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DOP068. Cognitive-behavioural therapy (CBT) improves inflammatory responsiveness but not mental health short term in IBD patients: A pilot randomised controlled trial

A. Mikocka-Walus1, P. Hughes2, M. Moretta2, A. Pilichiewicz3, H. Long4, D. Hetzel3, P. Bampton5, J. Andrews3, 1University of York, Health Sciences, York, United Kingdom, 2University of Adelaide, Nerve-Gut Research Laboratory, Discipline of Medicine, Adelaide, Australia, 3Royal Adelaide Hospital, University of Adelaide, IBD Service, Dept of Gastroenterology & Hepatology & School of Medicine, Adelaide, Australia, 4University of Adelaide, School of Psychology, Adelaide, Australia, 5Flinders Medical Centre, Gastroenterology and Hepatology, Adelaide, Australia

Background

Trial ID: ACTRN12609000913279 (Australian New Zealand Trial Registry). While psychological stress has been linked with disease course in IBD, it is uncertain whether psychotherapy has any clinical or anti-inflammatory effect on IBD. To date, CBT, a type of psychotherapy where patients are taught to recognise and modify unhelpful thinking styles, has not been extensively examined. Thus, this study aimed to investigate whether adding CBT to standard medical therapy prolongs remission in patients with clinically quiescent IBD in comparison with standard treatment alone.

Methods

A 2-arm parallel pragmatic randomised controlled trial (RCT) was conducted to compare a 10-week CBT program (either face-to-face or online) in addition to standard care compared to standard care alone. Participants were adults with clinical remission or only mild IBD symptoms for at least 3 months and have sufficient IQ & English to participate in the therapy. Outcome measures included disease activity, mental health and quality of life. A student t test, ANCOVA, their non-parametric equivalents and linear mixed-effects models were used.

Results

174 IBD patients were enrolled in the trial (87 in each group). At the univariate level, a significant improvement in each of: mental quality of life (p = 0.002), general anxiety (p = 0.024), trait anxiety (p = 0.011) & maladaptive coping (p = 0.002) was noted at 6 months in the CBT group but not controls. Both groups improved in their levels of stress (p = 0.019 CBT & p = 0.033 controls). These differences however disappeared in multivariate comparisons. A subanalysis of 29 participants conducted to investigate CBT's potential effect on inflammatory activity showed that in contrast to standard care alone, CBT reduced LPS stimulated concentrations of GMCSF, IL-18 and TNF-α, and PMA/ionomycin stimulated concentrations of IFN-γ, IL-2, IL-13, IL-18, IL-21, IL-22 and TNF-α. Further, at study entry the concentration of LPS stimulated GMCSF and IL-18 and PMA/ionomycin stimulated IFN-α, IL-2, IL-13, IL-18 and TNF-α was lower in those who responded to CBT than in non-responders.

Conclusion

CBT seems to have specific effects on the immune system of remissive IBD patients as compared to standard medical therapy; although, it has little impact on overall mental health short-term.

Trial status: Recruitment complete. Long-term follow-up in progress.

Trial sponsor: The first author received the Angela McAvoy Fellowship from the Crohn's and Colitis of Australia, Abbott Australia and Janssen Australia provided untied educational grants.