Internet Cognitive Behavioral Therapy Improves Quality of Life for Inflammatory Bowel Disease Patients

Abstract

Background:  Inflammatory bowel diseases (IBDs) increase risk for depression, anxiety, secondary Irritable Bowel Syndrome and impaired health related quality of life (HRQL). Cognitive-behavioral therapy (CBT) is a promising approach for helping IBD patients cope with their disease.  CBT teaches effective stress management through relaxation training, cognitive interventions that reduce maladaptive, catastrophic thinking, and behavioral interventions that reduce maladaptive avoidance, shame and secrecy and has been shown to reduce depression and anxiety. Unfortunately, access to trained CBT therapists is limited, and few IBD patients who could benefit receive this type of treatment.  Purpose: To test the acceptability and efficacy of a CBT-based self-help workbook in IBD patients.  Methods: 63 IBD patients with either co-morbid IBS or a high score on a measure of GI specific catastrophic thoughts were randomized to either immediate treatment or a waitlist control.  Results:  Treatment completers experienced significant decreases in GI specific catastrophizing, visceral anxiety, and levels of depression. In addition, participants in the immediate treatment group reported improved HRQL and significantly less distress about GI symptoms post-treatment.   Gains were generally maintained three months post-treatment.  Conclusions:  Self-help CBT is cost effective, easy to disseminate and could improve HRQL for many IBD patients.  CBT can be effective in treating a sub-set of the IBD population and a self-help format of CBT may extend its benefits to those who do not have access to or cannot afford trained therapists. CBT can improve the psychological, emotional, and behavioral aspects of IBDs, which are often not addressed by medical management.