title: Mindfulness-based therapy for inflammatory bowel disease patients with functional abdominal symptoms or high perceived stress levels. Changes in illness-related cognitions rather than distress mediate improvements in irritable bowel syndrome (IBS) symptoms and disability following a brief cognitive behavioural therapy intervention. Reduction of chronic abdominal pain in patients with inflammatory bowel disease through transcranial direct current stimulation: a randomized controlled trial A longitudinal study of the profiles of psychological thriving, resilience, and loss in people with inflammatory bowel disease. Presence of Irritable Bowel Syndrome Symptoms in Quiescent Inflammatory Bowel Disease Is Associated with High Rate of Anxiety and Depression Assessing telephone-delivered cognitive–behavioural therapy (CBT) and web-delivered CBT versus treatment as usual in irritable bowel syndrome (ACTIB): a multicentre randomised trial
abstract: BACKGROUND AND AIMS Psychological interventions are used in patients with inflammatory bowel disease ( IBD ) but there is uncertainty about who the optimal target population is . Multi-convergent therapy ( MCT ) is a form of psychotherapy that combines mindfulness meditation with aspects of cognitive behavioural therapy and has been used in the management of irritable bowel syndrome ( IBS ) . This study aim ed to assess the feasibility and efficacy of MCT in the management of IBD patients with either functional abdominal symptoms or high perceived stress levels . METHODS Sixty-six IBD patients in clinical remission with either IBS-type symptoms or high perceived stress levels were r and omly allocated to a 16-week MCT course or waiting list control group . Patients were followed-up for one year with the Inflammatory Bowel Disease Question naire ( IBDQ ) as the primary outcome measurement . RESULTS A higher mean IBDQ score was observed in the active group compared to controls at the 4-month assessment ( 167 vs. 156 , p=0.081 ) , but this was not statistically significant nor did it reached the predefined clinical ly significant difference of 20 . In patients with IBS-type symptoms at baseline there was a significantly higher mean IBDQ score in the active group compared to controls ( 161 vs. 145 , p=0.021 ) . There was no difference between groups in relapse rate based on faecal calprotectin measurement . CONCLUSIONS IBS-type symptoms in patients with IBD represent a potential therapeutic target to improve quality of life . This study suggests that MCT may be useful in the management of these symptoms but larger studies are required to confirm this . CLINICAL TRIAL REGISTRATION NUMBER NCT01426568 OBJECTIVE A previous r and omised controlled trial demonstrated that a cognitive behavioural therapy ( CBT ) self-management intervention significantly improved  irritable bowel syndrome ( IBS ) symptoms and disability  compared to treatment as usual ( TAU ) . The current study analysed additional data to establish whether ; 1 ) cognitive , behavioural and emotional factors hypothesized to perpetuate IBS symptoms and disability changed following CBT and , 2 ) ascertain if changes in these factors over the intervention period mediated treatment effects 6-months later . METHOD IBS patients ( CBT = 31 , TAU = 33 ) completed measures pre- and -post intervention including : Brief Illness Perception Question naire , Hospital Anxiety & Depression Scale and Cognitive and Behavioural Responses to Symptoms Question naire . Path models were evaluated to determine whether changes in cognitive and behavioural factors over the treatment period mediated treatment effects . RESULTS Compared to TAU , CBT patients showed significant positive changes on several cognitive variables but not anxiety and depression following intervention . Positive change in illness perceptions following intervention mediated the treatment effect on improved IBS symptom severity and social adjustment six months later . Changes in damaging beliefs mediated the effect on social adjustment . CONCLUSIONS Change in cognition rather than mood mediated treatment related improvements . Changing negative perceptions of IBS appears to be a particularly important treatment mechanism Abstract Inflammatory bowel disease ( IBD ) is frequently associated with chronic abdominal pain ( CAP ) . Transcranial direct current stimulation ( tDCS ) has been proven to reduce chronic pain . This study aim ed to investigate the effects of tDCS in patients with CAP due to IBD . This r and omized , sham-controlled , double blind , parallel- design ed study included 20 patients with either Crohn disease or ulcerative colitis with CAP ( ≥3/10 on the visual analog scale ( VAS ) in 3/6 months ) . Anodal or sham tDCS was applied over the primary motor cortex for 5 consecutive days ( 2 mA , 20 minutes ) . Assessment s included VAS , pressure pain threshold , inflammatory markers , and question naires on quality of life , functional and disease specific symptoms ( Irritable Bowel Syndrome – Severity Scoring System [ IBS – SSS ] ) , disease activity , and pain catastrophizing . Follow-up data were collected 1 week after the end of the stimulation . Statistical analyses were performed using analysis of variance and t tests . There was a significant reduction of abdominal pain in the anodal tDCS group compared with sham tDCS . This effect was evident in changes in VAS and pressure pain threshold on the left and right sides of the abdomen . In addition , 1 week after stimulation , pain reduction remained significantly decreased in the right side of the abdomen . There was also a significant reduction in scores on pain catastrophizing and on IBS – SSS when comparing both groups . Inflammatory markers and disease activity did not differ significantly between groups throughout the experiment . Transcranial direct current stimulation proved to be an effective and clinical ly relevant therapeutic strategy for CAP in IBD . The analgesic effects observed are unrelated to inflammation and disease activity , which emphasizes central pain mechanisms in CAP OBJECTIVES Despite the toll of inflammatory bowel disease ( IBD ) on adjustment , many patients are resilient to the challenges associated with living with IBD , and successfully cope with their illness and thrive . Yet there is little research on why some individuals with IBD enter a trajectory of growth , while others may struggle to adapt . The aim of this study was to investigate the adjustment-related factors that distinguished thriving , resilience , and loss in people with IBD across personal growth , life satisfaction , and relationship quality domains . DESIGN Prospect i ve cohort design with two data collection points , 6 months apart . METHODS From a sample of 420 people with active IBD who completed an online survey , 152 participants completed the follow-up survey and were included in the analyses . Participants completed measures of thriving , and cognitive , affective , social , and disease-related variables known to predict adjustment . RESULTS Time 1 ANCOVAs and pairwise comparisons controlling for demographics distinguished loss from resilience and thriving on the four outcomes - coping efficacy , illness acceptance , depressive symptoms , and perceived social support - for all three domains . Time 2 ANCOVAs and pairwise comparisons controlling for baseline outcomes revealed that the Time thriving categories predicted differences in Time 2 adjustment , mainly for the life satisfaction domain , with those experiencing loss reporting poorer adjustment than those experiencing resilience and thriving . CONCLUSIONS Findings highlight the distinctions among profiles of thriving , resilience , and loss in adjustment to IBD , and suggest that strategies that enhance coping and address depressive symptoms may optimize thriving in the context of IBD . Statement of contribution What is already known on this subject ? Inflammatory bowel disease ( IBD ) is associated with depression , poor coping , and stressful symptoms . Previous research has focused mainly on poor adjustment to IBD rather than on positive growth . There is little research on why some patients with IBD thrive or are resilient , while others struggle to adapt . What does this study add ? This study is the first to longitudinally examine the profiles of thriving , resilience , and loss in individuals with IBD . The thriving profiles differed in coping efficacy , illness acceptance , depressive symptoms , and social support outcomes at Time 1 , and predicted adjustment at T2 mainly for the life satisfaction domain . Strategies that enhance coping and social support may optimize thriving in the context of IBD Background Inflammatory bowel disease ( IBD ; Crohn ’s disease , CD and Ulcerative colitis , UC ) and irritable bowel syndrome ( IBS ) have overlapping symptoms . Few prevalence studies of IBS in quiescent IBD have used colonoscopy with histology to confirm inactive disease . The aims were ( 1 ) to determine the percentage of IBD patients in deep remission whose persistent IBS-like symptoms ( IBD/IBS+ ) would cause them to be classified as having active disease , based on the calculation of Harvey Bradshaw Index ( HBI ) or UC disease activity index ( UCDAI ) ; ( 2 ) to identify demographic and disease characteristics that are associated with IBD/IBS+ . Methods This was a prospect i ve study at a single tertiary care IBD center . 96/112 patients with colonoscopy and histology confirmed quiescent disease consented and completed Rome III criteria for IBS Survey  , and the  hospital anxiety and depression scale ( HADS ) . Other demographic and disease specific data were collected . Results 36 % ( 28/77 ) and 37 % ( 7/19 ) of CD and UC patients , respectively , met diagnostic criteria for IBS . Significantly higher HBI/UCDAI scores ( p = 0.005 ) and low short inflammatory bowel disease question naire ( SIBDQ ) scores ( p ≤ 0.0001 ) were seen in IBD/IBS+ patients . 29 % of patients in deep remission were mis-categorized by HBI/UCDAI as having active disease when they fulfilled Rome III criteria for IBS . Psychiatric diagnosis ( OR 3.53 95 % CI 1.2–10.2 ) and earlier onset of IBD ( OR 1.056 95 % CI 1.015–1.096 ) were associated with IBD/IBS+ . Patients fulfilling IBS criteria had higher hospital anxiety and depression scale ( HADS ) . Conclusion IBD/IBS+ affect scoring of IBD disease activity scales and become less useful in guiding treatment plans Objective To evaluate the clinical effectiveness of two modes of cognitive – behavioural therapy ( CBT ) for IBS compared with treatment as usual ( TAU ) in refractory IBS . Design A three-arm r and omised controlled trial assessing telephone-delivered CBT ( TCBT ) , web-based CBT ( WCBT ) with minimal therapist support , and TAU . Blinding participants and therapists was not possible . Chief investigator , assessors and statisticians were blinded . Participants were adults with refractory IBS ( clinical ly significant symptoms for ≥12 months despite first-line therapies ) , recruited by letter and opportunistically from 74 general practice s and three gastroenterology centres in London and South of Engl and between May 2014 to March 2016 . Co- primary outcomes were IBS Symptom Severity Score ( IBS-SSS ) and Work and Social Adjustment Scale ( WSAS ) at 12 months . Results 558/1452 ( 38.4 % ) patients screened for eligibility were r and omised : 76 % female : 91 % white : mean age 43 years . ( 391/558 ) 70.1 % completed 12 months of follow-up . Primary outcomes : Compared with TAU ( IBS-SSS 205.6 at 12 months ) , IBS-SSS was 61.6 ( 95 % CI 33.8 to 89.5 ) points lower ( p<0.001 ) in TCBT and 35.2 ( 95 % CI 12.6 to 57.8 ) points lower ( p=0.002 ) in WCBT at 12 months . Compared with TAU ( WSAS score 10.8 at 12 months ) WSAS was 3.5 ( 95 % CI 1.9 to 5.1 ) points lower ( p<0.001 ) in TCBT and 3.0 ( 95 % CI 1.3 to 4.6 ) points lower ( p=0.001 ) in WCBT . All secondary outcomes showed significantly greater improvement ( p≤0.002 ) in CBT arms compared with TAU . There were no serious adverse reactions to treatment . Conclusion Both CBT interventions were superior to TAU up to 12 months of follow-up . Trial registration number IS RCT N44427879
target: Psychosocial factors associated with pain-related interference included depression , catastrophising , fear avoidance , lower self-efficacy and worse mental well-being .
  Conclusions Pain in IBD is significantly associated with cognitive and behavioural factors as well as low mood .
background: Objective Pain is frequently reported by patients with inflammatory bowel disease ( IBD ) .
  Pain in IBD is not fully explained by disease activity or other clinical findings , and a recent systematic review suggested that psychosocial factors have an important role in IBD-pain .
  The aim of this study was to investigate psychosocial factors associated with pain in IBD .