Jennifer L. Kiebles

Preliminary evidence supporting a framework of psychological adjustment to inflammatory bowel disease

Background: Adjustment to chronic disease is a multidimensional construct described as successful adaptation to disease‐specific demands, preservation of psychological well‐being, functional status, and quality of life. Inflammatory bowel disease (IBD) can be particularly challenging due to the unpredictable, relapsing and remitting course of the disease. Methods: All participants were patients being treated in an outpatient gastroenterology clinic at a university medical center. Participants completed a survey of questionnaires assessing illness perceptions, stress, emotional functioning, disease acceptance, coping, disease impact, and disease‐specific and health‐related quality of life. Adjustment was measured as a composite of perceived disability, psychological functioning, and disease‐specific and health‐related quality of life. Results: Participants were 38 adults with a diagnosis of either Crohns disease (45%) or ulcerative colitis (55%). We observed that our defined adjustment variables were strongly correlated with disease characteristics (r = 0.33–0.80, all P < 0.05), an emotional representation of illness (r = 0.44–0.58, P < 0.01), disease acceptance (r = 0.34–0.74, P < 0.05), coping (r = 0.33–0.60, P < 0.05), and frequency of gastroenterologist visits (r = 0.39–0.70, P < 0.05). Better adjustment was associated with greater bowel and systemic health, increased activities engagement and symptom tolerance, less pain, less perceived stress, and fewer gastroenterologist visits. All adjustment variables were highly correlated (r = 0.40–0.84, P < 0.05) and demonstrated a cohesive composite. Conclusions: The framework presented and results of this study underscore the importance of considering complementary pathways of disease management including cognitive, emotional, and behavioral factors beyond the traditional medical and psychological (depression and anxiety) components. (Inflamm Bowel Dis 2010)

Gut-directed hypnotherapy significantly augments clinical remission in quiescent ulcerative colitis

Psychotherapy is not routinely recommended for in ulcerative colitis (UC). Gut‐directed hypnotherapy (HYP) has been linked to improved function in the gastrointestinal tract and may operate through immune‐mediated pathways in chronic diseases.

The role of self-efficacy in inflammatory bowel disease management: Preliminary validation of a disease-specific measure

Background: Inflammatory bowel diseases (IBDs) require self‐management skills that may be influenced by self‐efficacy (SE). Self‐efficacy represents an individuals perception of his or her ability to organize and execute the behaviors necessary to manage disease. The goal of this study was to develop a valid and reliable measure of IBD‐specific SE that can be used in clinical and research contexts. Methods: One hundred and twenty‐two adults with a verified IBD diagnosis participated in the study. Data were pooled from 2 sources: patients from an outpatient university gastroenterology clinic (n = 42) and a sample of online respondents (n = 80). All participants (N = 122) completed the IBD Self‐Efficacy Scale (IBD‐SES) and the Inflammatory Bowel Disease Questionnaire. Additionally, online participants completed the Brief Symptom Inventory‐18 and the Rosenberg Self‐Esteem Scale, whereas those in the clinic sample completed the Perceived Health Competence Scale, the Perceived Stress Questionnaire, and the Short Form Version 2 Health Survey. Results: The IBD‐SES was initially constructed to identify 4 distinct theoretical domains of self‐efficacy: (1) managing stress and emotions, (2) managing medical care, (3) managing symptoms and disease, and (4) maintaining remission. The 29‐item IBD‐SES has high internal consistency (r = 0.96), high test‐retest reliability (r = 0.90), and demonstrates strong construct and concurrent validity with established measures. Conclusions: The IBD‐SES is a critical first step toward addressing an important psychological construct that could influence treatment outcomes in IBD. (Inflamm Bowel Dis 2011)

The Potential Role of a Self-Management Intervention for Ulcerative Colitis: A Brief Report From the Ulcerative Colitis Hypnotherapy Trial

Inflammatory bowel diseases (IBD) are chronic inflammatory illnesses marked by unpredictable disease flares, which occur spontaneously and/or in response to external triggers, especially personal health behaviors. Behavioral triggers of flare may be responsive to disease self-management programs. We report on interim findings of a randomized controlled trial of gut-directed hypnotherapy (HYP, n = 19) versus active attention control (CON, n = 17) for quiescent ulcerative colitis (UC). To date, 43 participants have enrolled; after 5 discontinuations (1 in HYP) and 2 exclusions due to excessive missing data, 36 were included in this preliminary analysis. Aim 1 was to determine the feasibility and acceptability of HYP in UC. This was achieved, demonstrated by a reasonable recruitment rate at our outpatient tertiary care clinic (20%), high retention rate (88% total), and our representative IBD sample, which is reflected by an equal distribution of gender, an age range between 21 and 69, recruitment of ethnic minorities (∽20%), and disease duration ranging from 1.5 to 35 years. Aim 2 was to estimate effect sizes on key clinical outcomes for use in future trials. Effect sizes (group × time at 20 weeks) were small to medium for IBD self-efficacy (.34), Inflammatory Bowel Disease Questionnaire (IBDQ) total score (.41), IBDQ bowel (.50), and systemic health (.48). Between-group effects were observed for the IBDQ bowel health subscale (HYP > CON; p = .05) at 20 weeks and the Short Form 12 Health Survey Version 2 (SF-12v2) physical component (HYP > CON; p < .05) at posttreatment and 20 weeks. This study supports future clinical trials testing gut-directed HYP as a relapse prevention tool for IBD.

16 Gastrointestinal Diseases

This chapter focuses on chronic gastrointestinal disorders and places particular emphasis on that which is most relevant to health psychologists. The past decade has realized several advances in the understanding of the etiology and maintenance of irritable bowel syndrome (IBS), which is now framed around an empirically supported biopsychosocial model, first laid out in a presidential address to the American Gastroenterological Association in 1998 (Drossman 1998; Drossman et al. 1999) and gradually adopted over the next several years (Halpert & Drossman 2005; Levy et al. 2006). In the 2001 version of this chapter, the conceptualization of gastrointestinal syndromes remained in the psychosomatic realm, thereby emphasizing the contributions of psychopathology, child abuse, and stress to the development and expression of IBS. While each of these areas has a role in the current conceptual model of IBS, they are much less central than previously thought. Advances in cognitive neuroscience have described specific cognitive-affective processes that affect pain and gastrointestinal motility; these have informed psychological treatment. Finally, advances in IBS research have led to increased understanding of the psychological aspects of other gastrointestinal conditions, particularly esophageal disorders and inflammatory bowel diseases. Keywords: gastrointestinal; irritable bowel; esophageal disorders; inflammatory bowel diseases; psychosocial

Psychological Co-morbidities of Irritable Bowel Syndrome

IBS is a common, painful gastrointestinal condition associated with psychiatric comorbidities and significant psychological distress, occurring as either a cause or consequence of disabling and embarrassing bowel symptoms. The most common psychiatric comorbidities observed in IBS patients are the anxiety disorders, present in up to 50% of patients seeking treatment. To a lesser extent, somatization and mood disorders are also common. Psychological interventions, particularly gut-directed hypnotherapy and cognitive-behavioral therapy, have demonstrated modest efficacy in treating IBS symptoms directly, but very little research has tested the efficacy of psychotherapy for IBS when it is directly associated with psychiatric comorbidity. Current recommendations for treatment of IBS and comorbid psychiatric diagnoses are to treat them independently, acknowledging that each may contribute to the onset and maintenance of symptoms. Further, it is likely that an improvement in one condition may result in an improvement in the other. Recommendations for the assessment and treatment of IBS in the context of psychiatric comorbidity are presented in this chapter.