Corrigendum: The LIFEwithIBD Intervention: Study Protocol for a Randomized Controlled Trial of a Face-to-Face Acceptance and Commitment Therapy and Compassion-Based Intervention Tailored to People With Inflammatory Bowel Disease

[This corrects the article DOI: 10.3389/fpsyt.2021.699367.].

Corrigendum: The LIFEwithIBD Intervention: Study Protocol for a Randomized Controlled Trial of a Face-to-Face Acceptance and Commitment Therapy and Compassion-Based Intervention Tailored to People With Inflammatory Bowel Disease

[This corrects the article DOI: 10.3389/fpsyt.2021.699367.].

Psychological factors associated with inflammatory bowel disease

BACKGROUND

Both depression and anxiety are identified as significant experiences in inflammatory bowel disease (IBD); whether these are a consequence of the disease or an active contributor to the disease remains controversial. This review aimed to identify and critique recent evidence regarding mental health in IBD.

SOURCES OF DATA

PubmedⓇ, OvidⓇ, EmbaseⓇ, EBSCO PsychInfo and Google-Scholar were searched within the last 5 years (2016-2020).

AREAS OF AGREEMENT

Overall, both depression and anxiety affect disease activity, relapse and healthcare utilization.

AREAS OF CONTROVERSY

There is some controversy on whether depression and anxiety affect IBD outcomes differently depending on IBD subtype.

GROWING POINTS

The data support the need for depression and anxiety assessment to be incorporated in the routine management of IBD patients; prompt psychiatric and psychological management may ultimately reduce disease activity, relapses and healthcare costs.

AREAS TIMELY FOR DEVELOPING RESEARCH

More longitudinal research may further enlighten the role of depression and anxiety in IBD. Similarly, randomized controlled trials to investigate and clarify the effect of psychiatric/psychological management on IBD outcomes.

The LIFEwithIBD Intervention: Study Protocol for a Randomized Controlled Trial of a Face-to-Face Acceptance and Commitment Therapy and Compassion-Based Intervention Tailored to People With Inflammatory Bowel Disease

Background: There is ample evidence of the high mental health burden caused by Inflammatory Bowel Disease (IBD). Several constructs such as experiential avoidance, cognitive fusion, shame, and self-criticism have recently emerged as potential intervention targets to improve mental health in IBD. Psychotherapeutic models such as Acceptance and Commitment Therapy and compassion-based interventions are known to target these constructs. In this protocol, we aim to describe a two-arm Randomized Controlled Trial (RCT) testing the efficacy of an ACT and compassion-focused intervention named Living with Intention, Fullness, and Engagement with Inflammatory Bowel Disease (LIFEwithIBD) intervention + Treatment As Usual (TAU) vs. TAU in improving psychological distress, quality of life, work and social functioning, IBD symptom perception, illness-related shame, psychological flexibility, self-compassion, disease activity, inflammation biomarkers, and gut microbiota diversity. Methods: This trial is registered at ClinicalTrials.gov (Identifier: NCT03840707, date assigned 13/02/2019). The LIFEwithIBD intervention is an adaptation to the IBD population of the Mind programme for people with cancer, an acceptance, mindfulness, and compassion-based intervention designed to be delivered in a group format. The LIFEwithIBD intervention's structure and topics are presented in this protocol. Participants were recruited at the Gastroenterology Service of the Coimbra University Hospital between June and September 2019. Of the 355 patients screened, 61 participants were selected, randomly assigned to one of two conditions [experimental group (LIFEwithIBD + TAU) or control group (TAU)] and completed the baseline assessment. Outcome measurement took place at baseline, post-intervention, 3- and 12-month follow-ups. Discussion: Results from this RCT will support future studies testing the LIFEwithIBD intervention or other acceptance and/or compassion-based interventions for IBD.

COVID-19 Pandemic's Effects on Disease and Psychological Outcomes of People With Inflammatory Bowel Disease in Portugal: A Preliminary Research

AIMS

No empirical research on the psychological impact of the coronavirus disease 2019 (COVID-19) pandemic on people living with IBD, a population known to typically present high levels of anxiety and depression and to be potentially vulnerable to COVID-19, has yet been conducted. This study aimed to explore the links between contextual variables related to the COVID-19 pandemic and disease and psychological outcomes.

METHODS

The sample included 124 Portuguese patients with Crohn's disease or ulcerative colitis (85.48% women) who completed self-reported measures in an online survey during April 2020.

RESULTS

Fear of contracting COVID-19 and medication adherence were both high and unrelated. About half of the sample presented moderate (37.10%) to severe (14.50%) anxiety. Normal and mild anxiety levels were at 29.80% and 18.50%, respectively. Regarding depressive symptoms, 51.60% of the sample presented normal levels, 27.40% mild severity, 16.10% moderate, and 4.8% severe. No differences were found between Crohn's disease and ulcerative colitis patients. Regression analyses showed that anxiety explained IBD symptom perception (β = 0.29; P = 0.022); fear of contracting COVID-19 (β = 0.35; P < 0.001) and IBD symptom perception (β = -0.22; P = 0.009) explained depressive symptoms; and fear of contracting COVID-19 (β = 0.41; P < 0.001), IBD symptom perception (β = 0.26, P < 0.001), and being in isolation (β = -0.16, P = 0.041) explained anxiety. Type of medication was not linked to these outcomes.

CONCLUSIONS

The COVID-19 pandemic does not seem to be affecting adherence to medication but seems to present relevant effects on psychological well-being. Inflammatory bowel disease health care professionals should be attentive of patients' psychological response to this pandemic and of its possible consequences on disease expression. This study additionally provided a psychometrically sound measure of fear of contracting COVID-19.

Heavy Cannabis Use Is Associated With Low Bone Mineral Density and an Increased Risk of Fractures

PURPOSE

To investigate possible associations between recreational cannabis use and bone health in humans.

METHODS

Cross-sectional study of individuals recruited from primary care in the UK between 2011 and 2013. Cases were regular smokers of cannabis divided into moderate (n = 56) and heavy user (n = 144) subgroups depending on whether they reported fewer or more than 5000 cannabis smoking episodes during their lifetime. Controls comprised 114 cigarette smokers.

RESULTS

Heavy cannabis users had lower total hip bone mineral density (mean ± SD Z-score: -0.20 ± 0.9 vs +0.2 ± 0.9, P < .0005), lower spine bone mineral density (-0.5 ± 1.2 vs 0.0 ± 1.2, P < .0005), and lower body mass index (BMI; 26.5 ± 6.0 vs 29.0 ± 7.0, P = .01) than controls. Fracture rate was also increased in heavy users (rate ratio = 2.17; 95% confidence interval, 1.59-2.95; P < .001). When compared with controls, serum cross-linked C-telopeptide of type 1 collagen (CTX) concentrations were raised in heavy cannabis users (0.3 ± 0.1 vs 0.2 ± 0.1 pg/mL, P = .045), as were serum N-terminal propeptide of type 1 procollagen (P1NP) concentrations (47.1 ± 19.2 vs 41.2 ± 17.8 pg/mL, P = .01). Serum total 25-hydroxyvitamin D concentrations were reduced in heavy users compared with controls (25.3 ± 16.8 vs 36.9 ± 26.7 nmol/L, P = .002). Multiple regression analysis revealed that heavy cannabis use was an independent predictor of spine bone mineral density, accounting for 5.4% of the variance (P = .035), and total hip bone mineral density, accounting for 5.8% of the variance (P = .001), but mediation analysis suggested that the effect on spine bone mineral density was indirect and mediated through low body mass index.

CONCLUSIONS

Heavy cannabis use is associated with low bone mineral density, low BMI, high bone turnover, and an increased risk of fracture. Heavy cannabis use negatively impacts on bone health both directly and indirectly through an effect on BMI.

The relationship between acceptance, catastrophizing and illness representations in chronic pain

BACKGROUND

Cognitive- and acceptance-based approaches are used to help people live with chronic pain. Little is known about how these constructs relate to each other. In this study, we examined how cognitive representations of chronic pain relate to interpersonal styles such as catastrophizing and the behavioural process of acceptance of chronic pain. This study further examined how these processes relate to emotional and physical functioning in chronic pain.

METHODS

A cross-sectional design, employing validated questionnaires, was used to measure pain, emotional and physical dysfunction, illness representations, catastrophizing and acceptance in a heterogeneous sample of 150 chronic pain sufferers.

RESULTS

The psychological variables significantly mediated the impact of pain severity on both emotional and physical dysfunction. In addition, a distinct pattern of mediation was observed. The relationship between pain and emotional dysfunction was mediated by representations of pain as a highly emotive experience and by catastrophizing; acceptance did not mediate this relationship. By contrast, the relationship between pain and physical dysfunction was mediated by acceptance and representations of high consequences of chronic pain, but not by catastrophizing.

CONCLUSIONS

Pain severity itself is a relatively poor predictor of emotional and physical dysfunction in chronic pain states. These relationships are significantly mediated by psychological variables. Different approaches to chronic pain rehabilitation emphasize different targets (changing illness representations and reducing catastrophizing vs. acceptance and behavioural activation). This cross-sectional study suggests that these processes may differentially influence outcomes, but that they are complex and overlapping. Theoretical and clinical implications are discussed.