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Journal ArticleDOI

A systematic review and meta-analysis of mindfulness based interventions and yoga in inflammatory bowel disease.

01 Jan 2019-Journal of Psychosomatic Research (Elsevier)-Vol. 116, pp 44-53

TL;DR: Mindfulness interventions are effective in reducing stress and depression and improving quality of life and anxiety, but do not lead to significant improvements in the physical symptoms of IBD.

AbstractBackground: Mindfulness interventions are increasingly used as a part of integrated treatment in inflammatory bowel disease (IBD) but there are limited data and a lack of consensus regarding effectiveness. Objectives: We explored the efficacy of mindfulness interventions compared to treatment as usual (TAU), or other psychotherapeutic interventions, in treating physical and psychosocial symptoms associated with IBD. Methods: We conducted a systematic review and meta-analysis of relevant randomized controlled trials (RCTs). We included a broad range of mindfulness interventions including mindfulness-based interventions and yoga, with no restrictions on date of publication, participants’ age, language or publication type. We searched the following electronic databases: MEDLINE, EMBASE, PsycINFO, CINAHL and WHO ICTRP database. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines in conducting the review. Results: We included eight studies in the meta-analysis. Mindfulness interventions showed a statistically significant effect on stress in both the short(SMD = −0.48; 95%CI:–0.97, 0.00; P =.05), and long term(SMD = −0.55; 95%CI:-0.78, −0.32; P <.00001), significant long term effects on depression (SMD = −0.36; 95%CI:–0.66, −0.07; P =.02) and quality of life (SMD = 0.38; 95%CI:0.08, 0.68; P =.01),and small but not statistically significant improvements in anxiety (SMD = −0.27; 95%CI:-0.65, 0.11; P =.16).Effects on physical outcomes were equivocal and not statistically significant. Conclusions: Mindfulness interventions are effective in reducing stress and depression and improving quality of life and anxiety, but do not lead to significant improvements in the physical symptoms of IBD. Further research involving IBD-tailored interventions and more rigorously designed trials is warranted.

Topics: Mindfulness (57%), Systematic review (52%), Meta-analysis (51%), Randomized controlled trial (51%), Psychological intervention (50%)

Summary (5 min read)

Background

  • Mindfulness interventions are increasingly used as a part of integrated treatment in inflammatory bowel disease (IBD) but there are limited data and a lack of consensus regarding effectiveness.
  • The authors conducted a systematic review and meta-analysis of relevant randomised controlled trials (RCTs).
  • Rates of depression and anxiety in periods of remission are two to three times higher than in age matched individuals in the general population [4, 5].
  • To their knowledge, there has been only one systematic review to date examining the efficacy and use of mindfulness interventions in IBD [17], published in 2015.
  • This systematic review therefore addresses the evidence gap by exploring a wide range of mindfulness interventions and including papers published in languages other than English and German and conducted in individuals of any age.

Protocol and registration

  • This systematic review was registered with PROSPERO , an international database of prospectively registered systematic reviews (CRD42017080632) [20].
  • The authors followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines in designing this systematic review [21].
  • Ethical approval was not required as all included primary data had been previously published with ethical approval.

Design of included studies

  • Single-, double- or triple-blind RCTs were considered for inclusion.
  • Studies published as abstracts were only included if the authors were contactable and further information provided to allow evaluation of study quality and main outcomes.
  • Studies with a non RCT design and studies using non-validated outcome measures were excluded.
  • Participants AC C EP TE D M AN U SC R IP T Patients of any age, including paediatric populations, with a diagnosis of IBD were included.
  • The authors specified that the IBD diagnosis was based on established criteria, such as the Montreal classification system, including confirmation with ileocolonoscopy and biopsies of the affected tissues [20].

Interventions

  • The authors adopted a broad definition of mindfulness interventions to include any therapy or program based on mindfulness principles and involving mindfulness practices.
  • Interventions of interest included mindfulness-based programs, mindfulness-informed programs, adapted and shortened mindfulness interventions and yoga.
  • Mindfulness-based programs included MBSR and MBCT which are evidencebased, 8-week-long manualised group programs taught in weekly 2-2,5 hours sessions encompassing multiple mindfulness components, homework exercises and usually a day of silent practice [14, 23-25].
  • BBMW is an adapted program combining mindful movement, breathing practices, and meditation, delivered as a two-day workshop followed by six weekly sessions and monthly booster sessions [29].
  • For the purposes of this review, the authors divided the interventions into yoga studies and mindfulness programs involving MBSR, MBCT, adapted mindfulness programs and mindfulness informed interventions.

Comparators and context

  • Controls in the review included wait list, standard medical treatment or treatment as usual (TAU), and other evidence-based psychological interventions.
  • Studies in any clinical setting were included.

Outcomes

  • Studies examining IBD related psychological outcomes, quality of life and physical outcomes, assessed by validated screening tools were included.
  • Psychological outcomes of interest included the following: rates of depression, anxiety and stress as assessed by validated screening tools such as Depression, Anxiety and Stress Scale (DASS), Beck Depression Inventory (BDI) and Hospital Anxiety and Depression Scale (HADS) and coping as measured by the Brief Cope Questionnaire (COPE).
  • The authors extracted definitions of outcomes as reported in individual studies and recorded them in the data sheets in Covidence software [30] .

Sources of information

  • The following databases were searched: MEDLINE, EMBASE, PsycINFO and CINAHL.
  • These electronic databases searches were supplemented by searches of trial protocols and systematic reviews in the Cochrane Central Register of Controlled Trials , Australian and New Zealand Clinical Trials Register , WHO International Clinical Trials Registry Platform and the PROSPERO register of systematic reviews.
  • The authors also scanned the reference and citation lists of included studies to improve literature coverage.
  • The authors contacted the study authors for clarification and additional information when this was needed.
  • The searches were re-run prior to review completion to ensure currency.

Search strategies

  • The specific search strategies were created by a health clinical librarian with expertise in systematic review searching (KR).
  • Literature search strategies were developed using controlled vocabulary and text words related to mindfulness and IBD.

Study records

  • Data were managed by using EndNote and Covidence online software for conducting systematic reviews [30].
  • Literature search results were uploaded to EndNote and Covidence.
  • Data were extracted by one reviewer (TE) and checked for errors by a second (KR).
  • The authors used RevMan software to create a PRISMA flow diagram following the completion of the screening and data extraction.
  • Figure 1 shows the PRISMA diagram depicting the flow of studies through the systematic review.

Data selection and extraction

  • Two reviewers worked independently through all stages of the review, including screening papers for eligibility, examining full-text versions of studies for eligibility and inclusion in meta-analysis (TE, KR).
  • Any disagreements were resolved through discussion with the third author (SK) and reasons for decisions documented.

Risk of bias (quality) assessment

  • The methodological quality of the included trials was assessed independently by two reviewers using the Cochrane Collaboration's Assessment of Risk of Bias Tool [32].
  • The authors assessed risk of bias in the included studies against the six criteria from the Cochrane Risk of Bias Tool, including random sequence generation, allocation concealment, blinding of the participants and the outcome assessors, incomplete data reporting, selective data reporting and other bias .
  • The authors used risk of bias tables embeded in Covidence and adapted them by creating additional criteria involving interventions’ fidelity, validity of the outcome measures, inclusion and exclusion criteria and similarity of participants’ baseline characteristics.
  • The authors evaluated each of the criteria in the risk of bias tool as low, high or unclear risk of bias and provided decisions justification.
  • The authors did not assess publication bias due to having insufficient number of studies included in the review.

Data synthesis

  • The authors used statistical software RevMan 5.2, according to the guidelines referenced in the current version of the Cochrane Handbook for Systematic Reviews of Interventions [32].
  • Because different instruments were used across studies, standardised mean differences were specified as the effect of interest.
  • Results were presented by the two subgroups of AC C EP TE D M AN U SC R IP T mindfulness-based programs (MBPs) and yoga.
  • Where possible, the authors conducted sensitivity analyses for study quality or type of control.
  • If any meta-analysis included 10 or more studies, the authors planned to test for publication bias using funnel plot asymmetry, but only eight studies were included.

Results

  • The authors identified 202 records and removed 37 duplicates .
  • The authors excluded a further 154 after screening titles and abstracts of the remaining 165 records.
  • The authors examined the remaining 11 articles for eligibility and excluded 3 of them, two because of being conference abstracts which were superseded by the full text articles and one because of not having the RCT design.
  • The remaining 8 studies [34-41] were included in qualitative and quantitative analysis.
  • Seven were full text articles and one was a conference abstract (Rowan 2017) which was assessed from the abstract content and by enlarging the reported graphs and then measuring and analysing the illustrated outcomes.

Study quality (Risk of Bias)

  • Allocation concealment was not adequately described in 5 out of the 8 included studies.
  • Due to the nature of the intervention, it was difficult to blind the participants as they were aware of their group allocation in studies with waitlist and TAU controls.
  • There was also a significant proportion of studies with incomplete reporting with 6 studies having inadequate or incomplete data reporting.
  • All the others used complete case or per protocol population analysis.
  • Three out of eight studies described fidelity measures, both of the yoga studies and the MBCT study.

Participants’ characteristics

  • All the participants were adults as no paediatric studies met the inclusion criteria.
  • In all the studies, IBD was diagnosed with a combination of clinical, laboratory and endoscopic findings as per the widely accepted criteria.
  • All studies enrolled individuals with quiescent IBD or IBD in remission and excluded individuals with significant mental health diagnoses.

Interventions Characteristics

  • Two studies involved Mindfulness Based Programs (MBPs) , one MBSR [38] and one MBCT[42] , two of the studies used ACT, one MCT, one BBMW and two studies delivered yoga.
  • Duration of therapy was between 6 and 12 weeks (Table 1).
  • The shortest mindfulness intervention was BBMW with only 6 weeks duration, however it had an intensive two-day start and was followed by monthly booster sessions up till 26 weeks.
  • The longest intervention was MCT of 16 weeks duration but with only 6 sessions delivering a similar “dose” of mindfulness practices to the other interventions.

Comparators’ characteristics

  • All included studies had a parallel group allocation design.
  • Control groups were wait list patients in five out of eight studies, one had a written self-care control group and two studies had active controls.
  • In both studies with active controls, participants in the control group were receiving treatment that mimicked the amount of time and attention received by the treatment group but thought not to have significant therapeutic effect, referred to as attention placebo control [43].
  • Outcomes characteristics and outcomes collection time points Seven of the eight included studies measured both psychological and biological outcomes and all studies measured psychological outcomes.
  • For the purpose of this review, the authors classified post treatment outcomes collection point as a short-term follow-up which occurred 6-16 weeks post baseline, depending on the length of the intervention.

Psychological Outcomes Changes in Response to Mindfulness Interventions

  • Eight studies were included in the meta-analysis, providing data for 251 participants who received mindfulness interventions and 249 waitlist, TAU or active controls (Table 1).
  • Short-term psychological symptoms Outcome or Subgroup Studies Participants Standardised mean difference [95% CI], also known as Table 3.
  • There was no significant difference in depression scores between people who received mindfulness and those in the control group in the short-term.
  • These results were mirrored in the subgroup analyses of MBPs and yoga in the long-term but not the short-term .

Quality of Life Changes in Response to Mindfulness Interventions

  • Three studies reported on the QoL outcome at each time-point but only two were common to both times.
  • When the mindfulness and yoga interventions were combined in a single analysis, there was evidence for a statistically greater improvement in the long-term effect estimates , but not the short-term (Table 3).
  • None of the results in the subgroup analyses reached statistical significance (Tables 3 and 4).

Physical Outcomes Changes in Response to Mindfulness Interventions

  • There was limited information on physical disease outcomes, including systemic inflammatory markers (ESR/CRP), local inflammatory markers (FCP) and clinical disease activity.
  • Only one MBP and one yoga study reported short term physical outcomes, both reporting non-significant results.
  • Long-term physical outcomes were reported by two MBPs and one yoga study.

Discussion

  • This review is the first systematic review to explore the efficacy of a broad range of mindfulness interventions in IBD while including all population ages and settings and posing no language or time and type of publication restrictions.
  • Expanding the language only brought one additional study, published in Farsi, because the study conducted in Germany (Cramer 2017) and the study conducted in India (Sharma 2015) were both published in English.
  • One of the yoga studies, Cramer et al, outperformed all other mindfulness interventions in depression, anxiety and stress scores changes both short and longterm and in stress scores long-term.
  • Furthermore, the quality of individual studies has been affected by poor blinding of the outcome assessors, incomplete data reporting and a relative lack of fidelity measures.
  • The review suggests the need for mindfulness interventions that are tailored for IBD which could improve participants’ engagement and potentially increase their effect via a doseresponse relationship.

Contributions

  • Systematic review was conceived and designed by TE, SK and KR and critically revised by SK, MK, JB and KH.
  • Drafting of the paper was completed by TE.

Declarations of interests

  • None AC C EP TE D M AN U SC R IP T References 1. Kumar, V., C. Wijmenga, and R.J. Xavier, Genetics of immune-mediated disorders: from genomewide association to molecular mechanism.
  • Hofmann, S.G., et al., The Effect of Mindfulness-Based Therapy on Anxiety and Depression: A Meta-Analytic Review.
  • Journal of Consulting and Clinical Psychology, 2010.
  • Berrill, J.W., et al., Mindfulness-based therapy for inflammatory bowel disease patients with functional abdominal symptoms or high perceived stress levels.

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Accepted Manuscript
A systematic review and meta-analysis of mindfulness based
interventions and yoga in inflammatory bowel disease
Tatjana Ewais, Jake Begun, Maura Kenny, Kirsty Rickett, Karen
Hay, Bita Ajilchi, Steve Kisely
PII: S0022-3999(18)30870-5
DOI: https://doi.org/10.1016/j.jpsychores.2018.11.010
Reference: PSR 9622
To appear in: Journal of Psychosomatic Research
Received date: 1 October 2018
Revised date: 12 November 2018
Accepted date: 14 November 2018
Please cite this article as: Tatjana Ewais, Jake Begun, Maura Kenny, Kirsty Rickett, Karen
Hay, Bita Ajilchi, Steve Kisely , A systematic review and meta-analysis of mindfulness
based interventions and yoga in inflammatory bowel disease. Psr (2018), https://doi.org/
10.1016/j.jpsychores.2018.11.010
This is a PDF file of an unedited manuscript that has been accepted for publication. As
a service to our customers we are providing this early version of the manuscript. The
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journal pertain.

ACCEPTED MANUSCRIPT
A SYSTEMATIC REVIEW AND META-ANALYSIS OF MINDFULNESS BASED
INTERVENTIONS AND YOGA IN INFLAMMATORY BOWEL DISEASE
Tatjana Ewais
1,2,*
t.ewais@uq.edu.au, Jake Begun
1,2
jakob.begun@mater.uq.edu.au, Maura Kenny
3
maurak@adam.com.au, Kirsty Rickett
4
k.rickett@library.uq.edu.au, Karen Hay
5
karen.hay@qimrberghofer.edu.au, Bita Ajilchi
6
ajilchi_bita@yahoo.com, Steve Kisely
1
s.kisely@uq.edu.au
1
The University of Queensland, School of Medicine, Mater Clinical School and Princess Alexandra Clinical School, Raymond
Terrace, South Brisbane, Qld 4101
2
The Mater Young Adult Health Centre, Mater Misericordiae Ltd, Raymond Terrace, South Brisbane, Qld 4101
3
The University of Adelaide, Adelaide, SA 5005, Australia
4
The UQ/Mater McAuley Library, Mater Misericordiae Ltd, South Brisbane, Qld 4101, Australia
5
QIMR Berghofer, Herston, Qld 4006, Australia, Mater Misericordiae Ltd, South Brisbane, QLD 4101, Australia
6
Department of Psychology, Faculty of Human Science, Science and Research Branch, Islamic Azad University (IAU), Tehran, Iran
*
Corresponding author.
Abstract
Background
Mindfulness interventions are increasingly used as a part of integrated treatment in inflammatory
bowel disease (IBD) but there are limited data and a lack of consensus regarding effectiveness.
Objectives
We explored the efficacy of mindfulness interventions compared to treatment as usual (TAU), or other
psychotherapeutic interventions, in treating physical and psychosocial symptoms associated with IBD.
Methods
We conducted a systematic review and meta-analysis of relevant randomised controlled trials (RCTs).
We included a broad range of mindfulness interventions including mindfulness-based interventions and
yoga, with no restrictions on date of publication, participants age, language or publication type. We
searched the following electronic databases: MEDLINE, EMBASE, PsycINFO, CINAHL and WHO ICTRP
database. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analysis
(PRISMA) guidelines in conducting the review.
Results
We included eight studies in the meta-analysis. Mindfulness interventions showed a statistically
significant effect on stress in both the short(SMD=-0.48; 95%CI:-0.97, 0.00; P=0.05), and long
term(SMD=-0.55; 95%CI:-0.78, -0.32; P< 0.00001), significant long term effects on depression (SMD=-
0.36; 95%CI:-0.66, -0.07; P=0.02) and quality of life (SMD=0.38; 95%CI:0.08, 0.68; P=0.01),and small
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but not statistically significant improvements in anxiety (SMD=-0.27; 95%CI:-0.65, 0.11; P=0.16).Effects
on physical outcomes were equivocal and not statistically significant.
Conclusions
Mindfulness interventions are effective in reducing stress and depression and improving quality of life
and anxiety, but do not lead to significant improvements in the physical symptoms of IBD. Further
research involving IBD-tailored interventions and more rigorously designed trials is warranted.
Key words: IBD, mindfulness, systematic review.
Registration details: International Prospective Register of Systematic Reviews (PROSPERO)
registration number CRD42017080632
Introduction
Rationale
IBD is an immune-mediated disease associated with chronic inflammation of the gastrointestinal tract
and frequent extra-intestinal manifestations [1-3]. Individuals with IBD experience high burden of
disease and significant mental health comorbidities [4]. Rates of depression and anxiety in periods of
remission are two to three times higher than in age matched individuals in the general population [4,
5]. During active disease, rates of depression rise to over 60% with wide ranging implications in all
areas of life[6]. Despite this, treatment of depression and anxiety is not routinely included in standard
IBD care, although there are recommendations for screening and treatment of depression and anxiety
to be embeded in integrated IBD care [7].
There has been increasing research evidence outlining the impact of stress [8], anxiety and
depression on the course of IBD [5], with a recent systematic review showing that depression and
anxiety were independently associated with clinical recurrence of IBD [9].Mindfulness based
interventions have been of particular interest in IBD due to their effectiveness in attenuating stress
and treating depression and anxiety [10-12],as well as their potential to improve the course of IBD
related to emerging evidence of their salutogenic impact on the immune system [13].
Mindfulness is defined as an experiential practice of focussing one’s attention with intention and
without judgement[14]. While this definition of mindfulness is generally accepted, there is ongoing
debate in the literature regarding the measuring and operationalization of mindfulness [15, 16].
Mindfulness Interventions include manualised mindfulness-based programs such as Mindfulness-Based
Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT), mindfulness-informed
interventions such as Dialectical Behaviour Therapy (DBT) and Acceptance and Commitment Therapy
(ACT), modified mindfulness interventions and yoga.
To our knowledge, there has been only one systematic review to date examining the efficacy and use
of mindfulness interventions in IBD [17], published in 2015. The review included manualised and
adapted mindfulness programs published in English and German and it was restricted to adults. It
found that no study showed significant group differences regarding physical or psychological variables
in the main analysis, and that only a subset of patients with additional irritable bowel syndrome (IBS)
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symptoms experienced significant improvements in quality of life. The review reported that the
findings about the efficacy of mindfulness interventions in IBD were inconclusive, that these
interventions might be useful in subgroup of IBD patients with IBS symptoms and that further research
of higher methodological quality was needed.Two narrative reviews reported similar findings [18, 19].
Since then, there have been several further RCTs of mindfulness interventions in IBD This systematic
review therefore addresses the evidence gap by exploring a wide range of mindfulness interventions
and including papers published in languages other than English and German and conducted in
individuals of any age.
Methods
Objectives
The aim of this systematic review was to evaluate the effectiveness of mindfulness interventions in the
management of psychosocial and physical symptoms associated with IBD. We aimed to answer the
following questions:
1. Can mindfulness interventions improve psychological symptoms in IBD including depression,
anxiety, stress and coping?
2. Can mindfulness interventions improve quality of life (QoL) in IBD?
3. Are mindfulness interventions effective in improving biological markers in IBD and other measures
of IBD activity?
Protocol and registration
This systematic review was registered with PROSPERO , an international database of prospectively
registered systematic reviews (CRD42017080632) [20]. We followed the Preferred Reporting Items for
Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines in designing this systematic
review [21]. Ethical approval was not required as all included primary data had been previously
published with ethical approval.
Eligibility criteria
We included RCTs of participants with IBD that compared interventions based on core mindfulness
principles with TAU, waitlist or other psychosocial interventions using validated psychosocial and
physical outcomes.
Design of included studies
Single-, double- or triple-blind RCTs were considered for inclusion. Studies published as abstracts were
only included if the authors were contactable and further information provided to allow evaluation of
study quality and main outcomes. Studies with a non RCT design and studies using non-validated
outcome measures were excluded.
Participants
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Patients of any age, including paediatric populations, with a diagnosis of IBD were included. We
specified that the IBD diagnosis was based on established criteria, such as the Montreal classification
system, including confirmation with ileocolonoscopy and biopsies of the affected tissues [20]. Montreal
classification is an integrated IBD diagnostic and classification system involving clinical, serological and
genetic parameters, which has been widely used in clinical and research settings [22].
Interventions
We adopted a broad definition of mindfulness interventions to include any therapy or program based
on mindfulness principles and involving mindfulness practices. Interventions of interest included
mindfulness-based programs, mindfulness-informed programs, adapted and shortened mindfulness
interventions and yoga. Mindfulness-based programs included MBSR and MBCT which are evidence-
based, 8-week-long manualised group programs taught in weekly 2-2,5 hours sessions encompassing
multiple mindfulness components, homework exercises and usually a day of silent practice [14, 23-25].
Mindfulness-informed interventions included DBT, an experiential therapy using mindfulness as a
foundation of key DBT skills of distress tolerance, emotion regulation and interpersonal
effectiveness[26], and ACT, a psychological intervention using acceptance and mindfulness strategies
to increase psychological flexibility and commit to behaviour changes [27].
Abbreviated and adapted mindfulness Interventions such as Multi-Convergent Therapy (MCT) and
Breath-Body-Mind-Workshop (BBMW) were also included in the review. MCT is a psychotherapeutic
intervention combining mindfulness with cognitive behavioural techniques, usually delivered in six
sessions over 16 weeks [28]. BBMW is an adapted program combining mindful movement, breathing
practices, and meditation, delivered as a two-day workshop followed by six weekly sessions and
monthly booster sessions [29]. For the purposes of this review, we divided the interventions into yoga
studies and mindfulness programs involving MBSR, MBCT, adapted mindfulness programs and
mindfulness informed interventions.
Comparators and context
Controls in the review included wait list, standard medical treatment or treatment as usual (TAU), and
other evidence-based psychological interventions. Studies in any clinical setting were included.
Outcomes
Studies examining IBD related psychological outcomes, quality of life and physical outcomes, assessed
by validated screening tools were included. Psychological outcomes of interest included the following:
rates of depression, anxiety and stress as assessed by validated screening tools such as Depression,
Anxiety and Stress Scale (DASS), Beck Depression Inventory (BDI) and Hospital Anxiety and Depression
Scale (HADS) and coping as measured by the Brief Cope Questionnaire (COPE). Quality of life was
assessed by IBDQ or WHO-QoL. Physical outcomes included IBD activity as measured by biological
markers of disease including local inflammatory markers such as faecal calprotectin (FCP), systemic
inflammatory markers such as C-reactive protein (CRP) and Erythrocyte Sedimentation Rate (ESR),
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Citations
More filters

Journal ArticleDOI
TL;DR: The findings confirm the importance of perceived stress in reducing disease activity and increasing health-related quality of life in patients with ulcerative colitis and impairedquality of life and practitioners should keep psychosocial risk in mind as a risk factor for disease exacerbation.
Abstract: Objective Yoga positively affects health-related quality of life and disease activity in ulcerative colitis. The underlying modes of action remain unclear. Within the present study we hypothesized that patients´ perceived stress mediates the effects of yoga on health-related quality of life and disease activity. Methods This is a secondary analysis of a randomized controlled trial comparing the effects of yoga to written self-care advice in patients with inactive ulcerative colitis and impaired quality of life. Perceived stress was assessed using the Perceived Stress Questionnaire, health-related quality of life using the Inflammatory Bowel Disease Questionnaire and disease activity using the Clinical Activity Index. Outcomes were assessed at weeks 0, 12 and 24. Results Seventy-seven patients participated. Thirty-nine patients attended the 12 supervised weekly yoga sessions (71.8% women; 45.0 ± 13.3 years) and 38 patients written self-care advice (78.9% women; 46.1 ± 10.4 years). Perceived stress correlated significantly with health-related quality of life and disease activity at week 24. Perceived stress at week 12 fully mediated the effects of yoga on health-related quality of life (B = 16.23; 95% Confidence interval [6.73; 28.40]) and disease activity (B = −0.28; 95% Confidence interval [−0.56; −0.06]) at week 24. Conclusion Our findings confirm the importance of perceived stress in reducing disease activity and increasing health-related quality of life in patients with ulcerative colitis and impaired quality of life. Practitioners should keep psychosocial risk in mind as a risk factor for disease exacerbation, and consider yoga as an adjunct intervention for highly stressed patients with ulcerative colitis. ClinicalTrials.gov registration number The trial was registered at clinicaltrials.gov prior to patient recruitment (registration number NCT02043600)

8 citations


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TL;DR: Current understanding of the comorbidity of gastrointestinal diseases and psychological disorders is reviewed and the current evidence supporting the key role of the brain-gut-microbiome axis (BGMA) is reviewed.
Abstract: The high comorbidity of psychological disorders in both functional and organic gastrointestinal diseases suggests the intimate and complex link between the brain and the gut. Termed the brain-gut axis, this bidirectional communication between the central nervous system and enteric nervous system relies on immune, endocrine, neural, and metabolic pathways. There is increasing evidence that the gut microbiome is a key part of this system, and dysregulation of the brain-gut-microbiome axis (BGMA) has been implicated in disorders of brain-gut interaction, including irritable bowel syndrome, and in neuropsychiatric disorders, including depression, Alzheimer's disease, and autism spectrum disorder. Further, alterations in the gut microbiome have been implicated in the pathogenesis of organic gastrointestinal diseases, including inflammatory bowel disease. The BGMA is an attractive therapeutic target, as using prebiotics, probiotics, or postbiotics to modify the gut microbiome or mimic gut microbial signals could provide novel treatment options to address these debilitating diseases. However, despite significant advancements in our understanding of the BGMA, clinical data is lacking. In this article, we will review current understanding of the comorbidity of gastrointestinal diseases and psychological disorders. We will also review the current evidence supporting the key role of the BGMA in this pathology. Finally, we will discuss the clinical implications of the BGMA in the evaluation and management of psychological and gastrointestinal disorders.

6 citations


Journal ArticleDOI
TL;DR: This study aims to explore the experiences of adolescents and young adults with IBD and depression who completed a mindfulness-based cognitive therapy group program, as well as the role of therapeutic alliance, group affiliation, and other common psychotherapy and group factors within mindfulness programs.
Abstract: Background: Mindfulness-based programs are increasingly used as a part of integrated treatment for inflammatory bowel disease (IBD). However, the majority of research has been quantitative with limited qualitative exploration of patients’ experiences of mindfulness programs and no studies among adolescents and young adults with IBD. Furthermore, there has been a paucity of research exploring the role of common psychotherapy and group factors within mindfulness programs. Objective: This study aims to explore the experiences of adolescents and young adults with IBD and depression who completed a mindfulness-based cognitive therapy (MBCT) group program, as well as the role of therapeutic alliance, group affiliation, and other common psychotherapy and group factors. Methods: This mixed methods qualitative study, nested within a randomized controlled trial (RCT) of MBCT for adolescents and young adults with IBD, will obtain qualitative data from focus groups and open-ended survey questions. The study aims to conduct three to four focus groups with 6-8 participants in each group. It will employ data and investigator triangulation as well as thematic analysis of the qualitative data. Results: The study was approved by the Mater Hospital Human Research Ethics Committee and recruitment commenced in May 2019; study completion is anticipated by early 2020. Conclusions: The study will contribute to the assessment of acceptability and feasibility of the MBCT program for adolescents and young adults with IBD. It will also elucidate the role of previously unexplored common psychotherapy and group factors within mindfulness training and help inform the design of a future large-scale RCT of MBCT in this cohort. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12617000876392; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373115 International Registered Report Identifier (IRRID): PRR1-10.2196/14432

6 citations


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  • ...Mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT) are two manualized, 8-week group programs with strong evidence in the treatment of depression and anxiety that have been used successfully in integrated treatment of individuals with IBD [14-17]....

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  • ...Although mindfulness-based treatments have been used successfully in adults with IBD [14-17] and among AYAs with other chronic illnesses and depression [19-21], there have been no studies of mindfulness programs in AYAs with IBD....

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Journal ArticleDOI
TL;DR: The CSM can be utilised in IBD cohorts to evaluate key psychosocial processes that influence PROs and the efficacy of targeting CSM processes to promote psychological well-being and QoL in I BD cohorts is evaluated.
Abstract: Background and aims The aim of this paper was to undertake a systematic review of the research utilizing the Common Sense Model (CSM) involving IBD cohorts to explain the psychosocial processes, including illness perceptions and coping styles, that underpin patient reported outcomes (PROs) - psychological distress (PD) and quality of life (QoL). Methods Adult studies were identified through systematic searches of 8 bibliographic databases run in August 2020 including Medline, Embase, and PsychINFO. No language or year limits were applied. Results Of 848 records identified, 516 were selected with seven studies evaluating the CSM mediating pathways for final review (n = 918 adult participants). Consistent with the CSM, illness perceptions were associated with PD and QoL in six and five studies respectively. Illness perceptions acted as mediators, at least partially, on the relationship between IBD disease activity and PD and/or QoL in all seven studies. Coping styles, predominantly maladaptive-based coping styles, were found to act as mediators between illness perceptions and PD and/or QoL in five studies. Perceived stress was identified in one study as an additional psychosocial process that partially explained the positive influence of illness perceptions on PD, and a negative impact on QoL. Five studies were classified as high quality and two as moderate. Conclusions The CSM can be utilised in IBD cohorts to evaluate key psychosocial processes that influence PROs. Future research should explore additional psychosocial processes within the CSM and evaluate the efficacy of targeting CSM processes to promote psychological well-being and QoL in IBD cohorts.

3 citations


References
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TL;DR: Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness book.

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Abstract: FULL CATA STROPHE LIV ING: USING THE W ISDOM OF YOUR BODY A ND MIND TO FA CE STRESS, PA IN, A ND ILLNESS To read Full Catastrophe Living : Using the W isdom of Your Body and Mind to Face Stress, Pain, and Illness eBook, please click the link under and download the ebook or get access to additional information which might be related to Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness book.

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TL;DR: Effect size estimates suggest that mindfulness-based therapy was moderately effective for improving anxiety and mood symptoms from pre- to posttreatment in the overall sample, and this intervention is a promising intervention for treating anxiety and Mood problems in clinical populations.
Abstract: Objective:Although mindfulness-based therapy has become a popular treatment, little is known about its efficacy. Therefore, our objective was to conduct an effect size analysis of this popular intervention for anxiety and mood symptoms in clinical samples.Method:We conducted a literature search using PubMed, PsycINFO, the Cochrane Library, and manual searches. Our meta-analysis was based on 39 studies totaling 1,140 participants receiving mindfulness-based therapy for a range of conditions, including cancer, generalized anxiety disorder, depression, and other psychiatric or medical conditions. Results:Effect size estimates suggest that mindfulness-based therapy was moderately effective for improving anxiety (Hedges’sg!0.63) and mood symptoms (Hedges’sg!0.59) from pre- to posttreatment in the overall sample. In patients with anxiety and mood disorders, this intervention was associated with effect sizes (Hedges’sg) of 0.97 and 0.95 for improving anxiety and mood symptoms, respectively. These effect sizes were robust, were unrelated to publication year or number of treatment sessions, and were maintained over follow-up.Conclusions:These results suggest that mindfulnessbased therapy is a promising intervention for treating anxiety and mood problems in clinical populations.

2,774 citations