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

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.