title: Psychological interventions for treatment of inflammatory bowel disease.
abstract: BACKGROUND
  The effect of psychological interventions in inflammatory bowel diseases (IBD) is controversial.
  
  
  OBJECTIVE
  To assess the effects of psychological interventions (psychotherapy, patient education, relaxation techniques) on health related quality of life, coping, emotional state and disease activity in IBD.
  
  
  METHODS
  We searched the specialized register of the IBD/FBD Group, CENTRAL (Issue 5, 2010) and from inception to April 2010: Medline, Embase, LILACS, Psyndex, CINAHL, PsyInfo, CCMed, SOMED and Social SciSearch. Conference abstracts and reference lists were also checked.
  
  
  METHODS
  Randomized, quasi-randomized and non randomized controlled trials of psychological interventions in children or adults with IBD with a minimum follow up time of 2 months.
  
  
  METHODS
  Data were extracted and study quality was independently assessed by two raters. Pooled standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated using a random effects model.
  
  
  RESULTS
  Twenty-one studies were eligible for inclusion (1745 participants, 8 RCT, 4 QRCT, 8 NRCT; 19 in adults, 2 in adolescents). Most studies used multimodular approaches. The risk of bias was high for all studies.In adults, psychotherapy had no effect on quality of life at around 12 months (3 studies, 235 patients, SMD -0.07; 95% CI -0.33 to 0.19), emotional status (depression, 4 studies, 266 patients, SMD 0.03; 95% CI -0.22 to 0.27) or proportion of patients not in remission (5 studies, 287 patients, OR 0.85; 95% CI 0.48 to 1.48). Results were similar at 3 to 8 months. There was no evidence for statistical heterogeneity or subgroup effects based on type of disease or intensity of the therapy. In adolescents, there were positive short term effects of psychotherapy on most outcomes assessed including quality of life (2 studies, 71 patients, SMD 0.70; 95% CI 0.21 to 1.18) and depression (1 study, 41 patients, SMD -0.62; 95% CI -1.25 to 0.01).Educational interventions were ineffective with respect to quality of life at 12 months (5 studies, 947 patients, SMD 0.11; 95% CI -0.02 to 0.24), depression (3 studies, 378 patients, SMD -0.08; 95% CI -0.29 to 0.12) and proportion of patients not in remission (3 studies, 434 patients, OR 1.00; 95% CI 0.65 to 1.53).
  
  
  CONCLUSIONS
  There is no evidence for efficacy of psychological therapy in adult patients with IBD in general. In adolescents, psychological interventions may be beneficial, but the evidence is limited. Further evidence is needed to assess the efficacy of these therapies in subgroups identified as being in need of psychological interventions, and to identify what type of therapy maybe most useful.
authors.affiliation: Clinical Epidemiology, Bremen Institute for Prevention Research and Social Medicine, Achterstrasse 30, Bremen, Germany, 28359.
authors.forename: Antje
authors.initials: A
authors.lastname: Timmer
authors.forename: Jan C
authors.initials: JC
authors.lastname: Preiss
authors.forename: Edith
authors.initials: E
authors.lastname: Motschall
authors.forename: Gerta
authors.initials: G
authors.lastname: Rücker
authors.forename: Günther
authors.initials: G
authors.lastname: Jantschek
authors.forename: Gabriele
authors.initials: G
authors.lastname: Moser
mesh_terms: D000293:Adolescent; D000328:Adult; D003093:Colitis, Ulcerative / Q000523:psychology / Q000628:therapy; D003424:Crohn Disease / Q000523:psychology / Q000628:therapy; D003863:Depression / Q000628:therapy; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000523:psychology / Q000628:therapy*; D010353:Patient Education as Topic; D011613:Psychotherapy / Q000379:methods*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic