Cognitive-Behavioural Therapy for Inflammatory Bowel Disease: 24-Month Data from a Randomised Controlled Trial
Open accessAbstract
PURPOSE: There is ongoing controversy on the effectiveness of psychotherapy in inflammatory bowel disease (IBD). In the few small studies, cognitive-behavioural therapy (CBT) has been shown to alleviate symptoms of anxiety or depression. However, there is little research on the impact of CBT on physical outcomes in IBD and no studies on long-term effectiveness of CBT. METHODS: The present two-arm pragmatic randomised controlled trial aimed to establish the impact of CBT on disease course after 24 months of observation. The study compared standard care plus CBT (+CBT) with standard care alone (SC). CBT was delivered over 10 weeks, face-to-face (F2F) or online (cCBT). The data were analysed using linear mixed-effects models. RESULTS: CBT did not significantly influence disease activity as measured by disease activity indices at 24 months (Crohn's Disease Activity Index (CDAI), p = 0.92; Simple Clinical Colitis Activity Index (SCCAI), p = 0.88) or blood parameters (C-reactive protein (CRP), p < 0.62; haemoglobin (Hb), p = 0.77; platelet, p = 0.64; white cell count (WCC), p = 0.59) nor did CBT significantly affect mental health, coping or quality of life (all p > 0.05). CONCLUSIONS: Therefore, we conclude that CBT does not influence the course of IBD over 24 months. Given the high rate of attrition, particularly in the CBT group, future trials should consider a personalised approach to psychotherapy, perhaps combining online and one-to-one therapist time.
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Research has demonstrated that between 2 and 5 years of observations are required to draw meaningful conclusions of the impact of the intervention on disease course.
“Research has demonstrated that between 2 and 5 years of observations are required to draw meaningful conclusions of the impact of the intervention on disease course.39”
From Feasibility, Acceptability, and Preliminary Efficacy of Acceptance Commitment Therapy for Adults Living With Inflammatory Bowel Disease and Distress. (2024) · cites this paper as [39]
The Discussion says a 24-month follow-up is insufficient to capture the course of IBD and suggests that 5 to 10 years may offer more information. The Conclusions likewise say 24 months was not adequate. This contradicts the claim that 2 to 5 years is the required observation period. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredOnline versus in-person delivery of psychotherapy have produced inconclusive results.
“Online versus in-person delivery of psychotherapy have produced inconclusive results (Lavelle et al., 2022; Mikocka-Walus et al., 2017)”
From Moving Towards Acceptance and Values: A Qualitative Study of ACTforIBD Compared to IBD Psychoeducation (2024) · cites this paper as Mikocka-Walus et al., 2017
The Discussion (page not provided) gives a mixed picture: it reports that guided online self-help had effects comparable to face-to-face therapy in a review outside gastroenterology, but suggests face-to-face therapy may be safer than self-directed online therapy for IBD until better trials are available. The paper does not establish a general finding that comparisons of online and in-person psychotherapy have produced inconclusive results; its own trial compared CBT with standard care, not randomized delivery modes. (LLM, conf=0.78)
Experimental — accuracy not yet measuredThe combination of self- and therapist-led online psychotherapy programs appears to be most beneficial to individuals with IBD.
“whereas the combination of self- and therapist-led online psychotherapy programs appears to be most beneficial to this population (Dober et al., 2021; Mikocka-Walus et al., 2017).”
From Moving Towards Acceptance and Values: A Qualitative Study of ACTforIBD Compared to IBD Psychoeducation (2024) · cites this paper as Mikocka-Walus et al., 2017
The Discussion (page not provided) suggests adding therapist-run sessions to self-directed online CBT for people with IBD, but says this may reduce attrition rather than establishing that the combination is most beneficial. It also describes standard face-to-face therapy as potentially the safest option for meaningful outcomes until better online approaches are tested. (LLM, conf=0.87)
Experimental — accuracy not yet measuredPrevious qualitative research found the inclusion of both therapist-led and self-directed modules maximizes exposure to subject matter experts while circumnavigating possible non-adherence with fully self-directed programs.
“Previous qualitative research which explored perspectives of both consumers and health professionals found the inclusion of both therapist-led and self-directed modules maximizes exposure to subject matter experts while circumnavigating possible non-adherence with fully self-directed programs (Dober et al., 2021; Hanlon et al., 2022, Mikocka-Walus et al., 2017).”
From Moving Towards Acceptance and Values: A Qualitative Study of ACTforIBD Compared to IBD Psychoeducation (2024) · cites this paper as Mikocka-Walus et al., 2017
The Discussion (page unavailable) reports non-adherence with online CBT and suggests that adding therapist-run sessions may reduce attrition. But this paper reports a randomized trial, not qualitative research into consumer and health-professional perspectives; it does not establish that a mix of therapist-led and self-directed modules maximizes access to experts or prevents non-adherence. (LLM, conf=0.87)
Experimental — accuracy not yet measuredOther studies have not found improved disease outcomes after an extended time following psychological therapies.
“although other studies have not found improved disease outcomes after an extended time (71).”
From The 2023 Impact of Inflammatory Bowel Disease in Canada: Mental Health and Inflammatory Bowel Disease (2023) · cites this paper as [71]
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- Authors
- Mikocka-Walus, A., Bampton, P., Hetzel, D., Hughes, P., Esterman, A., & Andrews, J. M.
- Affiliations
- Flinders University (AU)
- Royal Adelaide Hospital (AU)
- The University of Adelaide (AU)
- University of South Australia (AU)
- Venue
- International Journal of Behavioral Medicine
- Published
- 2016-07-18
- Volume
- 24
- Issue
- 1
- Pages
- 127-135
- ISSN
- 1070-5503 (ISSN-L)
- 1532-7558
- PMC
- PMC5288424
- OpenAlex
- W2500504100
- Cited by
- 78
- References
- 41
- Citations by year
- 2026: 4 · 2025: 12 · 2024: 8 · 2023: 10 · 2022: 6 · 2021: 12 · 2020: 9 · 2019: 5 · 2018: 6 · 2017: 5 · 2016: 1
- FWCI
- 4.57
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- International Journal of Behavioral Medicine (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- ResearchOnline - JCU (James Cook University) (submittedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion, cc-by)
- Own your potential (DEAKIN) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- UniSA Research Outputs Repository (University of South Australia) (submittedVersion, other-oa)
- Funders
- the Crohn’s and Colitis of Australia
- Abbott Australia, MSD Australia and Janssen
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Inflammatory Bowel Disease
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- cognitive behavioral therapy, inflammatory bowel disease, Crohn's disease, disease activity, C-reactive protein, online therapy, attrition, mental health, quality of life, long-term effectiveness
- MeSH terms
- Anxiety, Depression, Follow-Up Studies, Humans, Mental Health, Psychotherapy, Quality of Life, Inflammatory Bowel Diseases, Cognitive Behavioral Therapy
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