Cognitive-behavioural therapy has no effect on disease activity but improves quality of life in subgroups of patients with inflammatory bowel disease: a pilot randomised controlled trial

BMC Gastroenterology

Jane M Andrews³  Adrian Esterman⁴  Patrick Hughes⁵  David Hetzel¹  Peter Bampton⁶  Antonina Mikocka-Walus² 

[1] Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia;School of Psychology, University of Adelaide, Adelaide, Australia;School of Medicine, University of Adelaide, Adelaide, Australia;School of Nursing and Midwifery and Sansom Institute for Health Research, University of South Australia, Adelaide, Australia;Nerve-Gut Research Laboratory, Discipline of Medicine, University of Adelaide, Adelaide, Australia;Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, Australia

关键词: Remission;    Quality of life;    Psychological;    Mental health;    Flare;    Cognitive-behavioural therapy;   

Others  :  1211534
DOI  :  10.1186/s12876-015-0278-2

 received in 2014-12-15, accepted in 2015-04-13,  发布年份 2015

【 摘 要 】

Background

Studies have demonstrated usefulness of cognitive-behavioural therapy (CBT) in managing distress in inflammatory bowel disease (IBD); however, few have focused on IBD course. The present trial aimed to investigate whether adding CBT to standard treatment prolongs remission in IBD in comparison to standard therapy alone.

Methods

A 2-arm parallel pragmatic randomised controlled trial (+CBT – standard care plus either face-to-face (F2F) or online CBT over 10 weeks versus standard care alone (SC)) was conducted with adult patients in remission. IBD remission at 12 months since baseline was the primary outcome measure while the secondary outcome measures were mental health status and quality of life (QoL). Linear mixed-effect models were used to compare groups on outcome variables while controlling for baseline.

Results

Participants were 174 patients with IBD (90 +CBT, 84 SC). There was no difference in remission rates between groups, with similar numbers flaring at 12 months. Groups did not differ in anxiety, depression or coping at 6 or 12 months (p >0.05). When only participants classified as ‘in need’ (young, high baseline IBD activity, recently diagnosed; poor mental health) were examined in the post-hoc analysis (n = 74, 34 CBT and 40 controls), CBT significantly improved mental QoL (p = .034, d = .56) at 6 months. Online CBT group had a higher score on Precontemplation than the F2F group, which is consistent with less developed coping with IBD in the cCBT group (p = .045).

Conclusions

Future studies should direct psychological interventions to patients ‘in need’ and attempt to recruit larger samples to compensate for significant attrition when using online CBT.

Trial registration

The protocol was registered on 21/10/2009 with the Australian New Zealand Clinical Trials Registry (ID: ACTRN12609000913279 webcite).

【 授权许可】

   
2015 Mikocka-Walus et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

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