Inflammatory Bowel DiseasesNCT04646785
Mindfulness-based Cognitive Therapy for Patients With Inflammatory Bowel Disease
A study testing Mindfulness-based cognitive therapy + TAU and Treatment as usual (TAU) in people with Inflammatory Bowel Diseases, run by Radboud University Medical Center at 4 sites in Netherlands.
Trial summary
Considering the limited availability of psychosocial interventions for IBD, this study aims to investigate MBCT as an adjunctive treatment to treatment as usual to reduce psychological stress and improve sleep quality/regularity in patients with IBD who report elevated stress levels. Read more about this study
- Who is it for?
- Ages 16 years and older
- Conditions the study is for
- Inflammatory Bowel Diseases
- What is being tested?
- Mindfulness-based cognitive therapy + TAU and Treatment as usual (TAU)
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 142 participants
- Where
- 4 sitesNetherlands
- Study dates
- 1 Aug 2021to 3 Oct 2023
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 16 years and older
- All sexes
- No healthy volunteers
- Child, Adult, Older adult
Who may be able to join
- Confirmed IBD diagnosis of Crohn's disease (CD), Ulcerative colitis (UC) or Indeterminate colitis (IC)
- Current IBD remission (Calprotectin < 250 mg/kg) since at least three months
- Hospital Anxiety and Depression Scale-score of >=11, indicating at least mild levels of psychological distress (Vodermaier 2011).
- Age of 16 or older
- Taking no IBD medication or on a stable dose of 5-ASA products, immunosuppressive medication, or biologics for at least three months prior to enrollment.
Who cannot join
- Severe psychiatric disorders (e.g. acute suicidality, psychosis)
- Current alcohol or drug dependency
- Untreated anemia
- Prior participation in an 8-week MBSR or MBCT-programme
Trial locations and contacts
4 sites in 1 country.
Netherlands4 sites
Jeroen Bosch Ziekenhuis
's-Hertogenbosch
Rijnstate Ziekenhuis
Arnhem
Radboud University Nijmegen Medical Center
Nijmegen, Gelderland, 6525 GC
Canisius Wilhelmina Ziekenhuis
Nijmegen
About this study
Official title: Mindfulness-based Cognitive Therapy to Improve Stress and Sleep in Patients With Inflammatory Bowel Disease
Considering the limited availability of psychosocial interventions for IBD, this study aims to investigate MBCT as an adjunctive treatment to treatment as usual to reduce psychological stress and improve sleep quality/regularity in patients with IBD who report elevated stress levels. The study will have a follow-up duration of 12 months from baseline.
Read the detailed description
Introduction:
Inflammatory bowel diseases (IBD) are chronic inflammatory diseases of the intestinal tract, consisting of crohn's disease (CD) and ulcerative colitis (UC). In The Netherlands, there are about 90,000 IBD patients, mainly young adults who are in a turbulent part of their life with starting a family and career. The prevalence of IBD seems to be rising. The peak incidence is between 15 and 30 years. The disease is characterized by periods of disease activity (flares) alternating with periods of (clinical) remission. Physical symptoms include abdominal pain, diarrhea, rectal bleeding and fatigue. Although the arsenal of drugs has increased in recent decades, there is no cure for the disease and patients are usually long-term treated with different (immunosuppressive) medications. Nevertheless, at this moment, we are only partially able to keep our IBD patients in remission.
Even in those in remission, IBD is associated with increased levels of psychological stress, with estimated prevalence rates of 21% for depressive symptoms and 35% for anxiety symptoms. In periods of disease activity, prevalence of elevated anxiety levels was even found to be as high as 75.6%. Besides psychological stress, IBD patients in remission report lower quality of life compared to the general population. This is due to the physical symptoms but also to fatigue, worries, anxiety, depression, impaired satisfaction with social role and sleep disturbances. More than 40 % of the IBD patients experience fatigue. This may contribute to the higher sick leave days and higher work impairment rates in quiescent IBD, causing high societal costs. In addition, poor sleep seems common in individuals with IBD and has been linked to disease activity and shown as a predictor for subclinical inflammation and a risk factor for relapse and poorer outcomes.
Mindfulness training, typically in the form of mindfulness-based stress reduction (MBSR) or mindfulness-based cognitive therapy (MBCT), is a psychosocial group-based intervention that has been shown to reduce psychological distress and improving quality of life, both in patients with mental health problems and those with chronic diseases such as diabetes, cancer, cardiovascular disease, rheumatoid arthritis and fibromyalgia. Mindfulness training focuses on the progressive acquisition of mindful awareness to better cope with negative repetitive thoughts and feelings, and for that reason may be a good option to reduce psychological stress and fatigue, and improve quality of life in patients with chronic conditions including IBD.
Although the available literature on the effectiveness of mindfulness-based interventions for IBD is still relatively scarce, a recent meta-analysis showed significant benefits in terms of stress, depression, and quality of life. However, the variety in types of interventions was rather high, and individual studies typically suffered from methodological limitations, including small sample size, poor blinding of the outcome assessors, incomplete data reporting and a relative lack of fidelity measures. Therefore, it seems warranted to conduct a high-quality, multicenter randomized controlled trial investigating the effectiveness of MBCT to improve stress, sleep quality, and quality of life.
Aims:
Considering the limited availability of psychosocial interventions for IBD, this study aims to investigate MBCT as an adjunctive treatment to TAU to reduce psychological stress in patients with IBD who report elevated stress levels. In addition, we aim to improve sleep quality/regularity and fatigue, IBD-related quality of life, perceived control over IBD, clinical indicators (fecal calprotectin, c-reactive protein levels, Harvey Brashaw Index for CD, Simple Clinical Colitis Activity Index for UC), IBD-related flare. We also aim to improve repetitive negative thinking, mindfulness skills, self-compassion skills, and positive mental health. We will investigate whether improving sleep quality may be one of the pathways through which mindfulness may help reduce psychological distress and improve quality of life in IBD (working mechanism).
Method:
A two-armed randomized, multicenter, parallel group pragmatic trial comparing Mindfulness-Based Cognitive Therapy (MBCT) vs. Treatment As Usual (TAU) for reducing psychological distress in distressed patients with Inflammatory Bowel Disease (IBD). Assessments will be conducted at baseline, post treatment (3 months) and follow-ups at 6, 9, and 12 months. Objective sleep measures will be taken at baseline, post treatment and 12 months.
The control group will receive treatment as usual (TAU) according to Dutch and European IBD treatment guidelines. The intervention group will receive Mindfulness-Based Cognitive Therapy (MBCT) in addition to TAU. The MBCT protocol that will be used is based on the protocol published by Segal, Williams and Teasdale. MBCT consists of eight weekly 2.5h group sessions, a six-hour silent day and daily home practice assignments guided by audio files. Mindfulness is characterized by deliberate, non-judging and sustained moment-to-moment awareness. Health related benefits include enhanced emotional processing and coping regarding the effects of chronic illness and stress, improved self-efficacy and control, and a more accepting attitude towards difficult emotions, thought and bodily sensations. Psycho-education and interactive dialogue typically focus on stress management, balancing activities, lifestyle factors, and strategies to stay well in the future (relapse prevention). Each group will be comprising 8-12 participants. MBCT courses will be taught on site by qualified mindfulness teachers. Teacher competency will be assessed with the Mindfulness-Based Interventions - Teaching Assessment Criteria, using a random selection of videotaped sessions, assessed by expert teachers who have been trained to use these assessment criteria.
- Conditions
- Inflammatory Bowel Diseases
- Being tested
- Mindfulness-based cognitive therapy + TAU, Treatment as usual (TAU)
- Keywords
- randomized controlled trial, mindfulness-based cognitive therapy, effectiveness, psychological distress, sleep, fatigue
- Medical subject headings
- Inflammatory Bowel Diseases, Fatigue
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Mindfulness-based cognitive therapy + TAUBehavioural
The proposed intervention is mindfulness-based cognitive therapy (MBCT), based on the protocol published by Segal, Williams and Teasdale. MBCT consists of eight weekly 2.5h group sessions, a six-hour silent day and daily home practice assignments guided by audio files. The program includes both formal and informal meditation exercises. Cognitive techniques include monitoring and scheduling of activities, identification of negative automatic thoughts and devising a relapse prevention plan. Psycho-education and interactive dialogue typically focus on stress management, balancing activities, and (lifestyle) strategies to stay well in the future (relapse prevention).
Treatment as usual (TAU) according Dutch and European IBD treatment guidelines. TAU focuses on pharmacological and surgical disease control, and prevention of complications.
| Study group | Role | What they receive |
|---|---|---|
| Mindfulness-based cognitive therapy (MBCT) added to treatment as usual | Experimental | Patients in the MBCT arm will in addition to their treatment as usual be invited to participate in MBCT. Receives: Behavioral: Mindfulness-based cognitive therapy + TAU |
| Treatment as usual (TAU) | Active comparator | Patients in this arm will receive treatment as usual. Receives: Other: Treatment as usual (TAU) |
What is being measured
The primary outcome is the main question the study is designed to answer.
Psychological distress
Measured by the Hospital Anxiety and Depression Scale (HADS). The HADS consists of 14 items, 7 related to depression and 7 related to anxiety. Scoring for each item ranges from zero to three. Three denotes highest anxiety or depression level meaning that a person can score between 0 and 21 for either anxiety or depression.
Measured: Change between baseline and 3 months
Psychological distress
Measured by the Hospital Anxiety and Depression Scale (HADS). The HADS consists of 14 items, 7 related to depression and 7 related to anxiety. Scoring for each item ranges from zero to three. Three denotes highest anxiety or depression level meaning that a person can score between 0 and 21 for either anxiety or depression.
Measured: Change between 3 and 12 months
Secondary outcomes (26)
Objective sleep quality
operationalized as total sleep time, time spent in slow wave sleep, sleep continuity, all measured with wearable sleep EEG (iBand+/ Arenar and Fitbit activity tracker).
Measured: Change between baseline and 3 months
Objective sleep quality
operationalized as total sleep time, time spent in slow wave sleep, sleep continuity, all measured with wearable sleep EEG (iBand+/ Arenar and Fitbit activity tracker).
Measured: Change between 3 and 12 months
Subjective sleep quality
Measured by the Pittsburgh Sleep Quality Inventory (PSQI). The PSQI consist of 19 items offering 7 components scores and one composite score. Scoring for each component ranges from zero to three. The overall PSQI score is then calculated by totaling the seven component scores, providing an global score ranging from zero to twenty-one. Lower scores indicate a healthier sleep quality.
Measured: Change between baseline and 3 months
Subjective sleep quality
Measured by the Pittsburgh Sleep Quality Inventory (PSQI). The PSQI consist of 19 items offering 7 components scores and one composite score. Scoring for each component ranges from zero to three. The overall PSQI score is then calculated by totaling the seven component scores, providing an global score ranging from zero to twenty-one. Lower scores indicate a healthier sleep quality.
Measured: Change between 3 and 12 months
Fatigue
measured by the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F).The FACIT-F is a 40-item self-reported measure that assesses fatigue and its impact on daily activities and function. Subdomains include: physical Well-Being, Social/Family Well-Being, Emotional Well-Being, Functional Well-Being and Fatigue. The subdomain fatigue consists of 13-items. Items are scored on a 0-4 response scale with anchors ranging from 'not at all' to 'very much so'. All items are summed to create a global fatigue score with a range from 0 to 52. Higher scores indicate increased fatigue.
Measured: Change between baseline and 3 months
Fatigue
measured by the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F).
Measured: Change between 3 and 12 months
IBD-related quality of life
measured by the Inflammatory Bowel Disease Quality of Life Questionnaire (IBDQ). The IBDQ has 32 items scored on a 7-point Likert scale, ranging from 1 (worst health) to 7 (best health). Overall score range from 32 to 224, with higher scores reflecting better quality of life.
Measured: Change between baseline and 3 months
IBD-related quality of life
measured by the Inflammatory Bowel Disease Quality of Life Questionnaire (IBDQ). The IBDQ has 32 items scored on a 7-point Likert scale, ranging from 1 (worst health) to 7 (best health). Overall score range from 32 to 224, with higher scores reflecting better quality of life.
Measured: Change between 3 and 12 months
Perceived control over IBD
measured by the IBD-Control questionnaire. The IBD-Control Questionnaire consists of eight items, which generate an overall score ranging from 0 (worst control) to 16 (best control).
Measured: Change between baseline and 3 months
Perceived control over IBD
Measured by the IBD-Control questionnaire. The IBD-Control Questionnaire consists of eight items, which generate an overall score ranging from 0 (worst control) to 16 (best control).
Measured: Change between 3 and 12 months
Calprotectin
Assessed in accordance with regular medical procedures. Having higher levels of calprotectin generally means that there is active inflammation in the body or intestines. For a calprotectin test, a normal reading is less than 100 mcg/g.
Measured: Change between baseline and 3 months
Calprotectin
Assessed in accordance with regular medical procedures. Having higher levels of calprotectin generally means that there is active inflammation in the body or intestines. For a calprotectin test, a normal reading is less than 100 mcg/g.
Measured: Change between 3 and 12 months
C-reactive protein levels
Assessed in accordance with regular medical procedures. Also having higher levels of c-reactive protein generally means that there is active inflammation in the body or intestines. For a CRP test, a normal reading is less than 10 milligram per liter (mg/L).
Measured: Change between baseline and 3 months
C-reactive protein levels
Assessed in accordance with regular medical procedures. Also having higher levels of c-reactive protein generally means that there is active inflammation in the body or intestines. For a CRP test, a normal reading is less than 10 milligram per liter (mg/L).
Measured: Change between 3 and 12 months
Clinical disease activity
Assessed by a clinician with the Harvey Brashaw Index (HBI) for Crohn's disease and the Simple Clinical Colitis Activity Index
Measured: change between baseline and 3 months
Clinical disease activity
Assessed by a clinician with the Harvey Brashaw Index (HBI) for Crohn's disease and the Simple Clinical Colitis Activity Index
Measured: change between 3 and 12 months
Repetitive negative thinking
measured by the 15-item Perseverative Thinking Questionnaire (PTQ). The PTQ is a 15-item self-report questionnaire. Respondents are asked to describe how they typically think about negative experiences or problems. They rate each item on a 5-point Likert scale from 0 (never) to 4 (almost always) the extent to which each statement applies to them when they think about negative experiences or problems. All items are summed to create a global repetitive negative thinking score ranging from 0 to 60. Higher scores indicate increased repetitive negative thinking.
Measured: Change between baseline and 3 months
Repetitive negative thinking
measured by the 15-item Perseverative Thinking Questionnaire (PTQ). The PTQ is a 15-item self-report questionnaire. Respondents are asked to describe how they typically think about negative experiences or problems. They rate each item on a 5-point Likert scale from 0 (never) to 4 (almost always) the extent to which each statement applies to them when they think about negative experiences or problems. All items are summed to create a global repetitive negative thinking score ranging from 0 to 60. Higher scores indicate increased repetitive negative thinking.
Measured: Change between 3 and 12 months
Mindfulness skills
24-item Five Facet Mindfulness Questionnaire Short Form (FFMQ-SF). This questionnaire is divided into the subscales observing, describing, acting with awareness, non-judging and non-reactivity.
Measured: Change between baseline and 3 months
Mindfulness skills
24-item Five Facet Mindfulness Questionnaire Short Form (FFMQ-SF). This questionnaire is divided into the subscales observing, describing, acting with awareness, non-judging and non-reactivity.
Measured: Change between 3 and 12 months
Positive mental health
Measured by the Mental Health Continuum-Short Form (MHC-SF). MHC-SF consists of 14-items and assesses emotional, psychological and social well-being. All items are summed and then a mean score is calculated, which represents a global positive mental health score ranging from 0 to 5. Higher scores indicate a better positive mental health.
Measured: Change between baseline and 3 months
Positive mental health
Measured by the Mental Health Continuum-Short Form (MHC-SF). MHC-SF consists of 14-items and assesses emotional, psychological and social well-being. All items are summed and then a mean score is calculated, which represents a global positive mental health score ranging from 0 to 5. Higher scores indicate a better positive mental health.
Measured: Change between 3 and 12 months
Self-compassion
We will use the 12-item Dutch short-form version of the SCS-SF to measure self-compassion. The scale consists of six components, including self-kindness, self-judgment, common humanity, isolation, mindfulness and over-identification. In the short form, each scale consists of 2 items scored between 1 ((almost) never) to 7 ((almost) always) and subscale score ranges between 2 and 14. A higher score indicates a higher level of self-kindness, common humanity, and mindfulness, and lower scores of self-judgment, isolation, and over-identification. Total scores range from 12 to 84 (summed subscale scores), a higher score indicates a higher level of self-compassion.
Measured: Change between baseline and 3 months
Self-compassion
We will use the 12-item Dutch short-form version of the SCS-SF to measure self-compassion. The scale consists of six components, including self-kindness, self-judgment, common humanity, isolation, mindfulness and over-identification. In the short form, each scale consists of 2 items scored between 1 ((almost) never) to 7 ((almost) always) and subscale score ranges between 2 and 14. A higher score indicates a higher level of self-kindness, common humanity, and mindfulness, and lower scores of self-judgment, isolation, and over-identification. Total scores range from 12 to 84 (summed subscale scores), a higher score indicates a higher level of self-compassion.
Measured: Change between 3 and 12 months
Costs
This will be investigated by using the Trimbos iMTA Questionnaire for Costs associated with Psychiatric Illness (TiC-P) as a measure of healthcare utilization. Unit cost estimates are derived from the national manual for cost prices in the healthcare sector.
Measured: 12 months
Health-related quality of life
This will be assessed by using the EuroQol-5D (EQ-5D-5L). The EQ-5D-5L consist of five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 5 levels: no problems, slight problems, moderate problems, severe problems and extreme problems. This short self-report instrument is used to assess quality adjusted life years.
Measured: 12 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted30 Nov 2020
- Study start1 Aug 2021
- Primary completion3 Oct 2023
- Study completion3 Oct 2023
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (18)Papers the sponsor has linked to this study.
- Other trials for Inflammatory Bowel DiseasesStudies of the same condition, open and under way.
- More trials run by Radboud University Medical CenterThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Supportive care
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- A randomized, multicenter, clinical trial with assessments at baseline, post treatment (3 months later) and follow-ups at 6, 9 and 12 months after baseline.
- Masking
- None (open label)
- Enrolment
- 142 participants (actual)
Sponsor and investigators
- Lead sponsor
- Radboud University Medical Center
- Sponsor type
- University, hospital or other
- Collaborators
- ZonMw: The Netherlands Organisation for Health Research and Development, Jeroen Bosch Ziekenhuis, Rijnstate Hospital, Canisius-Wilhelmina Hospital, Donders Centre for Cognitive Neuroimaging
- Responsible party
- Principal investigator, Anne Speckens, Radboud University Medical Center
- Investigators
- Anne Speckens, Dr., Principal investigator, Radboud University Medical CenterLoes Nissen, Dr., Study chair, Jeroen Bosch ZiekenhuisMarloes Huijbers, Dr., Study chair, Radboud University Medical Center
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT04646785
- Sponsor's protocol ID
- MBCT-IBD-2020-2024
- Status last verified
- Jan 2024
- First submitted
- 16 Nov 2020
- Last updated
- 24 Jan 2024
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes: The authors intend to make the data available to other researchers after completion of the study and will comply with open access procedures, including open access publishing, as much as possible.
Publications
Ewais T, Begun J, Kenny M, Rickett K, Hay K, Ajilchi B, Kisely S. A systematic review and meta-analysis of mindfulness based interventions and yoga in inflammatory bowel disease. J Psychosom Res. 2019 Jan;116:44-53. doi: 10.1016/j.jpsychores.2018.11.010. Epub 2018 Nov 14.
PubMed 30654993Neuendorf R, Harding A, Stello N, Hanes D, Wahbeh H. Depression and anxiety in patients with Inflammatory Bowel Disease: A systematic review. J Psychosom Res. 2016 Aug;87:70-80. doi: 10.1016/j.jpsychores.2016.06.001. Epub 2016 Jun 6.
PubMed 27411754Knowles SR, Graff LA, Wilding H, Hewitt C, Keefer L, Mikocka-Walus A. Quality of Life in Inflammatory Bowel Disease: A Systematic Review and Meta-analyses-Part I. Inflamm Bowel Dis. 2018 Mar 19;24(4):742-751. doi: 10.1093/ibd/izx100.
PubMed 29562277IsHak WW, Pan D, Steiner AJ, Feldman E, Mann A, Mirocha J, Danovitch I, Melmed GY. Patient-Reported Outcomes of Quality of Life, Functioning, and GI/Psychiatric Symptom Severity in Patients with Inflammatory Bowel Disease (IBD). Inflamm Bowel Dis. 2017 May;23(5):798-803. doi: 10.1097/MIB.0000000000001060.
PubMed 28301432Chavarria C, Casanova MJ, Chaparro M, Barreiro-de Acosta M, Ezquiaga E, Bujanda L, Rivero M, Arguelles-Arias F, Martin-Arranz MD, Martinez-Montiel MP, Valls M, Ferreiro-Iglesias R, Llao J, Moraleja-Yudego I, Casellas F, Antolin-Melero B, Cortes X, Plaza R, Pineda JR, Navarro-Llavat M, Garcia-Lopez S, Robledo-Andres P, Marin-Jimenez I, Garcia-Sanchez V, Merino O, Algaba A, Arribas-Lopez MR, Banales JM, Castro B, Castro-Laria L, Honrubia R, Almela P, Gisbert JP. Prevalence and Factors Associated With Fatigue in Patients With Inflammatory Bowel Disease: A Multicentre Study. J Crohns Colitis. 2019 Aug 14;13(8):996-1002. doi: 10.1093/ecco-jcc/jjz024.
PubMed 30721954van der Valk ME, Mangen MJ, Leenders M, Dijkstra G, van Bodegraven AA, Fidder HH, de Jong DJ, Pierik M, van der Woude CJ, Romberg-Camps MJ, Clemens CH, Jansen JM, Mahmmod N, van de Meeberg PC, van der Meulen-de Jong AE, Ponsioen CY, Bolwerk CJ, Vermeijden JR, Siersema PD, van Oijen MG, Oldenburg B; COIN study group and the Dutch Initiative on Crohn and Colitis. Healthcare costs of inflammatory bowel disease have shifted from hospitalisation and surgery towards anti-TNFalpha therapy: results from the COIN study. Gut. 2014 Jan;63(1):72-9. doi: 10.1136/gutjnl-2012-303376. Epub 2012 Nov 7.
PubMed 23135759Burisch J, Jess T, Martinato M, Lakatos PL; ECCO -EpiCom. The burden of inflammatory bowel disease in Europe. J Crohns Colitis. 2013 May;7(4):322-37. doi: 10.1016/j.crohns.2013.01.010. Epub 2013 Feb 8.
PubMed 23395397Qazi T, Farraye FA. Sleep and Inflammatory Bowel Disease: An Important Bi-Directional Relationship. Inflamm Bowel Dis. 2019 Apr 11;25(5):843-852. doi: 10.1093/ibd/izy334.
PubMed 30388243Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2013). Mindfulness-based cognitive therapy for depression (second).
Guo J, Wang H, Luo J, Guo Y, Xie Y, Lei B, Wiley J, Whittemore R. Factors influencing the effect of mindfulness-based interventions on diabetes distress: a meta-analysis. BMJ Open Diabetes Res Care. 2019 Dec 11;7(1):e000757. doi: 10.1136/bmjdrc-2019-000757. eCollection 2019.
PubMed 31908794Cillessen L, Johannsen M, Speckens AEM, Zachariae R. Mindfulness-based interventions for psychological and physical health outcomes in cancer patients and survivors: A systematic review and meta-analysis of randomized controlled trials. Psychooncology. 2019 Dec;28(12):2257-2269. doi: 10.1002/pon.5214. Epub 2019 Sep 11.
PubMed 31464026Scott-Sheldon LAJ, Gathright EC, Donahue ML, Balletto B, Feulner MM, DeCosta J, Cruess DG, Wing RR, Carey MP, Salmoirago-Blotcher E. Mindfulness-Based Interventions for Adults with Cardiovascular Disease: A Systematic Review and Meta-Analysis. Ann Behav Med. 2020 Jan 1;54(1):67-73. doi: 10.1093/abm/kaz020.
PubMed 31167026Zhou B, Wang G, Hong Y, Xu S, Wang J, Yu H, Liu Y, Yu L. Mindfulness interventions for rheumatoid arthritis: A systematic review and meta-analysis. Complement Ther Clin Pract. 2020 May;39:101088. doi: 10.1016/j.ctcp.2020.101088. Epub 2020 Jan 11.
PubMed 31957665Haugmark T, Hagen KB, Smedslund G, Zangi HA. Mindfulness- and acceptance-based interventions for patients with fibromyalgia - A systematic review and meta-analyses. PLoS One. 2019 Sep 3;14(9):e0221897. doi: 10.1371/journal.pone.0221897. eCollection 2019.
PubMed 31479478Crane RS, Eames C, Kuyken W, Hastings RP, Williams JM, Bartley T, Evans A, Silverton S, Soulsby JG, Surawy C. Development and validation of the mindfulness-based interventions - teaching assessment criteria (MBI:TAC). Assessment. 2013 Dec;20(6):681-8. doi: 10.1177/1073191113490790. Epub 2013 Jun 21.
PubMed 23794181
Study at a glance
From the registry record, last updated by the sponsor on 24 Jan 2024. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Mindfulness-based Cognitive Therapy to Improve Stress and Sleep in Patients With Inflammatory Bowel Disease
- ClinicalTrials.gov ID
- NCT04646785
- Acronym / sponsor ID
- MBCT-IBD-2020-2024
- Conditions
- Inflammatory Bowel Diseases
- Keywords
- randomized controlled trial, mindfulness-based cognitive therapy, effectiveness, psychological distress, sleep, fatigue
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 142 participants (actual)
- Lead sponsor
- Radboud University Medical CenterUniversity, hospital or other
- Collaborators
- ZonMw: The Netherlands Organisation for Health Research and Development, Jeroen Bosch Ziekenhuis, Rijnstate Hospital, Canisius-Wilhelmina Hospital, Donders Centre for Cognitive Neuroimaging
- Study start
- 1 Aug 2021 (actual)
- Primary completion
- 3 Oct 2023 (actual)
- Study completion
- 3 Oct 2023 (actual)
- First posted
- 30 Nov 2020 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Considering the limited availability of psychosocial interventions for IBD, this study aims to investigate MBCT as an adjunctive treatment to treatment as usual to reduce psychological stress and improve sleep quality/regularity in patients with IBD who report elevated stress levels. The study will have a follow-up duration of 12 months from baseline.
Detailed description
Introduction:
Inflammatory bowel diseases (IBD) are chronic inflammatory diseases of the intestinal tract, consisting of crohn's disease (CD) and ulcerative colitis (UC). In The Netherlands, there are about 90,000 IBD patients, mainly young adults who are in a turbulent part of their life with starting a family and career. The prevalence of IBD seems to be rising. The peak incidence is between 15 and 30 years. The disease is characterized by periods of disease activity (flares) alternating with periods of (clinical) remission. Physical symptoms include abdominal pain, diarrhea, rectal bleeding and fatigue. Although the arsenal of drugs has increased in recent decades, there is no cure for the disease and patients are usually long-term treated with different (immunosuppressive) medications. Nevertheless, at this moment, we are only partially able to keep our IBD patients in remission.
Even in those in remission, IBD is associated with increased levels of psychological stress, with estimated prevalence rates of 21% for depressive symptoms and 35% for anxiety symptoms. In periods of disease activity, prevalence of elevated anxiety levels was even found to be as high as 75.6%. Besides psychological stress, IBD patients in remission report lower quality of life compared to the general population. This is due to the physical symptoms but also to fatigue, worries, anxiety, depression, impaired satisfaction with social role and sleep disturbances. More than 40 % of the IBD patients experience fatigue. This may contribute to the higher sick leave days and higher work impairment rates in quiescent IBD, causing high societal costs. In addition, poor sleep seems common in individuals with IBD and has been linked to disease activity and shown as a predictor for subclinical inflammation and a risk factor for relapse and poorer outcomes.
Mindfulness training, typically in the form of mindfulness-based stress reduction (MBSR) or mindfulness-based cognitive therapy (MBCT), is a psychosocial group-based intervention that has been shown to reduce psychological distress and improving quality of life, both in patients with mental health problems and those with chronic diseases such as diabetes, cancer, cardiovascular disease, rheumatoid arthritis and fibromyalgia. Mindfulness training focuses on the progressive acquisition of mindful awareness to better cope with negative repetitive thoughts and feelings, and for that reason may be a good option to reduce psychological stress and fatigue, and improve quality of life in patients with chronic conditions including IBD.
Although the available literature on the effectiveness of mindfulness-based interventions for IBD is still relatively scarce, a recent meta-analysis showed significant benefits in terms of stress, depression, and quality of life. However, the variety in types of interventions was rather high, and individual studies typically suffered from methodological limitations, including small sample size, poor blinding of the outcome assessors, incomplete data reporting and a relative lack of fidelity measures. Therefore, it seems warranted to conduct a high-quality, multicenter randomized controlled trial investigating the effectiveness of MBCT to improve stress, sleep quality, and quality of life.
Aims:
Considering the limited availability of psychosocial interventions for IBD, this study aims to investigate MBCT as an adjunctive treatment to TAU to reduce psychological stress in patients with IBD who report elevated stress levels. In addition, we aim to improve sleep quality/regularity and fatigue, IBD-related quality of life, perceived control over IBD, clinical indicators (fecal calprotectin, c-reactive protein levels, Harvey Brashaw Index for CD, Simple Clinical Colitis Activity Index for UC), IBD-related flare. We also aim to improve repetitive negative thinking, mindfulness skills, self-compassion skills, and positive mental health. We will investigate whether improving sleep quality may be one of the pathways through which mindfulness may help reduce psychological distress and improve quality of life in IBD (working mechanism).
Method:
A two-armed randomized, multicenter, parallel group pragmatic trial comparing Mindfulness-Based Cognitive Therapy (MBCT) vs. Treatment As Usual (TAU) for reducing psychological distress in distressed patients with Inflammatory Bowel Disease (IBD). Assessments will be conducted at baseline, post treatment (3 months) and follow-ups at 6, 9, and 12 months. Objective sleep measures will be taken at baseline, post treatment and 12 months.
The control group will receive treatment as usual (TAU) according to Dutch and European IBD treatment guidelines. The intervention group will receive Mindfulness-Based Cognitive Therapy (MBCT) in addition to TAU. The MBCT protocol that will be used is based on the protocol published by Segal, Williams and Teasdale. MBCT consists of eight weekly 2.5h group sessions, a six-hour silent day and daily home practice assignments guided by audio files. Mindfulness is characterized by deliberate, non-judging and sustained moment-to-moment awareness. Health related benefits include enhanced emotional processing and coping regarding the effects of chronic illness and stress, improved self-efficacy and control, and a more accepting attitude towards difficult emotions, thought and bodily sensations. Psycho-education and interactive dialogue typically focus on stress management, balancing activities, lifestyle factors, and strategies to stay well in the future (relapse prevention). Each group will be comprising 8-12 participants. MBCT courses will be taught on site by qualified mindfulness teachers. Teacher competency will be assessed with the Mindfulness-Based Interventions - Teaching Assessment Criteria, using a random selection of videotaped sessions, assessed by expert teachers who have been trained to use these assessment criteria.
Study design
- Primary purpose
- Supportive care
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
- Model description
- A randomized, multicenter, clinical trial with assessments at baseline, post treatment (3 months later) and follow-ups at 6, 9 and 12 months after baseline.
| Arm | Type | Receives |
|---|---|---|
| Mindfulness-based cognitive therapy (MBCT) added to treatment as usual | Experimental | Behavioral: Mindfulness-based cognitive therapy + TAUPatients in the MBCT arm will in addition to their treatment as usual be invited to participate in MBCT. |
| Treatment as usual (TAU) | Active comparator | Other: Treatment as usual (TAU)Patients in this arm will receive treatment as usual. |
Who may qualify
- Ages
- 16 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child, Adult, Older adult
Key inclusion criteria (5 listed)
- Confirmed IBD diagnosis of Crohn's disease (CD), Ulcerative colitis (UC) or Indeterminate colitis (IC)
- Current IBD remission (Calprotectin < 250 mg/kg) since at least three months
- Hospital Anxiety and Depression Scale-score of >=11, indicating at least mild levels of psychological distress (Vodermaier 2011).
- Age of 16 or older
- Taking no IBD medication or on a stable dose of 5-ASA products, immunosuppressive medication, or biologics for at least three months prior to enrollment.
Key exclusion criteria (4 listed)
- Severe psychiatric disorders (e.g. acute suicidality, psychosis)
- Current alcohol or drug dependency
- Untreated anemia
- Prior participation in an 8-week MBSR or MBCT-programme
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Mindfulness-based cognitive therapy + TAUThe proposed intervention is mindfulness-based cognitive therapy (MBCT), based on the protocol published by Segal, Williams and Teasdale. MBCT consists of eight weekly 2.5h group sessions, a six-hour silent day and daily home practice assignments guided by audio files. The program includes both formal and informal meditation exercises. Cognitive techniques include monitoring and scheduling of activities, identification of negative automatic thoughts and devising a relapse prevention plan. Psycho-education and interactive dialogue typically focus on stress management, balancing activities, and (lifestyle) strategies to stay well in the future (relapse prevention). | Behavioural | Mindfulness-based cognitive therapy (MBCT) added to treatment as usual |
| Treatment as usual (TAU)Treatment as usual (TAU) according Dutch and European IBD treatment guidelines. TAU focuses on pharmacological and surgical disease control, and prevention of complications. | Other | Treatment as usual (TAU) |
Primary outcome
Psychological distress
Time frame: Change between baseline and 3 months
Measured by the Hospital Anxiety and Depression Scale (HADS). The HADS consists of 14 items, 7 related to depression and 7 related to anxiety. Scoring for each item ranges from zero to three. Three denotes highest anxiety or depression level meaning that a person can score between 0 and 21 for either anxiety or depression.
Psychological distress
Time frame: Change between 3 and 12 months
Measured by the Hospital Anxiety and Depression Scale (HADS). The HADS consists of 14 items, 7 related to depression and 7 related to anxiety. Scoring for each item ranges from zero to three. Three denotes highest anxiety or depression level meaning that a person can score between 0 and 21 for either anxiety or depression.
26 secondary outcomes
Objective sleep quality
Time frame: Change between baseline and 3 months
Objective sleep quality
Time frame: Change between 3 and 12 months
Subjective sleep quality
Time frame: Change between baseline and 3 months
Subjective sleep quality
Time frame: Change between 3 and 12 months
Fatigue
Time frame: Change between baseline and 3 months
Fatigue
Time frame: Change between 3 and 12 months
IBD-related quality of life
Time frame: Change between baseline and 3 months
IBD-related quality of life
Time frame: Change between 3 and 12 months
Perceived control over IBD
Time frame: Change between baseline and 3 months
Perceived control over IBD
Time frame: Change between 3 and 12 months
Calprotectin
Time frame: Change between baseline and 3 months
Calprotectin
Time frame: Change between 3 and 12 months
C-reactive protein levels
Time frame: Change between baseline and 3 months
C-reactive protein levels
Time frame: Change between 3 and 12 months
Clinical disease activity
Time frame: change between baseline and 3 months
Clinical disease activity
Time frame: change between 3 and 12 months
Repetitive negative thinking
Time frame: Change between baseline and 3 months
Repetitive negative thinking
Time frame: Change between 3 and 12 months
Mindfulness skills
Time frame: Change between baseline and 3 months
Mindfulness skills
Time frame: Change between 3 and 12 months
Positive mental health
Time frame: Change between baseline and 3 months
Positive mental health
Time frame: Change between 3 and 12 months
Self-compassion
Time frame: Change between baseline and 3 months
Self-compassion
Time frame: Change between 3 and 12 months
Costs
Time frame: 12 months
Health-related quality of life
Time frame: 12 months
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 24 Jan 2024.
- Background: PubMed 30654993Ewais T, Begun J, Kenny M, Rickett K, Hay K, Ajilchi B, Kisely S. A systematic review and meta-analysis of mindfulness based interventions and yoga in inflammatory bowel disease. J Psychosom Res. 2019 Jan;116:44-53. doi: 10.1016/j.jpsychores.2018.11.010. Epub 2018 Nov 14.
- Background: PubMed 27411754Neuendorf R, Harding A, Stello N, Hanes D, Wahbeh H. Depression and anxiety in patients with Inflammatory Bowel Disease: A systematic review. J Psychosom Res. 2016 Aug;87:70-80. doi: 10.1016/j.jpsychores.2016.06.001. Epub 2016 Jun 6.
- Background: PubMed 29562277Knowles SR, Graff LA, Wilding H, Hewitt C, Keefer L, Mikocka-Walus A. Quality of Life in Inflammatory Bowel Disease: A Systematic Review and Meta-analyses-Part I. Inflamm Bowel Dis. 2018 Mar 19;24(4):742-751. doi: 10.1093/ibd/izx100.
- Background: PubMed 28301432IsHak WW, Pan D, Steiner AJ, Feldman E, Mann A, Mirocha J, Danovitch I, Melmed GY. Patient-Reported Outcomes of Quality of Life, Functioning, and GI/Psychiatric Symptom Severity in Patients with Inflammatory Bowel Disease (IBD). Inflamm Bowel Dis. 2017 May;23(5):798-803. doi: 10.1097/MIB.0000000000001060.
- Background: PubMed 30721954Chavarria C, Casanova MJ, Chaparro M, Barreiro-de Acosta M, Ezquiaga E, Bujanda L, Rivero M, Arguelles-Arias F, Martin-Arranz MD, Martinez-Montiel MP, Valls M, Ferreiro-Iglesias R, Llao J, Moraleja-Yudego I, Casellas F, Antolin-Melero B, Cortes X, Plaza R, Pineda JR, Navarro-Llavat M, Garcia-Lopez S, Robledo-Andres P, Marin-Jimenez I, Garcia-Sanchez V, Merino O, Algaba A, Arribas-Lopez MR, Banales JM, Castro B, Castro-Laria L, Honrubia R, Almela P, Gisbert JP. Prevalence and Factors Associated With Fatigue in Patients With Inflammatory Bowel Disease: A Multicentre Study. J Crohns Colitis. 2019 Aug 14;13(8):996-1002. doi: 10.1093/ecco-jcc/jjz024.
- Background: PubMed 23135759van der Valk ME, Mangen MJ, Leenders M, Dijkstra G, van Bodegraven AA, Fidder HH, de Jong DJ, Pierik M, van der Woude CJ, Romberg-Camps MJ, Clemens CH, Jansen JM, Mahmmod N, van de Meeberg PC, van der Meulen-de Jong AE, Ponsioen CY, Bolwerk CJ, Vermeijden JR, Siersema PD, van Oijen MG, Oldenburg B; COIN study group and the Dutch Initiative on Crohn and Colitis. Healthcare costs of inflammatory bowel disease have shifted from hospitalisation and surgery towards anti-TNFalpha therapy: results from the COIN study. Gut. 2014 Jan;63(1):72-9. doi: 10.1136/gutjnl-2012-303376. Epub 2012 Nov 7.
- Background: PubMed 23395397Burisch J, Jess T, Martinato M, Lakatos PL; ECCO -EpiCom. The burden of inflammatory bowel disease in Europe. J Crohns Colitis. 2013 May;7(4):322-37. doi: 10.1016/j.crohns.2013.01.010. Epub 2013 Feb 8.
- Background: PubMed 30388243Qazi T, Farraye FA. Sleep and Inflammatory Bowel Disease: An Important Bi-Directional Relationship. Inflamm Bowel Dis. 2019 Apr 11;25(5):843-852. doi: 10.1093/ibd/izy334.
- BackgroundSegal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2013). Mindfulness-based cognitive therapy for depression (second).
- Background: PubMed 31908794Guo J, Wang H, Luo J, Guo Y, Xie Y, Lei B, Wiley J, Whittemore R. Factors influencing the effect of mindfulness-based interventions on diabetes distress: a meta-analysis. BMJ Open Diabetes Res Care. 2019 Dec 11;7(1):e000757. doi: 10.1136/bmjdrc-2019-000757. eCollection 2019.
- Background: PubMed 31464026Cillessen L, Johannsen M, Speckens AEM, Zachariae R. Mindfulness-based interventions for psychological and physical health outcomes in cancer patients and survivors: A systematic review and meta-analysis of randomized controlled trials. Psychooncology. 2019 Dec;28(12):2257-2269. doi: 10.1002/pon.5214. Epub 2019 Sep 11.
- Background: PubMed 31167026Scott-Sheldon LAJ, Gathright EC, Donahue ML, Balletto B, Feulner MM, DeCosta J, Cruess DG, Wing RR, Carey MP, Salmoirago-Blotcher E. Mindfulness-Based Interventions for Adults with Cardiovascular Disease: A Systematic Review and Meta-Analysis. Ann Behav Med. 2020 Jan 1;54(1):67-73. doi: 10.1093/abm/kaz020.
- Individual participant dataSharing planned: Yes. The authors intend to make the data available to other researchers after completion of the study and will comply with open access procedures, including open access publishing, as much as possible.
Related trials for Inflammatory Bowel Diseases
Active, not recruitingObservational study
An Observational Prospective Long-term Exposure Registry of Adult Patients With Moderate-to-Severe Ulcerative Colitis
Ulcerative Colitis
RecruitingPhase 1/2
Safety, Dosage, and Microbiome Engraftment Study of MGT-006 for Ulcerative Colitis (ROOT Study)
Ulcerative Colitis (UC), Ulcerative Colitis, Active Moderate
Recruiting
A Prospective Randomised Study of Treatment Selection Based on Epigenetic Markers Versus Standard of Care Treatment Selection in Adults With CROHN's Disease
Crohn Disease (CD)
Enrolling by invitation
Partial Enteral Nutrition as Therapeutic Augmentation of Advanced Pharmacological Therapy in Patients With Active Crohn's Disease
Crohn's Disease, Active
RecruitingPhase 4
A Remotely Conducted Study to Assess Concentration of TREMFYA in Breast Milk of Lactating Women Who Are Receiving TREMFYA Therapeutically
Psoriasis, Colitis, Ulcerative
Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Anne Speckens, Dr. principal investigator
Radboud University Medical Center
Loes Nissen, Dr. study chair
Jeroen Bosch Ziekenhuis
Marloes Huijbers, Dr. study chair
Radboud University Medical Center
4 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Mindfulness-based cognitive therapy + TAU and Treatment as usual (TAU) in people with Inflammatory Bowel Diseases, run by Radboud University Medical Center at 4 sites in Netherlands.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 5 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 24 Jan 2024. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 4 sites in Netherlands. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Psychological distress (time frame: Change between baseline and 3 months). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT04646785, which also lists 18 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 24 Jan 2024.