Facilitating Adjustment to Inflammatory Bowel Disease: A Model of Psychosocial Intervention in Non-Psychiatric Patients

Abstract

Background: There is no consensus about the most appropriate psychosocial interventions for people with inflammatory bowel disease (IBD) or the most appropriate criteria by which to select which patients might benefit from the available interventions. Nonetheless the perception that stress and other subjective factors contribute to suffering in IBD is persistent and professionals are often called upon to offer appropriate support. A model of normal psychosocial adjustment to IBD and the interventions which can improve difficulties with adjustment will facilitate rational therapeutic intervention and needed research in this area. Methods: A model of normal adjustment to IBD is developed from a synthesis of the empirical literature and clinical experience in a tertiary care medical/surgical IBD centre and is used to identify potential points of psychosocial intervention. Results: Normal adjustment to IBD can be understood as a process involving the interaction of a triad of adaptive challenges: illness uncertainty, loss and change, and suffering. Each of these challenges requires different criteria of psychosocial assessment and may lead to different interventions. Conclusions: Although the interventions available for improving adjustment to IBD have not been exhaustively investigated, the existing data support the value of further study. The model of psychosocial adjustment presented here provides a synthesis of the existing data and a starting point for further research.

Effects of Mind-Body Therapy on Quality of Life and Neuroendocrine and Cellular Immune Functions in Patients with Ulcerative Colitis

“…The present results are in keeping with several published reports on the effects of nonpharmacological intervention programs in patients with IBD, most of which consisted of one or several components of mind-body therapy, mostly stress reduction and relaxation training [9, 25, 26, 57]. Similar to our own results, the vast majority of previous studies found improvements primarily in psychological rather than clinical parameters, although one study reported improvements in the use of anti-inflammatory drugs following relaxation training [26].…”

“…This may have contributed to a selection bias, which favored individuals who were a priori interested and open to alternative treatment approaches, who attribute changes in disease activity to psychological stress, and may accordingly have had positive expectations regarding the efficacy of mind-body therapy. It is not known whether patients’ acceptance and openness towards alternative treatment options may increase the success of such therapies [57]. Clearly, further studies are needed to investigate the potential of mind-body therapy to serve as an adjunct to standard medical therapy in IBD patients with higher disease activity, different degrees of psychological comorbidities and varying degrees of acceptance of mind-body medicine.…”

Sequential Treatment: A New Way of Integrating Pharmacotherapy and Psychotherapy

“…This sequential model that was developed for preventing relapse in depression [16]may potentially apply to any type of psychiatric disorder [13]or when psychotherapy is associated with medical illness [21, 22]. Marks [23]suggested that current prevailing therapeutic mechanisms for explaining therapeutic effectiveness in psychotherapy are about to change.…”

Psychosomatic medicine: A specialty for generalists

“…Importantly, there are often opportunities to intervene to reduce uncertainty, to augment tolerance of irreducible uncertainty, and to promote meaningful responses to irreducible suffering in chronic disease in medical patients [12]. Recognizing that psychosomatic expertise is required to respond effectively to these complex sources of suffering, symptoms, and impairment, even in the absence of psychiatric disease, is an argument for the integration of psychosomatic experts within multidisciplinary medical/surgical teams (not merely as consultants for identified "cases") and an argument against exclusively diagnosis-based models of treatment and professional remuneration.…”