Cognitive and psychological therapies

Your health care provider may refer you to a psychologist or psychiatrist familiar with IBD who can share strategies for managing a chronic illness. Some of these therapies may be beneficial in the management of IBD, but research is still limited. 

Interventions such as mindfulness and meditation, acceptance and commitment therapy (ACT), cognitive behavioural therapy (CBT), and stress management and relaxation strategies (such as exercise), may help people with IBD by lowering their stress levels and improving daily functioning.

Scroll down to learn more about what these therapies are and how effective they are in managing symptoms of IBD and mental health.

Mindfulness, meditation and relaxation

Mindfulness, meditation and relaxation techniques may improve quality of life by managing symptoms and possibly decreasing inflammatory activity in IBD. But there is little research evidence to say if it is effective in preventing flares or altering the course of your disease. 

What is Mindfulness?

Mindfulness is the ability to be fully present and paying attention to what’s happening in the mind, body, and environment. It’s a practice that develops over time and trains your brain and body to respond to stress in a more effective way.

Mindfulness is about responding with awareness versus reacting, to help you make decisions that better align with your values. Mindfulness can help you discover how best to care for yourself in the moment.

If you are experiencing pain, focus on a pleasant or neutral place. When you feel joy, stay present in the moment. The realities of IBD are true: the disease is unpredictable and the symptoms are real. Mindfulness helps you notice how you feel and respond with kindness.

Mindfulness is an opportunity to help prevent mental health conditions that may develop. 

Is Mindfulness Effective for Managing IBD? 

Numerous research studies have reported that mindfulness interventions are effective in reducing stress, depression and anxiety and improving the quality of life in individuals suffering from IBD. 

In teens with IBD that completed in-person mindfulness skills sessions demonstrated improved emotional functioning and reported personal applications of mindfulness.

The effects of mindfulness interventions on physical disease outcomes (e.g., inflammation) is not yet known and more research in this area is needed.

How to get access to mindfulness therapy 

There are several online resources to help guide you through mindfulness and meditation strategies: 

  • Digital apps such as CALM, Headspace, The Mindfulness App are recommended by health care professionals.

  • Mindspace is a full-service operation promoting well-being in individuals, organizations, and communities. They are a leading provider of personal and professional mindfulness-based training programs in Quebec and have online offerings.
  • The SickKids Mindfulness Project offers events, courses and workshops for young patients and families plus mindfulness resources on their mental health hub on AboutKidsHealth.

Other in-person resources include counsellors, psychotherapists, psychologists, psychiatrics, and nurse practitioners who may provide mindfulness therapy. Talk to your health care provider about how to get a referral to a mental health specialist in your community.

Breathing and Relaxation Exercises

Engaging in deep breathing can also help calm your nerves:

  • Practice inhaling for a count of four, holding for a count of four, and releasing for a count of four (a technique called “box breathing”).

  • Close your eyes, plant your feet, and breathe for a few minutes to feel calmer.

  • Practice disconnecting from technology and spend some time in nature, really noticing your surroundings. 

Watch the video below to learn more from an expert psychologist about how mindfulness and cognitive therapy can help manage symptoms of Crohn's or colitis. 

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Acceptance and Commitment Training (ACT)

What is ACT? 

Acceptance and Commitment Training (ACT) encourages people to accept adverse thoughts and feelings and move towards fulfilling the positive values they have identified. This type of cognitive and behavioural therapy encourages people to be flexible, open, and aware of their feelings in the moment, but doesn’t attempt to eliminate these feelings.

Is ACT Effective in Managing IBD?

In a study of patients with IBD, an ACT therapy course was associated with reduced stress and depression, but not anxiety. More research in this area is needed to determine the effectiveness of this therapy for people affected by Crohn's or colitis. 

Crohn's and Colitis Canada supports research programs that examine the effectiveness of online ACT programs for people affected by IBD. Dr. Kohut is testing a program called iACT-P, an online workshop series on a type of mindfulness therapy called acceptance and commitment therapy (ACT). This program is designed to teach parents how to take care of their own health while managing their child’s IBD symptoms, medication, and diet. On the online platform, parents have the opportunity to connect with others and share their experiences, providing a space to talk about coping with a child’s illness. To learn more about this research program, please click here.

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Cognitive Behavioural Therapy (CBT)

What is CBT?

Cognitive Behavioural Therapy (also called 'CBT') is a practical form of psychotherapy that can have a positive impact on mental health by managing symptoms of anxiety and depression.

When we feel stressed or anxious, there may be maladaptive or negative cognitions associated with it that may contribute to future emotional distress and problematic behaviour. Cognitions include beliefs, attitudes, thoughts, or schemas about the external environment, the self, and the future.

CBT aims to help people identify and change how their thoughts are associated with reactions that may cause issues. It also aims to identify what a realistic thought is versus what is a negative and automatic thought, and tries to come up with a more balanced way of looking at a scenario instead of jumping to the worst case. 

By modifying negative thinking and challenging the relationship between thoughts and emotions or reactions, it may be possible to restructure these thoughts that are unhelpful.

How is CBT delivered? 

CBT is focused on the present-time or here and now. It’s a structured, collaborative treatment that usually takes place over 5-20 sessions with homework to practice on your own time.

Patients work with a psychologist or mental health professional to identify which thoughts are helpful and which are not as helpful in order to change thinking patterns, emotional reactions, and finally, actions. It’s based on allowing what you can’t control to be, developing a more balanced outlook (versus being hyperaware) and developing new skills or strategies to help you cope.

Disease-specific approaches to CBT have been developed to target cognitive and behavioral factors associated with that disease. Generally, the goal of CBT is to reduce symptoms, improve overall functioning and quality of life. Although the focus of therapy is still on cognitive factors, it also considers the important role of physiological, emotional, and behavioral factors on maintenance of a disease.

Talk to your healthcare provider or IBD specialist about getting a referral to a mental health professional with experience in providing CBT to people with gastrointestinal or chronic disease. 

Is CBT Effective in Managing IBD?

CBT can be effective in reducing symptoms of anxiety and depression, alone or in combination with medication. But research that examines if CBT can improve disease outcomes and mental health conditions, specifically in people with IBD is limited, and what we know so far is mixed. 

Randomized Clinical Trials (RCTs) are considered the gold-standard in studying the benefits of therapeutic interventions. One study found that CBT improved quality of life and was associated with an improvement in IBD activity over time. This suggests that that the treatment of psychological symptoms could be beneficial for overall management of IBD. In another study, CBT improved short-term quality of life and the ability to cope with disease, but had little effect on long-term disease activity or inflammation, anxiety and depression.

More research and RCTs in this area are needed. Crohn's and Colitis Canada and CANIBD is funding research that examines the use of of an online CBT program for people affected by IBD.

How to Access CBT

There are many online and self-guided tools for CBT, however it recommended that these tools are used in combination with visiting a mental health professional that can administer CBT. Here are a few ‘expert-approved’ CBT programs offered online and in-person:

  • Togetherall is a free online mental health support network for Ontarians 16+. It is a safe and anonymous service that is available 24/7 to get help whenever you need it. It includes self-guided tools to help you better understand your mental health, as well guided support courses including CBT for anxiety, depression, smoking cessation and more. They also offer an online peer support community to connect with others struggling with similar issues and experiences.

  • ConnexOntario provides treatment service information or referral for people experiencing problems with mental health, alcohol and/or drug abuse. It is available 24/7 via calls, emails or webchat. The referral service is free and confidential.  

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