Facilitating adjustment to inflammatory bowel disease: a model of psychosocial intervention in non-psychiatric patients.
BACKGROUND
There is no consensus about the most appropriate psychosocial interventions for people with inflammatory bowel disease (IBD) or the most appropriate criteria by which to select which patients might benefit from the available interventions. Nonetheless the perception that stress and other subjective factors contribute to suffering in IBD is persistent and professionals are often called upon to offer appropriate support. A model of normal psychosocial adjustment to IBD and the interventions which can improve difficulties with adjustment will facilitate rational therapeutic intervention and needed research in this area.


METHODS
A model of normal adjustment to IBD is developed from a synthesis of the empirical literature and clinical experience in a tertiary care medical/surgical IBD centre and is used to identify potential points of psychosocial intervention.


RESULTS
Normal adjustment to IBD can be understood as a process involving the interaction of a triad of adaptive challenges: illness uncertainty, loss and change, and suffering. Each of these challenges requires different criteria of psychosocial assessment and may lead to different interventions.


CONCLUSIONS
Although the interventions available for improving adjustment to IBD have not been exhaustively investigated, the existing data support the value of further study. The model of psychosocial adjustment presented here provides a synthesis of the existing data and a starting point for further research.
Maunder
R
R
Department of Psychiatry, University of Toronto, and Department of Psychiatry and IBD Centre, Mount Sinai Hospital, Toronto, Ontario, Canada. bmaunder@interlog.com
Esplen
M J
MJ
D000223:Adaptation, Psychological; D000342:Affective Symptoms / Q000209:etiology / Q000628:therapy; D002908:Chronic Disease; D003093:Colitis, Ulcerative / Q000523:psychology; D003424:Crohn Disease / Q000523:psychology; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000523:psychology*; D008297:Male; D008960:Models, Psychological; D012944:Social Support; D012960:Socioenvironmental Therapy / Q000379:methods*