P517 Cognitive-behavioural therapy has no effect on disease activity but it improves quality of life in sub-groups of patients with inflammatory bowel disease short-term: a randomised controlled trial with a 24-month follow-up
A. Mikocka-Walus1, J. Andrews*2, P. Bampton3, D. Hetzel2, P. Hughes4, A. Esterman5
1University of York, Health Sciences, York, United Kingdom, 2Royal Adelaide Hospital, Department of Gastroenterology and Hepatology, Q7 North Wing, Adelaide, Australia, 3Flinders Medical Centre, Department of Gastroenterology, Adelaide, Australia, 4University of Adelaide, Nerve-Gut Research Laboratory, Discipline of Medicine, Adelaide, Australia, 5University of South Australia, School of Nursing and Midwifery, Adelaide, Australia
Studies have demonstrated the usefulness of cognitive-behavioural therapy (CBT) in managing distress in inflammatory bowel disease (IBD) patients; however, few have focused on IBD course. The present trial aimed to investigate whether adding CBT to standard treatment prolongs remission in IBD in comparison to standard therapy alone.
A 2-arm parallel pragmatic randomised controlled trial (+CBT – standard care plus either face-to-face [F2F] or online over 10 weeks versus standard care alone [SC]) was conducted with adult patients in remission. IBD remission at 12 months since baseline was the primary outcome measure, and the secondary outcome measures were mental health status and quality of life (QoL) at 6, 12, and 24 months. Linear mixed-effect models were used to compare groups on outcome variables whilst controlling for baseline. The protocol was registered with the Australian New Zealand Clinical Trials Registry (ID: ACTRN12609000913279).
Participants were 174 patients with IBD (90 +CBT, 84 SC). There was no difference in remission rates between groups, with similar numbers flaring at 12 months. Groups did not differ in anxiety, depression, or coping at 6, 12 or 24 months (p > 0.05). When only participants classified as ‘in need’ (young, high baseline IBD activity, recently diagnosed; poor mental health) were examined in the post-hoc analysis (n = 74, 34 CBT and 40 controls), CBT significantly improved mental QoL (p = 0.034, d = 0.56) at 6 months. Online CBT group had a higher score on precontemplation compared with the F2F group, which is consistent with less-developed coping with IBD in the cCBT group (p = 0.045).
Future studies should direct psychological interventions to patients ‘in need’ and attempt to recruit larger samples to compensate for significant attrition when using online CBT.