Efficacy of different psychological interventions for the treatment of inflammatory bowel disease: a systematic review and network meta-analysis

Abstract

Objective: National guidelines for inflammatory bowel disease (IBD) recommend psychotherapy, but the relative efficacy of different psychological interventions is unclear. To address this issue, we conducted a systematic review and network meta-analysis.

Methods: The PubMed, Cochrane Library, Embase, and Web of Science databases were systematically searched for randomized controlled trials (RCTs) from the databases' inception to October 11, 2024. The primary outcomes were depression, anxiety, and stress levels, and the secondary outcomes were disease activity and quality of life. Two reviewers independently selected studies, extracted data according to pre-specified criteria, and assessed the risk of bias using the Cochrane Collaboration's risk of bias tool. Network meta-analysis was performed using Stata 16.0 and R. Comparators included usual care (UC), waiting list (WL), and head-to-head comparisons between psychological interventions.

Results: Nineteen RCTs (1,637 participants) evaluating 12 interventions were included. Compared with WL, mindfulness interventions (MI) (SMD -0.63, 95% CI -1.20 to -0.05) and cognitive behavioral therapy (CBT) (SMD -0.54, 95% CI -0.90 to -0.17) reduced depression. Compared with WL, acceptance and commitment therapy with a compassion-focused group component (SMD -1.15, 95% CI -2.21 to -0.05), acceptance and commitment therapy (SMD -1.01, 95% CI -1.83 to -0.16), and CBT (SMD -0.75, 95% CI -1.41 to -0.09) reduced anxiety. For QoL, MI improved outcomes versus WL (SMD 2.21, 95% CI 0.25-4.12) and versus UC (SMD 1.82, 95% CI 0.53-3.10). No significant differences were detected for stress or disease activity versus WL or UC (where available). SUCRA rankings suggested that MI ranked highest for depression and QoL, compassion-focused ACT ranked highest for anxiety and disease activity, and CBT ranked highest for stress.

Conclusion: Psychological interventions appear to provide adjunctive benefits for people with IBD. MI shows consistent advantages for depression and QoL; ACT (with or without a compassion-focused component) and CBT reduce anxiety; CBT ranks favorably for stress. Effects on disease activity remain uncertain, and further high-quality trials are warranted.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD4202460005.

Keywords: depression; inflammatory bowel disease; network meta-analysis; psychotherapy; quality of life.

Figure 1

Flow chart of the study identification, screening, eligibility assessment and inclusion processes.

Figure 2

Assessment of risk of bias in the included studies (RCTs). (A) Percent of studies with categories for risk of bias; (B) summary of the risk of bias in each study.

Figure 3

Network plots at the end of treatment. (A) Depression; (B) anxiety; (C) stress; (D) disease activity; (E) quality of life. The size of the nodes relates to the number of participants in that intervention type. And the thickness of lines between the interventions relates to the number of studies for that comparison.

Figure 4

Pooled estimates of the network meta-analysis at the end of treatment. Effect estimates are presented as pooled WMD or RR with 95% CIs. (A) Depression; (B) anxiety; (C) stress; (D) disease activity; (E) quality of life.

Figure 5

Comparative effectiveness of different interventions surface under the cumulative ranking curves (SUCRA) at the end of treatment. Effect estimates are presented as pooled WMD or RR with 95% CIs. (A) Depression; (B) anxiety; (C) stress; (D) disease activity; (E) quality of life.