Abstract
Psychosocial factors play an important role in the disease course and illness experience of patients with inflammatory bowel disease (IBD). Consultation with a health psychologist is an important component of care for many IBD patients and provides an opportunity to identify areas of psychosocial concern, recognize coping deficits and strengths, and facilitate treatment recommendations. Psychosocial assessment in IBD requires a nuanced approach that goes beyond general mental health screening and considers the disease-specific concerns that impact patients. In this paper, we outline strategies for an IBD-focused psychological evaluation, including specific guidance for assessing disease-specific concerns of anxiety, depression, post-traumatic stress, sleep, pain, body image disturbance, food-related quality of life, and psychological resilience.
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References
Alcalá, M. J., Casellas, F., Fontanet, G., Prieto, L., & Malagelada, J.-R. (2004). Shortened questionnaire on quality of life for inflammatory bowel disease. Inflammatory Bowel Diseases, 10(4), 383–391. https://doi.org/10.1097/00054725-200407000-00009
Ballesio, A., Bacaro, V., Vacca, M., Chirico, A., Lucidi, F., Riemann, D., Baglioni, C., & Lombardo, C. (2021). Does cognitive behaviour therapy for insomnia reduce repetitive negative thinking and sleep-related worry beliefs? A systematic review and meta-analysis. Sleep Medicine Reviews, 55, 101378. https://doi.org/10.1016/j.smrv.2020.101378
Ballou, S., & Keefer, L. (2017). Psychological interventions for irritable bowel syndrome and inflammatory bowel diseases. Clinical and Translational Gastroenterology, 8(1), e214. https://doi.org/10.1038/ctg.2016.69
Bannaga, A. S., & Selinger, C. P. (2015). Inflammatory bowel disease and anxiety: Links, risks, and challenges faced. Clinical and Experimental Gastroenterology, 8, 111–117. https://doi.org/10.2147/CEG.S57982
Barberio, B., Zamani, M., Black, C. J., Savarino, E. V., & Ford, A. C. (2021). Prevalence of symptoms of anxiety and depression in patients with inflammatory bowel disease: A systematic review and meta-analysis. The Lancet Gastroenterology & Hepatology, 6(5), 359–370. https://doi.org/10.1016/S2468-1253(21)00014-5
Bastien, C. H., Vallières, A., & Morin, C. M. (2001). Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Medicine, 2(4), 297–307. https://doi.org/10.1016/s1389-9457(00)00065-4
Bennebroek Evertsz, F., Bockting, C., Braamse, A., van Dissel, M., Duijvestein, M., Kager, L., Kool, M., Löwenberg, M., Mares, W. … Knoop, H. (2024). Implementation of ‘IBD-specific cognitive behavioural therapy’ for patients with inflammatory bowel diseases with poor mental quality of life, anxiety and depression. Journal of Clinical Psychology in Medical Settings.
Blevins, C. A., Weathers, F. W., Davis, M. T., Witte, T. K., & Domino, J. L. (2015). The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Development and initial psychometric evaluation. Journal of Traumatic Stress, 28(6), 489–498. https://doi.org/10.1002/jts.22059
Coates, M. D., Clarke, K., Williams, E., Jeganathan, N., Yadav, S., Giampetro, D., Gordin, V., Smith, S., Vrana, K., Bobb, A., Gazzio, T. T., Tressler, H., & Dalessio, S. (2023). Abdominal pain in inflammatory bowel disease: An evidence-based, multidisciplinary review. Crohn’s & Colitis. https://doi.org/10.1093/crocol/otad055
Fairbrass, K. M., Costantino, S. J., Gracie, D. J., & Ford, A. C. (2020). Prevalence of irritable bowel syndrome-type symptoms in patients with inflammatory bowel disease in remission: A systematic review and meta-analysis. The Lancet Gastroenterology & Hepatology, 5(12), 1053–1062. https://doi.org/10.1016/S2468-1253(20)30300-9
Fairbrass, K. M., Guthrie, E. A., Black, C. J., Selinger, C. P., Gracie, D. J., & Ford, A. C. (2023). Characteristics and effect of anxiety and depression trajectories in inflammatory bowel disease. The American Journal of Gastroenterology, 118(2), 304.
Fairburn, C. G., & Beglin, S. J. (1994). Assessment of eating disorders: Interview or self-report questionnaire? International Journal of Eating Disorders, 16(4), 363–370. https://doi.org/10.1002/1098-108X(199412)16:4%3c363::AID-EAT2260160405%3e3.0.CO;2-#
Ferguson, M., Rhodes, K., Loughhead, M., McIntyre, H., & Procter, N. (2022). The effectiveness of the safety planning intervention for adults experiencing suicide-related distress: A systematic review. Archives of Suicide Research, 26(3), 1022–1045. https://doi.org/10.1080/13811118.2021.1915217
Hays, R. D., Bjorner, J. B., Revicki, D. A., Spritzer, K. L., & Cella, D. (2009). Development of physical and mental health summary scores from the patient-reported outcomes measurement information system (PROMIS) global items. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation, 18(7), 873–880. https://doi.org/10.1007/s11136-009-9496-9
Hill, E., Nguyen, N. H., Qian, A. S., Patel, S., Chen, P. L., Tse, C.-S., & Singh, S. (2022). Impact of comorbid psychiatric disorders on healthcare utilization in patients with inflammatory bowel disease: A nationally representative cohort study. Digestive Diseases and Sciences, 67(9), 4373–4381. https://doi.org/10.1007/s10620-022-07505-9
Keefer, L., Bedell, A., Norton, C., & Hart, A. L. (2022). How should pain, fatigue, and emotional wellness be incorporated into treatment goals for optimal management of inflammatory bowel disease? Gastroenterology, 162(5), 1439–1451. https://doi.org/10.1053/j.gastro.2021.08.060
Keefer, L., Taft, T. H., Kiebles, J. L., Martinovich, Z., Barrett, T. A., & Palsson, O. S. (2013). Gut-directed hypnotherapy significantly augments clinical remission in quiescent ulcerative colitis. Alimentary Pharmacology & Therapeutics, 38(7), 761–771. https://doi.org/10.1111/apt.12449
Keightley, P., & Knowles, S. R. (2019). Psychological assessment, formulation, and intervention planning in gastrointestinal cohorts with psychological issues. In S. R. Knowles, L. Keefer, & A. Mikocka-Walus (Eds.), Psychogastroenterology for Adults: A Handbook for Mental Health Professionals (pp. 149–159). Routledge.
Knowles, S. R., Graff, L. A., Wilding, H., Hewitt, C., Keefer, L., & Mikocka-Walus, A. (2018). Quality of life in inflammatory bowel disease: A systematic review and meta-analyses—part I. Inflammatory Bowel Diseases, 24(4), 742–751. https://doi.org/10.1093/ibd/izx100
Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
Love, J. R., Irvine, E. J., & Fedorak, R. N. (1992). Quality of life in inflammatory bowel disease. Journal of Clinical Gastroenterology, 14(1), 15–19. https://doi.org/10.1097/00004836-199201000-00005
McDermott, E., Mullen, G., Moloney, J., Keegan, D., Byrne, K., Doherty, G. A., Cullen, G., Malone, K., & Mulcahy, H. E. (2015). Body image dissatisfaction: Clinical features, and psychosocial disability in inflammatory bowel disease. Inflammatory Bowel Diseases, 21(2), 353–360. https://doi.org/10.1097/MIB.0000000000000287
Mikocka-Walus, A., Massuger, W., Knowles, S. R., Moore, G. T., Buckton, S., Connell, W., Pavli, P., Raven, L., & Andrews, J. M. (2020). Psychological distress is highly prevalent in inflammatory bowel disease: A survey of psychological needs and attitudes. JGH Open, 4(2), 166–171. https://doi.org/10.1002/jgh3.12236
Pater, R., Zentveld, D., & Booth, L. (2022). Promoting at-home disease management of IBD with a multidisciplinary digital therapy app: Short-term results. Gastroenterology, 162(3), S94. https://doi.org/10.1053/j.gastro.2021.12.196
Peery, A. F., Crockett, S. D., Murphy, C. C., Jensen, E. T., Kim, H. P., Egberg, M. D., Lund, J. L., Moon, A. M., Pate, V., Barnes, E. L., Schlusser, C. L., Baron, T. H., Shaheen, N. J., & Sandler, R. S. (2022). Burden and cost of gastrointestinal, liver, and pancreatic diseases in the United States: Update 2021. Gastroenterology, 162(2), 621–644. https://doi.org/10.1053/j.gastro.2021.10.017
Petrik, M., Palmer, B., Khoruts, A., & Vaughn, B. (2021). Psychological features in the inflammatory bowel disease–irritable bowel syndrome overlap: Developing a preliminary understanding of cognitive and behavioral factors. Crohn’s & Colitis. https://doi.org/10.1093/crocol/otab061
Pilkonis, P. A., Choi, S. W., Reise, S. P., Stover, A. M., Riley, W. T., Cella, D., & PROMIS Cooperative Group. (2011). Item banks for measuring emotional distress from the Patient-Reported Outcomes Measurement Information System (PROMIS®): Depression, anxiety, and anger. Assessment, 18(3), 263–283. https://doi.org/10.1177/1073191111411667
Pothemont, K., Quinton, S., Jayoushe, M., Jedel, S., Bedell, A., Hanauer, S. B., Mutlu, E. A., & Taft, T. H. (2022). Patient perspectives on medical trauma related to inflammatory bowel disease. Journal of Clinical Psychology in Medical Settings, 29(3), 596–607. https://doi.org/10.1007/s10880-021-09805-0
Regueiro, M., Click, B., Anderson, A., Shrank, W., Kogan, J., McAnallen, S., & Szigethy, E. (2018). Reduced unplanned care and disease activity and increased quality of life after patient enrollment in an inflammatory bowel disease medical home. Clinical Gastroenterology and Hepatology, 16(11), 1777–1785. https://doi.org/10.1016/j.cgh.2018.04.007
Riggott, C., Mikocka-Walus, A., Gracie, D. J., & Ford, A. C. (2023). Efficacy of psychological therapies in people with inflammatory bowel disease: A systematic review and meta-analysis. The Lancet Gastroenterology & Hepatology, 8(10), 919–931. https://doi.org/10.1016/S2468-1253(23)00186-3
Rivière, P., Zallot, C., Desobry, P., Sabaté, J. M., Vergniol, J., Zerbib, F., Peyrin-Biroulet, L., Laharie, D., & Poullenot, F. (2017). Frequency of and factors associated with sexual dysfunction in patients with inflammatory bowel disease. Journal of Crohn’s & Colitis, 11(11), 1347–1352. https://doi.org/10.1093/ecco-jcc/jjx100
Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092–1097. https://doi.org/10.1001/archinte.166.10.1092
Sullivan, M. J. L., Bishop, S. R., & Pivik, J. (1995). The Pain Catastrophizing Scale: Development and validation. Psychological Assessment, 7(4), 524–532. https://doi.org/10.1037/1040-3590.7.4.524
Taft, T. H., Ballou, S., Bedell, A., & Lincenberg, D. (2017). Psychological considerations and interventions in inflammatory bowel disease patient care. Gastroenterology Clinics of North America, 46(4), 847–858. https://doi.org/10.1016/j.gtc.2017.08.007
Taft, T. H., Bedell, A., Craven, M. R., Guadagnoli, L., Quinton, S., & Hanauer, S. B. (2019). Initial assessment of post-traumatic stress in a US cohort of inflammatory bowel disease patients. Inflammatory Bowel Diseases, 25(9), 1577–1585. https://doi.org/10.1093/ibd/izz032
Taft, T. H., McGarva, J., Omprakash, T. A., Tomasino, K., Pandit, A., Mutlu, E. A., & Hanauer, S. B. (2023). Hospitalization experiences and post-traumatic stress in inflammatory bowel disease: Opportunities for change. Inflammatory Bowel Diseases, 29(5), 675–683. https://doi.org/10.1093/ibd/izac148
Taft, T. H., Quinton, S., Jedel, S., Simons, M., Mutlu, E. A., & Hanauer, S. B. (2022). Posttraumatic stress in patients with inflammatory bowel disease: Prevalence and relationships to patient-reported outcomes. Inflammatory Bowel Diseases, 28(5), 710–719. https://doi.org/10.1093/ibd/izab152
Trieschmann, K., Chang, L., Park, S., Naliboff, B., Joshi, S., Labus, J. S., Sauk, J. S., Limketkai, B. N., & Mayer, E. A. (2022). The visceral sensitivity index: A novel tool for measuring GI-symptom-specific anxiety in inflammatory bowel disease. Neurogastroenterology & Motility, 34(9), e14384. https://doi.org/10.1111/nmo.14384
Wabich, J., Bellaguarda, E., Joyce, C., Keefer, L., & Kinsinger, S. (2020). Disordered eating, body dissatisfaction, and psychological distress in patients with inflammatory bowel disease (IBD). Journal of Clinical Psychology in Medical Settings, 27(2), 310–317. https://doi.org/10.1007/s10880-020-09710-y
Wilkins, K., Evans, S., Van Niekerk, L., Romano, D., Fuller-Tyszkiewicz, M., Knowles, S., Chesterman, S., Raven, L., & Mikocka-Walus, A. (2024). Moving towards acceptance and values: A qualitative longitudinal study of ACTforIBD compared to IBD psychoeducation. Journal of Clinical Psychology in Medical Settings. https://doi.org/10.1007/s10880-023-09999-5
Xiong, Q., Tang, F., Li, Y., Xie, F., Yuan, L., Yao, C., Wu, R., Wang, J., Wang, Q., & Feng, P. (2022). Association of inflammatory bowel disease with suicidal ideation, suicide attempts, and suicide: A systematic review and meta-analysis. Journal of Psychosomatic Research, 160, 110983. https://doi.org/10.1016/j.jpsychores.2022.110983
Yelencich, E., Truong, E., Widaman, A. M., Pignotti, G., Yang, L., Jeon, Y., Weber, A. T., Shah, R., Smith, J., Sauk, J. S., & Limketkai, B. N. (2022). Avoidant restrictive food intake disorder prevalent among patients with inflammatory bowel disease. Clinical Gastroenterology and Hepatology. https://doi.org/10.1016/j.cgh.2021.08.009
Zeitz, J., Ak, M., Müller-Mottet, S., Scharl, S., Biedermann, L., Fournier, N., Frei, P., Pittet, V., Scharl, M., Fried, M., Rogler, G., Vavricka, S., & Swiss IBD Cohort Study Group. (2016). Pain in IBD patients: Very frequent and frequently insufficiently taken into account. PLoS ONE, 11(6), e0156666. https://doi.org/10.1371/journal.pone.0156666
Zickgraf, H. F., & Ellis, J. M. (2018). Initial validation of the Nine Item Avoidant/Restrictive Food Intake disorder screen (NIAS): A measure of three restrictive eating patterns. Appetite, 123, 32–42. https://doi.org/10.1016/j.appet.2017.11.111
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MP contributed to conceptualization, writing of the original draft, and manuscript reviewing and editing; TK contributed to writing of the original draft and manuscript reviewing and editing. SK contributed to conceptualization, writing of the original draft, and manuscript reviewing and editing. All authors reviewed the final manuscript.
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Megan Petrik, PhD had no conflicts of interest to disclose. Tyler Kuhn, PhD had no conflicts of interest to disclose. Sarah Kinsinger, PhD is a Consultant, Advisor, and/or Speaker for the following: Ardelyx, Mahana Therapeutics, and metaMe Health and received licensing fees metaMe Health.
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Petrik, M., Kuhn, T. & Kinsinger, S. Clinical Education: Psychosocial Assessment and Treatment Planning for Patients with Inflammatory Bowel Disease. J Clin Psychol Med Settings 31, 237–244 (2024). https://doi.org/10.1007/s10880-024-10006-8
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DOI: https://doi.org/10.1007/s10880-024-10006-8