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Targeting early goals of mental health improves outcomes in IBD
ORLANDO, Fla. — Identifying and targeting early indicators of possible mental health distress allows physicians to elicit better overall outcomes from their patients with inflammatory bowel disease, according to an expert at Advances in IBD 2017.
“I want us to really start by thinking about earlier characteristics and how we might be able to work on those early psychosocial factors that might ... influence patient activation and see some of those outcomes before we have psychiatric problems,” Laurie A. Keefer, PhD, director of psychobehavioral research within the division of gastroenterology at Mount Sinai Health System, said during her presentation.
Keefer said there are five aspects of mental health that can be cultivated in early diagnoses of IBD: disease acceptance, social support, resilience, self-confidence and self-regulation.
Before moving on in engaging a patient and teaching them coping mechanisms, that patient must accept they have a chronic, lifelong disease that must be managed.
“They may not approve of it, but they have to accept it. ... If they do not accept it, then we’re going to see much longer course of disease,” Keefer said.
This acceptance leads to activation and engagement in disease management, she said.
Next, the social support must be identified and, if lacking, encouraged, Keefer said.
“Social support has a very important physiologic component to it,” Keefer said. “Patients who are lonely and isolated ... tend to create higher symptom reporting.”
Lacking that social support is an additional risk factor for more severe psychosocial outcomes such as depression, anxiety and substance abuse, she said.
Resilience awareness exists in psychological evaluations, but is a “newer concept” in chronic disease, Keefer said.
“Patients who are resilient who can bounce back no matter what happens to them are much less likely to go on and develop depression and anxiety. They’re much more likely to report a better quality of life,” she said.
When looking at self-confidence, Keefer warned against assuming confidence elsewhere in life translates to confidence in IBD. She suggested a self-efficacy tool that would measure the ability of a patient to manage the disease, manage stress, manage symptoms and maintain wellness.
“Those are all very specific self-management tasks that patients need to be able to build the confidence of,” Keefer said. “Just because you’re really good at managing projects in your life ... doesn’t mean you have those same skills or confidence to manage your IBD. Those things need to be taught, shaped and reinforced. And those lead to much better outcomes early on in IBD care.”
Lastly, self-regulation is the ability of a patient to act on their disease management despite feeling stressed, anxious or depressed. The patient should be able to act in his or her best long-term interests, calm down when upset or find the positive outlook when feeling otherwise “down,” she said.
“Those are skills that we learn and sometimes have to learn in different ways when we’re going through a problem,” Keefer said. “Failures of self-regulation tend to arise when people are really sick. They just don’t have anything more to give.”
She added that her team is working to harness wearable sensors and other technology to help patients improve self-regulation. – by Katrina Altersitz
Reference:
Keefer L. Clinical Session IA. Presented at: Advances in IBD; Nov. 9-11, 2017; Orlando, Fla.
Disclosure: Keefer reports she serves on the scientific advisory board of www.MetaMeConnect.com, a company that has developed an online brain-gut psychotherapy platform.