title: Does Computerized Cognitive Behavioral Therapy Help People with Inflammatory Bowel Disease? A Randomized Controlled Trial.
abstract: BACKGROUND
  Cognitive behavioral therapy may be useful for improving health-related quality of life (HRQOL) of at least some patients with inflammatory bowel disease (IBD), especially those with psychiatric comorbidities. However, cognitive behavioral therapy can be difficult to access. These difficulties can be overcome by computerized cognitive behavioral therapy (CCBT). This is a randomized controlled trial of a self-administered CCBT intervention for patients with IBD focused on improving HRQOL. It is hypothesized that CCBT completers will have an improved HRQOL relative to people not allocated to CCBT.
  
  
  METHODS
  Patients with IBD were randomly allocated to CCBT (n = 113) versus treatment as usual (n = 86). The IBD Questionnaire at 12 weeks after baseline was the primary outcome, while generic HRQOL, anxiety, depression, coping strategies, perceived stress, and IBD symptoms were secondary outcomes. Outcomes were also measured at 6 months after baseline. Predictors of dropout were also determined.
  
  
  RESULTS
  Twenty-nine CCBT participants (25.7%) completed the CCBT. The IBD Questionnaire was significantly increased at 12 weeks in CCBT completers compared with treatment-as-usual patients (F = 6.38, P = 0.01). Short Form-12 mental score (F = 5.00, P = 0.03) was also significantly better in CCBT compared with treatment-as-usual patients at 12 weeks. These outcomes were not maintained at 6 months. The predictors of dropout were baseline depression, biological use, lower IBD Questionnaire scores, and not having steroids.
  
  
  CONCLUSIONS
  Improvements at 12 weeks after baseline were not maintained at 6 months. Future research should aim to improve adherence rates. Moreover, CCBT may not work for patients with IBD with comorbid depression.
authors.affiliation: *Department of Medicine, University of Otago, Christchurch, New Zealand; †University of South Australia, Adelaide, Australia; ‡Department of Psychological Medicine, University of Otago, Christchurch, New Zealand; and §Department of Health Sciences, University of York, York, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: McCombie
authors.forename: Richard
authors.initials: R
authors.lastname: Gearry
authors.forename: Jane
authors.initials: J
authors.lastname: Andrews
authors.forename: Roger
authors.initials: R
authors.lastname: Mulder
authors.forename: Antonina
authors.initials: A
authors.lastname: Mikocka-Walus
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000295:instrumentation*; D003865:Major Depressive Disorder / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000523:psychology* / Q000628:therapy*; D008297:Male; D011379:Prognosis; D011788:Quality of Life; D013813:Therapy, Computer-Assisted / Q000379:methods*