In the Journals

Psychological therapies appear to benefit IBD patients

Psychological therapies, especially cognitive behavioral therapy, may provide some short-term benefits on depression and quality of life in patients with inflammatory bowel disease, according to the results of a recent systematic review and meta-analysis.

However, these interventions did not appear to affect disease activity or other measures of psychological wellbeing in this patient population, the investigators concluded.

Alexander C. Ford, MD

Alexander C. Ford

“Evidence is increasing to suggest that poor psychological health might have negative effects on the natural history of inflammatory bowel disease,” Alexander C. Ford, MD, of the Leeds Gastroenterology Institute, St James’s University Hospital, Leeds, U.K., and colleagues wrote. “Findings from a previous systematic review and meta-analysis of randomized controlled trials suggested that psychological therapies might have beneficial effects on quality of life in inflammatory bowel disease, but data were scarce and different types of therapy were not discussed.”

Ford and colleagues therefore reviewed relevant literature published up to Sept. 22, 2016, and ultimately included 14 randomized control trials of psychological therapies involving a total of 1,196 IBD patients.

They found that psychological therapy was not associated with a significantly reduced relative risk for relapse of quiescent IBD compared with control interventions (RR = 0.98; 95% CI, 0.77-1.24).

Among patients with quiescent IBD, psychological therapy was associated with significant improvements in depression scores (P = .04) and quality of life (P = .01) at the end of the intervention.

“However, these beneficial effects were lost at final point of follow-up,” the researchers noted.

When evaluating different types of therapy individually, only cognitive behavioral therapy showed significant benefits on quality of life.

Only two trials evaluated improvements in quality of life after psychological therapy in patients with active disease, but the difference between patients and controls was not significant.

Further, only one trial reported “dichotomous data for the efficacy of psychological therapy in induction of remission of active inflammatory bowel disease [and] 12 (21%) of 57 patients receiving psychological therapy entered clinical remission compared with two (4%) of 57 patients in the control group, after 18 months of follow-up.”

Ford and colleagues concluded that “psychological therapies might provide a small, short-term improvement in depression scores and quality life in patients with clinically quiescent inflammatory bowel disease, but ... these effects appear to be lost over time. The beneficial effect on quality of life was most notable when we only included RCTs that used [cognitive behavioral therapy], which is thought to have the best evidence for efficacy in management of anxiety and depression.”

They also added that because observational studies have shown “the greatest psychological burden is [often] seen in patients with active disease or those with quiescent disease with ongoing gastrointestinal symptoms in the absence of inflammation, suggesting that these subgroups of patients might benefit most from these types of treatment.”

Despite limited evidence supporting the benefit of psychological therapies in IBD patients, “the strong association between depression and anxiety and unfavorable disease course suggests that clinicians should identify people with inflammatory bowel disease who also have substantial problems with anxiety and depression and refer them to appropriate treatment resources,” John R. Walker, PhD, of the department of clinical health psychology at the University of Manitoba, and St. Boniface Hospital in Winnipeg, Canada, wrote in a related editorial.

He recommended that clinicians use available anxiety and depression screening tools, or even ask a few simple questions during the clinical encounter to help identify patients with anxiety and mood disorders.

“Attention to psychological functioning is likely to improve treatment outcome and reduce disability in patients with inflammatory bowel disease,” he concluded. – by Adam Leitenberger

Disclosures: The researchers and Walker report no relevant financial disclosures.

Psychological therapies, especially cognitive behavioral therapy, may provide some short-term benefits on depression and quality of life in patients with inflammatory bowel disease, according to the results of a recent systematic review and meta-analysis.

However, these interventions did not appear to affect disease activity or other measures of psychological wellbeing in this patient population, the investigators concluded.

Alexander C. Ford, MD

Alexander C. Ford

“Evidence is increasing to suggest that poor psychological health might have negative effects on the natural history of inflammatory bowel disease,” Alexander C. Ford, MD, of the Leeds Gastroenterology Institute, St James’s University Hospital, Leeds, U.K., and colleagues wrote. “Findings from a previous systematic review and meta-analysis of randomized controlled trials suggested that psychological therapies might have beneficial effects on quality of life in inflammatory bowel disease, but data were scarce and different types of therapy were not discussed.”

Ford and colleagues therefore reviewed relevant literature published up to Sept. 22, 2016, and ultimately included 14 randomized control trials of psychological therapies involving a total of 1,196 IBD patients.

They found that psychological therapy was not associated with a significantly reduced relative risk for relapse of quiescent IBD compared with control interventions (RR = 0.98; 95% CI, 0.77-1.24).

Among patients with quiescent IBD, psychological therapy was associated with significant improvements in depression scores (P = .04) and quality of life (P = .01) at the end of the intervention.

“However, these beneficial effects were lost at final point of follow-up,” the researchers noted.

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When evaluating different types of therapy individually, only cognitive behavioral therapy showed significant benefits on quality of life.

Only two trials evaluated improvements in quality of life after psychological therapy in patients with active disease, but the difference between patients and controls was not significant.

Further, only one trial reported “dichotomous data for the efficacy of psychological therapy in induction of remission of active inflammatory bowel disease [and] 12 (21%) of 57 patients receiving psychological therapy entered clinical remission compared with two (4%) of 57 patients in the control group, after 18 months of follow-up.”

Ford and colleagues concluded that “psychological therapies might provide a small, short-term improvement in depression scores and quality life in patients with clinically quiescent inflammatory bowel disease, but ... these effects appear to be lost over time. The beneficial effect on quality of life was most notable when we only included RCTs that used [cognitive behavioral therapy], which is thought to have the best evidence for efficacy in management of anxiety and depression.”

They also added that because observational studies have shown “the greatest psychological burden is [often] seen in patients with active disease or those with quiescent disease with ongoing gastrointestinal symptoms in the absence of inflammation, suggesting that these subgroups of patients might benefit most from these types of treatment.”

Despite limited evidence supporting the benefit of psychological therapies in IBD patients, “the strong association between depression and anxiety and unfavorable disease course suggests that clinicians should identify people with inflammatory bowel disease who also have substantial problems with anxiety and depression and refer them to appropriate treatment resources,” John R. Walker, PhD, of the department of clinical health psychology at the University of Manitoba, and St. Boniface Hospital in Winnipeg, Canada, wrote in a related editorial.

He recommended that clinicians use available anxiety and depression screening tools, or even ask a few simple questions during the clinical encounter to help identify patients with anxiety and mood disorders.

“Attention to psychological functioning is likely to improve treatment outcome and reduce disability in patients with inflammatory bowel disease,” he concluded. – by Adam Leitenberger

Disclosures: The researchers and Walker report no relevant financial disclosures.

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