Psychological therapies may lead to short-term benefits in quality of life for patients with inflammatory bowel disease (IBD), but the same cannot be said for disease activity, results from a systematic review and meta-analysis suggested.
Looking at data from randomized controlled trials (RCTs) published from 2016 to 2023, psychological therapy led to improvements in quality-of-life scores versus control treatment among patients with active IBD in four RCTs at therapy completion (standardized mean difference [SMD] 0.68, 95% CI 0.09-1.26), though no benefit was noted for anxiety scores in two RCTs (SMD -1.04, 95% CI -2.46 to 0.39).
However, heterogeneity between studies was high, wrote Alexander Ford, MD, of Leeds Gastroenterology Institute at St. James’s University Hospital in England, and colleagues in Lancet Gastroenterology and Hepatology.
In the trials that evaluated patients with quiescent IBD, psychological therapies did not reduce the relative risk (RR) of a relapse of disease activity in 10 RCTs compared with controls (RR 0.83, 95% CI 0.62-1.12), with moderate heterogeneity.
Notably, psychological therapies among patients with quiescent IBD did significantly lower anxiety scores (13 RCTs; SMD -0.23, 95% CI -0.36 to -0.09), depression scores (15 RCTs; SMD -0.26, 95% CI -0.38 to -0.15), and stress scores (11 RCTs; SMD -0.22, 95% CI -0.42 to -0.03), and significantly raised quality-of-life scores (16 RCTs; SMD 0.31, 95% CI 0.16-0.46) at therapy completion.
Statistically significant benefits persisted up to final follow-up for depression scores only (12 RCTs; SMD -0.16, 95% CI -0.30 to -0.03).
“The effect appeared to be strongest in RCTs of third-wave therapies (i.e., acceptance, mindfulness, and value-focused approaches) and in RCTs that recruited people with impaired psychological health, fatigue, or reduced quality of life at baseline who could be expected to derive the most benefit from psychological therapies,” Ford and team noted.
“The gut and brain communicate through the gut-brain axis, and this bi-directional communication system is being increasingly recognized as having a crucial role in both the psychological health and prognosis of individuals with IBD,” they wrote. “Once psychological symptoms develop, they appear to be persistent or fluctuating, with as few as one in ten people with IBD having complete resolution of these symptoms.”
“Although there have been multiple RCTs examining the effects of interventions, including cognitive behavioral therapy (CBT) and gut-directed hypnotherapy, in people with IBD, many of these RCTs are small and underpowered, have high rates of loss to follow-up, study different outcomes (e.g., anxiety, depression, stress, or quality of life), and show conflicting results,” they added.
In an accompanying editorial, Andrea Shin, MD, of the Indiana University School of Medicine in Indianapolis, noted that the improvements in quality of life were important in this study population.
“Quality of life is a particularly important clinical metric that captures peoples’ experiences from an integrative and personal perspective, not a purely biological one,” she wrote. “It is directly correlated with disease severity; a person’s ability to understand, engage, and manage their healthcare during the course of chronic disease; financial distress; and work productivity, which further affect traditional outcomes, including disease course, treatment adherence, and healthcare costs.”
“Future IBD trials should incorporate the factors (e.g., objects, experiences, events, environment, and qualities) that contribute to a person’s wellness and can be measured as a primary endpoint and assess the effects of quality of life on clinical variables,” Shin added. “Studies should also consider measuring disease activity responses among people with active inflammation so that opportunities to examine IBD within the framework of the gut-brain axis are not missed.”
For this review and meta-analysis, Ford and colleagues searched MEDLINE, Embase, Embase Classic, PsycINFO, and the Cochrane Central Register of Controlled Trials from January 2016 through April 2023 for RCTs recruiting patients ages 16 or older with IBD that compared psychological therapy with a control intervention or treatment as usual.
Trials were analyzed separately according to whether they recruited patients with clinically active IBD or quiescent IBD. Of 469 new records identified, 25 RCTs were eligible for the meta-analysis, all of which were at high risk of bias, the authors said. Only four RCTs recruited patients with active IBD, and there were insufficient data for meta-analysis of remission, disease activity indices, depression scores, and stress scores.
Shin noted that this review and meta-analysis also highlighted “major knowledge gaps, including the lack of prospective trials of people with active IBD or overlapping IBD and IBS and the lack of research examining differences between Crohn’s disease and ulcerative colitis.”
“Despite these limitations, biopsychosocial perspectives should be embraced and the ways that the health and wellness of a person are defined when delivering IBD care should be reconsidered,” she wrote.
Disclosures
The study authors reported no conflicts of interest.
Shin reported being on the Ardelyx Scientific Communications Advisory Board for Irritable Bowel Syndrome, and support from the National Institute of Diabetes and Digestive and Kidney Diseases.
Primary Source
The Lancet Gastroenterology and Hepatology
Source Reference: Riggott C, et al “Efficacy of psychological therapies in people with inflammatory bowel disease: a systematic review and meta-analysis” Lancet Gastroenterol Hepatol 2023; DOI: 10.1016/S2468-1253(23)00186-3.
Secondary Source
The Lancet Gastroenterology and Hepatology
Source Reference: Shin A “Psychological therapies in inflammatory bowel disease” Lancet Gastroenterol Hepatol 2023; DOI: 10.1016/S2468-1253(23)00229-7.
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