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Self-help Cognitive Behavioral Therapy Improves Health-Related Quality of Life for Inflammatory Bowel Disease Patients: A Randomized Controlled Effectiveness Trial

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Abstract

Patients with inflammatory bowel disease (IBD) often have poor health-related quality of life (HRQL) and are at risk for anxiety and depression. Cognitive behavioral therapy (CBT) can help patients with IBD cope with their disease. Unfortunately, barriers to care include expense and availability of qualified therapists. Stand-alone, self-help CBT could improve access to care. This study examined the effectiveness of a self-help CBT workbook for patients with IBD. A randomized controlled trial compared the CBT workbook to an active psychoeducational control workbook. A total of 140 participants enrolled. In both groups, scores improved on a range of measures, including catastrophizing, visceral sensitivity, and HRQL, although pre-post effect sizes were generally larger in the CBT group. Only participants in the CBT group experienced significant improvements in anxiety and depression. Improvements were generally maintained or consolidated at 3-month follow-up. Self-help CBT can be an effective and inexpensive way to improve HRQL for patients with IBD.

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References

  • Beck, A. T., Steer, R. A., Ball, R., & Ranieri, W. F. (1996). Comparison of Beck depression inventories-IA and-II in psychiatric outpatients. Journal of Personality Assessment, 67, 588–597.

    Article  CAS  Google Scholar 

  • Bernstein, C. N., Singh, S., Graff, L. A., Walker, J. R., & Cheang, M. (2011). A prospective population-based study of triggers of symptomatic flares in IBD. American Journal of Gastroenterology, 105, 1994–2002.

    Article  Google Scholar 

  • Bitton, A., Dobkin, P. L., Edwardes, M. D., Sewitch, M. J., Meddings, J. B., Rawal, S., … Wild, G. E. (2009). Predicting relapse in Crohn’s disease. Diseases of the Colon & Rectum, 52, 546. https://doi.org/10.1097/01.dcr.0000345759.79776.e3.

  • Bonaz, B. L., & Bernstein, C. N. (2013). Brain-gut interactions in inflammatory bowel disease. Gastroenterology, 144, 36–49. https://doi.org/10.1053/j.gastro.2012.10.003.

    Article  PubMed  Google Scholar 

  • Burisch, J., Jess, T., Martinato, M., Lakatos, P. L., & on behalf of ECCO –EpiCom. (2013). The burden of inflammatory bowel disease in Europe. Journal of Crohn’s and Colitis, 7(4), 322–337. https://doi.org/10.1016/j.crohns.2013.01.010.

    Article  PubMed  Google Scholar 

  • Craven, M. R., Quinton, S., & Taft, T. H. (2018). Inflammatory bowel disease patient experiences with psychotherapy in the community. Journal of Clinical Psychology in Medical Settings. https://doi.org/10.1007/s10880-018-9576-5.

    Article  Google Scholar 

  • Evertsz’, F. B., Bockting, C. L., Stokkers, P. C., Hinnen, C., Sanderman, R., & Sprangers, M. A. (2012). The effectiveness of cognitive behavioral therapy on the quality of life of patients with inflammatory bowel disease: multi-center design and study protocol (KL!C- study). BMC Psychiatry. https://doi.org/10.1186/1471-244x-12-227.

    Article  PubMed Central  Google Scholar 

  • Evertsz, F. B., Hoeks, C. C., Nieuwkerk, P. R., Stokker, P. C. F., Ponsioen, C. Y., Bockting, C. L. H., … Sprangers, M. A. G. (2013). Development of the Patient Harvey Bradshaw Index (P-HBI) and a comparison with a clinician-based Harvey Bradshaw Index assessment of Crohn’s disease activity. Journal of Clinical Gastroenterology, 47, 850–856. https://doi.org/10.1097/mcg.0b013e31828b2196.

  • Evertsz’, F. B., Thijssens, N., Stokkers, P., Grootenhuis, M., Bockting, C., Nieuwkerk, P., & Sprangers, M. (2012). Do inflammatory bowel disease patients with anxiety and depressive symptoms receive the care they need? Journal of Crohn’s and Colitis, 6(1), 68–76. https://doi.org/10.1016/j.crohns.2011.07.006.

    Article  Google Scholar 

  • Flay, B. R. (1986). Efficacy and effectiveness trials (and other phases of research) in the development of health promotion programs. Preventative Medicine, 15, 451–474.

    Article  CAS  Google Scholar 

  • Glasgow, R. E., Lichtenstein, E., & Marcus, A. C. (2003). Why don’t we see more translation of health promotion research to practice? Rethinking the efficacy-to-effectiveness transition. American Journal of Public Health, 93, 1261–1267.

    Article  Google Scholar 

  • Goodhand, J. R., Wahed, M., Mawdsley, J. E., Farmer, A. D., Aziz, Q., & Rampton, D. S. (2012). Mood disorders in inflammatory bowel disease: Relation to diagnosis, disease activity, perceived stress, and other factors. Inflammatory Bowel Diseases, 18, 2301–2309. https://doi.org/10.1002/ibd.22916.

    Article  PubMed  CAS  Google Scholar 

  • Gracie, D. J., & Ford, A. C. (2017). A bidirectional relationship between symptom reporting and perceived stress, but not disease activity, in inflammatory bowel disease: More questions than answers? Gastroenterology, 153, 1444–1445.

    Article  Google Scholar 

  • Gracie, D. J., Irvine, A. J., Sood, R., Mikocka-Walus, A., Hamlin, P. J., & Ford, A. C. (2017). Effect of psychological therapy on disease activity, psychological comorbidity, and quality of life in inflammatory bowel disease: A systematic review and meta-analysis. The Lancet: Gastroenterology & Hepatology, 2, 189–199.

    Google Scholar 

  • Graff, L. A., Walker, J. R., & Bernstein, C. N. (2009). Depression and anxiety in inflammatory bowel disease: A review of comorbidity and management. Inflammatory Bowel Diseases, 15, 1105–1118. https://doi.org/10.1002/ibd.20873.

    Article  PubMed  Google Scholar 

  • Graff, L. A., Walker, J. R., Clara, I., Lix, L., Miller, N., Rogala, L., … Bernstein, C. N. (2009). Stress coping, distress, and health perceptions in inflammatory bowel disease and community controls. American Journal of Gastroenterology, 104, 2959–2969. https://doi.org/10.1038/ajg.2009.529.

  • Guthrie, E. (2002). Psychological disorder and severity of inflammatory bowel disease predict health-related quality of life in ulcerative colitis and Crohn’s disease. The American Journal of Gastroenterology, 97, 1994–1999. https://doi.org/10.1016/s0002-9270(02)04198-9.

    Article  PubMed  Google Scholar 

  • Harvey, R., & Bradshaw, J. (1980). A simple index of Crohn’s disease activity. The Lancet, 315, 514.

    Article  Google Scholar 

  • Häuser, W., Moser, G., Klose, P., & Miocka-Walus, A. (2014). Psychosocial issues in evidence-based guidelines on inflammatory bowel diseases: A review. World Journal of Gastroenterology, 20, 3663–3671.

    Article  Google Scholar 

  • Hunt, M., Ertel, E., Coello, J., & Rodriguez, L. (2014a). Empirical support for a self-help treatment for IBS. Cognitive Therapy and Research, 39, 215–227. https://doi.org/10.1007/s10608-014-9647-3.

    Article  Google Scholar 

  • Hunt, M. G., Ertel, E., Coello, J. A., & Rodriguez, L. (2014b). Development and validation of the GI-cognitions questionnaire. Cognitive Therapy and Research, 38, 472–482.

    Article  Google Scholar 

  • Hunt, M. G., Moshier, S., & Milonova, M. (2009). Brief cognitive-behavioral internet therapy for irritable bowel syndrome. Behaviour Research and Therapy, 47, 797–802. https://doi.org/10.1016/j.brat.2009.05.002.

    Article  PubMed  Google Scholar 

  • Hunt, M., Rodriguez, L., & Marcelle, E. (2017). A cognitive behavioral therapy workbook delivered online with minimal therapist feedback improves quality of life for inflammatory bowel disease patients. Internal Medicine Review, 3, 1–16.

    Google Scholar 

  • IBM. (2012). IBM SPSS missing values 21. Armonk, NY: IBM Corporation.

    Google Scholar 

  • Iglesias-Rey, M., Barreiro-de Acosta, M., Caamaño-Isorna, F., Rodríguez, I. V., Ferreiro, R., Lindkvist, B., … & Dominguez-Munoz, J. E. (2013). Psychological factors are associated with changes in the health-related quality of life in inflammatory bowel disease. Inflammatory bowel diseases, 20, 92–102. https://doi.org/10.1097/01.mib.0000436955.78220.bc.

  • Irvine, E. J., Zhou, Q., & Thompson, A. K. (1996). The short inflammatory bowel disease questionnaire: A quality of life instrument for community physicians managing inflammatory bowel disease. CCRPT Investigators. Canadian Crohn’s Relapse Prevention Trial. American Journal of Gastroenterology, 91, 1571–1578.

    PubMed  CAS  Google Scholar 

  • King, R. J., Orr, J. A., Poulsen, B., Giacomantonio, S. G., & Haden, C. (2017). Understanding the therapist contribution to psychotherapy outcome: A meta-analytic approach. Administration and Policy in Mental Health and Mental Health Services Research, 44, 664–680. https://doi.org/10.1007/s10488-016-0783-9.

    Article  PubMed  Google Scholar 

  • Knowles, S. R., Monshat, K., & Castle, D. J. (2013). The efficacy and methodological challenges of psychotherapy for adults with inflammatory bowel disease: A review. Inflammatory Bowel Diseases, 19, 2704–2715.

    Article  Google Scholar 

  • Kovacs, Z., & Kovacs, F. (2007). Depressive and anxiety symptoms, dysfunctional attitudes and social aspects in irritable bowel syndrome and inflammatory bowel disease. The International Journal of Psychiatry in Medicine, 37, 245–255. https://doi.org/10.2190/pm.37.3.a.

    Article  PubMed  Google Scholar 

  • Labus, J. S., Bolus, R., Chang, L., Wiklund, I., Naesdal, J., Mayer, E. A., & Naliboff, B. D. (2004). The visceral sensitivity index: Development and validation of a gastrointestinal symptom-specific anxiety scale. Alimentary Pharmacology and Therapeutics Aliment, 20, 89–97.

    Article  CAS  Google Scholar 

  • Levenstein, S. (2000). Stress and exacerbation in ulcerative colitis: A prospective study of patients enrolled in remission. The American Journal of Gastroenterology, 95, 1213–1220. https://doi.org/10.1016/s0002-9270(00)00804-2.

    Article  PubMed  CAS  Google Scholar 

  • Matcham, F., Rayner, L., Hutton, J., Monk, A., Steel, C., & Hotopf, M. (2014). Self-help interventions for symptoms of depression, anxiety and psychological distress in patients with physical illnesses: A systematic review and meta-analysis. Clinical Psychology Review, 34(2), 141–157. https://doi.org/10.1016/j.cpr.2014.01.005.

    Article  PubMed  CAS  Google Scholar 

  • Mathieu, E., McGeechan, K., Barratt, A., & Herbert, R. (2013). Internet-based randomized controlled trials: A systematic review. Journal of the American Medical Informatics Association, 20, 568–576. https://doi.org/10.1136/amiajnl-2012-001175.

    Article  PubMed  Google Scholar 

  • Maunder, R. G., & Greenberg, G. R. (2004). Comparison of a disease activity index and patients’ self-reported symptom severity in ulcerative colitis. Inflammatory Bowel Diseases, 10, 632–636.

    Article  Google Scholar 

  • Maunder, R. G., & Levenstein, S. (2008). The role of stress in the development and clinical course of inflammatory bowel disease: epidemiological evidence. Current Molecular Medicine, 8, 247–252.

    Article  CAS  Google Scholar 

  • Mawdsley, J. E., & Rampton, D. S. (2005). Psychological stress in IBD: New insights into pathogenic and therapeutic implications. Gut, 54(10), 1481–1491. https://doi.org/10.1136/gut.2005.064261.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Mawdsley, J. E., & Rampton, D. S. (2006). The role of psychological stress in inflammatory bowel disease. Neuroimmunomodulation, 13, 327–336. https://doi.org/10.1159/000104861.

    Article  PubMed  CAS  Google Scholar 

  • McCombie, A., Gearry, R., Andrews, J., Mulder, R., & Mikocka-Walus, A. (2016). Does computerized cognitive-behavioral therapy help people with inflammatory bowel disease? A randomized controlled trial. Inflammatory Bowel Diseases, 22, 171–181.

    Article  Google Scholar 

  • Mikocka-Walus, A., Bampton, P., Hetzel, D., Hughes, P., Esterman, A., & Andrews, J. M. (2015). 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. https://doi.org/10.1186/s12876-015-0278-2.

    Article  PubMed  PubMed Central  Google Scholar 

  • Mikocka-Walus, A., Bampton, P., Hetzel, D., Hughes, P., Esterman, A., & Andrews, J. M. (2017). Cognitive-behavioural therapy for inflammatory bowel disease: 24-month data from a randomised controlled trial. International Journal of Behavioral Medicine, 24, 127–135. https://doi.org/10.1007/s12529-016-9580-9.

    Article  PubMed  Google Scholar 

  • Mikocka-Walus, A., Knowles, S. R., Keefer, L., & Graff, L. (2016a). Controversies revisited: A systematic review of the comorbidity of depression and anxiety with inflammatory bowel diseases. Inflammatory Bowel Diseases, 22, 752–762.

    Article  Google Scholar 

  • Mikocka-Walus, A., Pittet, V., Rossel, J. B., & von Känel, R. (2016b). Symptoms of depression and anxiety are independently associated with clinical recurrence of inflammatory bowel disease. Clinical Gastroenterology and Hepatology, 14, 829–835.

    Article  Google Scholar 

  • Mittermaier, C., Dejaco, C., Waldhoer, T., Oefferlbauer-Ernst, A., Miehsler, W., Beier, M., … Moser, G. (2004). Impact of depressive mood on relapse in patients with inflammatory bowel disease: A prospective 18-month follow-up study. Psychosomatic Medicine, 66, 79–84. https://doi.org/10.1097/01.psy.0000106907.24881.f2.

  • Mussell, M., Böcker, U., Nagel, N., Olbrich, R., & Singer, M. (2003). Reducing psychological distress in patients with inflammatory bowel disease by cognitive-behavioural treatment: Exploratory study of effectiveness. Scandinavian Journal of Gastroenterology, 38, 755–762. https://doi.org/10.1080/00365520310003110.

    Article  PubMed  CAS  Google Scholar 

  • Neilson, K., Ftanou, M., Monshat, K., Salzberg, M., Bell, S., Kamm, M. A., … Castle, D. (2016). A controlled study of a group mindfulness intervention for individuals living with inflammatory bowel disease. Inflammatory Bowel Diseases, 22, 694–701. https://doi.org/10.1097/mib.0000000000000629.

  • Norcross, J. C. (2000). Here comes the self-help revolution in mental health. Psychotherapy, 37, 370–377.

    Article  Google Scholar 

  • Persoons, P., Vermeire, S., Demyttenaere, K., Fischler, B., Vandenberghe, J., Oudenhove, L. V., … Rutgeerts, P. (2005). The impact of major depressive disorder on the short- and long-term outcome of Crohn’s disease treatment with infliximab. Alimentary Pharmacology and Therapeutics, 22, 101–110. https://doi.org/10.1111/j.1365-2036.2005.02535.x.

  • Rosen, G. M. (1993). Self-help or hype? Comments on psychology’s failure to advance self-care. Professional Psychology: Research and Practice, 24, 340–345.

    Article  Google Scholar 

  • Sajadinejad, M. S., Asgari, K., Molavi, H., Kalantari, M., & Adibi, P. (2012). Psychological issues in inflammatory bowel disease: An overview. Gastroenterology Research and Practice, 2012, 1–11. https://doi.org/10.1155/2012/106502.

    Article  Google Scholar 

  • Sewitch, M. (2001). Psychological distress, social support, and disease activity in patients with inflammatory bowel disease. The American Journal of Gastroenterology, 96, 1470–1479. https://doi.org/10.1016/s0002-9270(01)02363-2.

    Article  PubMed  CAS  Google Scholar 

  • Sexton, K. A., Walker, J. R., Graff, L. A., Bernstein, M. T., Beatie, B., Miller, N., … Targownik, L. E. (2017). Evidence of bidirectional associations between perceived stress and symptom activity: A prospective longitudinal investigation in inflammatory bowel disease. Inflammatory Bowel Disease, 23, 473–483.

  • Sica, G. S., & Biancone, L. (2013). Surgery for inflammatory bowel disease in the era of laparoscopy. World Journal of Gastroenterology, 19, 2445–2448. https://doi.org/10.3748/wjg.v19.i16.2445.

    Article  PubMed  PubMed Central  Google Scholar 

  • Singal, A. G., Higgins, P. D. R., & Waljee, A. K. (2014). A primer on effectiveness and efficacy trials. Clinical and Translational Gastroenterology, 5, e45. https://doi.org/10.1038/ctg.2013.13.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Spielberger, C. D., Gorsuch, R. L., Lushene, R., Vagg, P. R., & Jacobs, G. A. (1983). Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press.

    Google Scholar 

  • Spratt, M., Carpenter, J., Sterne, J. A., Carlin, J. B., Heron, J., Henderson, J., & Tilling, K. (2010). Strategies for multiple imputation in longitudinal studies. American Journal of Epidemiology, 172, 478–487. https://doi.org/10.1093/aje/kwq137.

    Article  PubMed  Google Scholar 

  • Szigethy, E. M., Allen, J. I., Reiss, M., Cohen, W., Perera, L. P., Brillstein, L., … Regueiro, M. D. (2017). The impact of mental and psychosocial factors on the care of patients with inflammatory bowel disease. Clinical Gastroenterology and Hepatology, 15, 986–997.

  • Vermeire, S., Schreiber, S., Sandborn, W. J., Dubois, C., & Rutgeerts, P. (2010). Correlation between the Crohn’s disease activity and Harvey-Bradshaw Indices in assessing Crohn’s disease severity. Clinical Gastroenterology and Hepatology, 8, 357–363. https://doi.org/10.1016/j.cgh.2010.01.001.

    Article  PubMed  Google Scholar 

  • von Wietersheim, J., & Kessler, H. (2006). Psychotherapy with chronic inflammatory bowel disease patients: A review. Inflammatory Bowel Diseases, 12, 1175–1184.

    Article  Google Scholar 

  • Wiklund, I. K., Fullerton, S., Hawkey, C. J., Jones, R. H., Longstreth, G. F., Mayer, E. A., … Naesdal, J. (2003). An irritable bowel syndrome-specific symptom questionnaire: Development and validation. Scandinavian Journal of Gastroenterology, 38, 947–954.

  • Williams, C., & Martinez, R. (2008). Increasing access to CBT: Stepped care and CBT self-help models in practice. Behavioural and Cognitive Psychotherapy, 36, 675–683.

    Article  Google Scholar 

  • Yoshida, E. M. (1999). The Crohn’s Disease Activity Index, its derivatives and the inflammatory bowel disease questionnaire: A review of instruments to assess in Crohn’s disease. Canadian Journal of Gastroenterology, 13, 65–73. https://doi.org/10.1155/1999/506915.

    Article  PubMed  CAS  Google Scholar 

  • Zhou, Y., Ren, W., Irvine, E. J., & Yang, D. (2010). Assessing health-related quality of life in patients with inflammatory bowel disease in Zhejiang, China. Journal of Clinical Nursing, 19, 79–88. https://doi.org/10.1111/j.1365-2702.2009.03020.x.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Psychology, University of Pennsylvania, 425 S. University Ave, Philadelphia, PA, 19104-6241, USA

    Melissa G. Hunt, Paddy Loftus, Michael Accardo, Mary Keenan & Lauren Cohen

  2. Division of Gastroenterology, Penn Presbyterian Medical Center, Philadelphia, PA, USA

    Mark T. Osterman

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  1. Melissa G. Hunt
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  2. Paddy Loftus
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  4. Mary Keenan
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Correspondence to Melissa G. Hunt.

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Melissa G. Hunt, Paddy Loftus, Michael Accardo, Mary Keenan, Lauren Cohen, and Mark T. Osterman declare that they have no conflicts of interest.

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Hunt, M.G., Loftus, P., Accardo, M. et al. Self-help Cognitive Behavioral Therapy Improves Health-Related Quality of Life for Inflammatory Bowel Disease Patients: A Randomized Controlled Effectiveness Trial. J Clin Psychol Med Settings 27, 467–479 (2020). https://doi.org/10.1007/s10880-019-09621-7

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