Psychological Aspects of Inflammatory Bowel Disease

Inflammatory bowel disease (IBD), comprising Crohn’s disease, ulcerative colitis, and IBD-unspecified, can often have severe and debilitating symptoms. These symptoms can often lead to significant depression, anxiety, and impaired health-related quality of life (HRQOL). Not only can the symptoms themselves lead to psychological distress (PD) but certain individual characteristics, such as personality and coping strategies, may determine how one responds to the disease and their subsequent psychological outcomes. This thesis explores the interrelationships between IBD and psychological factors using both observational and interventional techniques. Chapter 1 provides a general overview of IBD in terms of its symptoms, worldwide epidemiology, causes, and treatments. Chapter 2 discusses how IBD can lead to PD in many of its patients and that improvements in coping strategies may improve outcomes in IBD patients. Psychological interventions may be a treatment for at least some IBD patients. Chapter 3 systematically reviews psychotherapy for IBD. However, given that psychotherapy is expensive and difficult to access, computerised psychological interventions may be a more cost-effective and accessible treatment to many patients. No studies have been published in computerised psychological interventions in IBD patients and so Chapter 4 systematically reviews computerised cognitive behavioural therapy (CCBT) as an intervention for physical illnesses in general, the first time that this has been reviewed. Chapter 5 comprises an original observational longitudinal study of newly diagnosed IBD patients during the first six months post diagnosis. This study showed that coping changed, HRQOL improved, and neuroticism had strong associations with anxiety, depression, and HRQOL. As to whether the coping strategies are a cause or a consequence of fluctuations in HRQOL needs to be tested in an interventional study. Chapter 6 contains a study comparing patient preferences for a computerised or face-to-face psychological intervention. An appetite for a computerised psychological intervention was demonstrated and so was tested in Chapter 7 in the form of a randomised controlled trial of CCBT for IBD patients. Few participants complied with the CCBT regiment but those who did trended towards having better improvements in HRQOL post-intervention than controls. However, these effects were not maintained at six months post-intervention. Therefore, the overall result of this study is negative. One of the conclusions from Chapters 2 and 5 was that an IBD specific coping questionnaire should be developed. Chapter 8 contains such a questionnaire, namely the IBD Cope. The “good” and “bad” coping subscales of the IBD Cope were shown to match the Brief COPE adaptive and maladaptive coping subscales despite the IBD Cope having fewer questions than the Brief COPE. The most important findings from this thesis in Chapter 9 are that (1) coping is better measured in IBD patients using the IBD Cope than the Brief COPE; and (2) CCBT can improve HRQOL in the short term for IBD patients but adherence needs to be improved and long term benefits need to be maximised through “booster” sessions