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A Randomized Controlled Trial of Mindfulness-Based Stress Reduction to Prevent Flare-Up in Patients with Inactive Ulcerative Colitis
Open accessAbstract
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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“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]
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“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
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“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]
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“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]
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Oddsson, S. J., Gunnarsdottir, T., Jóhannsdóttir, L. G., Ámundadóttir, M. L., Frimannsdottir, A., Molander, P., Ylanne, A. K., Íslind, A. S., Óskarsdóttir, M., & Þorgeirsson, T. (2023) · JMIR Formative Research · doi:10.2196/39331 · Cited by 15
Ballesio, A., Micheli, F., Baccini, F., Zagaria, A., Forno, A. D., Fiori, V., Palombelli, G., Scalamonti, S., Ruffa, A., Magiotta, A., et al. (2024) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2024.111592 · Cited by 13
Ferreira, C., Pereira, J., Skvarc, D., Oliveira, S., Galhardo, A., Ferreira, N. B., Lucena-Santos, P., Carvalho, S. A., Matos-Pina, I., Rocha, B. S., et al. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1367913 · Cited by 12
Parian, A. M., Mullin, G. E., Langhorst, J., & Brown, A. C. (2017) · Elsevier eBooks · doi:10.1016/b978-0-323-35868-2.00050-5 · Cited by 15
Psychological interventions for treatment of inflammatory bowel disease
Tiles-Sar, N., Neuser, J., de Sordi, D., Baltes, A., Preiß, J., Moser, G., & Timmer, A. (2025) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd006913.pub3 · Cited by 13
Kohut, S. A., Forgeron, P. A., McMurtry, M., Weiser, N., Iuliano, A., & Stinson, J. (2021) · Journal of Child and Family Studies · doi:10.1007/s10826-021-02040-z · Cited by 10
The Practical Pros and Cons of Complementary and Alternative Medicine in Practice
Winter, R. W., & Korzenik, J. R. (2017) · Gastroenterology Clinics of North America · doi:10.1016/j.gtc.2017.08.013 · Cited by 10
Lindsay, E. K. (2021) · Brain, Behavior, & Immunity - Health · doi:10.1016/j.bbih.2021.100338 · Cited by 10
McClintock, A. S., Goldberg, S. B., Coe, C. L., & Zgierska, A. E. (2019) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2019.07.018 · Cited by 11
Avest, M. M. T., Huijbers, M. J., Horjus, C. S., Römkens, T. E. H., Witteman, E. M., van Dop, W. A., Dresler, M., Donders, A. R. T., Dijkstra, G. D. H., Nissen, L. H. C., et al. (2025) · Inflammatory Bowel Diseases · doi:10.1093/ibd/izaf116 · Cited by 9
Mindfulness, psychological distress, and somatic symptoms among women engaged in sex work in China
Tam, C. C., Zhou, Y., Qiao, S., Li, X., & Shen, Z. (2022) · Applied Psychology Health and Well-Being · doi:10.1111/aphw.12362 · Cited by 10
Qian, X., & Zhang, J. (2024) · Actas Españolas de Psiquiatría · doi:10.62641/aep.v52i4.1559 · Cited by 9
Out of sight, out of mind? Exploring the long-term effects of Relational Mindfulness Training (RMT)
Vich, M., Lukeš, M., & Burian, J. (2020) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2020.04.001 · Cited by 10
Fábián, A., Rutka, M., Ferenci, T., Bor, R., Bálint, A., Farkas, K., Milassin, Á., Szántó, K. J., Lénárt, Z., Nagy, F. T., et al. (2018) · Gastroenterology Research and Practice · doi:10.1155/2018/9137805 · Cited by 8
Tamara, V. D. S. (2015) · Gastroenterology & Hepatology Open Access · doi:10.15406/ghoa.2015.02.00038 · Cited by 8
Mindfulness-Based Stress Reduction and Transcendental Meditation: Current State of Research
Holt, A. (2015) · Journal of Patient-Centered Research and Reviews · doi:10.17294/2330-0698.1199 · Cited by 7
Liang, Y., Li, Y., & Zhou, M. (2024) · Gastroenterology Nursing · doi:10.1097/sga.0000000000000831 · Cited by 7
Spagnuolo, R., Basile, A., Corea, A., Iaquinta, F. S., Milić, N., Doldo, P., Luzza, F., & Abenavoli, L. (2022) · Reviews on Recent Clinical Trials · doi:10.2174/1574887117666220628151256 · Cited by 7
Chappell, K. D., Meakins, D., Marsh-Joyal, M., Bihari, A., Goodman, K. J., Mellédo, J. L., Lim, A., Peerani, F., & Kroeker, K. I. (2024) · JMIR Formative Research · doi:10.2196/53550 · Cited by 7
Psychosocial interventions for psoriasis: a Bayesian network meta-analysis
Lu, L., Xu, Y., Shi, M., & Liu, A. (2025) · Journal of Dermatological Treatment · doi:10.1080/09546634.2024.2427321 · Cited by 7
Complementary and Alternative Medicine in Crohn’s Disease
Seminerio, J. L. (2022) · Gastroenterology Clinics of North America · doi:10.1016/j.gtc.2021.12.009 · Cited by 7
Metadata
- 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)
- Venue
- Digestion
- Publisher
- S. Karger AG
- Published
- 2014
- Volume
- 89
- Issue
- 2
- Pages
- 142-155
- ISSN
- 0012-2823 (ISSN-L)
- 1421-9867
- 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
- green
- www.ncbi.nlm.nih.gov
- 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
- Health Sciences › Medicine › Gastroenterology › 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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