Acceptance commitment therapy (ACT) for psychological distress associated with inflammatory bowel disease (IBD): protocol..., 2022, Evans et al

Andy

Andy

Retired committee member
Full title: Acceptance commitment therapy (ACT) for psychological distress associated with inflammatory bowel disease (IBD): protocol for a feasibility trial of the ACTforIBD programme

Abstract

Introduction Inflammatory bowel disease (IBD) involves an abnormal immune response to healthy gut bacteria. When a person develops IBD, their susceptibility to anxiety and/or depression increases. The ACTforIBD programme, specifically designed for people with IBD and comorbid psychological distress, draws on acceptance and commitment therapy (ACT), which promotes acceptance of situations that cannot be solved such as persistent physical symptoms. There are no ACT trials for IBD using an active control group or a telemedicine approach, which is important to improve accessibility, particularly in the context of the ongoing COVID-19 pandemic. The ACTforIBD programme is administered online with a 4-hour therapist involvement per participant only; if successful it can be widely implemented to improve the well-being of many individuals with IBD.

Methods and analysis Our team have codesigned with consumers the ACTforIBD programme, an 8-week intervention of 1-hour sessions, with the first three sessions and the last session delivered one-to-one by a psychologist, and the other sessions self-directed online. This study aims to evaluate the feasibility and preliminary efficacy of ACTforIBD to reduce psychological distress in patients with IBD. Using a randomised controlled trial, 25 participants will be randomised to ACTforIBD, and 25 patients to an active control condition.

Ethics and dissemination This protocol has been approved by Deakin University Research Ethics Committee in September 2021 (Ref. 2021-263) and the New Zealand Central Health and Disability Ethics Committee in December 2021 (Ref. 2021 EXP 11384). The results of this research will be published in peer-reviewed journals and shared with various stakeholders, including community members, policy-makers and researchers, through local and international conferences.

Open access, https://bmjopen.bmj.com/content/12/6/e060272
 
Researchers listed in the protocol:

Subhadra Evans1, Lisa Olive2, Madeleine Dober3, Simon Knowles4, Matthew Fuller-Tyszkiewicz3, Eric O5, Peter Gibson6, Leanne Raven7, Richard Gearry8, Andrew McCombie9, Leesa van Niekerk10, Susan Chesterman2, Daniel Romano2 and Antonina Mikocka-Walus1

At the following institutions:
  1. Psychology, Deakin University Faculty of Health, Burwood, Victoria, Australia
  2. School of Pyschology, Deakin, Geelong, Victoria, Australia
  3. School of Psychology, Deakin University, Burwood, Victoria, Australia
  4. School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
  5. Faculty of Health, Deakin University, Burwood, Victoria, Australia
  6. Gastroenterology, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia
  7. Crohn's and Colitis Australia, Camberwell, Victoria, Australia
  8. Department of Medicine, Christchurch School of Medicine and Health Sciences, Medicine, Christchurch, New Zealand
  9. Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
  10. School of Psychological Sciences, University of Tasmania, Hobart, Tasmania, Australia
 
Andy said:
The ACTforIBD programme, specifically designed for people with IBD and comorbid psychological distress, draws on acceptance and commitment therapy (ACT), which promotes acceptance of situations that cannot be solved such as persistent physical symptoms.
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Sean said:
So, how does that work with the whole 'ignore your symptoms and push on through' thing?
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Based solely on the abstract it's just possible this is an appropriate use of ACT, i.e. using ACT to improve your ability to live as well as possible with symptoms you can't do anything about (I won't be reading the paper so as not to risk destroying the illusion).

I expect ACT has its place but the big question is always have adequate attempts at relieving symptoms been made first, before resorting to ACT? In a cash-strapped health system I have my doubts.

Another question is does it have to be formal therapy or would any form of kind attention - a few chats with another, more experienced patient maybe - have the same or even better effect?
 
Ravn said:
Based solely on the abstract it's just possible this is an appropriate use of ACT, i.e. using ACT to improve your ability to live as well as possible with symptoms you can't do anything about (I won't be reading the paper so as not to risk destroying the illusion).

I expect ACT has its place but the big question is always have adequate attempts at relieving symptoms been made first, before resorting to ACT? In a cash-strapped health system I have my doubts.

Another question is does it have to be formal therapy or would any form of kind attention - a few chats with another, more experienced patient maybe - have the same or even better effect?
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If it is the same as my local pain clinic the real aim is to stop you looking for solutions.

As I told the doctor there I am so glad I didn't do this as I would never have found the useful things that did help with pain.

Applied to IBS the aim would be to stop patients reading research and ask for drugs or to investigate things that might help them that need a prescription or input from a professional.
It was cleared stated as one of the objectives of the pain clinic I attended.

I have never seen a sign that this approach can help me with any of the distress I feel with my different medical conditions. I don't think this is the real objective though. The real objective is on the absolute acceptance that there is no medical treatment (regardless of what tests could really be run or treatments that could be tried).

Guessing it might be the same for IBS?
 
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ukxmrv said:
Guessing it might be the same for IBS?
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This is for IBD, not IBS, ie things like Chron's disease and Ulcerative collitis where there is evidence of damage to the gut and I understand there are treatments that can help with symptoms but are not curative. If this therapy is designed to help people cope, then maybe it's OK, but I would think coping is much better helped by support from consultants and specialist nurses, not therapists with no real understanding of the physical disease, how to manage it, or the impact on people's lives.

I'm afraid the name 'acceptance and committment' sounds to me far too much like religion, as I'm sure I've said before. I wouldn't go within a mile of it.
 
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