title: INSPIRE study: does stress management improve the course of inflammatory bowel disease and disease-specific quality of life in distressed patients with ulcerative colitis or Crohn's disease? A randomized controlled trial.
abstract: BACKGROUND
  The use of stress management psychotherapy is hypothesized to produce greater improvement in disease course and disease-specific quality of life (IBDQ) compared to usual medical care alone in patients with ulcerative colitis (UC) or Crohn's disease (CD) showing high levels of stress (based on the Perceived Stress Questionnaire [PSQ]).
  
  
  METHODS
  Fifty-eight patients with UC and 56 patients with CD who had experienced continuous disease activity or had relapsed over the previous 18 months, with an activity index for UC or CD ≥ 4, a PSQ ≥ 60, and without serious psychiatric disorders or other serious medical conditions were randomized to receive either treatment as usual (TAU) or TAU plus stress management psychotherapy. Psychotherapy consisted of three group sessions (psychoeducation, problem-solving, relaxation) and 6-9 individual sessions based on cognitive behavior therapy-related methods with 1-3 booster sessions at 6 and 12 months follow-up. Gastroenterologists blinded to intervention group assessed disease activity and course at baseline and at 3, 6, 12, and 18 months. Patients completed the IBDQ at baseline, 6, 12, and 18 months.
  
  
  RESULTS
  The intervention did not improve disease or reduce relapse; however, it increased the IBDQ score (P = 0.009, mean differences 16.3 [SD 6.1]). On analysis of UC and CD separately, improvement of IBDQ was only found in the UC group.
  
  
  CONCLUSIONS
  Stress management psychotherapy does not appear to improve disease course or reduce relapse in patients with IBD. It might improve quality of life, particularly in patients with UC.
authors.affiliation: Department of Neuropsychiatry and Psychosomatic Medicine, Oslo University Hospital, Norway. birgitte.boye@oslo-universitetssykehus.no
authors.forename: Birgitte
authors.initials: B
authors.lastname: Boye
authors.forename: Knut E A
authors.initials: KE
authors.lastname: Lundin
authors.forename: Günter
authors.initials: G
authors.lastname: Jantschek
authors.forename: Siv
authors.initials: S
authors.lastname: Leganger
authors.forename: Kjell
authors.initials: K
authors.lastname: Mokleby
authors.forename: Tone
authors.initials: T
authors.lastname: Tangen
authors.forename: Ingrid
authors.initials: I
authors.lastname: Jantschek
authors.forename: Are H
authors.initials: AH
authors.lastname: Pripp
authors.forename: Swavek
authors.initials: S
authors.lastname: Wojniusz
authors.forename: Astri
authors.initials: A
authors.lastname: Dahlstroem
authors.forename: Ann Christin
authors.initials: AC
authors.lastname: Rivenes
authors.forename: Dieter
authors.initials: D
authors.lastname: Benninghoven
authors.forename: Trygve
authors.initials: T
authors.lastname: Hausken
authors.forename: Arne
authors.initials: A
authors.lastname: Roseth
authors.forename: Sebastian
authors.initials: S
authors.lastname: Kunzendorf
authors.forename: Ingvard
authors.initials: I
authors.lastname: Wilhelmsen
authors.forename: Michael
authors.initials: M
authors.lastname: Sharpe
authors.forename: Svein
authors.initials: S
authors.lastname: Blomhoff
authors.forename: Ulrik F
authors.initials: UF
authors.lastname: Malt
authors.forename: Jorgen
authors.initials: J
authors.lastname: Jahnsen
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000150:complications / Q000523:psychology* / Q000628:therapy; D003424:Crohn Disease / Q000150:complications / Q000523:psychology* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009497:Neurotic Disorders / Q000209:etiology / Q000628:therapy*; D011379:Prognosis; D011613:Psychotherapy; D011788:Quality of Life; D012008:Recurrence; D013315:Stress, Psychological / Q000628:therapy*; D011795:Surveys and Questionnaires; D055815:Young Adult