Treatment for Comorbid Pediatric Gastrointestinal and Anxiety Disorders: A Pilot Study of a Flexible Health Sensitive Cognitive-Behavioral Therapy Program

Abstract

Anxiety is a prevalent and impairing psychiatric condition among children and adolescents with inflammatory bowel disease (IBD). Despite the need for effective treatment, no studies have examined the benefit of cognitive-behavioral therapy (CBT) for anxiety disorders among children or adults with IBD. The aim of this paper is twofold: (a) to briefly describe a newly adapted CBT protocol, treatment of anxiety and physical symptoms related to IBD (TAPS ϩ IBD), that concurrently addresses anxiety (including IBD-specific anxiety) and disease management among children and adolescents with IBD in pediatric medical offices; and (b) to present initial pilot data examining the feasibility and potential efficacy of TAPS ϩ IBD compared to nondirective supportive therapy (NDST) among youth with comorbid IBD and anxiety. Twenty-two youth (59% female; mean age 13.2 Ϯ 2.1) with comorbid IBD and anxiety disorder were randomly assigned to a 13-session TAPS ϩ IBD or NDST program. Following treatment, participants in TAPS ϩ IBD demonstrated higher treatment response rates relative to the NDST control treatment. Compared with NDST, TAPS ϩ IBD was associated with significantly greater reductions in IBD-specific anxiety immediately following treatment and 3 months later. TAPS ϩ IBD shows initial promise for the treatment of anxiety in youth with IBD. The direct integration of behavioral health strategies into medical settings and use of a flexible CBT approach sensitive to acute disease fluctuations appears to be beneficial among youth with comorbid IBD and anxiety.

A Systematic Review of Self-Management Interventions for Children and Adolescents With Inflammatory Bowel Disease

“…A total of 808 references were identified, of which eleven articles, reporting nine trials 23,[25][26][27][28][29][30]31,32 were included (Figure 1).…”

“…All except one of the trials were conducted in the USA 23,[25][26][27][28][29][30]32 Seven were randomized controlled trials (RCTs) 23,[25][26][27][28][29][30] and two were non-randomized controlled trials 31,32 . Overall, 521 CA participated in the trials and in most trials parents/carers were involved except for one that included adolescents only 31 .…”

“…Overall, 521 CA participated in the trials and in most trials parents/carers were involved except for one that included adolescents only 31 . A majority of trials were small with seven recruiting fewer than 50 participants 23,[26][27][28][30][31][32] . Mean age ranged from 8.5-15 years and more than 68% were Caucasian.…”

“…Eight trials reported separately for IBD subtypes, in which the proportions with ulcerative colitis (UC) ranged from 17.5% -33.3%, Crohn's disease (CD) from 54% -78.6% and Indeterminate Colitis (IDC) from 3%-12.5%, although one trial did not specify the IBD types 28 . Severity of IBD was reported in six studies, in which between 30-100% of participants had active disease 25-28, 30, 32 .…”

“…One trial recruited only participants who had comorbid IBD and anxiety disorder 28 and two trials recruited participants with IBD who met the criteria for depression 29,30 . Table 2)…”