Intervention Review

Psychological interventions for treatment of inflammatory bowel disease

  1. Antje Timmer1,*,
  2. Jan C Preiss2,
  3. Edith Motschall3,
  4. Gerta Rücker3,
  5. Günther Jantschek4,†,
  6. Gabriele Moser5

Editorial Group: Cochrane Inflammatory Bowel Disease and Functional Bowel Disorders Group

Published Online: 16 FEB 2011

Assessed as up-to-date: 29 APR 2010

DOI: 10.1002/14651858.CD006913.pub2

Database Title

Additional Information

How to Cite

Timmer A, Preiss JC, Motschall E, Rücker G, Jantschek G, Moser G. Psychological interventions for treatment of inflammatory bowel disease. Cochrane Database of Systematic Reviews 2011, Issue 2. Art. No.: CD006913. DOI: 10.1002/14651858.CD006913.pub2.

Author Information

  1. 1

    Bremen Institute for Prevention Research and Social Medicine, Clinical Epidemiology, Bremen, Germany

  2. 2

    Charité - Universitätsmedizin Berlin, Med. Klinik I, Berlin, Germany

  3. 3

    Institute of Medical Biometry and Medical Informatics, University Medical Center Freiburg, German Cochrane Centre, Freiburg, Germany

  4. 4

    Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lubeck, Germany

  5. 5

    Medical University of Vienna, Clinic of Internal Medicine III, A-1090 Vienna, Austria

  1. †

    Deceased

*Antje Timmer, Clinical Epidemiology, Bremen Institute for Prevention Research and Social Medicine, Achterstrasse 30, Bremen, 28359, Germany. timmer@bips.uni-bremen.de.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 16 FEB 2011

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Resumen

Background

The effect of psychological interventions in inflammatory bowel diseases (IBD) is controversial.

Objectives

To assess the effects of psychological interventions (psychotherapy, patient education, relaxation techniques) on health related quality of life, coping, emotional state and disease activity in IBD.

Search methods

We searched the specialized register of the IBD/FBD Group, CENTRAL (Issue 5, 2010) and from inception to April 2010: Medline, Embase, LILACS, Psyndex, CINAHL, PsyInfo, CCMed, SOMED and Social SciSearch. Conference abstracts and reference lists were also checked.

Selection criteria

Randomized, quasi-randomized and non randomized controlled trials of psychological interventions in children or adults with IBD with a minimum follow up time of 2 months.

Data collection and analysis

Data were extracted and study quality was independently assessed by two raters. Pooled standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated using a random effects model.

Main results

Twenty-one studies were eligible for inclusion (1745 participants; 19 in adults, 2 in adolescents). Most studies used multimodular approaches. The risk of bias was high for all studies. In adults, psychotherapy had no effect on quality of life at around 12 months (3 studies, 235 patients, SMD -0.07; 95% CI -0.33 to 0.19), emotional status (depression, 4 studies, 266 patients, SMD 0.03; 95% CI -0.22 to 0.27) or proportion of patients not in remission (5 studies, 287 patients, OR 0.85; 95% CI 0.48 to 1.48). Results were similar at 3 to 8 months. There was no evidence for statistical heterogeneity or subgroup effects based on type of disease or intensity of the therapy. In adolescents, there were positive short term effects of psychotherapy on most outcomes assessed including quality of life (2 studies, 71 patients, SMD 0.70; 95% CI 0.21 to 1.18) and depression (1 study, 41 patients, SMD -0.62; 95% CI -1.25 to 0.01). Educational interventions had no effect on quality of life at 12 months (5 studies, 947 patients, SMD 0.11; 95% CI -0.02 to 0.24), depression (3 studies, 378 patients, SMD -0.08; 95% CI -0.29 to 0.12) and proportion of patients not in remission (3 studies, 434 patients, OR 1.00; 95% CI 0.65 to 1.53). No adverse events were reported in any of the included studies.

Authors' conclusions

There is no evidence for efficacy of psychological therapy in adult patients with IBD in general. In adolescents, psychological interventions may be beneficial, but the evidence is limited. Further evidence is needed to assess the efficacy of these therapies in subgroups identified as being in need of psychological interventions, and to identify what type of therapy may be most useful.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Resumen

Psychological interventions in inflammatory bowel disease

This review examined the effect of psychological interventions in patients with inflammatory bowel diseases (Crohn's disease and ulcerative colitis) on health related quality of life, emotional state and disease activity. Overall, 21 studies were included in the review, but not all provided sufficient data for the different study questions. All studies were of low methodological quality. Most studies examined combination therapies, often aimed at improving stress management. For example, a therapy might include patient information sessions, training in relaxation techniques and psychotherapy sessions, such as group therapy. Others were restricted to just providing information materials to patients. None of the included studies reported any side effects of psychological interventions.

In adults, psychotherapy was not effective at 6 and 12 months for all outcomes (quality of life, emotional status/depression and relapse/disease activity), based on 3 studies. There was no difference by type of disease (Crohn's disease versus ulcerative colitis) or intensity of the therapy. In adolescents, there was a small positive effect for all outcomes (quality of life, coping, depression and anxiety), but only short term effects were reported in this group. Disease activity and relapse rates were not examined in adolescents. In adults, educational interventions were also not effective to improve quality of life and the course of the disease over 1 year, based on 5 studies.

Generally, at this moment, it can not be recommended that all patients with IBD receive psychotherapy. We assume that adolescents, and patients with special needs (e.g. emotional problems) may benefit from psychological therapy. More research is needed to examine the effect of psychotherapy focusing on the individual psychological situation of IBD patients.

 

Resumen

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  2. Abstract
  3. Plain language summary
  4. Resumen

Antecedentes

Intervenciones psicológicas para el tratamiento de la enfermedad intestinal inflamatoria

El efecto de las intervenciones psicológicas en las enfermedades intestinales inflamatorias (EII) es polémico.

Objetivos

Evaluar los efectos de las intervenciones psicológicas (psicoterapia, educación de los pacientes, técnicas de relajación) sobre la calidad de vida relacionada con la salud, el afrontamiento, el estado emocional y la actividad de la enfermedad en las EII.

Estrategia de búsqueda

Se hicieron búsquedas en el registro especializado del Grupo de EII/TFI (IBD/FBD Group), CENTRAL (número 5, 2010) y desde su inicio hasta abril 2010: Medline, Embase, LILACS, Psyndex, CINAHL, PsyInfo, CCMed, SOMED y Social SciSearch. También se verificaron los resúmenes de congresos y las listas de referencias.

Criterios de selección

Ensayos controlados aleatorios, cuasialeatorios y no aleatorios de intervenciones psicológicas en niños o adultos con EII, con un tiempo de seguimiento mínimo de dos meses.

Obtención y análisis de los datos

Dos evaluadores de forma independiente extrajeron los datos y evaluaron la calidad de los estudios. Las diferencias de medias estandarizadas (DME) agrupadas y los intervalos de confianza (IC) del 95% se calcularon mediante un modelo de efectos aleatorios.

Resultados principales

Fueron elegibles para inclusión 21 estudios (1745 participantes, ocho ECA, cuatro ensayos controlados cuasialeatorios, ocho ensayos controlados no aleatorios; 19 en adultos, dos en adolescentes). La mayoría de los estudios utilizó enfoques multimodulares. El riesgo de sesgo era elevado en todos los estudios.

En los adultos la psicoterapia no tuvo efecto sobre la calidad de vida alrededor de los 12 meses (tres estudios, 235 pacientes; DME −0,07; IC del 95%: −0,33 a 0,19), sobre el estado emocional (depresión, cuatro estudios, 266 pacientes; DME 0,03; IC del 95%: −0,22 a 0,27) ni sobre la proporción de pacientes que no lograron la remisión (cinco estudios, 287 pacientes; OR 0,85; IC del 95%: 0,48 a 1,48). Los resultados fueron similares a los tres a ocho meses. No hubo pruebas de heterogeneidad estadística ni de efectos de subgrupos según el tipo de enfermedad o la intensidad de la terapia. En los adolescentes hubo efectos positivos a corto plazo de la psicoterapia en la mayoría de los resultados evaluados, incluidas la calidad de vida (dos estudios, 71 pacientes; DME 0,70; IC del 95%: 0,21 a 1,18) y la depresión (un estudio, 41 pacientes; DME −0,62; IC del 95%: −1,25 a 0,01).

Las intervenciones educacionales no fueron eficaces con respecto a la calidad de vida a los 12 meses (cinco estudios, 947 pacientes; DME 0,11; IC del 95%: −0,02 a 0,24), la depresión (tres estudios, 378 pacientes; DME −0,08; IC del 95%: −0,29 a 0,12) y la proporción de pacientes que no lograron la remisión (tres estudios, 434 pacientes; OR 1,00; IC del 95%: 0,65 a 1,53).

Conclusiones de los autores

No existen pruebas de la eficacia de la terapia psicológica en los pacientes adultos con EII en general. Las intervenciones psicológicas pueden ser beneficiosas en los adolescentes, pero las pruebas son limitadas. Se necesitan pruebas adicionales para evaluar la eficacia de estas terapias en subgrupos identificados como necesitados de intervenciones psicológicas, y para identificar qué tipo de terapia podría ser más útil.

Traducción

Traducción realizada por el Centro Cochrane Iberoamericano

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