Psychological therapies improve short-term quality of life in quiescent IBD
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Key takeaways:
- Psychological therapies improved quality of life but not disease activity in adults with quiescent inflammatory bowel disease.
- Third-wave therapies had a stronger effect than cognitive behavior therapy.
Psychological therapies provided short-term improvements in anxiety, depression, stress and quality of life in people with quiescent inflammatory bowel disease but did not improve disease activity or prevent relapse, according to analysis.
“The gut and brain communicate through the gut-brain axis, and this bidirectional communication system is being increasingly recognized as having a crucial role in both the psychological health and prognosis of individuals with IBD,” Christy Riggott, MBChB, of Leeds Gastroenterology Institute, and colleagues wrote in The Lancet Gastroenterology & Hepatology. “However, whether treatments directed at the gut-brain axis, such as psychological therapies, can influence disease activity or psychological health in individuals with IBD is unclear.”
In a systematic review and meta-analysis, Riggott and colleagues aimed to update a previous review from 2017 and assess whether psychological therapy affects disease activity, psychological symptoms or health-related quality of life.
Researchers identified 25 randomized controlled trials that compared psychological treatment with a control or standard care in patients aged 16 years and older. Four trials included only patients with active IBD, 18 were conducted in patients with quiescent IBD and three included mixed populations. Trial data was pooled according to disease state.
Researchers noted 10 trials used third-wave therapies such as mindfulness or acceptance and commitment therapy, eight used cognitive behavioral therapy and two used solution-focused therapy. The remainder used psychodynamic therapy, gut-directed hypnotherapy, guided imagery, stress management or combination therapy.
Results from two trials showed psychological therapy had no benefit compared with control for anxiety scores at the end of treatment in patients with active IBD (standardized mean difference [SMD] = –1.04; 95% CI, –2.46 to 0.39), while four trials demonstrated significant benefit of psychological therapy on quality of life (SMD = 0.68; 95% CI, 0.09-1.26).
Among patients with quiescent IBD, 10 trials showed the relative risk for relapse of disease activity was not reduced with psychological therapy (RR = 0.83; 95% CI, 0.62-1.12). There also was no difference in disease activity indices between psychological therapy vs. control in 13 trials of patients with quiescent disease (SMD = –0.01; 95% CI, –0.13 to 0.12).
However, scores for anxiety (13 trials; SMD = –0.23; 95% CI, –0.36 to –0.09), depression (15 trials; SMD = –0.26; 95% CI, –0.38 to –0.15) and stress (11 trials; SMD = –0.22; 95% CI, –0.42 to –0.03) were lower with psychological therapy vs. control, and quality of life (16 trials; SMD = 0.31; 95% CI, 0.16-0.46) was higher at treatment completion.
“The findings of this systematic review and meta-analysis show the potential efficacy of psychological therapies in providing short-term improvements in anxiety, depression, stress and quality-of-life scores in individuals with quiescent IBD, but not in improving disease activity indices or in preventing relapse of disease activity,” Riggott and colleagues wrote. “Third-wave therapies appeared to exert a stronger effect than CBT in individuals with quiescent IBD and the benefit of third-wave therapies persisted until final follow-up for depression and stress scores.”
They continued: “However, further prospective trials assessing the efficacy of these therapies in individuals who are most likely to benefit from them are needed to enable formal guidelines to be developed to aid clinicians in the selection of individuals for psychological therapy in clinical settings.”
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