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P644 Mindfulness-based stress reduction in adult patients with active Crohn's disease: preliminary findings based on the subjective units of distress scale: an IIRN study

D. Schwartz*1, G. Goren2, P. Perpinial2, M. Friger3, O. Sarid2, V. Slonim-Nevo2, R. Sergienko3, A. Nemirovsky4, E. Vinogradov4, D. Greenberg6, A. Monsonego4, D. Turner7, A. Eliakim8, S. Ben Horin8, Y. Chowers9, H. Yanai10, I. Dotan10, S. Odes1

1Soroka Medical Center, Gastroenterology, Beer Sheva, Israel, 2Ben-Gurion University of the Negev, Social Work, Beer Sheva, Israel, 3Ben-Gurion University of the Negev, Public Health, Beer Sheva, Israel, 4Ben-Gurion University of the Negev, Microbiology, Immunology and Genetics, Beer Sheva, Israel, 6Ben-Gurion University of the Negev, Health Systems Management, Beer Sheva, Israel, 7Shaare Zedek Medical Center, Gastroenterology, Jerusalem, Israel, 8Sheba Medical Center, Gastroenterology, Tel Hashomer, Israel, 9Rambam Health Care Campus, Gastroenterology, Haifa, Israel, 10Rabin Medical Center, Gastroenterology, Petach Tikva, Israel

Background

Crohn’s disease patients suffer from a host of mental symptoms, particularly when the disease is active (Schwartz D et al. United European Gastroenterol J 2018; 6: Supplement 1). We postulated that psychological distress can be diminished by teaching Mindfulness-Based Stress Reduction (MBSR) to patients using an internet-based format.

Methods

Randomly selected adult patients with active Crohn’s disease, attending for routine follow-up in a teaching hospital, were enlisted in a program where MBSR is taught by specially trained social workers in a series of 1-h sessions delivered once a week, using Skype™ and a standardised protocol. Home practice twice daily with feedback to an application was required. Disease activity (Harvey–Bradshaw Index) was monitored. The Subjective Units of Distress Scale (SUDS, Wolpe J, 1969) was administered before and after each teaching session. The SUDS scale range is 0–10; a higher score indicates more stress. Data analysis using the Wilcoxon signed-ranks test was conducted on SUDS scores of patients with five completed MBSR sessions each. The analysis included sessions 2 through 5 (session 1 was regarded as entry into the protocol). The SUDS scores are labelled as ‘begin-score’ (at beginning of each treatment session) and ‘end-score’ (at end of session). Data are given as median (range).

Results

The cohort comprised 13 patients, all with good compliance. Patients' characteristics were: age 29 (22–63) years, females 85%, non-smokers 92%, illness duration 3 (1–25) years, past surgery in 3 patients. All patients had active disease: The Harvey–Bradshaw Index was 8 (6–15). Seven patients were receiving long-term biological medication. The median SUDS begin-score was highest in session 2 and less in subsequent sessions (Table 1). SUDS end-scores were significantly reduced compared with begin-scores in all sessions. The end-score at session 5 was significantly lower than the begin-score at session 2 (p = .011).

Session2345
Begin score6 (3–10)4 (1–7)3 (1–7)5 (2–7)
End score3 (1–7)3 (1–6)2 (0–5)3 (1–6)
p0.0090.0170.0070.003

SUDS scores at beginning and end of sessions, median (range).

Conclusion

These preliminary findings, albeit in a small uncontrolled cohort, suggest that MBSR taught weekly, and accompanied by twice-daily home practice, reduces the level of subjective psychological distress in Crohn’s disease patients. Teaching by Skype™ was effective (and could be a cost-saving measure) and daily report to an app ensured compliance. A randomised trial in a large cohort employing several psychological scales is in progress to determine the precise efficacy and long-term effect of MBSR in the armamentarium of therapies available to Crohn’s disease patients.