Cognitive-behavioural therapy for the management of inflammatory bowel disease-fatigue: a feasibility randomised controlled trial
Open accessAbstract
BACKGROUND: Fatigue is the third most prevalent symptom for patients with inflammatory bowel disease (IBD), yet optimal strategies for its management are unclear. Treatment protocols for fatigue in other conditions have been based on cognitive-behavioural models. Targeting cognitions, emotions and behaviour related to fatigue through cognitive-behavioural therapy (CBT) may be a viable option to improve fatigue and quality of life (QoL) in IBD. METHODS: This single centre, two-arm, feasibility randomised controlled trial (RCT) aimed to assess the feasibility and initial estimates of potential efficacy of a CBT intervention for the management of IBD-fatigue. Feasibility, acceptability and initial estimates of potential efficacy outcomes were collected through self-report measures and semi-structured interviews. Participants were recruited from one tertiary referral centre. Intervention Group 1 received a CBT manual for fatigue, one 60-min and seven 30-min telephone sessions with a therapist over 8-weeks. Control Group 2 received a fatigue information sheet without therapist support. A nested qualitative study evaluated patients' and therapists' experiences, and IBD-healthcare professionals' (HCPs) perceptions of the intervention. RESULTS: Eighty-nine participants were assessed for eligibility. Of these, 31 of the 70 eligible participants consented to participate (recruitment rate of 44%). Of the 15 participants randomised to the intervention group, 13 (87%) started it and 10 (77% of those who started) completed all 8 sessions. Follow-up questionnaires were completed by 22 (71%) participants at 3 months, 14 (45%) at 6 months and 12 (39%) at 12 months' follow-up. The intervention was acceptable to participants and feasible for therapists to deliver. HCPs reported that the intervention would be applicable, but time, finance and training constraints limit its implementation. Initial estimates of potential efficacy with complete case analysis showed a reduction in fatigue and an increase in QoL at 3, 6 and 12 months post-randomisation. CONCLUSIONS: A full-scale effectiveness RCT testing CBT for IBD-fatigue is feasible and is potentially worthwhile with some changes to the protocol. However, given the small numbers, further pilot work is warranted before a full-scale RCT. TRIAL REGISTRATION: Registration Trial ISRCTN 17917944, Registered 2 September 2016.
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Retention rates of approximately 80% or above may be considered high feasibility when comparing with similar psychotherapy trials.
“Specifically, retention rates of approximately 80% or above may be considered high feasibility when comparing with similar psychotherapy trials in this space.24”
From Feasibility, Acceptability, and Preliminary Efficacy of Acceptance Commitment Therapy for Adults Living With Inflammatory Bowel Disease and Distress. (2024) · cites this paper as [24]
The Methods (Feasibility and acceptability outcomes; page unavailable) set a retention-related progression criterion of no more than 20% withdrawal, equivalent to at least 80% remaining in treatment. The Discussion (Advised revisions to the protocol; page unavailable) says the observed 23% withdrawal was comparable to CBT dropout rates across conditions, but exceeded the trial’s criterion. The paper therefore supports an approximate 80% benchmark, not the claim that this rate is considered high feasibility relative to similar psychotherapy trials. (LLM, conf=0.83)
Experimental — accuracy not yet measuredRetention of the intervention group was better than the 77% reported for a feasibility trial looking at CBT but poorer than the 100% reported in an online writing intervention.
“Retention of the intervention group was better than the 77% reported for a feasibility trial looking at CBT24 but poorer than the 100% reported in an online writing intervention.36”
From Feasibility, Acceptability, and Preliminary Efficacy of Acceptance Commitment Therapy for Adults Living With Inflammatory Bowel Disease and Distress. (2024) · cites this paper as [24]
The recruitment rate is in line with what would be expected from this population, especially compared with similar trials conducted with people diagnosed with IBD.
“This recruitment rate is in line with what we would expect from this population, especially when compared with similar trials conducted with people diagnosed with IBD.24,36”
From Feasibility, Acceptability, and Preliminary Efficacy of Acceptance Commitment Therapy for Adults Living With Inflammatory Bowel Disease and Distress. (2024) · cites this paper as [24]
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“Of relevance, a recent feasibility trial of a telephone-based CBT intervention for fatigue included a nested qualitative element (Artom et al., 2019).”
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- Authors
- Artom, M., Czuber-Dochan, W., Sturt, J., Proudfoot, H., Roberts, D., & Norton, C.
- Affiliations
- King's College London (GB)
- University College London (GB)
- Corresponding author
- Norton, Christine
- Venue
- Pilot and Feasibility Studies
- Published
- 2019-12
- Volume
- 5
- Issue
- 1
- Pages
- 145-145
- ISSN
- 2055-5784 (ISSN-L)
- PMC
- PMC6905023
- OpenAlex
- W2995807263
- Cited by
- 48
- References
- 114
- Citations by year
- 2026: 10 · 2025: 11 · 2024: 5 · 2023: 5 · 2022: 5 · 2021: 6 · 2020: 6
- FWCI
- 2.56
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Pilot and Feasibility Studies (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- King's College London
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Inflammatory Bowel Disease
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Keywords
- cognitive behavioral therapy, inflammatory bowel disease, fatigue, quality of life, telephone-delivered therapy, feasibility, acceptability, healthcare professionals' perceptions, pilot intervention
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