Psychological therapies have short-term benefits on QOL in IBD patients but do not alter disease activity

Psychological therapies do not alter the disease activity but have short-term beneficial effects on anxiety, depression, stress, and quality of life scores as per a recent study that was published in the journal 'The Lancet Gastroenterology & Hepatology.' 

Psychological therapies have been successfully created and applied to various medical disorders. These address stress-related and psychological variables that may contribute to the manifestation or impact of medical conditions. Inflammatory bowel disease represents a range of organic, immune-mediated inflammatory disorders, characterized by abdominal pain, urgent diarrhea, rectal bleeding, weight loss, and fatigue. Previous literature suggested that psychological interventions can help in reducing the burden of the disease. But due to uncertainty in the results, researchers from Leeds Institute of Medical Research conducted a study to assess whether the inclusion of more randomized controlled trials (RCTs) showed any beneficial effects and whether these effects varied by treatment modality. 

By searching various databases from Jan 1, 2016, to April 30, 2023, RCTs recruited individuals aged 16 years or older with IBD that compared psychological therapy with a control intervention or treatment as usual. Dichotomous data was pooled to obtain relative risks (RR) with 95% CIs of inducing remission in people with active disease or of relapse in people with quiescent disease at final follow-up.  Continuous data was pooled to estimate standardized mean differences (SMD) with 95% CIs in disease activity indices, anxiety scores, depression scores, stress scores, and quality-of-life scores at completion of therapy ant final follow-up. All the data was pooled using a random-effects model. Trials were analyzed separately according to whether they recruited people with clinically active IBD or predominantly individuals whose disease was quiescent. Subgroup analyses were conducted by mode of therapy and according to whether trials recruited selected groups of people with IBD. The Cochrane risk of bias tool was used to assess bias at the study level and set funnel plots using the Egger test. Heterogeneity was assessed using the I2 statistic. 

A total of 469 new records were identified, 11 of which met eligibility criteria. In total, 25 RCTs were eligible for this meta-analysis, all of which were at high risk of bias. Only four RCTs recruited patients with active IBD; there were insufficient data for meta-analysis of remission, disease activity indices, depression scores, and stress scores.

Key findings: 

• In active IBD patients, psychological therapy had no benefit compared with control for anxiety scores but did have significant benefit for quality-of-life scores after therapy despite high heterogeneity between studies. 
• Relative risk of relapse of disease activity was not reduced with psychological therapy In individuals with quiescent IBD (with moderate heterogeneity), and the funnel plot suggested evidence of publication bias or other small study effects.
• For people with quiescent IBD at the completion of therapy, there was no difference in disease activity indices between psychological therapy and control. 
• Anxiety scores, depression scores, and stress scores were significantly lower, and quality-of-life scores were significantly higher, with psychological therapy versus control at treatment completion.
• Statistically significant benefits persisted up to the final follow-up for depression scores.
• Effects were strongest in RCTs of third-wave therapies and in RCTs that recruited people with impaired psychological health, fatigue, or reduced quality of life at baseline. 

Thus, psychological therapy dies not alter the disease activity or relapse rates except for short-term beneficial effects on anxiety, depression, stress, and quality-of-life scores. 

Further reading: Efficacy of psychological therapies in people with inflammatory bowel disease: a systematic review and meta-analysis. https://doi.org/10.1016/S2468-1253(23)00186-3