Behavioral interventions may prolong remission in patients with inflammatory bowel disease.
Inflammatory Bowel Diseases (IBDs) are chronic, relapsing and remitting gastrointestinal conditions with no known cure. Previous studies have linked behavioral factors, including stress and medication adherence, to relapse.


OBJECTIVE
We sought to determine the effect of participation in a behavioral self-management program on incidence of flare within 12 months following behavioral intervention when compared to the natural history of flare incidence prior to program participation.


RESULTS
Results from a 2-level regression model indicated that those participants in the treatment group were 57% less likely to flare in the following 12 months (compared to 18% in the control group). The decline in "flare odds" was about 2 times greater in treatment versus controls (OR=0.52, t(34)=2.07, p<0.05). Office visits, ER visits, and disease severity (all p<0.05) were identified as moderators of flare risk.


CONCLUSIONS
We have demonstrated 1) a statistical model estimating the likelihood of flare rates in the 12 months following a behavioral intervention for IBD (compared to a control condition), and 2) that the introduction of a behavioral intervention can alter the natural course of a chronic, relapsing and remitting gastrointestinal condition such as IBD.
Division of Gastroenterology, Northwestern University Feinberg School of Medicine, Center for Psychosocial Research, 676N. St. Clair, Suite 1400, Chicago, IL 60611, USA. laurie.keefer@northwestern.edu
Laurie
L
Keefer
Jennifer L
JL
Kiebles
Zoran
Z
Martinovich
Elyse
E
Cohen
Alyssa
A
Van Denburg
Terrence A
TA
Barrett
D000293:Adolescent; D000328:Adult; D000368:Aged; D015928:Cognitive Behavioral Therapy; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D006990:Hypnosis; D015212:Inflammatory Bowel Diseases / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D055502:Secondary Prevention; D012648:Self Care; D012720:Severity of Illness Index; D016896:Treatment Outcome
Br J Pharmacol. 2004 Apr;141(8):1321-30
15100165
Am J Gastroenterol. 2008 Jan;103(1):154-61
18076736
Am J Gastroenterol. 2003 Oct;98(10):2203-8
14572569
Gastroenterology. 2004 May;126(6):1504-17
15168363
J Occup Environ Med. 2008 Nov;50(11):1261-72
19001952
Int J Clin Exp Hypn. 2007 Oct;55(4):457-66
17786661
Am J Gastroenterol. 2005 Aug;100(8):1796-804
16086717
Gastroenterology. 2007 Feb;132(2):763-86
17258735
Inflamm Bowel Dis. 2005 Feb;11(2):171-7
15677911
N Engl J Med. 1987 Dec 24;317(26):1625-9
3317057
Inflamm Bowel Dis. 2009 Oct;15(10):1599-604
19653291
Inflamm Bowel Dis. 2010 Jan;16(1):112-24
19653289
Gastroenterology. 1976 Mar;70(3):439-44
1248701
Nat Clin Pract Gastroenterol Hepatol. 2004 Nov;1(1):26-31
16265041
J Psychosom Res. 2004 Jun;56(6):687-96
15193965
Am J Gastroenterol. 2007 Aug;102(8):1683-91
17459026
Am J Gastroenterol. 2000 May;95(5):1213-20
10811330
AARN News Lett. 1988 May;44(5):16-7
3389064
J Consult Clin Psychol. 2002 Jun;70(3):739-50
12090380
Inflamm Bowel Dis. 2008 Apr;14(4):526-35
18183608
Am J Gastroenterol. 2009 May;104(5):1298-313; quiz 1314
19337242
Curr Opin Gastroenterol. 2009 Jul;25(4):301-5
19349861
Ann Intern Med. 1996 Jan 15;124(2):204-11
8533995
Physiol Behav. 2004 Mar;81(1):71-84
15059686
Am J Gastroenterol. 2008 Dec;103(12):3123-31
18786111
Inflamm Bowel Dis. 2010 Oct;16(10):1685-95
20155849
Am J Physiol. 1999 Apr;276(4):G1027-36
10198347
N Engl J Med. 2002 Feb 21;346(8):614-6
11856802
Am J Gastroenterol. 2010 Sep;105(9):1994-2002
20372115
Am J Physiol. 1998 Nov;275(5):G1037-44
9815034
Behav Res Ther. 1991;29(2):167-77
2021379
Curr Gastroenterol Rep. 2002 Dec;4(6):513-6
12441042
Aliment Pharmacol Ther. 2007 Oct 1;26(7):987-1003
17877506
Am J Gastroenterol. 2008 Aug;103(8):1989-97
18796096
J Clin Gastroenterol. 2005 May-Jun;39(5):390-5
15815207
Rev Gastroenterol Disord. 2006 Spring;6(2):97-105
16699478
Gastroenterology. 2006 Aug;131(2):410-9
16890594
Gut. 2004 Nov;53(11):1639-45
15479685