van den Brink G¹, Stapersma L², Bom AS¹, Rizopolous D³, van der Woude CJ⁴, Stuyt RJL⁵, Hendriks DM⁶, van der Burg JAT⁶, Beukers R⁷, Korpershoek TA⁷, Theuns-Valks SDM⁸, Utens EMWJ^2,9,10, Escher JC¹. Inflamm Bowel Dis. 2019 May 3. pii: izz073. doi: 10.1093/ibd/izz073. [Epub ahead of print]

Author information

1 Department of Pediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands.

2 Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands.

3 Department of Biostatistics, Erasmus MC, Rotterdam, the Netherlands.

4 Department of Gastroenterology, Erasmus MC, Rotterdam, the Netherlands.

5 Department of Gastroenterology, Haga Hospital, Den Haag, the Netherlands.

6 Department of Pediatrics, Juliana Children's Hospital, Den Haag, the Netherlands.

7 Department of Gastroenterology, Albert Schweitzer Hospital, Dordrecht, the Netherlands.

8 Department of Pediatrics, Albert Schweitzer Hospital, Dordrecht, the Netherlands.

9 Research Institute of Child Development and Education, University of Amsterdam, the Netherlands.

10 Academic Center for Child Psychiatry the Bascule/Department of Child and Adolescent Psychiatry, Academic Medical Center, Amsterdam, the Netherlands.

Abstract

BACKGROUND: Anxiety and depressive symptoms are prevalent in patients with inflammatory bowel disease (IBD) and may negatively influence disease course. Disease activity could be affected positively by treatment of psychological symptoms. We investigated the effect of cognitive behavioral therapy (CBT) on clinical disease course in 10-25-year-old IBD patients experiencing subclinical anxiety and/or depression.

METHODS: In this multicenter parallel group randomized controlled trial, IBD patients were randomized to disease-specific CBT in addition to standard medical care (CBT + care us usual [CAU]) or CAU only. The primary outcome was time to first relapse in the first 12 months. Secondary outcomes were clinical disease activity, fecal calprotectin, and C-reactive protein (CRP). Survival analyses and linear mixed models were performed to compare groups.

RESULTS: Seventy patients were randomized (CBT+CAU = 37, CAU = 33), with a mean age of 18.3 years (±50% < 18 y, 31.4% male, 51.4% Crohn's disease, 93% in remission). Time to first relapse did not differ between patients in the CBT+CAU group vs the CAU group (n = 65, P = 0.915). Furthermore, clinical disease activity, fecal calprotectin, and CRP did not significantly change over time between/within both groups. Exploratory analyses in 10-18-year-old patients showed a 9% increase per month of fecal calprotectin and a 7% increase per month of serum CRP in the CAU group, which was not seen in the CAU+CBT group.

CONCLUSIONS: CBT did not influence time to relapse in young IBD patients with subclinical anxiety and/or depression. However, exploratory analyses may suggest a beneficial effect of CBT on inflammatory markers in children.