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Cited by 143Inflammatory Bowel DiseaseMindfulness and Compassion InterventionsHealth, psychology, and well-being

A Randomized Controlled Trial of Mindfulness-Based Stress Reduction to Prevent Flare-Up in Patients with Inactive Ulcerative Colitis

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Jedel, S., Hoffman, A., Merriman, P., Swanson, B., Voigt, R., Rajan, K.B., Shaikh, M., Li, H. +1 more·2014·Digestion
DOI 10.1159/000356316PMC PMC4059005
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Abstract

Background/Aims: The primary therapeutic goals in ulcerative colitis (UC) are to maintain excellent quality of life (QOL) by treating flare-ups when they occur, and preventing flare-ups. Since stress can trigger UC flare-ups, we investigated the efficacy of mindfulness-based stress reduction (MBSR) to reduce flare-ups and improve QOL. Methods: Patients with moderately severe UC, in remission, were randomized to MBSR or time/attention control. Primary outcome was disease status. Secondary outcomes were changes in markers of inflammation and disease activity, markers of stress and psychological assessments. Results: 55 subjects were randomized. Absence of flares, time to flare and severity of flare over 1 year were similar between the two groups. However, post hoc analysis showed that MBSR decreased the proportion of participants with at least one flare-up among those with top tertile urinary cortisol and baseline perceived stress (30 vs. 70%; p < 0.001). MBSR patients who flared demonstrated significantly lower stress at the last visit compared to flared patients in the control group (p = 0.04). Furthermore, MBSR prevented a drop in the Inflammatory Bowel Disease Quality of Life Questionnaire during flare (p < 0.01). Conclusion: MBSR did not affect the rate or severity of flare-ups in UC patients in remission. However, MBSR might be effective for those with high stress reactivity (high perceived stress and urinary cortisol) during remission. MBSR appears to improve QOL in UC patients by minimizing the negative impact of flare-ups on QOL. Further studies are needed to identify a subset of patients for whom MBSR could alter disease course.

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  • Twelve of the 15 intervention studies reported significant improvements in stress.

    “with 12 studies 33 , 37 , 39 , 40 , 42 , 44 , 45 , 50 , 51 , 52 , 54 , 58 reporting significant improvements in stress (Table 4).”

    From Systematic review: the role of psychological stress in inflammatory bowel disease (2022) · cites this paper as [39]

    The Results (Markers of Stress) report significantly lower perceived-stress scores for MBSR patients who experienced a flare than for control patients who experienced a flare (p=0.04). They also report no significant change in perceived-stress scores over the course of the study overall. This paper therefore supports a significant stress finding in a subgroup, not an unqualified improvement across its participants; it cannot itself establish the citing paper’s count of 12 studies. (LLM, conf=0.83)

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  • Mindfulness-based stress reduction interventions increase quality of life and reduce psychological symptoms, fatigue, and concentrations of C-reactive protein and faecal calprotectin in IBD.

    “Mindfulness-Based Stress Reduction (MBSR) interventions have been shown to increase the quality of life (Jedel et al., 2014; Goren et al., 2022) and reduce psychological symptoms (Drent et al., 2016; Goren et al., 2022), fatigue (Goren et al., 2022), and the concentration of C-reactive Protein (CRP) and faecal calprotectin in IBD (Berrill et al., 2014; Gonzalez-Moret et al., 2020).”

    From Randomized controlled trial of an Acceptance and Commitment Therapy and compassion-based group intervention for persons with inflammatory bowel disease: the LIFEwithIBD intervention (2024) · cites this paper as Jedel et al., 2014

    Jedel et al. is cited for the quality-of-life part of the sentence, not for psychological symptoms, fatigue, CRP, or faecal calprotectin. The Discussion reports that MBSR prevented a drop in quality of life among patients who experienced a UC flare-up, rather than increasing quality of life generally. (LLM, conf=0.88)

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  • Group programmes that included meditation or mindfulness or Acceptance-Commitment Therapy reduced distress and perceived stress.

    “Group programmes that included meditation or mindfulness 37 , 39 , 52 or Acceptance‐Commitment Therapy 58 reduced distress and perceived stress.”

    From Systematic review: the role of psychological stress in inflammatory bowel disease (2022) · cites this paper as [39]

    The Results report lower perceived-stress scores in the MBSR group than in controls among patients whose ulcerative colitis flared, but no significant overall change in perceived stress. The Results also found no group differences in anxiety or depression, so this paper does not establish a reduction in distress. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • ACT is effective for improving HRQL in clinical samples of adults living with chronic illness such as IBD.

    “Empirical findings suggest that ACT is effective for improving HRQL in clinical samples of adults living with chronic illness such as IBD [13,14] and in parents of children with chronic conditions, chronic pain, and anxiety [11,15,16,17,18].”

    From Online Acceptance and Commitment Therapy and Nutrition Workshop for Parents of Children with Inflammatory Bowel Disease: Feasibility, Acceptability, and Initial Effectiveness. (2021) · cites this paper as [13]

    The Intervention section identifies the treatment as mindfulness-based stress reduction (MBSR), not acceptance and commitment therapy (ACT). The Results and Discussion report better IBD-specific quality of life with MBSR among patients who experienced a flare-up, but they do not establish that ACT improves HRQL. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

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Research works printed but not linked: 1

  1. [23]Carlson JF Waller NG 1998 Review of the Beck Depression Inventory Impara JC Plake BS Murray LL Thirteenth mental measurement yearbook, Boros Institute of Mental Measurement Lincoln (NE) University of Nebraska 100 21

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Authors
Jedel, S., Hoffman, A., Merriman, P., Swanson, B., Voigt, R., Rajan, K. B., Shaikh, M., Li, H., & Keshavarzian, A.
Affiliations
  • Rush University Medical Center (US)
  • University of Chicago (US)
  • Rosalind Franklin University of Medicine and Science (US)
  • Rush University (US)
ORCID
Venue
Digestion
Publisher
S. Karger AG
Published
2014
Volume
89
Issue
2
Pages
142-155
ISSN
  • 0012-2823 (ISSN-L)
  • 1421-9867
DOI
10.1159/000356316
PMC
PMC4059005
OpenAlex
W1485424371
Semantic Scholar
35e046d57ebe87ffa2080e98775260d22b3e293c
Cited by
143
References
30
Citations by year
2026: 3 · 2025: 17 · 2024: 16 · 2023: 13 · 2022: 16 · 2021: 12 · 2020: 12 · 2019: 12 · 2018: 13 · 2017: 17 · 2016: 5 · 2015: 5 · 2014: 2
FWCI
6.35
Type
journal article
Language
en
Open access
Licence
Locations
  • Digestion (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health
  • National Center for Complementary and Integrative Health (R21AT003939)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Inflammatory Bowel Disease
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
  • Health Sciences › Health Professions › General Health Professions › Health, psychology, and well-being
Keywords
mindfulness-based stress reduction, ulcerative colitis, flare prevention, remission, perceived stress, urinary cortisol, stress reactivity, psychological intervention, inflammatory markers
MeSH terms
Adult, Attention, C-Reactive Protein, Colitis, Ulcerative, Double-Blind Method, Feces, Female, Humans, Hydrocortisone, Interleukins, Male, Middle Aged, Quality of Life, Surveys and Questionnaires, Stress, Psychological, Time Factors, Disease Progression, Disease-Free Survival, Leukocyte L1 Antigen Complex, Mindfulness

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