title: Effect of psychotherapy and relaxation on the psychosocial and somatic course of Crohn's disease: main results of the German Prospective Multicenter Psychotherapy Treatment study on Crohn's Disease.
abstract: OBJECTIVE
  Few studies have been published on the influence of psychotherapy on the physical and psychosocial course of Crohn's disease (CD).
  
  
  METHODS
  The present study, a prospective, randomized multicenter investigation conducted with 108 of 488 consecutive CD patients, was designed to investigate the influence of short-term psychodynamic therapy and relaxation in addition to a standardized glucocorticoid therapy on the somatic course of the disease as well as on patient psychosocial status. Based on the same standardized somatic treatment, the psychotherapy and control groups were compared after a 1-year treatment period and a follow-up of another year with regard to somatic course and psychosocial situation.
  
  
  RESULTS
  A total of 81 (75%) of 108 randomized patients completed the psychosocial follow-up. The comparison between the therapy groups after 1 year showed no significant differences in the four main target criteria of psychosocial status (depression, anxiety, psychosocial-communicative status and health-related quality of life). The mean Beck's Depression Inventory (BDI) score at admission was 12.3 in the psychotherapy group and 8.7 in the control group. At the 1-year follow-up, the scores for depression have been 7.8 (psychotherapy group) and 7.8 (control group). In the 2-year follow-up, 84 patients were classified into four groups on the basis of somatic course; 23% of the control group and 30% of the psychotherapy group showed episode-free courses, 29% and 17% respectively underwent surgery due to failure of immunosuppressive or medical therapy, and a further subranking showed no significant differences between the two groups (P=.125). At the 1-year follow-up, the scores for depression of patients with an active episode respective remission were 14.6 vs. 5.8. From the patient's point of view, at the end of the 2-year follow-up, the overall subjective evaluation of the effectiveness of psychotherapy was positive.
  
  
  CONCLUSIONS
  The patients included showed no psychosocial disturbances of clinical relevance. Although a tendency toward fewer surgical interventions, fewer relapses and reduction of depression was noted, the analysis was unable to demonstrate any benefit from psychosocial intervention on hypothesized parameters of psychosocial status and somatic course. Further studies should be performed to identify patient subgroups that may benefit from psychosocial intervention.
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Benjamin Franklin Clinic, Free University Berlin, Hindenburgdamm 30, 12200 Berlin, Germany. kellerw@tww-berlin.de
authors.forename: Wolfram
authors.initials: W
authors.lastname: Keller
authors.forename: Maria
authors.initials: M
authors.lastname: Pritsch
authors.forename: Jörn
authors.initials: J
authors.lastname: Von Wietersheim
authors.forename: Peter
authors.initials: P
authors.lastname: Scheib
authors.forename: Walter
authors.initials: W
authors.lastname: Osborn
authors.forename: Friedrich
authors.initials: F
authors.lastname: Balck
authors.forename: Reiner
authors.initials: R
authors.lastname: Dilg
authors.forename: Eva
authors.initials: E
authors.lastname: Schmelz-Schumacher
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Doppl
authors.forename: Günther
authors.initials: G
authors.lastname: Jantschek
authors.forename: Hans-Christian
authors.initials: HC
authors.lastname: Deter
mesh_terms: D000328:Adult; D003424:Crohn Disease / Q000523:psychology* / Q000601:surgery / Q000628:therapy*; D003863:Depression / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011614:Psychotherapy, Brief; D012064:Relaxation Therapy; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents