Development and Feasibility Trial of a Cognitive Behavioural Self-Management Program for Inflammatory Bowel Disease
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Inflammatory Bowel Disease (IBD) is a chronic illness marked by inflammation of the digestive system that is associated with physical and psychosocial symptoms. Psychotherapy interventions for IBD have yielded inconsistent results that could be contributed to by clinical and methodological limitations. Specifically, most studies did not include pre-screening for study inclusion, protocols were either not developed or not sufficiently described, and Randomized-Controlled Trial (RCT) designs were not implemented in many studies. The primary aim of this dissertation was to develop an empirically supported psychotherapy intervention for IBD. Several objectives were completed to facilitate program development. First, mediators of the relationship between pain and Health-Related Quality of Life (HRQoL) were examined using cross-sectional and longitudinal mediation models to identify intervention targets. In a cross-sectional mediation model, pain catastrophizing and illness-focused coping mediated the relationship between pain and HRQoL. In longitudinal models with pain at time 1, pain catastrophizing and illness-focused coping at time 2, and HRQoL at time 3, parallel mediation was not evident. However, there was a serial mediation effect. Pain predicted future pain catastrophizing, which predicted contemporaneous illness-focused coping, which then predicted future HRQoL. This suggests the importance of targeting these constructs during therapy in order to create long-term improvements in HRQoL. The second objective was to develop a research-informed therapy program. This resulted in the selection of a CBT orientation, a group self-management modality, and a manualized protocol. In addition, pre-screening for anxiety, depression and HRQoL was implemented to ensure study participants had psychosocial symptoms of adequate severity to require psychotherapy. The third objective was to examine the usefulness and applicability of the program using with an advisory panel. IBD patients provided feedback on the therapy program and several changes were implemented based on suggestions that were consistent with the research literature. The final objective was to conduct a feasibility trial of the program. Results indicated the program was effective for improving anxiety, depression, generalized catastrophizing, stigmatization, and shame. Long-term improvements at 3-months and 6-months post-therapy were evident for systemic HRQoL and a composite measure of anxiety and depression. The results led to considerations for future studies.