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Mindfulness-based Cognitive Therapy for Patients With Inflammatory Bowel Disease

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT04646785
Recruitment Status : Not yet recruiting
First Posted : November 30, 2020
Last Update Posted : November 30, 2020
Sponsor:
Collaborators:
ZonMw: The Netherlands Organisation for Health Research and Development
Jeroen Bosch Ziekenhuis
Rijnstate Hospital
Canisius-Wilhelmina Hospital
Donders Institute for Brain, Cognition and Behaviour
Information provided by (Responsible Party):
Anne Speckens, Radboud University Medical Center

Brief Summary:
Considering the limited availability of psychosocial interventions for IBD, this study aims to investigate MBCT as an adjunctive treatment to treatment as usual to reduce psychological stress and improve sleep quality/regularity in patients with IBD who report elevated stress levels. The study will have a follow-up duration of 12 months from baseline.

Condition or disease Intervention/treatment Phase
Inflammatory Bowel Diseases Behavioral: Mindfulness-based cognitive therapy + TAU Other: Treatment as usual (TAU) Not Applicable

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 136 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: A randomized, multicenter, clinical trial with assessments at baseline, post treatment (3 months later) and follow-ups at 6, 9 and 12 months after baseline.
Masking: None (Open Label)
Primary Purpose: Supportive Care
Official Title: Mindfulness-based Cognitive Therapy to Improve Stress and Sleep in Patients With Inflammatory Bowel Disease
Estimated Study Start Date : May 1, 2021
Estimated Primary Completion Date : May 1, 2024
Estimated Study Completion Date : May 1, 2024

Arm Intervention/treatment
Experimental: Mindfulness-based cognitive therapy (MBCT) added to treatment as usual
Patients in the MBCT arm will in addition to their treatment as usual be invited to participate in MBCT.
Behavioral: Mindfulness-based cognitive therapy + TAU
The proposed intervention is mindfulness-based cognitive therapy (MBCT), based on the protocol published by Segal, Williams and Teasdale. MBCT consists of eight weekly 2.5h group sessions, a six-hour silent day and daily home practice assignments guided by audio files. The program includes both formal and informal meditation exercises. Cognitive techniques include monitoring and scheduling of activities, identification of negative automatic thoughts and devising a relapse prevention plan. Psycho-education and interactive dialogue typically focus on stress management, balancing activities, and (lifestyle) strategies to stay well in the future (relapse prevention).

Active Comparator: Treatment as usual (TAU)
Patients in this arm will receive treatment as usual.
Other: Treatment as usual (TAU)
Treatment as usual (TAU) according Dutch and European IBD treatment guidelines. TAU focuses on pharmacological and surgical disease control, and prevention of complications.




Primary Outcome Measures :
  1. Psychological distress [ Time Frame: Change between baseline and 3 months ]
    Measured by the Hospital Anxiety and Depression Scale (HADS). The HADS consists of 14 items, 7 related to depression and 7 related to anxiety. Scoring for each item ranges from zero to three. Three denotes highest anxiety or depression level meaning that a person can score between 0 and 21 for either anxiety or depression.

  2. Psychological distress [ Time Frame: Change between 3 and 12 months ]
    Measured by the Hospital Anxiety and Depression Scale (HADS). The HADS consists of 14 items, 7 related to depression and 7 related to anxiety. Scoring for each item ranges from zero to three. Three denotes highest anxiety or depression level meaning that a person can score between 0 and 21 for either anxiety or depression.


Secondary Outcome Measures :
  1. Objective sleep quality [ Time Frame: Change between baseline and 3 months ]
    operationalized as total sleep time, time spent in slow wave sleep, sleep continuity, all measured with wearable sleep EEG (iBand+/ Arenar and Fitbit activity tracker).

  2. Objective sleep quality [ Time Frame: Change between 3 and 12 months ]
    operationalized as total sleep time, time spent in slow wave sleep, sleep continuity, all measured with wearable sleep EEG (iBand+/ Arenar and Fitbit activity tracker).

  3. Subjective sleep quality [ Time Frame: Change between baseline and 3 months ]
    Measured by the Pittsburgh Sleep Quality Inventory (PSQI). The PSQI consist of 19 items offering 7 components scores and one composite score. Scoring for each component ranges from zero to three. The overall PSQI score is then calculated by totaling the seven component scores, providing an global score ranging from zero to twenty-one. Lower scores indicate a healthier sleep quality.

  4. Subjective sleep quality [ Time Frame: Change between 3 and 12 months ]
    Measured by the Pittsburgh Sleep Quality Inventory (PSQI). The PSQI consist of 19 items offering 7 components scores and one composite score. Scoring for each component ranges from zero to three. The overall PSQI score is then calculated by totaling the seven component scores, providing an global score ranging from zero to twenty-one. Lower scores indicate a healthier sleep quality.

  5. Fatigue [ Time Frame: Change between baseline and 3 months ]
    measured by the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F).The FACIT-F is a 40-item self-reported measure that assesses fatigue and its impact on daily activities and function. Subdomains include: physical Well-Being, Social/Family Well-Being, Emotional Well-Being, Functional Well-Being and Fatigue. The subdomain fatigue consists of 13-items. Items are scored on a 0-4 response scale with anchors ranging from 'not at all' to 'very much so'. All items are summed to create a global fatigue score with a range from 0 to 52. Higher scores indicate increased fatigue.

  6. Fatigue [ Time Frame: Change between 3 and 12 months ]
    measured by the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F).

  7. IBD-related quality of life [ Time Frame: Change between baseline and 3 months ]
    measured by the Inflammatory Bowel Disease Quality of Life Questionnaire (IBDQ). The IBDQ has 32 items scored on a 7-point Likert scale, ranging from 1 (worst health) to 7 (best health). Overall score range from 32 to 224, with higher scores reflecting better quality of life.

  8. IBD-related quality of life [ Time Frame: Change between 3 and 12 months ]
    measured by the Inflammatory Bowel Disease Quality of Life Questionnaire (IBDQ). The IBDQ has 32 items scored on a 7-point Likert scale, ranging from 1 (worst health) to 7 (best health). Overall score range from 32 to 224, with higher scores reflecting better quality of life.

  9. Perceived control over IBD [ Time Frame: Change between baseline and 3 months ]
    measured by the IBD-Control questionnaire. The IBD-Control Questionnaire consists of eight items, which generate an overall score ranging from 0 (worst control) to 16 (best control).

  10. Perceived control over IBD [ Time Frame: Change between 3 and 12 months ]
    Measured by the IBD-Control questionnaire. The IBD-Control Questionnaire consists of eight items, which generate an overall score ranging from 0 (worst control) to 16 (best control).

  11. Calprotectin [ Time Frame: Change between baseline and 3 months ]
    Assessed in accordance with regular medical procedures. Having higher levels of calprotectin generally means that there is active inflammation in the body or intestines. For a calprotectin test, a normal reading is less than 100 mcg/g.

  12. Calprotectin [ Time Frame: Change between 3 and 12 months ]
    Assessed in accordance with regular medical procedures. Having higher levels of calprotectin generally means that there is active inflammation in the body or intestines. For a calprotectin test, a normal reading is less than 100 mcg/g.

  13. C-reactive protein levels [ Time Frame: Change between baseline and 3 months ]
    Assessed in accordance with regular medical procedures. Also having higher levels of c-reactive protein generally means that there is active inflammation in the body or intestines. For a CRP test, a normal reading is less than 10 milligram per liter (mg/L).

  14. C-reactive protein levels [ Time Frame: Change between 3 and 12 months ]
    Assessed in accordance with regular medical procedures. Also having higher levels of c-reactive protein generally means that there is active inflammation in the body or intestines. For a CRP test, a normal reading is less than 10 milligram per liter (mg/L).

  15. Clinical disease activity [ Time Frame: change between baseline and 3 months ]
    Assessed by a clinician with the Harvey Brashaw Index (HBI) for Crohn's disease and the Simple Clinical Colitis Activity Index

  16. Clinical disease activity [ Time Frame: change between 3 and 12 months ]
    Assessed by a clinician with the Harvey Brashaw Index (HBI) for Crohn's disease and the Simple Clinical Colitis Activity Index

  17. Repetitive negative thinking [ Time Frame: Change between baseline and 3 months ]
    measured by the 15-item Perseverative Thinking Questionnaire (PTQ). The PTQ is a 15-item self-report questionnaire. Respondents are asked to describe how they typically think about negative experiences or problems. They rate each item on a 5-point Likert scale from 0 (never) to 4 (almost always) the extent to which each statement applies to them when they think about negative experiences or problems. All items are summed to create a global repetitive negative thinking score ranging from 0 to 60. Higher scores indicate increased repetitive negative thinking.

  18. Repetitive negative thinking [ Time Frame: Change between 3 and 12 months ]
    measured by the 15-item Perseverative Thinking Questionnaire (PTQ). The PTQ is a 15-item self-report questionnaire. Respondents are asked to describe how they typically think about negative experiences or problems. They rate each item on a 5-point Likert scale from 0 (never) to 4 (almost always) the extent to which each statement applies to them when they think about negative experiences or problems. All items are summed to create a global repetitive negative thinking score ranging from 0 to 60. Higher scores indicate increased repetitive negative thinking.

  19. Mindfulness skills [ Time Frame: Change between baseline and 3 months ]
    24-item Five Facet Mindfulness Questionnaire Short Form (FFMQ-SF). This questionnaire is divided into the subscales observing, describing, acting with awareness, non-judging and non-reactivity.

  20. Mindfulness skills [ Time Frame: Change between 3 and 12 months ]
    24-item Five Facet Mindfulness Questionnaire Short Form (FFMQ-SF). This questionnaire is divided into the subscales observing, describing, acting with awareness, non-judging and non-reactivity.

  21. Positive mental health [ Time Frame: Change between baseline and 3 months ]
    Measured by the Mental Health Continuum-Short Form (MHC-SF). MHC-SF consists of 14-items and assesses emotional, psychological and social well-being. All items are summed and then a mean score is calculated, which represents a global positive mental health score ranging from 0 to 5. Higher scores indicate a better positive mental health.

  22. Positive mental health [ Time Frame: Change between 3 and 12 months ]
    Measured by the Mental Health Continuum-Short Form (MHC-SF). MHC-SF consists of 14-items and assesses emotional, psychological and social well-being. All items are summed and then a mean score is calculated, which represents a global positive mental health score ranging from 0 to 5. Higher scores indicate a better positive mental health.

  23. Self-compassion [ Time Frame: Change between baseline and 3 months ]
    We will use the 12-item Dutch short-form version of the SCS-SF to measure self-compassion. The scale consists of six components, including self-kindness, self-judgment, common humanity, isolation, mindfulness and over-identification. In the short form, each scale consists of 2 items scored between 1 ((almost) never) to 7 ((almost) always) and subscale score ranges between 2 and 14. A higher score indicates a higher level of self-kindness, common humanity, and mindfulness, and lower scores of self-judgment, isolation, and over-identification. Total scores range from 12 to 84 (summed subscale scores), a higher score indicates a higher level of self-compassion.

  24. Self-compassion [ Time Frame: Change between 3 and 12 months ]
    We will use the 12-item Dutch short-form version of the SCS-SF to measure self-compassion. The scale consists of six components, including self-kindness, self-judgment, common humanity, isolation, mindfulness and over-identification. In the short form, each scale consists of 2 items scored between 1 ((almost) never) to 7 ((almost) always) and subscale score ranges between 2 and 14. A higher score indicates a higher level of self-kindness, common humanity, and mindfulness, and lower scores of self-judgment, isolation, and over-identification. Total scores range from 12 to 84 (summed subscale scores), a higher score indicates a higher level of self-compassion.

  25. Costs [ Time Frame: 12 months ]
    This will be investigated by using the Trimbos iMTA Questionnaire for Costs associated with Psychiatric Illness (TiC-P) as a measure of healthcare utilization. Unit cost estimates are derived from the national manual for cost prices in the healthcare sector.

  26. Health-related quality of life [ Time Frame: 12 months ]
    This will be assessed by using the EuroQol-5D (EQ-5D-5L). The EQ-5D-5L consist of five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 5 levels: no problems, slight problems, moderate problems, severe problems and extreme problems. This short self-report instrument is used to assess quality adjusted life years.



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Confirmed IBD diagnosis of Crohn's disease (CD), Ulcerative colitis (UC) or Indeterminate colitis (IC)
  • Current IBD remission (Calprotectin < 250 mg/kg) since at least three months
  • Hospital Anxiety and Depression Scale-score of >=11, indicating at least mild levels of psychological distress (Vodermaier 2011).
  • Age of 18 or older
  • Taking no IBD medication or on a stable dose of 5-ASA products, immunosuppressive medication, or biologics for at least three months prior to enrollment.

Exclusion Criteria:

  • Severe psychiatric disorders (e.g. acute suicidality, psychosis)
  • Current alcohol or drug dependency
  • Untreated anemia
  • Prior participation in an 8-week MBSR or MBCT-programme

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04646785


Contacts
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Contact: Marloes Huijbers, dr. (024) 361 0405 marloes.huijbers@radboudumc.nl
Contact: Annelieke van Velthoven, MSc. 024-3668456 annelieke.vanvelthoven@radboudumc.nl

Sponsors and Collaborators
Radboud University Medical Center
ZonMw: The Netherlands Organisation for Health Research and Development
Jeroen Bosch Ziekenhuis
Rijnstate Hospital
Canisius-Wilhelmina Hospital
Donders Institute for Brain, Cognition and Behaviour
Investigators
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Principal Investigator: Anne Speckens, Dr. Radboud University Medical Center
Study Chair: Loes Nissen, Dr. Jeroen Bosch Ziekenhuis
Study Chair: Marloes Huijbers, Dr. Radboud University Medical Center
Publications:
Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2013). Mindfulness-based cognitive therapy for depression (second).

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Responsible Party: Anne Speckens, Principal Investigator and Director of Radboudumc Centre for Mindfulness, Radboud University Medical Center
ClinicalTrials.gov Identifier: NCT04646785    
Other Study ID Numbers: MBCT-IBD-2020-2024
First Posted: November 30, 2020    Key Record Dates
Last Update Posted: November 30, 2020
Last Verified: November 2020
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description: The authors intend to make the data available to other researchers after completion of the study and will comply with open access procedures, including open access publishing, as much as possible.
Supporting Materials: Study Protocol
Statistical Analysis Plan (SAP)
Analytic Code
Time Frame: we expect the final report of the primary endpoint of the study December 2024, and we will have an embargo period of 6 months after publication.
Access Criteria: We will use restricted access, such that interested researchers are welcome to contact us with requests for data. The project team will review the quality of the request and grant permission if the request is in accordance with the terms of use drafted by the Radboudumc.
URL: https://www.lcrdm.nl/

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Anne Speckens, Radboud University Medical Center:
randomized controlled trial
mindfulness-based cognitive therapy
effectiveness
psychological distress
sleep
fatigue
Additional relevant MeSH terms:
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Intestinal Diseases
Inflammatory Bowel Diseases
Gastrointestinal Diseases
Digestive System Diseases
Gastroenteritis