Cognitive behaviour therapy for distress in people with Inflammatory bowel disease: A bench marking study

Objective: Anxiety and depression are common in inflammatory bowel disease (IBD) and have been linked to clinical recurrence. Previous randomised controlled trials have found no evidence that psychological interventions enhance outcomes for people with IBD but have recruited patients without distress. This study investigates the clinical benefits of a non-randomised uncontrolled study of clinic based cognitive behaviour therapy (CBT) for people with IBD who had moderate to severe levels of anxiety or low mood and compares the results to a previous randomised controlled trial of CBT in this population. Method: Assessments were completed at baseline and end of treatment and included measures of low mood, generalised anxiety, quality of life and symptomatic disease activity. The patient health questionnaire and generalised anxiety disorder 7 measures were the primary outcomes. Results in the form of a standardized effect size of treatment were compared with a previous randomised controlled trial to consider if CBT had greater benefits for those with distress. Results: Thirty patients were deemed appropriate for CBT and twenty eight accepted treatment. The results from this clinic based CBT intervention suggest statistically significant reductions in symptoms of anxiety (<0.001), low mood (<0.001) and disease activity (p<0.01) and increases in quality of life (p<0.001).The uncontrolled effect sizes were large and superior to those found in published RCTs. Conclusion: This nonrandomised uncontrolled trial of a clinic based CBT intervention suggests CBT may have benefits for those with moderate to severe disturbances to mood and that effect sizes can be improved by targeting those with distress. RCTs are required to establish efficacy.