Psychotherapy Improves Mental Health But Not IBD Disease Activity

Psychological therapies have no effect on IBD disease activity despite beneficial effects on anxiety, depression, and QOL.

Psychotherapy may improve QOL and lead to short-term reduced anxiety, depression, and stress in people with inflammatory bowel disease (IBD), but it does not improve disease activity levels, according to study findings published in The Lancet Gastroenterology & Hepatology.

Researchers conducted a systematic review and meta-analysis of randomized controlled trials, searching MEDLINE, Embase, Embase Classic, the Cochrane Central Register of Controlled Trials, and PsychoINFO for studies that compared the efficacy of psychological therapy with standard treatment or other controlled interventions in individuals with IBD aged 16 years and older. The researchers analyzed results of 25 randomized controlled trials, only 4 of which included participants with clinically active IBD, while the remaining trials had participants with quiescent IBD.

While psychotherapy did not significantly reduce anxiety in patients with active IBD by the end of the trials (standard mean difference [SMD], -1.04; 95% CI, -2.46 to 0.39), patients did report improvements in QOL at the completion of therapy (SMD, 0.68; 95% CI, 0.09 to 1.26).

The findings … show the potential efficacy of psychological therapies in providing short-term improvements … but not in improving disease activity indices or in preventing relapse of disease activity.

Compared with individuals with active IBD, psychotherapy did reduce anxiety (SMD, -0.23; 95% CI, -0.36 to -0.09), depression (SMD, -0.26; 95% CI, -0.38 to -0.15), and stress (SMD, -0.22; 95% CI, -0.42 to -0.03), in addition to improving QOL scores (SMD, 0.31; 95% CI, 0.16 to 0.46) for people with quiescent IBD at treatment completion. However, psychotherapy neither decreased the risk for relapse of disease activity (relative risk [RR], 0.83; 95% CI, 0.62 to 1.12) nor did it result in significant differences per disease activity indices, compared with control interventions (SMD, -0.01; 95% CI, -0.13 to 0.12) in people with quiescent IBD.

Participants continued to report decreased depression at final follow-ups in 12 of the 25 trials, indicating that benefits of psychotherapy persisted short-term after completion of treatment.

“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,” the study authors noted.

Study limitations include the small number of studies including patients with clinically active IBD, the high risk for bias in all included studies, the difficulty of double-blinding in psychological studies, and the heterogeneity of trials of effect on QOL outcomes. Additional limitations include lack of consideration for confounding factors, such as medication changes or treatments escalations in most included studies, and the inability to generalize findings to populations outside of high-income countries.

This article originally appeared on Gastroenterology Advisor

References:

Riggott C, Mikocka-Walus A, Gracie DJ, Ford AC. Efficacy of psychological therapies in people with inflammatory bowel disease: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. Published online August 2, 2023. doi:10.1016/S2468-1253(23)00186-3