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Treatments that improve mood could help those with Crohn’s and colitis – study

Talking therapies could be “a valuable tool” for people with bowel disorders such as Crohn’s disease and ulcerative colitis, researchers have suggested.

Academics from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London found treatments that improve the mood reduced inflammation in patients with inflammatory bowel disease (IBD) by 18%.

They said their findings “highlight the potential of mental health treatments as a complementary treatment” for people with IBD.

IBD, which comprises Crohn’s disease and ulcerative colitis, can cause diarrhoea, stomach pain and tiredness.

According to the charity Crohn’s & Colitis UK, the conditions affect about one in every 123 people.

The research team looked at studies which measured the biomarkers c-reactive protein and faecal calprotectin, which are specific indicators of IBD.

They analysed data from 28 trials, involving 1,789 patients, and found the likes of cognitive behavioural therapy (CBT), acceptance and commitment therapy, and mindfulness-based stress reduction had the “best outcomes” on inflammation.

When the team looked at IBD-specific inflammation, they found a “small reduction” in c-reactive protein and faecal calprotectin following mood interventions.

First author Natasha Seaton, a PhD student at King’s IoPPN, said: “IBD is a distressing condition and current medication that reduces inflammation is expensive and can have side-effects.

“Our study showed that interventions that treat mental health reduce levels of inflammation in the body. This indicates that mood interventions could be a valuable tool in our approach to help those with IBD.”

Professor Valeria Mondelli, co-lead of the psychosis and mood disorders theme at the NIHR Maudsley Biomedical Research Centre, and clinical professor of psychoneuroimmunology at King’s IoPPN, said the findings – published in eBiomedicine, part of The Lancet Discovery Science – suggest “improvements in mood can influence physical diseases through modulation of the immune system”.

“We know stress-related feelings can increase inflammation and the findings suggest that by improving mood we can reduce this type of inflammation,” she added.

“This adds to the growing body of research demonstrating the role of inflammation in mental health and suggests that interventions working to improve mood could also have direct physical effects on levels of inflammation. However, more research is needed to understand exact mechanisms in IBD.”

Rona Moss-Morris, a professor of psychology as applied to medicine at IoPPN and digital therapies theme lead at NIHR Maudsley BRC, said integrated mental health support alongside pharmacological treatment “may offer a more holistic approach to IBD care, potentially leading to reduced disease and healthcare costs”.

“Currently, medications taken to reduce inflammation are often very costly compared to psychological therapies in the UK,” Prof Moss-Morris added.

“Given this, including psychological interventions, such as cost-effective digital interventions, within IBD management might reduce the need for anti-inflammatory medication, resulting in an overall cost benefit.”

Ruth Wakeman, director of services, advocacy and evidence at Crohn’s & Colitis UK, said: “People tell us every day that Crohn’s and colitis can have a huge impact on their mental wellbeing as well as their physical health.

“There are very few ‘quick fixes’ when it comes to mental wellbeing and, unfortunately, we know that many patients can face difficulty in accessing psychological support when they need it.

“We welcome any research into improving life for people with inflammatory bowel disease.”

– The study was supported by the National Institute for Health and Care Research (NIHR) and Medical Research Council (MRC).