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

BACKGROUND

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 & Commitment Therapy (ACT) on biopsychosocial outcomes. We aimed to examine the efficacy of an ACT Program (intervention) in comparison to a CBT-Informed Psychoeducation Program (active control) for individuals with IBD and co-existent psychological distress. Both programs were delivered online via a hybrid format (i.e. therapist led and participant-led sessions).

METHODS

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, post intervention, and 3-month follow-up.

RESULTS

The primary outcome HRQoL significantly improved in the intervention group when compared with the active control group, with a significantly different rate of change observed from baseline to post intervention (t [190] = 2.15, p = 0.033) in favor of the intervention group with a medium effect size (β = 0.41, MD = 0.07, 95%CI [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, MD = -9.43, 95%CI [-13.72, -5.13], p < 0.001) p = 0.014). Further, 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.

CONCLUSION

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

Informations de copyright

Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.