A randomized controlled trial of mindfulness-based stress reduction to prevent flare-up in patients with inactive ulcerative colitis

S. Jedel, A. Hoffman, P. Merriman, B. Swanson, R. Voigt, Kumar Rajan, M. Shaikh, H. Li, A. Keshavarzian

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

Background/Aims: The primary therapeutic goals in ulcerative colitis (UC) are to maintain excellent quality of life (QOL) by treating flare-ups when they occur, and preventing flare-ups. Since stress can trigger UC flare-ups, we investigated the efficacy of mindfulness-based stress reduction (MBSR) to reduce flare-ups and improve QOL. Methods: Patients with moderately severe UC, in remission, were randomized to MBSR or time/attention control. Primary outcome was disease status. Secondary outcomes were changes in markers of inflammation and disease activity, markers of stress and psychological assessments. Results: 55 subjects were randomized. Absence of flares, time to flare and severity of flare over 1 year were similar between the two groups. However, post hoc analysis showed that MBSR decreased the proportion of participants with at least one flare-up among those with top tertile urinary cortisol and baseline perceived stress (30 vs. 70%; p < 0.001). MBSR patients who flared demonstrated significantly lower stress at the last visit compared to flared patients in the control group (p = 0.04). Furthermore, MBSR prevented a drop in the Inflammatory Bowel Disease Quality of Life Questionnaire during flare (p < 0.01). Conclusion: MBSR did not affect the rate or severity of flare-ups in UC patients in remission. However, MBSR might be effective for those with high stress reactivity (high perceived stress and urinary cortisol) during remission. MBSR appears to improve QOL in UC patients by minimizing the negative impact of flare-ups on QOL. Further studies are needed to identify a subset of patients for whom MBSR could alter disease course.

Original languageEnglish (US)
Pages (from-to)142-155
Number of pages14
JournalDigestion
Volume89
Issue number2
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

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Mindfulness
Ulcerative Colitis
Randomized Controlled Trials
Quality of Life
Hydrocortisone
Inflammatory Bowel Diseases
Psychological Stress
Inflammation
Control Groups

Keywords

  • Flare-up prevention
  • Inactive ulcerative colitis
  • Inflammatory Bowel Disease Quality of Life Questionnaire
  • Mindfulness-based stress reduction
  • Quality of life
  • Ulcerative colitis

ASJC Scopus subject areas

  • Gastroenterology

Cite this

A randomized controlled trial of mindfulness-based stress reduction to prevent flare-up in patients with inactive ulcerative colitis. / Jedel, S.; Hoffman, A.; Merriman, P.; Swanson, B.; Voigt, R.; Rajan, Kumar; Shaikh, M.; Li, H.; Keshavarzian, A.

In: Digestion, Vol. 89, No. 2, 01.01.2014, p. 142-155.

Research output: Contribution to journalArticle

Jedel, S, Hoffman, A, Merriman, P, Swanson, B, Voigt, R, Rajan, K, Shaikh, M, Li, H & Keshavarzian, A 2014, 'A randomized controlled trial of mindfulness-based stress reduction to prevent flare-up in patients with inactive ulcerative colitis', Digestion, vol. 89, no. 2, pp. 142-155. https://doi.org/10.1159/000356316
Jedel, S. ; Hoffman, A. ; Merriman, P. ; Swanson, B. ; Voigt, R. ; Rajan, Kumar ; Shaikh, M. ; Li, H. ; Keshavarzian, A. / A randomized controlled trial of mindfulness-based stress reduction to prevent flare-up in patients with inactive ulcerative colitis. In: Digestion. 2014 ; Vol. 89, No. 2. pp. 142-155.
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AU - Rajan, Kumar

AU - Shaikh, M.

AU - Li, H.

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AB - Background/Aims: The primary therapeutic goals in ulcerative colitis (UC) are to maintain excellent quality of life (QOL) by treating flare-ups when they occur, and preventing flare-ups. Since stress can trigger UC flare-ups, we investigated the efficacy of mindfulness-based stress reduction (MBSR) to reduce flare-ups and improve QOL. Methods: Patients with moderately severe UC, in remission, were randomized to MBSR or time/attention control. Primary outcome was disease status. Secondary outcomes were changes in markers of inflammation and disease activity, markers of stress and psychological assessments. Results: 55 subjects were randomized. Absence of flares, time to flare and severity of flare over 1 year were similar between the two groups. However, post hoc analysis showed that MBSR decreased the proportion of participants with at least one flare-up among those with top tertile urinary cortisol and baseline perceived stress (30 vs. 70%; p < 0.001). MBSR patients who flared demonstrated significantly lower stress at the last visit compared to flared patients in the control group (p = 0.04). Furthermore, MBSR prevented a drop in the Inflammatory Bowel Disease Quality of Life Questionnaire during flare (p < 0.01). Conclusion: MBSR did not affect the rate or severity of flare-ups in UC patients in remission. However, MBSR might be effective for those with high stress reactivity (high perceived stress and urinary cortisol) during remission. MBSR appears to improve QOL in UC patients by minimizing the negative impact of flare-ups on QOL. Further studies are needed to identify a subset of patients for whom MBSR could alter disease course.

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