The Role of Psychotherapy in the Management of Inflammatory Bowel Disease
Keywords:
Anxiety, Depression, IBD, psychotherapyAbstract
Inflammatory bowel disease (IBD), consisting of ulcerative colitis (UC) and Crohn’s disease (CD), represents one of the debilitating chronic gastrointestinal diseases that affects the physical and psychological aspects of patients, leading to increased morbidity and mortality and affecting patients' quality of life. There is an increased prevalence of depressive disorders and anxiety among IBD patients, with the gut-brain axis as the proposed underlying mechanism. Treatment of psychological issues among patients with IBD enhances long-term management outcomes. Therefore, we provide a comprehensive review of epidemiology, pathomechanism, diagnosis, and treatment modality of psychological issues frequently found among IBD patients.References
Askar S, Sakr MA, Alaty WHA, et al. The psychological impact of inflammatory bowel disease as regards anxiety and depression: a single-center study. Middle East Curr Psychiatry. 2021;28(1):73.
Azzam NA, Aljebreen A, Almuhareb A, Almadi MA. Disability and quality of life before and during the COVID-19 outbreak: A cross-sectional study in inflammatory bowel disease patients. Saudi J Gastroenterol. 2020;26(5):256–62.
Bannaga AS, Selinger CP. Inflammatory bowel disease and anxiety: links, risks, and challenges faced. Clin Exp Gastroenterol. 2015;8:111–7.
Bernstein CN. Psychological stress and depression: Risk factors for IBD? Dig Dis Basel Switz. 2016;34(1–2):58–63.
Gracie DJ, Guthrie EA, Hamlin PJ, Ford AC. Bi-directionality of brain-gut interactions in patients with inflammatory bowel disease. Gastroenterology. 2018;154(6):1635-1646.e3.
Seyedian SS, Nokhostin F, Malamir MD. A review of the diagnosis, prevention, and treatment methods of inflammatory bowel disease. J Med Life. 2019;12(2):113–22.
Block KI, Gyllenhaal C, Lowe L, et al. Designing a broad-spectrum integrative approach for cancer prevention and treatment. Semin Cancer Biol. 2015;35(Suppl):S276–304.
Lichtenstein GR, Loftus EV, Isaacs KL, Regueiro MD, Gerson LB, Sands BE. ACG clinical guideline: Management of Crohn’s disease in adults. Am J Gastroenterol. 2018;113(4):481–517.
Rubin DT, Ananthakrishnan AN, Siegel CA, Sauer BG, Long MD. ACG clinical guideline: Ulcerative colitis in adults. Am J Gastroenterol. 2019;114(3):384–413.
Mokhtar NM, Nawawi KNM, Verasingam J, et al. A four-decade analysis of the incidence trends, sociodemographic and clinical characteristics of inflammatory bowel disease patients at a single tertiary centre, Kuala Lumpur, Malaysia. BMC Public Health. 2019;19(4):550.
Mulder DJ, Noble AJ, Justinich CJ, Duffin JM. A tale of two diseases: the history of inflammatory bowel disease. J Crohns Colitis. 2014;8(5):341–8.
Feuerstein JD, Isaacs KL, Schneider Y, et al. AGA Clinical practice guidelines on the management of moderate to severe ulcerative colitis. Gastroenterology. 2020;158(5):1450–61.
Perkumpulan Gastroenterologi Indonesia. Konsensus penatalaksanaan inflammatory bowel disease (IBD). Jakarta: Perkumpulan Gastroenterol Indones; 2022.
Hu S, Chen Y, Chen Y, Wang C. Depression and anxiety disorders in patients with inflammatory bowel disease. Front Psychiatry. 2021;12:714057.
Li X, Song P, Li J, et al. The disease burden and clinical characteristics of inflammatory bowel disease in the Chinese population: A systematic review and meta-analysis. Int J Environ Res Public Health. 2017;14(3):238.
Burisch J, Jess T, Martinato M, Lakatos PL, ECCO -EpiCom. The burden of inflammatory bowel disease in Europe. J Crohns Colitis. 2013;7(4):322–37.
IsHak WW, Pan D, Steiner AJ, et al. Patient-reported outcomes of quality of life, functioning, and GI/psychiatric symptom severity in patients with inflammatory bowel disease (IBD). Inflamm Bowel Dis. 2017;23(5):798–803.
Szigethy E, Murphy SM, Ehrlich OG, et al. Mental health costs of inflammatory bowel diseases. Inflamm Bowel Dis. 2021;27(1):40–8.
Tarricone I, Regazzi MG, Bonucci G, et al. Prevalence and effectiveness of psychiatric treatments for patients with IBD: A systematic literature review. J Psychosom Res. 2017;101:68–95.
Gracie DJ, Hamlin PJ, Ford AC. The influence of the brain-gut axis in inflammatory bowel disease and possible implications for treatment. Lancet Gastroenterol Hepatol. 2019;4(8):632–42.
Barberio B, Zamani M, Black CJ, Savarino EV, Ford AC. Prevalence of symptoms of anxiety and depression in patients with inflammatory bowel disease: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2021;6(5):359–70.
Choi K, Chun J, Han K, et al. Risk of anxiety and depression in patients with inflammatory bowel disease: A nationwide, population-based Study. J Clin Med. 2019;8(5):654.
Bernstein CN, Zhang L, Lix LM, et al. The validity and reliability of screening measures for depression and anxiety disorders in inflammatory bowel disease. Inflamm Bowel Dis. 2018;24(9):1867–75.
Narula N, Pinto-Sanchez MI, Calo NC, et al. Anxiety, but not depression, predicts poor outcomes in inflammatory bowel disease. Inflamm Bowel Dis. 2019;25(7):1255–61.
Faraj J, Takanti V, Tavakoli HR. The gut-brain axis: literature overview and psychiatric applications. Fed Pract. 2021;38(8):356–62.
Appleton J. The gut-brain axis: influence of microbiota on mood and mental health. Integr Med Clin J. 2018;17(4):28–32.
Weaver E, Szigethy E. Managing pain and psychosocial care in IBD: A primer for the practicing gastroenterologist. Curr Gastroenterol Rep. 2020;22(4).
Rozich JJ, Holmer A, Singh S. Effect of lifestyle factors on outcomes in patients with inflammatory bowel diseases. Am J Gastroenterol. 2020;115(6):832–40.
Lewis K, Marrie RA, Bernstein CN, et al. The prevalence and risk factors of undiagnosed depression and anxiety disorders among patients with inflammatory bowel disease. Inflamm Bowel Dis. 2019;25(10):1674–80.
Regueiro M, Greer JB, Szigethy E. Etiology and treatment of pain and psychosocial issues. Gastroenterology. 2017;152(2):430-439.e4.
Goodhand JR, Wahed M, Mawdsley JE, Farmer AD, Aziz Q, Rampton DS. Mood disorders in inflammatory bowel disease: Relation to diagnosis, disease activity, perceived stress, and other factors. Inflamm Bowel Dis. 2012;18(12):2301–9.
Tarescavage AM, Forner EH, Ben-Porath Y. Construct validity of DSM-5 level 2 assessments (PROMIS depression, anxiety, and anger): evidence from the MMPI-2-RF. Assessment. 2021;28(3):788–95.
McGuire FH, Carl A, Woodcock L, et al. Differences in patient and parent informant reports of depression and anxiety symptoms in a clinical sample of transgender and gender diverse youth. LGBT Health. 2021;8(6):404–11.
Zimmerman M, Martinez JH, Young D, Chelminski I, Dalrymple K. Severity classification on the Hamilton depression rating scale. J Affect Disord. 2013;150(2):384– 8.
Mitchell AJ. Clinical utility of screening for clinical depression and bipolar disorder. Curr Opin Psychiatry. 2012;25(1):24–31.
Topp CW, Østergaard SD, Søndergaard S, Bech P. The WHO-5 well-being index: A systematic review of the literature. Psychother Psychosom. 2015;84(3):167–76.
Holi M. Assessment of psychiatric symptoms using the SCL-90. University of Helsinki, 2003.
Yiengprugsawan V, Kelly M, Tawatsupa B. Kessler psychological distress scale. Encyclopedia of quality of life and well-being research. Springer; 2014. p. 3469–70.
Campbell-Sills L, Norman SB, Craske MG, et al. Validation of a brief measure of anxiety-related severity and impairment: The overall anxiety severity and impairment scale (OASIS). J Affect Disord. 2009;112(1–3):92–101.
Colombel JF, Shin A, Gibson PR. AGA clinical practice update on functional gastrointestinal symptoms in patients with inflammatory bowel disease: Expert review. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2019;17(3):380-390.e1.
Neilson K, Ftanou M, Monshat K, et al. A Controlled study of a group mindfulness intervention for individuals living with inflammatory bowel disease. Inflamm Bowel Dis. 2016;22(3):694–701.
Shikatani B, Antony MM, Kuo JR, Cassin SE. The impact of cognitive restructuring and mindfulness strategies on post-event processing and affect in social anxiety disorder. J Anxiety Disord. 2014;28(6):570–9.
Mikocka-Walus A, Bampton P, Hetzel D, Hughes P, Esterman A, Andrews JM. Cognitive-behavioural therapy for inflammatory bowel disease: 24-month data from a randomized controlled trial. Int J Behav Med. 2017;24(1):127–35.
Mikocka-Walus A, Ford AC, Drossman DA. Antidepressants in inflammatory bowel disease. Nat Rev Gastroenterol Hepatol. 2020;17(3):184–92.
Szigethy E. Hypnotherapy for inflammatory bowel disease across the lifespan. Am J Clin Hypn. 2015;58(1):81–99.
Paulides E, Boukema I, van der Woude CJ, de Boer NKH. The effect of psychotherapy on quality of life in IBD patients: A systematic review. Inflamm Bowel Dis. 2020;27(5):711–24.
Prendergast KL, Gowey MA, Barnes MJ, Keller CV, Horne C, Young J. Treating anxiety and depression in inflammatory bowel disease: a systematic review. Psychol Health. 2022 Jan 2;37(1):105–30.
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Copyright (c) 2025 Hamzah Shatri, Rudi Putranto, Edward Faisal, Vinandia Irvianita, Dika Sinulingga, Yanuar Ardani, Dadang Makmun, Muhammad Faisal Prananda, Ayu Suciah Khaerani

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