The effectiveness of psychological therapies in patients with inflammatory bowel disease

The influence of the gut-brain axis on inflammatory bowel disease (IBD) has been highlighted in many studies, which indicate the potential of psychological therapies being effective in treating people with IBD. However, the available data on this effect is conflicting.

In a recent meta-analysis published in Lancet Gastroenterology and Hepatology, scientists update a previous systematic review and meta-analysis to understand whether the inclusion of more recent randomized controlled trials (RCTs) projected better effectiveness of psychological therapies in treating people with IBD.

Study: Efficacy of psychological therapies in people with inflammatory bowel disease: a systematic review and meta-analysis. Image Credit: LightField Studios / Shutterstock.com

Background

IBD is a chronic gastrointestinal condition that can be further subdivided into Crohn’s disease and ulcerative colitis. An increased prevalence of IBD has been observed throughout Europe and North America. Some key factors involved in the development of IBD include reduced integrity of the intestinal barrier, microbial dysbiosis, and immunological dysfunction within the gut.

The gut-brain axis is a bidirectional communication system through which the gut and brain communicate. Recently, several studies have emphasized the importance of the gut-brain axis on psychological health and the prognosis of IBD.

Many individuals with IBD develop symptoms of anxiety or depression. IBD patients with these psychological symptoms are more likely to experience adverse disease outcomes as compared to IBD patients without these symptoms.

There remains a lack of studies regarding the efficacy of psychological therapies targeted to the gut-brain axis to alleviate IBD symptoms. Further, it remains unclear whether these therapies positively influence disease activity and improve the psychological health of IBD patients.

Although numerous RCTs have assessed the efficacy of various psychological therapies, such as gut-directed hypnotherapy and cognitive behavioral therapy (CBT), the sample size of these studies has been small and were associated with conflicting results.

The authors of the current study previously published a systematic review and meta-analysis on the efficacy of psychological therapies in people with IBD, wherein they considered all RCTs published until 2016. Notably, this meta-analysis failed to identify any long-term positive effect of psychological therapies on IBD activity or psychological health. 

About the study

After publication of the aforementioned meta-analysis, numerous RCTs have been conducted on this topic. In this updated review, the authors consider the most recent publications to assess how psychological therapies influence IBD activity, quality of life, and psychological health of patients.

All relevant studies were obtained from MEDLINE, Embase Classic, PsychINFO, Embase, and the Cochrane Central Register of Controlled Trials. From these databases, studies published between January 1, 2016, and April 30, 2023 were selected for the analysis.

For this systematic review and meta-analysis, conference proceedings were also considered. Studies related to adults with an endoscopically, radiologically, or histologically confirmed diagnosis of IBD and were subjected to psychological therapies were considered.

Study findings

A total of 469 new studies were identified in the updated literature search, 11 of which met all eligibility criteria. Fourteen additional studies were included from a previous meta-analysis that was published in 2017. Taken together, the current systematic review and meta-analysis considered a total of 25 RCTs, all of which were at a high risk of bias. 

Only one study evaluated the efficacy of psychological therapy in people who were clinically diagnosed with IBD, which prevented researchers from making a definitive conclusion about the effect. Furthermore, few studies investigated the effects of psychological therapy on psychological health and revealed no significant benefit except for mild improvement in anxiety scores.

Psychological therapies did not have any effect on the risk of relapse of IBD activity, nor did these treatments alleviate clinical disease activity indices in individuals with quiescent IBD. However, this treatment exhibited positive outcomes on other symptoms such as depression, anxiety, and stress scores in individuals with quiescent IBD.

The positive effect of psychological therapies, particularly on anxiety and stress scores, persisted until the final follow-up in people with quiescent IBD. However, a similar level of persistent improvement was not observed for depression scores.

Most of the observed effects of psychological therapies were small to moderate. Nevertheless, the strongest effect of psychological therapies was observed in RCTs of third-wave therapies that included acceptance, mindfulness, and value-focused approaches.

A mild to moderate improvement was observed in the quality of life of people with IBD who underwent psychological therapies. However, these improvements were not statistically significant at the final follow-up.

Conclusions

The current systematic review and meta-analysis indicated that psychological therapies provide short-term improvements in stress, anxiety, depression, and quality-of-life scores in individuals with quiescent IBD. However, these therapies did not improve disease activity indices nor prevented relapse of disease activity.