Department of Medical Psychology.
Department of General Practice & Elderly Care Medicine, VU University Medical Center Amsterdam.
J Consult Clin Psychol. 2017 Sep;85(9):918-925. doi: 10.1037/ccp0000227.
OBJECTIVE: Inflammatory bowel disease (IBD) is characterized by a low level of quality of life (QoL) and a high prevalence of anxiety and depression, especially in patients with poor QoL. We examined the effect of IBD-specific cognitive-behavioral therapy (CBT) on QoL, anxiety, and depression in IBD patients with poor mental QoL. METHOD: This study is a parallel-group multicenter randomized controlled trial. One hundred eighteen IBD patients with a low level of QoL (score ≤23 on the mental health subscale of the Medical Outcomes Study Short Form 36 Health Survey [SF-36]) were included from 2 academic medical centers (Academic Medical Center Amsterdam, VU University Medical Centre Amsterdam) and 2 peripheral medical centers (Flevo Hospital, Slotervaart Hospital) in the Netherlands. Patients were randomized to an experimental group receiving CBT (n = 59) versus a wait-list control group (n = 59) receiving standard medical care for 3.5 months, followed by CBT. Both groups completed baseline and 3.5 months follow-up assessments. The primary outcome was a self-report questionnaire and disease-specific QoL (Inflammatory Bowel Disease Questionnaire [IBDQ]). Secondary outcomes were depression (Hospital Anxiety and Depression Scale-Depression Subscale [HADS-D], Center for Epidemiologic Studies Depression Scale [CES-D]), anxiety (HADS-Anxiety Subscale [HADS-A]) and generic QoL (SF-36). RESULTS: Data were analyzed both on intention to treat as well as on per protocol analysis (completed ≥5 sessions). CBT had a positive effect on disease-specific-QoL (Cohen's d = .64 for IBDQ total score), depression (Cohen's d = .48 for HADS-D and .78 for CES-D), anxiety (Cohen's d = .58 for HADS-A), and generic QoL (Cohen's d = 1.08 for Mental Component Summary of the SF-36; all ps < .01). CONCLUSIONS: IBD-specific CBT is effective in improving QoL and in decreasing anxiety and depression in IBD patients with poor QoL. Clinicians should incorporate screening on poor mental QoL and consider offering CBT. (PsycINFO Database Record
目的：炎症性肠病（IBD）的特点是生活质量（QoL）水平较低，焦虑和抑郁的患病率较高，尤其是在 QoL 较差的患者中。我们研究了 IBD 特异性认知行为疗法（CBT）对 QoL、焦虑和抑郁在 QoL 较差的 IBD 患者中的影响。
方法：这是一项平行组多中心随机对照试验。从荷兰的 2 个学术医疗中心（阿姆斯特丹学术医疗中心，VU 大学医学中心阿姆斯特丹）和 2 个外围医疗中心（弗勒沃医院，斯劳特瓦赫特医院）共纳入 118 例 QoL 水平较低的 IBD 患者（医疗结局研究短表单 36 健康调查[SF-36]心理健康子量表得分≤23）。患者被随机分配到实验组（n=59）接受 CBT，与对照组（n=59）接受标准医疗护理 3.5 个月，然后接受 CBT。两组均在基线和 3.5 个月时进行评估。主要结局是自我报告问卷和疾病特异性 QoL（炎症性肠病问卷[IBDQ]）。次要结局是抑郁（医院焦虑和抑郁量表-抑郁子量表[HADS-D]，流行病学研究中心抑郁量表[CES-D]），焦虑（HADS 焦虑子量表[HADS-A]）和通用 QoL（SF-36）。
结果：根据意向治疗和方案完成（完成≥5 次）进行分析。CBT 对疾病特异性 QoL（IBDQ 总分的 Cohen's d=0.64）、抑郁（HADS-D 的 Cohen's d=0.48，CES-D 的 Cohen's d=0.78）、焦虑（HADS-A 的 Cohen's d=0.58）和通用 QoL（SF-36 心理成分综合得分的 Cohen's d=1.08；均 p<0.01）均有积极影响。
结论：IBD 特异性 CBT 可有效改善 QoL，并降低 QoL 较差的 IBD 患者的焦虑和抑郁。临床医生应将筛查纳入 QoL 较差的患者，并考虑提供 CBT。
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