A stress management programme for Crohn’s disease
Introduction
Crohn’s disease (CD) involves an inflammatory process which begins under the mucosa and spreads outward, penetrating all layers of the bowel, causing submucosal inflammation and edema. This leads to thickening of the bowel wall, which, along with scarring, may cause bowel obstruction. CD usually affects the lower ileum, but may occur in any part of the gastrointestinal tract from the esophagus to the rectum. It may also occur in two or more sites separated by healthy tissue. The clinical course of the disease is commonly marked by periods of remission and exacerbation. CD is primarily characterized by diarrhoea, abdominal pain, weight loss and fever. Patients also frequently develop fistulas extending to the bladder or/and to the surface of the skin.
CD affects about 56% of patients before the age of 22, with a similar incidence in both sexes. Evidence suggests that the global incidence of this disease is on the increase (Irvine, Farrokhyar and Swarbrick, 2001, Pajares and Gisbert, 2001, Sonnenberg, McCarty and Jacobsen, 1991). In Asturias (Spain), the incidence from 1965 to 1975 was 0.48 per 100,000 inhabitants/year whereas from 1975 to 1985 this figure had increased to 1.9 (Martínez, Fernández, Rodrigo and Martínez, 1983, Saro, Argüelles, Alvarez and Diaz, 1986).
Section snippets
Crohn’s disease and stress
The notion that stressors may affect the expression of symptoms in individuals with Crohn’s disease has been investigated by a number of researchers (Anton, 1999, Drossman, 1998, Garret and Drossman, 1990, Garrett, Brantley, Jones and McKnight, 1991, García-Vega and Fernández, 1998, Gerbert, 1980, Greene, Blanchard and Wan, 1994, Milne, Joachim and Niedhardt, 1986, Schwartz and Blanchard, 1991, Schwartz and Schwartz, 1982, Szabo, 1985). While stressful life events related to the onset of
Participants
The 45 subjects with CD (64% females and 36% males) selected for this study all met the following criteria: they were in a non-active stage of the illness (Harvey’s index, Harvey & Bradshaw, 1980), were receiving pharmacological treatment with sulfasalazine (5-ASA compounds) and were not following any dietary restrictions. These factors were used as exclusion criteria, since variability of these was considered to be a potential cause of error in the results.
Patients who met these criteria were
Semi-structured interviews
A semi-structured protocol was used to collect the following categories of variables: demographic (age, sex, marital status); work-related (professional activity, number of days off sick/year, difficulty in carrying out a job, job satisfaction); social (quality of free time, restrictions caused by the illness, influence of CD on social and sexual relationships); factors responsible for the initial stages of the symptomatology (worry about disease, existence of possible stressful factors, life
Procedure
Once the subjects had been selected by the gastroenterologist they were randomly assigned to one of the three treatment groups: 15 subjects were allocated to the experimental stress management group, 15 subjects to the experimental self-directed stress management group and 15 subjects to the conventional medical treatment group. For patients in the two experimental groups, treatment consisted of 8 week individual sessions led by the same psychologist. The first two sessions were dedicated to
Results
Digestive symptoms were monitored in the CD symptoms diary. The average frequency and intensity of each symptom along the baseline (2 weeks) and each week of treatment were calculated from the self-monitoring of symptoms according to the following formulae:e.g. one patient with diarrhoea on Monday, Friday and Sunday, and
Discussion
The objective of this study was, first of all, to assess the effectiveness of a stress management treatment programme, comparing it with the effectiveness of conventional medical treatment; and second, to identify the differential effectiveness of a self-applied stress management programme and stress management treatment supervised by a therapist.
According to the results of patients’ demographic data (age: 31.7±7.6, and sex: 64% women and 36% males) and clinical data (symptoms, number of
References (32)
- et al.
Rederived values of the eight coefficients of the Crohn’s disease Activity Index (CDAI)
Gastroenterology
(1979) - et al.
Two controlled evaluations of multicomponent psychological treatment of irritable bowel syndrome
Behaviour Research and Therapy
(1992) - et al.
Long-term monitoring of psychosocial stress and symptomatology in inflammatory bowel disease
Behaviour Research and Therapy
(1994) - et al.
A simple index of Crohn’s disease activity
The Lancet
(1980) - et al.
Geographic variation of inflammatory bowel disease within the United States
Gastroenterology
(1991) Stress and mind-body impact on the course of inflammatory bowel disease
Seminary of Gastrointestinal Disease
(1999)- et al.
Entrenamiento en relajación progresiva (Progressive relaxation training)
(1983) - et al.
Diagnosis and treatment of fecal incontinence
Digestive Diseases
(1990) Presidential address: gastrointestinal illness and the biopsychosocial model
Psychosomatic Medicine
(1998)- et al.
Psychotherapeutic interventions in alexithymic patients with special regard to ulcerative colitis and Crohn’s patients
Psychotherapy and Psychosomatics
(1985)
Intervención psicológica en la Enfermedad de Crohn
Análisis y Modificación de Conducta
Algunos factores predictores en la enfermedad de Crohn
Psicothema
Health status in inflammatory bowel disease. Biological and behavioral considerations
Gastroenterology
The relation between daily stress and Crohn’s disease
Journal of Behavioral Medicine
Psychological aspects of Crohn’s disease
Journal of Behavioral Medicine
A critical review of epidemiological studies in inflammatory bowel disease
Scandinavian Journal of Gastroenterology
Cited by (99)
Chronic abdominal pain in inflammatory bowel disease: A practical guide
2023, Frontline GastroenterologyA Systematic Review of Self-Management Interventions for Patients with Inflammatory Bowel Disease
2023, Inflammatory Intestinal DiseasesManagement of Pelvic Pain in Patients with Crohn’s Disease—Current Overview
2023, Journal of Clinical MedicineFlare-Ups in Crohn’s Disease: Influence of Stress and the External Locus of Control
2022, International Journal of Environmental Research and Public HealthAbdominal Pain in Inflammatory Bowel Diseases: A Clinical Challenge
2022, Journal of Clinical Medicine