title: A randomized controlled trial of mindfulness-based stress reduction to prevent flare-up in patients with inactive ulcerative colitis.
abstract: OBJECTIVE
  The primary therapeutic goals in ulcerative colitis (UC) are to maintain excellent quality of life (QOL) by treating flare-ups when they occur, and preventing flare-ups. Since stress can trigger UC flare-ups, we investigated the efficacy of mindfulness-based stress reduction (MBSR) to reduce flare-ups and improve QOL.
  
  
  METHODS
  Patients with moderately severe UC, in remission, were randomized to MBSR or time/attention control. Primary outcome was disease status. Secondary outcomes were changes in markers of inflammation and disease activity, markers of stress and psychological assessments.
  
  
  RESULTS
  55 subjects were randomized. Absence of flares, time to flare and severity of flare over 1 year were similar between the two groups. However, post hoc analysis showed that MBSR decreased the proportion of participants with at least one flare-up among those with top tertile urinary cortisol and baseline perceived stress (30 vs. 70%; p < 0.001). MBSR patients who flared demonstrated significantly lower stress at the last visit compared to flared patients in the control group (p = 0.04). Furthermore, MBSR prevented a drop in the Inflammatory Bowel Disease Quality of Life Questionnaire during flare (p < 0.01).
  
  
  CONCLUSIONS
  MBSR did not affect the rate or severity of flare-ups in UC patients in remission. However, MBSR might be effective for those with high stress reactivity (high perceived stress and urinary cortisol) during remission. MBSR appears to improve QOL in UC patients by minimizing the negative impact of flare-ups on QOL. Further studies are needed to identify a subset of patients for whom MBSR could alter disease course.
authors.affiliation: Division of Digestive Diseases and Nutrition, Department of Internal Medicine, Rush University Medical Center, Chicago, Ill., USA.
authors.forename: S
authors.initials: S
authors.lastname: Jedel
authors.forename: A
authors.initials: A
authors.lastname: Hoffman
authors.forename: P
authors.initials: P
authors.lastname: Merriman
authors.forename: B
authors.initials: B
authors.lastname: Swanson
authors.forename: R
authors.initials: R
authors.lastname: Voigt
authors.forename: K B
authors.initials: KB
authors.lastname: Rajan
authors.forename: M
authors.initials: M
authors.lastname: Shaikh
authors.forename: H
authors.initials: H
authors.lastname: Li
authors.forename: A
authors.initials: A
authors.lastname: Keshavarzian
mesh_terms: D000328:Adult; D001288:Attention; D002097:C-Reactive Protein / Q000378:metabolism; D003093:Colitis, Ulcerative / Q000097:blood / Q000517:prevention & control* / Q000523:psychology*; D018450:Disease Progression; D018572:Disease-Free Survival; D004311:Double-Blind Method; D005243:Feces / Q000737:chemistry; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000652:urine; D007378:Interleukins / Q000097:blood; D039841:Leukocyte L1 Antigen Complex / Q000032:analysis; D008297:Male; D008875:Middle Aged; D064866:Mindfulness; D011788:Quality of Life; D013315:Stress, Psychological / Q000517:prevention & control* / Q000652:urine; D011795:Surveys and Questionnaires; D013997:Time Factors
chemical_list: D007378:Interleukins; D039841:Leukocyte L1 Antigen Complex; D002097:C-Reactive Protein; D006854:Hydrocortisone