Acceptance and Commitment Therapy Reduces Psychological Stress in Patients With Inflammatory Bowel Diseases

Wynne B1, McHugh L1, Gao W2, Keegan D3, Byrne K3, Rowan C3, Hartery K3, Kirschbaum C2, Doherty G3, Cullen G3, Dooley B1, Mulcahy HE4. Gastroenterology. 2018 Nov 16. pii: S0016-5085(18)35278-8. doi: 10.1053/j.gastro.2018.11.030. [Epub ahead of print]

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1 School of Psychology, University College Dublin, Belfield, Dublin D04 V1W8, Ireland.

2 Department of Psychology, Technische Universität Dresden, Andreas-Schubert-Bau, Zellescher Weg 19, 01069, Dresden, Germany.

3 Department of Gastroenterology, St Vincent's University Hospital/University College Dublin, Elm Park, Dublin D04 T6F4, Ireland.

4 Department of Gastroenterology, St Vincent's University Hospital/University College Dublin, Elm Park, Dublin D04 T6F4, Ireland. Electronic address: hugh.mulcahy@ucd.ie.


BACKGROUND & AIMS: Patients with Crohn's disease or ulcerative colitis patients have relatively high levels of stress and psychological dysfunction. Acceptance and commitment therapy (ACT) is a psychological intervention that comprises acceptance and mindfulness procedures along with commitment and behavior change strategies to increase psychological flexibility and reduce stress. We performed a randomized controlled trial to investigate the effect of ACT on stress in subjects with inflammatory bowel diseases (IBD).

METHODS: One hundred twenty-two subjects with quiescent or stable mildly active IBD were randomly assigned to an 8-week ACT program or treatment as usual (control group). Clinical, demographic, disease activity and psychological data, blood and feces were collected at baseline and at 8 weeks and 3 months after the intervention (week 20). Scalp hair was collected at baseline and week 20 for measurement of steroid concentrations. The primary endpoint was change in stress symptoms, assessed with the DASS-21. Secondary endpoints included changes in perceived stress, anxiety, depression, quality of life domains, disease activity, and cortisol concentration in hair.

RESULTS: Seventy-nine subjects were included in the complete case intention to treat analysis. There was a 39% and 45% reduction in stress in the treatment group from baseline to 8 and 20 weeks, respectively, compared with 8% and 11% in the control group (group x time interaction, P=.001). ACT was associated with reduced perceived stress (P=.036) and depression (P=.010), but not anxiety (P=.388) compared with controls. In the intention to treat analysis, changes in all 4 quality of life domains over time were similar in ACT and control groups. In the per-protocol analysis, the overall wellbeing quality of life domain improved in the ACT group compared with controls (P=.009). Subjective and objective disease activity measurements were similar between groups over the study period (all P values >.05). Hair cortisol concentrations correlated with stress (rs 0.205; P=.050) and anxiety (rs 0.208; P=.046) at baseline, but did not change significantly in the ACT group over the study period compared with controls (P=.831).

CONCLUSION: In a randomized controlled trial of patients with IBD, an 8-week ACT therapy course improved stress and other indices of psychological health. ClinicalTrials.gov Identifier: NCT02350920.

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