Inflammatory bowel diseases (IBD), including Crohn’s disease and ulcerative colitis, are typically treated with immunosuppressant medication and surgery. These conditions cause both physical symptoms (abdominal pain and bloody diarrhea) and mental distress (anxiety, depression, fatigue). Because distress can worsen disease progression, mindfulness training has been proposed as an adjunctive treatment to reduce illness burden.

Previous research on mindfulness training for IBD has yielded mixed results and has rarely included objective measures of symptom-related sleep disturbance. ter Avest et al. [Inflammatory Bowel Diseases] examined the effects of Mindfulness-Based Cognitive Therapy (MBCT) versus treatment-as-usual (TAU) on mental and physical health symptoms in IBD patients, incorporating objective assessments of disease severity and sleep.

In this randomized controlled trial, researchers assigned 142 Dutch adults (average age = 49 years; 64% female) with IBD in remission and Hospital Anxiety and Depression Scale (HADS) scores ≥11 to TAU alone or TAU plus MBCT. The MBCT program consisted of eight weekly 150-minute group sessions, a retreat day, and regular home practice. TAU consisted of medication and surgical interventions following Dutch and European treatment guidelines. Assessments were conducted at baseline, post-intervention, and 6-,9-, and 12-month follow-ups, including self-report of distress and disease severity, as well as stool samples for fecal calprotectin (a marker of intestinal inflammation). 

Sleep quality was objectively assessed at baseline and post-intervention using three consecutive nights of home EEG recordings. The primary outcome was HADS score; while secondary outcomes included total sleep time, sleep efficiency, sleep onset latency, and wake after sleep onset. 

By post-intervention, the MBCT group had significantly greater reductions in HADS distress scores than the TAU group (d=-0.61). MBCT showed reduced total sleep time (d=-0.67) and increased deep sleep proportion (d=0.70) compared with TAU. Improvements in HADS scores in the MBCT group persisted throughout the 12-month study period but were no longer statistically significant at 12 months because the TAU group showed gradual improvement over the follow period. At 12 months, the MBCT group had significantly decreased fecal calprotectin levels compared to TAU (d=-0.49).

This trial demonstrates that MBCT can reduce distress in IBD patients for up to a year and may increase the proportion of deep sleep without extending total sleep time. However, the study was limited by technical issues with EEG recordings which prevented complete sleep assessments for all participants. Seventy of the 142 randomized participants provided usable EEG data at baseline and 56 provided useable data at post-intervention without a between-groups difference in usable data. The lack of correlation between fecal calprotectin levels and disease improvement may reflect the selection of IBD patients in remission with a low incidence of flares. Although MBCT reduced mean HADS scores from 16.4 to 11.6, post-intervention averages remained above the threshold for clinical concern.

Reference:

ter Avest, M. M., Huijbers, M. J., Horjus, C. S., ... Speckens, A. E. M. (2025). Group-Delivered Mindfulness-Based Cognitive Therapy to Reduce Psychological Distress and Improve Sleep in Patients With Inflammatory Bowel Diseases: A Multicenter Randomized Controlled Trial (MindIBD). Inflammatory Bowel Diseases.

Link to study