Ulcerative colitis is a debilitating chronic inflammatory bowel disease with symptoms that include diarrhea, abdominal pain, fecal incontinence, fever, and fatigue. The disease is characterized by acute symptomatic flares interspersed with periods of asymptomatic remission. Flares can be triggered by stress, and mindfulness-based interventions may have a role to play in disease management.
Jedel et al. [Inflammatory Bowel Diseases] tested whether mindfulness-based stress reduction (MBSR) could reduce symptom flare frequency and severity in patients with inactive ulcerative colitis.
The researchers randomly assigned 43 meditation-naïve ulcerative colitis patients with inactive disease (average age = 42 years; 58% female; 72% Caucasian) to either modified MBSR or a psychoeducational control. MBSR was delivered in 8 weekly 1½-2-hour weekly group sessions with a 4-hour retreat in the 7th week. The shortened session lengths were made to accommodate the very small class sizes.
The psychoeducational control consisted of similarly structured group sessions with didactic material on the causes of physical illness, the effects of stress on physical health, the protective role of exercise, and cardiovascular disease risk factors.
Participants completed assessments at baseline, post-intervention, and 6- and 12-month follow-up. Participants completed measures of perceived stress, depression, anxiety, sleep quality, mindfulness (Five-Facet Mindfulness Questionnaire), disease symptoms and quality of life. They also submitted stool, urine, and blood samples, and were given sigmoidoscopies.
Stool samples were evaluated for levels of calprotectin which is associated with bowel inflammation, and urine samples were evaluated for levels of cortisol (a stress hormone). Blood samples were assessed for the proinflammatory biomarkers IL-6, IL-8, and C-reactive protein.
The results showed MBSR participants experienced significantly fewer flares: none of the 20 MBSR participants experienced flares while 5 of the 23 controls did. There were no significant between-group differences on any biological or psychological measure once participants who experienced flares were excluded. Those who experienced flares were excluded because the steroid treatment they received for their flares would have influenced their biological markers.
Mindfulness scores were significantly correlated with decreased perceived stress scores (r= -.54) and calprotectin levels were correlated with elevated urinary cortisol (r = .37), supporting the role of stress in ulcerative colitis.
The study shows that MBSR reduced the incidence of symptom flares in ulcerative colitis patients relative to a psychoeducation program.
The study is limited by its small sample size. The researchers also interpreted MBSR as having a positive effect on several psychological variables (e.g., mindfulness, depression) because of significant within-group improvements on these variables over time even though there were no between-group differences on these variables.
Jedel, S., Beck, T., Swanson, G., Hood, M. M., Voigt, R. M., Gorenz, A., Jakate, S., Raeisi, S., Hobfoll, S., & Keshavarzian, A. (2022). Mindfulness Intervention Decreases Frequency and Severity of Flares in Inactive Ulcerative Colitis Patients: Results of a Phase II, Randomized, Placebo-Controlled Trial. Inflammatory Bowel Diseases.
Link to study