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Randomized Controlled Trial
. 2024 Aug 20;120(8):1839-1851.
doi: 10.14309/ajg.0000000000003032.

Acceptance and Commitment Therapy for Adults Living With Inflammatory Bowel Disease and Distress: A Randomized Controlled Trial

Colette Naude  1 , David Skvarc  1 , Bernadette Maunick  1 , Subhadra Evans  1 , Daniel Romano  1 , Susan Chesterman  1 , Lahiru Russell  1 , Madeleine Dober  1 , Matthew Fuller-Tyszkiewicz  1 , Richard Gearry  2 , Peter R Gibson  3 , Simon Knowles  4 , Andrew McCombie  5 , Eric O  6 , Leanne Raven  7 , Leesa Van Niekerk  8 , Antonina Mikocka-Walus  1
Affiliations
Randomized Controlled Trial

Acceptance and Commitment Therapy for Adults Living With Inflammatory Bowel Disease and Distress: A Randomized Controlled Trial

Colette Naude et al. Am J Gastroenterol. .

Abstract

Introduction: The bidirectional relationship between disease activity and mental health in inflammatory bowel disease (IBD) has prompted investigations into the efficacy of psychotherapeutic interventions such as acceptance and commitment therapy (ACT) on biopsychosocial outcomes. We aimed to examine the efficacy of an ACT program (intervention) in comparison with a cognitive behavioral therapy-informed psychoeducation program (active control) for individuals with IBD and coexistent psychological distress. Both programs were delivered online through a hybrid format (i.e., therapist-led and participant-led sessions).

Methods: A total of 120 adults with IBD were randomized to either the intervention (N = 61) or active control groups (N = 59). Efficacy was determined using linear mixed models for group differences, in rate of changes in study outcomes, between baseline, postintervention, and 3-month follow-up.

Results: The primary outcome health-related quality of life significantly improved in the intervention group when compared with the active control group, with a significantly different rate of change observed from baseline to postintervention ( t [190] = 2.15, P = 0.033) in favor of the intervention group with a medium effect size (β = 0.41, mean difference = 0.07, 95% confidence interval 0.01-0.12, P = 0.014). Similarly, the secondary outcome Crohn's disease activity significantly reduced in the intervention group when compared with the active control group, with a significantly different rate of change observed from baseline to 3-month follow-up ( t [90] = -2.40, P = 0.018) in favor of the intervention group with a large effect size (β = -0.77, mean difference = -9.43, 95% confidence interval -13.72 to -5.13, P < 0.001) ( P = 0.014). Furthermore, when observing the rate of change in outcomes over time for the groups separately, anxiety symptoms and pain significantly improved in the intervention group only, and conversely, ulcerative colitis activity and stress symptoms significantly improved in the active control group only. All other outcomes (N = 14) significantly improved over time in both groups including IBD activity, gastrointestinal unhelpful thinking patterns, visceral anxiety, fatigue interference, fatigue severity, fatigue frequency, psychological inflexibility, self-efficacy, resilience, current health status, depression symptoms, IBD control, and pain catastrophizing; however, these changes were not significantly different between the groups.

Discussion: Both programs were of benefit to people with IBD and distress. However, ACT offers a significant added benefit for health-related quality of life and self-reported Crohn's disease activity and may be a useful adjuvant therapy in integrated IBD care.

Keywords: Crohn's disease; acceptance and commitment therapy; inflammatory bowel disease; randomized controlled trial; ulcerative colitis.

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Conflict of interest statement

Guarantor of the article:

Specific author contributions:

Financial support: The current study was funded by the Litwin IBD Pioneers Award (#828660) from Crohn's & Colitis Foundation of America.

Potential competing interests: The authors report no conflicts of interest in relation to the current study; however, outside this work, S.K. has served as an educational speaker for Janssen, Ferring, and Takeda. P.G. has served as a consultant or advisory board member for Anatara, Atmo Biosciences, Topas, and Comvita. He has received research grants for investigator-driven studies from Atmo Biosciences and Mindset Health and speaker honoraria from Dr Falk Pharma and Mindset Health. He holds shares in Atmo Biosciences. L. Raven served on the Roche International Patient Advisory Council and the Takeda IBD Patient Expert Council. R.G. has served on advisory boards for AbbVie New Zealand and Australia, Zespri New Zealand, and Jannsen New Zealand and has received research funding from AbbVie and Atmo Biosciences. A.M.-W. has served as an educational speaker for Janssen and Ferring.

Registration: The trial was registered prospectively in the Australian New Zealand Clinical Trials Registry (ACTRN12621001316897: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382493&isReview=true).

Figures

Figure 1.
Figure 1.
Consolidated Standards of Reporting Trials diagram of participant flow throughout the study.
Figure 2.
Figure 2.
Effects plots for the outcomes of total HRQoL and Crohn's disease activity. HRQoL, health-related quality of life.
See this image and copyright information in PMC

References

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