Non-pharmacological therapies for inflammatory bowel disease: Recommendations for self-care and physician guidance

Table 3 Summary of best available evidence for psychological interventions in inflammatory bowel disease

Intervention	Recommendation	Ref.
Cognitive behavioural therapy	May be useful for developing adaptive coping skills[85,88,90], reducing IBD-related stress[85], and improving quality of life[86-88,90] Therapeutic gains are observed in individuals with varying degrees of distress.[85,86,90,91] Outcomes on anxiety and depression are inconsistent[85,86,88-90]	Mussell et al[85], 2003 Díaz-Sibaja et al[86], 2009 Keefer et al[87], 2012a McCombie et al[88], 2016 Mikocka-Walus et al[89], 2016 Mikocka-Walus et al[90], 2015 Keefer et al[91], 2012
Mindfulness-based therapies	Could foster adaptive coping[96] and maintain quality of life during flare ups, particularly among individuals with moderate-severe distress or abdominal symptoms[96,97]. The evidence for managing anxiety and depression[98], as well as disease activity[97,99], is limited.	Berrill et al[96], 2014 Jedel et al[97], 2014 Schoultz et al[98], 2015 Gerbarg et al[99], 2015
Hypnosis	Demonstrates the most promise for managing disease activity[104,106,107]	Keefer et al[104], 2013 Miller/Whorwell[106], 2008 Mawdsley et al[107], 2008
Stress management	These interventions appear to target anxiety[110-112], reduce IBD-related stress[109,110], and improve quality of life[108,110]. There is some support for managing pain[110,114,115]	Boye et al[108], 2011 Milne et al[109], 1986 Mizrahi et al[110], 2012 Larsson et al[111], 2003 Smith et al[112], 2012 Shaw/Ehrlich[114], 1987 Garcia-Vega/Fernandez-Rodriguez[115], 2004
Psychodynamic psychotherapy, supportive expressive group therapy, solution-focused therapy, multi-component behavioural treatment	Insufficient evidence to make recommendations at this time

IBD: Inflammatory bowel disease.