease; Psychiatry; Treatment; Personality traits; Depression; Anxiety Core tip: The involvement of a dysfunction of brain-gut interactions in the pathogenesis of inflammatory bowel disease (IBD) is represented by a dysfunction of the autonomic nervous system, an abnormal hypothalamicpituitary-adrenal axis and cholinergic anti-inflammatory pathway, a deleterious effect of stress and depression, an abnormal coupling of the prefrontal cortex-amygdaloid complex, and an abnormal relation between the microbiota and the brain as pro-inflammatory factors. New investigations have provided a critical link between forebrain changes and abdominal pain independent of active disease and drug treatment, providing a potential basis for an explanation of the psychological symptoms and brain influence in the pathogenesis of IBD.

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“…In CD patients, life events occured more frequently in the past 6 month preceding diagnosis, however, the association was no more significant when other factors were also taken into account. A metaanalysis pointed out that stress in UC and depressive symptoms in CD play roles in the disease course, but it also could not find evidence that they contribute to disease onset [180]. Recently it was also shown that job strain, indicating work-related stress, did not correlate with the onset of either CD or UC [181].…”

Section: Stress and Mood Disordersmentioning

confidence: 99%

Pathogenesis of Ulcerative Colitis and Crohn’s Disease: Similarities, Differences and a Lot of Things We Do Not Know Yet

Molnár¹

2014

J Clin Cell Immunol

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The pathogenesis of inflammatory bowel diseases (IBD), such as ulcerative colitis (UC) and Crohn's disease (CD) is complex, and our knowledge on the topic is constantly growing. The two disorders are distinct, yet overlap in their clinical manifestations and underlying causes. This review aims to provide a broad overview of the numerous pathogenetic factors that can lead to the development of IBD, focusing on novel findings and on the differences between UC and CD. Recent advances in genetics have identified new components in the pathogenesis, as an example, the importance of Th17 lymphocytes and the IL-17/IL-23 pathway have been highlighted in both diseases, apart from the previously known Th1-Th2 driven processes. Genetic background of increased permeability has been explored in UC, and the role of defective autophagy was recently described in CD. Genetic alterations can lead to an exaggerated immune response to the resident microbial flora. This microflora is altered in IBD patients, probably due to their reduced ability to stabilize its bacterial components and due to different environmental factors. An exhaustive exploration of environmental factors is particularly important, as they can be influential in many cases. The impact of smoking is the most established environmental factor, having deleterious effects in CD and protective in UC. Recent opinions on other factors, such as early appendectomy, diet, reduced vitamin D levels, the use of specific medications, breastfeeding, personal hygiene and psychological factors are also discussed. Epigenetics, a new field of research, links environmental factors to genetics. Understanding these factors is of great significance as changing lifestyles and improving life circumstances have started to increase the prevalence of IBD also in developing countries.

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The Role of Stress in the Development and Clinical Course of Inflammatory Bowel Disease: Epidemiological Evidence

Abstract: There is consistent evidence for a contribution of psychological factors to IBD disease course, especially stress in UC and depressive symptoms in CD. More rigorous tests of psychological interventions in IBD are needed.

Cited by 164 publications

References 46 publications

Self-Compassion, Stress, and Coping in the Context of Chronic Illness

Self-Compassion, Stress, and Coping in the Context of Chronic Illness

Psychiatric comorbidity in the treatment of patients with inflammatory bowel disease

Pathogenesis of Ulcerative Colitis and Crohn’s Disease: Similarities, Differences and a Lot of Things We Do Not Know Yet

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