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Randomized Controlled Trial
. 2019 Nov 14;25(12):1945-1956.
doi: 10.1093/ibd/izz073.

Effect of Cognitive Behavioral Therapy on Clinical Disease Course in Adolescents and Young Adults With Inflammatory Bowel Disease and Subclinical Anxiety and/or Depression: Results of a Randomized Trial

Gertrude van den Brink  1 , Luuk Stapersma  2 , Anna Sophia Bom  1 , Dimitris Rizopolous  3 , C Janneke van der Woude  4 , Rogier J L Stuyt  5 , Danielle M Hendriks  6 , Joyce A T van der Burg  6 , Ruud Beukers  7 , Thea A Korpershoek  7 , Sabine D M Theuns-Valks  8 , Elisabeth M W J Utens  2   9   10 , Johanna C Escher  1
Affiliations
Randomized Controlled Trial

Effect of Cognitive Behavioral Therapy on Clinical Disease Course in Adolescents and Young Adults With Inflammatory Bowel Disease and Subclinical Anxiety and/or Depression: Results of a Randomized Trial

Gertrude van den Brink et al. Inflamm Bowel Dis. .

Abstract

Background: Anxiety and depressive symptoms are prevalent in patients with inflammatory bowel disease (IBD) and may negatively influence disease course. Disease activity could be affected positively by treatment of psychological symptoms. We investigated the effect of cognitive behavioral therapy (CBT) on clinical disease course in 10-25-year-old IBD patients experiencing subclinical anxiety and/or depression.

Methods: In this multicenter parallel group randomized controlled trial, IBD patients were randomized to disease-specific CBT in addition to standard medical care (CBT + care us usual [CAU]) or CAU only. The primary outcome was time to first relapse in the first 12 months. Secondary outcomes were clinical disease activity, fecal calprotectin, and C-reactive protein (CRP). Survival analyses and linear mixed models were performed to compare groups.

Results: Seventy patients were randomized (CBT+CAU = 37, CAU = 33), with a mean age of 18.3 years (±50% < 18 y, 31.4% male, 51.4% Crohn's disease, 93% in remission). Time to first relapse did not differ between patients in the CBT+CAU group vs the CAU group (n = 65, P = 0.915). Furthermore, clinical disease activity, fecal calprotectin, and CRP did not significantly change over time between/within both groups. Exploratory analyses in 10-18-year-old patients showed a 9% increase per month of fecal calprotectin and a 7% increase per month of serum CRP in the CAU group, which was not seen in the CAU+CBT group.

Conclusions: CBT did not influence time to relapse in young IBD patients with subclinical anxiety and/or depression. However, exploratory analyses may suggest a beneficial effect of CBT on inflammatory markers in children.

Keywords: IBD; anxiety; children; cognitive behavioral therapy; depression; disease course; psychotherapy.

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Figures

FIGURE 1.
FIGURE 1.
Consort study flowchart.
FIGURE 2.
FIGURE 2.
Survival curve time to first flare.
FIGURE 3.
FIGURE 3.
Raw means of clinical disease activity scores over time.
See this image and copyright information in PMC

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