Living with IBD: What coping strategies are most effective?

In a recent review article published in the Journal of Clinical Medicine, researchers summarized the results of a systematic review that explored the impact of different coping strategies for people living with inflammatory bowel disease (IBD).

Study: Coping Strategies and Inflammatory Bowel Disease: A Narrative Review. Image Credit: PeopleImages.com – Yuri A/Shutterstock.com

Background

Through keyword searches, they identified 57 articles published in English in medical databases such as the Cochrane Library, PubMed, EBSCOhost, and EMBASE, concluding that personalized interventions can help diverse populations with IBD rehabilitation and management.

Challenges treating IBD

The two forms of IBD, namely ulcerative colitis (UC) and Crohn’s disease (CD), are thought to occur as a result of mucosal barrier dysfunctions, gastrointestinal microbiome disturbances, immune response dysregulation, genetic background, and environmental risk factors including smoking, air pollution, diet, and stress.

As many as four in 10 IBD patients show no response to biological therapy, though patient education regarding risk factors can improve the management of the disease.

Since IBD can be chronic, it has significant psychosocial effects and can affect work and quality of life.

Patients may cope with these stresses through adaptive strategies that could mitigate their psychological burden, while maladaptive strategies like denial or avoidance could lead to worsening symptoms.

Effects of coping mechanisms

Researchers identified active coping strategies in which individuals act directly to solve problems and address stressors, known as problem-focused coping.

This could include actively monitoring the disease and its symptoms to identify triggers, changes, and patterns. However, becoming overly focused on monitoring can increase stress.

Another form of emotion-focused coping involves reframing thoughts, regulating emotions, and seeking support systems. While these strategies can improve mental well-being, they can also reduce adherence to treatment and lead to individuals delaying seeking medical care.

Disease severity, complications, and activity influence the health-related quality of life (HRQoL) of people living with IBD. However, effectively managing stress, seeking support, being physically active, and adhering to medicine can improve their symptomology and overall well-being.

Adaptive coping mechanisms can lead to perceiving the illness more positively and reduce distress. People with IBD often show resilience by adapting to the side effects of treatments, psychosocial stressors, and symptom flares with problem-solving skills and psychological flexibility.

Individuals may experience reduced psychological resilience after being diagnosed with IBD, but mindfulness can be an effective form of therapy.

Maladaptive coping strategies that are negatively associated with HRQoL include negative religious coping, acceptance-resignation, catastrophizing, low acceptance, passive coping, decreased cognitive flexibility, emotion-focused coping, and perceived control.

Some strategies are also correlated with higher levels of anxiety and depression and lower work productivity.

Researchers have found differences in coping strategies between people with UC and CD. People with CD may experience higher levels of psychological distress and neuroticism while being more likely to adopt maladaptive coping strategies.

In another study, people with UC were more likely to cope by modifying meal content, sleeping more, and seeking medical care.

People with CD, however, adopted strategies like skipping meals or switching to elemental diets as they perceived these as more useful.

Interventions for IBD patients

Educational programs can reduce disease-related anxiety and depression while improving knowledge and the use of adaptive coping strategies. Notably, these improvements have been observed despite disease activity remaining similar.

This suggests that uncertainty around IBD can lead to worse outcomes and that individuals who know more about their condition benefit from this understanding.

Cognitive behavioral therapy (CBT) has also been shown to improve symptoms of depression and anxiety, while interventions focusing on mind-body relaxation additionally improved symptoms and reduced expression of genes directly linked to inflammatory processes.

Another study found that transcranial direct current stimulation reduced pain in the short term, but the effects faded after one week.

People with inactive IBD show a higher inclination to participate in treatment; they also experience lower depression and a higher quality of life.

Some patients with IBD may also experience joint and back pain; they show greater adaptability and flexibility but are less likely to perceive medical interventions as effective.

Conclusions

Individuals living with IBD experience severe challenges to their health and quality of life. As the prevalence of this condition increases, effective coping strategies must be identified to improve the treatment and management of this disease.

The review indicates that patients adopt a multitude of coping mechanisms, some adaptive and some maladaptive.

Their experience of the disease in terms of duration and severity modifies their coping strategies, and these strategies may also affect their condition.

Understanding these complex interplays can help health professionals tailor interventions to groups of people who have specific needs, providing the necessary level of social support and promoting resilience and treatment adherence.