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Psychotherapy for inflammatory bowel disease: A review and update
Abstract
BACKGROUND: Psychotherapy may be a useful intervention for inflammatory bowel disease (IBD) patients. We systematically reviewed all randomized controlled trials that have been performed in psychotherapy for inflammatory bowel disease patients. METHODS: Systematic searches were undertaken on 1 and 8 March, 2012 of studies of psychotherapy for IBD. RESULTS: Eighteen studies (19 papers) were included in this review. Psychotherapy was found to have minimal effect on measures of anxiety, depression, QOL and disease progression although shows promise in reducing pain, fatigue, relapse rate and hospitalisation, and improving medication adherence. It may also be cost effective. CONCLUSIONS: The effects of psychotherapy on IBD is mixed: future studies should determine whether patient screening or measuring different dependent variables improves outcomes and whether particular psychotherapies are superior over others.
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“psychotherapy with a strong psychoeducation focus has been shown to have little to no effect on symptoms of depression and anxiety in people diagnosed with IBD,16”
From Feasibility, Acceptability, and Preliminary Efficacy of Acceptance Commitment Therapy for Adults Living With Inflammatory Bowel Disease and Distress. (2024) · cites this paper as [16]
Experimental — accuracy not yet measuredIn the citing paper
“Nonetheless, new approaches to healthcare delivery such as stepped care or integrated care may facilitate better detection and management of anxiety and depression coexistent with IBD (87-89).”
From Controversies Revisited: A Systematic Review of the Comorbidity of Depression and Anxiety with Inflammatory Bowel Diseases (2016) · cites this paper as [87]
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“However, recent reviews that used more appropriate categorization of psychological interventions, analyzing different types of treatments separately, demonstrated that one type of psychotherapy, cognitive behavioral therapy, improves psychological distress, with modest changes in gastrointestinal symptoms.(92,93) Thes…”
ResultA comprehensive review and update on Crohn's disease
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Fatigue in IBD: epidemiology, pathophysiology and management
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Chronic Diarrhea and Constipation Are More Common in Depressed Individuals
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“Gender: Male 24% (8) 21% (7) Female 76% (25) 79% (26) Diagnosis:”
Inflammatory Bowel Disease: A Stressed “Gut/Feeling”
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“[153] concluded that the effect of psychotherapy led to inconsistent results in IBD patients.”
ResultSystematic review: interventions for abdominal pain management in inflammatory bowel disease
Norton, C. S., Czuber‐Dochan, W., Artom, M., Sweeney, L., & Hart, A. L. (2017) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.14108 · Cited by 110
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“Psychotherapy, especially cognitive behavioral therapy (CBT) where people are taught to identify and modify unhelpful thinking styles and maladaptive behaviors, may be a useful intervention for at least some patients with IBD, especially those with psychiatric comorbidities.(2,8,9) CBT is based on the premise that alt…”
BackgroundBerrill, J., Green, J. T., Hood, K., & Campbell, A. K. (2013) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.12335 · Cited by 99
“92 (chi-square) CD 13 (42%) 27 (41%) Disease Location UC (n = 57) Proctitis 6 (33%) 7 (18%) N/A‡ Left-Sided 7 (39%) 21 (54%) Pan-Colitis 5 (28%) 11 (28%) CD (n = 40) Ileal 5 (38%) 7 (26%) N/A‡ Colonic 3 (23%) 10 (37%) Ileo-colonic 5 (38%) 10 (37%) Median disease duration, years (range) 9 (1-36) 8 (1-47) 0.”
Depression and Anxiety Disorders in Patients With Inflammatory Bowel Disease
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“Accordingly, an alternative evidence-based therapeutic approaches focusing on stress management could have the potential to manage disease flare-ups and ultimately improve overall QoL [18–21].”
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“In recent years, several reviews have been published on the efficacy of psychotherapy for QoL, emotional status and remission/flare status in IBD [7-10].”
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“Our findings partially contrast the reported mixed effects in aforementioned systematic reviews on the effect of psychotherapy on IBD patients (Knowles et al., 2013; McCombie et al., 2013; Timmer et al., 2011).”
ResultMikocka-Walus, A., Bampton, P., Hetzel, D., Hughes, P., Esterman, A., & Andrews, J. M. (2017) · International Journal of Behavioral Medicine · doi:10.1007/s12529-016-9580-9 · Cited by 78
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Keeton, R. L., Mikocka-Walus, A., & Andrews, J. M. (2015) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2014.12.004 · Cited by 72
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Stigma and Disclosure in Patients With Inflammatory Bowel Disease
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Risk Factors for Rehospitalization Within 90 Days in Patients with Inflammatory Bowel Disease
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“an even greater impact may be made by targeting specific psychiatric diagnoses.(19) This cohort demonstrates an association between”
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The effect of psychotherapy on quality of life in IBD Patients: A systematic review
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“12, 14, 15 When comparing the effectiveness of psychotherapy to other chronic autoimmune diseases, some research has found similar results in patients with psoriasis.”
BackgroundResultPractical Guideline for Fatigue Management in Inflammatory Bowel Disease
Kreijne, J. E., Lie, M. R. K. L., Vogelaar, L., & van der Woude, C. J. (2015) · Journal of Crohn s and Colitis · doi:10.1093/ecco-jcc/jjv168 · Cited by 48
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“Alternative methods of delivery of psychotherapy such as using the computerized self-guided program may also be of interest to the IBD population with its flexible time commitments, although this may be at the expense of both adherence and expert guidance.[28]”
MethodOpioid Analgesics Do Not Improve Abdominal Pain or Quality of Life in Crohn’s Disease
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Unmet Needs in IBD: the Case of Fatigue
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“Psychotherapy should be offered to the patient as this has been shown effective in a recent systematic review [81].”
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“In most studies of adults with IBD, treatment with psychotherapy has been associated with improved depression and anxiety [51,52].”
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Craven, M. R. A., Quinton, S., & Taft, T. (2018) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-018-9576-5 · Cited by 38
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The role of hypnotherapy for the treatment of inflammatory bowel diseases
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“[19] found psychotherapy to have a minimal effect on the measures of anxiety, depression, QoL and disease progression, as well as in reducing pain, fatigue, relapse rate and hospitalization and improving medication adherence.”
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High Demand for Psychotherapy in Patients with Inflammatory Bowel Disease
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“Several review articles and meta-analyses have established that the efficacy of psychotherapy for IBD patients is mixed (Ballou & Keefer, 2017; Gracie et al., 2017; Knowles et al., 2013; McCombie et al., 2013; Tarricone et al., 2017; Timmer et al., 2011).”
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“This is supported by evidence from the literature that emotional and dietary support plays a key part in the quality of life for patients with IBD and should be met accordingly [31–35].”
Managing Pain and Psychosocial Care in IBD: a Primer for the Practicing Gastroenterologist
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“Psychotherapy may be of benefit and should be considered on an individual basis [84].”
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“Five participants were lost to follow-up at the postintervention survey (ACTforIBD, n = 3; active control, n = 2).”
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Qazi, T. (2020) · Current Opinion in Gastroenterology · doi:10.1097/mog.0000000000000644 · Cited by 19
“In contrast, psychotherapy appears to show significant improvement in fatigue [74].”
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“To date, most psychological interventions for IBD have been designed to reduce affective outcomes (ie, anxiety or depression) rather than targeting other symptoms that are burdensome for patients [23,24].”
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“Specifically, the non-adherence in young females with IBD identified in this review [2,47,53,55,90] is consistent with previous findings [110].”
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“Previous studies have shown that anxiety and depression are present between 21% and 35%, respectively [23].”
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Exploring the management and treatment of IBD from the perspective of psychological comorbidities
Feng, L., Cai, X., Zou, Q., Peng, Y., Xu, L., Wang, L., Liu, Q., & Lou, T. (2024) · Therapeutic Advances in Gastroenterology · doi:10.1177/17562848241290685 · Cited by 14
“84 The placebo effect in IBD treatment underscores the importance of patient perception and cognitive experience in the regulation of the disease and clinical outcomes.”
BackgroundSelf-Management Techniques in IBD
Keefer, L., & Kane, S. V. (2015) · Springer eBooks · doi:10.1007/978-3-319-22285-1_5 · Cited by 12
“A review of 18 behavioral trials for IBD demonstrated that brief, problem-focused psychotherapies such as cognitive-behavior therapy may actually show promise with respect to reducing pain, fatigue, relapse rate and, hospitalization and improving medication adherence [53].”
BackgroundIBD-related mental health disorders: where do we go from here?
Gomez, D. A., Ahmad-waqar, M., Brookes, M., & Kumar, A. (2023) · Frontline Gastroenterology · doi:10.1136/flgastro-2023-102403 · Cited by 14
Keller, R., Fusco, S., Stange, E. F., Malek, N. P., Wehkamp, J., & Klag, T. (2020) · Zeitschrift für Gastroenterologie · doi:10.1055/a-1068-2877 · Cited by 11
“In the literature both entities are equally connected to depression and anxiety modulated by stress [26].”
BackgroundLing, F., Tu, L., Li, J., Chen, Y., Xu, M., & Zhu, L. (2021) · Scandinavian Journal of Gastroenterology · doi:10.1080/00365521.2021.1966093 · Cited by 10
“At present, psychotherapy has been proved to reduce the pain, fatigue and recurrence rate of IBD, improve the medication compliance [33].”
BackgroundTreating anxiety and depression in inflammatory bowel disease: a systematic review
Prendergast, K. L., Gowey, M. A., Barnes, M. J., Keller, C. V., Horne, C., & Young, J. N. (2021) · Psychology and Health · doi:10.1080/08870446.2020.1867135 · Cited by 10
“…et al., 2011; Yeh et al., 2017), whereas others have examined disparate treatment types separately but noted limited evidence to recommend one intervention type over another (Ballou & Keefer, 2017; Goodhand et al., 2009; Knowles et al., 2013; McCombie et al., 2013; Von Wietersheim & Kessler, 2006).”
BackgroundInfluentialGavrilescu, O., Prelipcean, C. C., Dranga, M., Soponaru, C., & Mihai, C. (2020) · The Turkish Journal of Gastroenterology · doi:10.5152/tjg.2020.19669 · Cited by 9
“Some existing studies have used QoL assessment questionnaires to identify patients who may respond to psychological therapies (29, 30).”
MethodAdherence improvement in patients with ulcerative colitis: a multidisciplinary consensus document
Casellas, F., González‐Lama, Y., Vicens, D. G., García‐López, S., Muñoz, F., Sánchez, L. M., Camacho, L., Cábez, A., Fortes, M. D. P., Gómez, S., et al. (2021) · Revista Española de Enfermedades Digestivas · doi:10.17235/reed.2021.8130/2021 · Cited by 8
Mocciaro, F., Pecoraro, G. M., Mitri, R. D., Scimeca, D., Bossa, F., Russo, G., Martino, G., Costanza, V., Profita, M. A., Orlando, C., et al. (2017) · Digestive and Liver Disease · doi:10.1016/j.dld.2017.06.009 · Cited by 8
Gregory, V. L. (2019) · Journal of Evidence-Based Social Work · doi:10.1080/26408066.2019.1610682 · Cited by 7
Psychoneuroimmunological approach to gastrointestinal related pain
Toljan, K., & Vrooman, B. (2017) · Scandinavian Journal of Pain · doi:10.1016/j.sjpain.2017.10.010 · Cited by 7
Psychische Störungen bei somatischen Krankheiten
Kapfhammer, H. (2017) · Springer eBooks · doi:10.1007/978-3-662-49295-6_88 · Cited by 6
Danesh, M., Gholamrezaei, A., Torkzadeh, F., Mirbagher, L., Soluki, R., & Emami, M. H. (2015) · International journal of body, mind and culture · doi:10.22122/ijbmc.v2i2.29 · Cited by 6
De-escalation of IBD Therapy: When, Who, and How?
Waljee, A. K., Chaisidhivej, N., Saini, S. D., & Higgins, P. (2019) · Crohn s & Colitis 360 · doi:10.1093/crocol/otz008 · Cited by 5
Common psychological disorders in inflammatory bowel disease and implications for disease management
Graff, L. A., & Dudley-Brown, S. L. (2013) · Journal of clinical outcomes management · Cited by 5
Skvarc, D., Evans, S., Cheah, S., Cranney, M., German, B., Orr, R., Emerson, C., Olive, L., Beswick, L., Massuger, W., et al. (2022) · Complementary Therapies in Clinical Practice · doi:10.1016/j.ctcp.2022.101616 · Cited by 4
Bogale, K., Yadav, S. K., Stuart, A., Kunselman, A. R., Dalessio, S., Bernasko, N., Tinsley, A., Clarke, K., Williams, E., & Coates, M. D. (2021) · Inflammatory Intestinal Diseases · doi:10.1159/000520797 · Cited by 4
Tse, C. S., Singh, S., & Sandborn, W. J. (2022) · Inflammatory Bowel Diseases · doi:10.1093/ibd/izab153 · Cited by 3
Renna, M. E., O’Toole, M. S., Fresco, D. M., Heimberg, R. G., & Mennin, D. S. (2021) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2021.102403 · Cited by 4
Emerson, C., Skvarc, D., Fuller‐Tyszkiewicz, M., OLIVE, L. S., Gibson, P. R., & Mikocka‐Walus, A. A. (2022) · Digestive Diseases and Sciences · doi:10.1007/s10620-022-07476-x · Cited by 3
“This is in line with findings outlined by McCombie, Mulder [11], where psychological interventions in the IBD population are prone to high rates of attrition and CBT being the most effective intervention for psychological symptoms in the IBD population.”
BackgroundResultThe Role of Integrated Interventions in Psychosomatic Diseases
Biondi, M., Bersani, F. S., & Pasquini, M. (2018) · Integrating psychiatry and primary care · doi:10.1007/978-3-319-74736-1_14 · Cited by 3
Young, E., Lawrence, M. J., Thomas, M., & Andrews, J. M. (2019) · JGH Open · doi:10.1002/jgh3.12193 · Cited by 3
Psychische Störungen bei somatischen Krankheiten
Kapfhammer, H. (2015) · Springer eBooks · doi:10.1007/978-3-642-45028-0_88-1 · Cited by 2
Chronisch entzündliche Darmerkrankungen
Schaefert, R., & Häuser, W. (2016) · Elsevier eBooks · doi:10.1016/b978-3-437-21833-0.00082-6 · Cited by 2
Emotional dysfunction and inflammatory bowel disease
Li, S., & Wu, Q. (2019) · World Chinese Journal of Digestology · doi:10.11569/wcjd.v27.i12.727 · Cited by 1
Zhao, Y.-Y., Zhang, L., Yang, Y.-X., Hao, N., Wang, B., & Liu, Y. (2021) · World Chinese Journal of Digestology · doi:10.11569/wcjd.v29.i12.628 · Cited by 1
(2015) · Journal of Crohn s and Colitis · doi:10.1093/ecco-jcc/jju027.751 · Cited by 1
Störungen des gastrointestinalen Systems
Musial, F., & Enck, P. (2015) · Springer-Lehrbuch · doi:10.1007/978-3-662-48035-9_8
MEANING MAKING OF ILLNESS BY CHRONICALLY ILL PATIENTS. SELECTED RESEARCH RESULTS.
Zaøuski, M., & Matjanowska, A. (2015) · Jagiellonian University Repository (Jagiellonian University)
Graffigna, G., Bosio, C., Pagnini, F., Volpato, E., Previtali, E., Leone, S., D’Amico, F., Armuzzi, A., & Danese, S. (2021) · Research Square · doi:10.21203/rs.3.rs-587615/v1
Healthcare Maintenance in the Patient with Inflammatory Bowel Disease: High-Yield Interventions
Roitman, I., Mone, A., & Swaminath, A. C. (2021) · Clinical gastroenterology · doi:10.1007/978-3-030-81780-0_7
Taft, T., & Riehl, M. E. (2014) · Springer eBooks · doi:10.1007/978-0-387-09817-3_18
(2016) · Elsevier eBooks · doi:10.1016/b978-3-437-21833-0.16001-2
Inflammatory bowel disease and cognitive behavioral therapy (CBT) in the young
Stapersma, L., Escher, J. C., & Utens, E. M. W. J. (2023) · Elsevier eBooks · doi:10.1016/b978-0-323-85757-4.00015-8
Metadata
- Authors
- McCombie, A. M., Mulder, R. T., & Gearry, R. B.
- Affiliations
- University of Otago (NZ)
- Corresponding author
- McCombie, Andrew M.
- Mulder, Roger T.
- Gearry, Richard B.
- Venue
- Journal of Crohn s and Colitis
- Publisher
- Oxford University Press (OUP)
- Published
- 2013-12
- Volume
- 7
- Issue
- 12
- Pages
- 935-949
- ISSN
- 1873-9946 (ISSN-L)
- OpenAlex
- W2120277733
- Cited by
- 105
- References
- 121
- Citations by year
- 2025: 5 · 2024: 3 · 2023: 5 · 2022: 4 · 2021: 17 · 2020: 11 · 2019: 11 · 2018: 5 · 2017: 12 · 2016: 7 · 2015: 14 · 2014: 8 · 2013: 3
- FWCI
- 1.31
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Crohn s and Colitis (publishedVersion)
- PubMed (publishedVersion)
- Funders
- University of Otago Doctoral Scholarship
- Todd Foundation Award for Excellence
- Topics
- Health Sciences › Medicine › Gastroenterology › Inflammatory Bowel Disease
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- psychotherapy, inflammatory bowel disease
- MeSH terms
- Anxiety, Depression, Fatigue, Hospitalization, Humans, Psychotherapy, Quality of Life, Recurrence, Inflammatory Bowel Diseases, Randomized Controlled Trials as Topic, Medication Adherence, Pain Management
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