Background: The inflammatory bowel diseases are associated with high levels of psychological stress. Acceptance and commitment therapy (ACT) is a psychological intervention that comprises acceptance and mindfulness procedures along with commitment and behaviour-change strategies to increase psychological flexibility and reduce stress. The aim of this study was to determine the effect of ACT on stress in IBD patients.
Methods: Ninety five patients (mean age 40 years; 42 male) with quiescent or mildly active IBD were randomly assigned to an eight week ACT course (n=47) or to a control group (n=48) stratified by disease type and gender. Clinical, demographic, disease activity, biochemical (including CRP and faecal calprotectin) and psychological data were collected at i) baseline, ii) post-intervention (8 weeks) and iii) 20 weeks. Patients on antidepressants, those with psychiatric disorders or those who had received steroids over the previous three months were excluded from study. Stress symptoms and reaction to stress was measured using the DASS-21 and perceived stress using the stressometer. Intervention and control groups were well matched for age, gender, social variables, disease activity, CRP and calprotectin levels.
Results: ACT was associated with a 42% and 37% reduction in DASS-21 stress scores at 8 and 20 weeks respectively, in comparison with control patients whose DASS-21 stress scores remained stable over the study period (ANOVA, p<0.05) (see Figure 1).
ACT was also associated with a reduction in perceived stress scores at 8 and 20 weeks when compared with control patients (p<0.05). No changes were found in clinical or biochemical disease activity, nor in other psychological parameters, in either group over the 20 week study period.
Conclusions: An 8 week course of ACT is an effective treatment for reducing stress in IBD patients. If it is true that stress is causally associated with subsequent IBD activity, future therapeutic paradigms may include appropriate psychological treatments to favourably impact on stress and, perhaps, long term disease activity.
ClinicalTrials.gov Registration No: NCT02350920