Posted: 03.12.2014 | by AMRA
Inflammatory Bowel Diseases (IBD) are a group of chronic autoimmune disorders that include ulcerative colitis and Crohn’s Disease. Despite the best medical management, IBD patients often experience episodic inflammatory flare-ups with a return of clinical symptoms including abdominal pain, cramps, vomiting, diarrhea, and rectal bleeding. Flare-ups may sometimes be triggered by stress, and there is a great deal of interest in stress-reduction interventions for IBD that might improve quality of life and reduce flare-ups.
While IBD is distinct from Irritable Bowel Syndrome (IBS), a functional bowel disorder without inflammatory pathology, IBD patients often complain of IBS symptoms (for example, abdominal pain and bloating) even when in remission. Berrill et al. [Journal of Crohn’s and Colitis.] explored whether a mindfulness-based intervention could impact IBS symptoms in IBD patients. They randomly assigned 66 clinically-remitted IBD patients with either IBS symptoms or high perceived stress to either Multiconvergent Therapy (MCT) or a wait-list control.
MCT is delivered over the course of six forty-minute sessions and includes training in mindfulness meditation along with cognitive behavioral techniques for stress, coping style, and relapse prevention. Participants were assessed at baseline, 4, 8, and 12 months on a variety of measures including measures of bowel inflammation (fecal calprotectin), perceived stress, and IBD quality of life.
Of the 33 patients assigned to MCT, 8 never attended and 6 dropped out. Quality of life for those who completed MCT improved significantly, both statistically and clinically (an average 20 point improvement on a measure of IBD quality of life), while that of the control group did not. This improvement was especially evident for patients with IBS symptoms, reflecting both a reduction in their IBS symptoms as well as their emotional reactivity to those symptoms. While quality of life in MCT remained higher than controls at both 8 and 12 months, the difference was no longer statistically significant. Quality of life changes were unaccompanied by a reduction in IBD flare-ups.
The high MCT dropout rate suggests that MCT may not be a feasible intervention for some patients. The study is limited by low statistical power due to its high dropout rate, its reliance on a single therapist, and its use of a wait-list control rather than a placebo as IBS is known to be highly placebo-responsive.
While MCT improved quality of life and IBS symptoms for IBD patients, it didn’t significantly impact IBD relapse, whether measured by clinical signs or by calprotectin levels.
Berrill, J. W., Sadlier, M., Hood, K., & Green, J. T. (2014). Mindfulness-based therapy for inflammatory bowel disease patients with functional abdominal symptoms or high perceived stress levels. Journal of Crohn’s & Colitis, S1873-9946(14):00023-3. [PMID: 24529603]