The Use of Mindfulness-Based Cognitive Therapy for Patients with Inflammatory Bowel Disease

Background: Inflammatory Bowel Disease (IBD) is a group of chronic gastrointestinal diseases with a relapsing nature. The two main types are Crohn’s disease (CD) and ulcerative colitis (UC). Both CD and UC patients experience very similar and distressing symptoms: acute abdominal pain, vomiting, malnutrition, fever, fatigue, diarrhoea and rectal bleeding. These symptoms are disabling and have a severe impact on physical and psychosocial wellbeing. Around 30% of patients suffer from moderate to severe psychological distress and have difficulties coping with the illness even in remission. However, it appears that mental health is overlooked by clinicians who often focus on physical gastrointestinal symptoms only. Mindfulness-Based Cognitive Therapy (MBCT) is evidence based, group psychological intervention that has been successful in reducing depression and anxiety scores in patients with depression while improving overall quality of life. However, MBCT has never been tested in the IBD population before. PhD question: Can MBCT be used as an adjunct therapy to IBD symptom management, for improving IBD patients' general well-being and quality of life? Aims and objectives: The overall aim of the thesis was to develop and collate the evidence for a definitive randomised controlled trial (RCT) testing the effectiveness of MBCT for patients with inflammatory bowel disease (IBD). The thesis brings together six publications. The six publications were integrated into four objectives that collectively contributed in answering the overall PhD question. Results: The findings from the first three publications highlighted the disease-related concerns and psychological needs for patients with IBD. The findings from the last three publications highlighted how feasible it is to use MBCT in IBD and emphasised the IBD patients’ perspectives about MBCT. Conclusion: The thesis concluded that a definitive RCT of MBCT for IBD patients is both feasible and acceptable

Participants' perspectives on mindfulness-based cognitive therapy for inflammatory bowel disease:a qualitative study nested within a pilot randomised controlled trial

Background: Mindfulness-based interventions have shown to improve depression and anxiety symptoms as well as quality of life in patients with inflammatory bowel disease (IBD). However, little is known about the experiences of this group of patients participating in mindfulness interventions. This paper sets out to explore the perspectives of patients with IBD recruited to a pilot randomised controlled trial (RCT) of mindfulness-based cognitive therapy (MBCT) about the intervention. Methods: In a qualitative study nested within a parallel two-arm pilot RCT of mindfulness-based cognitive therapy for patients with IBD, two focus group interviews (using the same schedule) and a free text postal survey were conducted. Data from both were analysed using thematic analysis. Data and investigator triangulation was performed to enhance confidence in the ensuing findings. Forty-four patients with IBD were recruited to the pilot RCT from gastroenterology outpatient clinics from two Scottish NHS boards. Eighteen of these patients (ten from mindfulness intervention and eight from control group) also completed a postal survey and participated in two focus groups after completing post intervention assessments. Results: The major themes that emerged from the data were the following: perceived benefits of MBCT for IBD, barriers to attending MBCT and expectations about MBCT. Participants identified MBCT as a therapeutic, educational and an inclusive process as key benefits of the intervention. Key barriers included time and travel constraints. Conclusions: This qualitative study has demonstrated the acceptability of MBCT in a group of patients with IBD. Participants saw MBCT as a therapeutic and educational initiative that transformed their relationship with the illness. The inclusive process and shared experience of MBCT alleviated the sense of social isolation commonly associated with IBD. However, time commitment and travel were recognised as a barrier to MBCT which could potentially influence the degree of therapeutic gain from MBCT for some participants.</p

Assessment of causal link between psychological factors and symptom exacerbation in inflammatory bowel disease: a systematic review utilising Bradford Hill criteria and meta-analysis of prospective cohort studies

BACKGROUND: Psychological stress is a prevalent factor in inflammatory bowel disease (IBD) with detrimental effects on patients' quality of life and possibly disease course. Although the aetiology of symptom exacerbation in IBD has been explored, determining any causation between psychological stress and symptom worsening remains challenging and requires a methodologically rigorous approach. AIM: The aim of this systematic review with meta-analysis was to determine a causal relationship between psychological stress and symptom exacerbation in IBD, subsequently utilising Bradford Hill's criteria (approach never used in this topic area before) to evaluate the likelihood of causal associations. METHODS: Medline, EMBASE, CINAHL and PsycInfo were searched for relevant studies up to July 20, 2019. Data extraction and quality appraisal were performed by two independent reviewers. Results of all retained papers were presented as a narrative synthesis. A random-effect meta-analysis was conducted on studies meeting the criteria for meta-analysis. Bradford Hill criteria were applied to assess the causality of the relationship between all psychological factors and symptom exacerbation. RESULTS: The searches yielded 2472 potential articles. Nineteen clinical prospective cohort studies were eligible for the narrative review with five suitable for the meta-analysis. Meta-analysis showed depression, anxiety and perceived stress did not have a statistically significant association with an increased risk of symptom exacerbation. Four of the Bradford Hill criteria were met which indicates that there is weak to moderate evidence of a causal association between all the psychological factors and disease activity. Inconsistent results and a dearth of studies using the same tools for measuring psychological factors suggest the need for more research to be done to facilitate more conclusive findings. CONCLUSIONS: This original review utilising Bradford Hill criteria in addition to meta-analysis to evaluate the causality of relationship between psychological factors and symptom exacerbation in IBD provides evidence that psychological factors have a weak to moderate causal involvement in IBD symptom exacerbation. However, when combining this finding with the outcomes of the meta-analysis, we can say that the results were inconclusive. Interventions to reduce the associated psychological impact should be part of the treatment plan for patients with IBD. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42012003143

Exploring barriers to care home research recruitment during the COVID-19 pandemic:The influence of social media recruitment posts and public sentiment

IntroductionRecruitment of care home staff to research studies is recognised as challenging. This was further exacerbated by the COVID-19 pandemic and the associated negative media portrayal of care home workers. Social media use has surged since the onset of COVID-19 lockdowns, offering a plausible approach to understanding the barriers to care home research recruitment and gaining insight into public perceptions of care home workers.AimTo utilise comments from two Facebook recruitment posts to: 1) gain an understanding of potential barriers to recruitment of healthcare workers (HCWs) in UK care homes, and 2) explore public sentiment towards care home research and care homes in the context of the COVID-19 pandemic.MethodsThis cross-sectional study analysed comments from two Facebook posts (available June-October 2021) advertising a separate study on psychological support for care staff during the pandemic. This study was situated within a larger investigation into the mental health and wellbeing of care home staff and employed both qualitative analysis and quantitative methods (word count and correlations between words used and between posts).ResultsThree themes were identified from the qualitative analysis: support, mistrust and blame. There was a greater use of words associated with support and negative emotive words in post 2. Post 2 comments featured significantly more choice words and first-person singular pronouns than post 1 which indicated a resentful sentiment from those who advocate freedom of choice and control. Discussion of mistrust towards researchers was most prominent in post 1 indicating the importance of relationship building between researchers and HCWs in UK care homes. With attribution to blame, there was a larger range of negative emotion words than positive emotion words.Discussion and conclusionTaken together our findings offer novel insights into why recruitment to care home research during the pandemic including the use of social media might be problematic. Social media is a useful tool for recruitment but should not be considered as a one-time input. Researchers should pro-actively engage with the study population from the start using co-design with resident and public groups to support recruitment and ensure these populations are accurately represented within research

The use of mindfulness-based cognitive therapy for improving quality of life for inflammatory bowel disease patients:study protocol for a pilot randomised controlled trial with embedded process evaluation

Background: Inflammatory bowel disease (IBD) is a chronic condition with an unpredictable disease course. Rates of anxiety and depression among IBD patients in relapse (active disease symptoms) as well as in remission are higher than in the general population. Previous studies suggest that the prolonged effect of pain, anxiety, distress and depression have a detrimental effect on patients’ quality of life (QoL). Poor QoL in itself is associated with further symptom relapse. Mindfulness based cognitive therapy (MBCT) is a psychological group intervention that has the potential to improve QoL. When used in other chronic conditions, it demonstrated reduced negative effect from pain and psychological factors at completion of an 8-week MBCT course. The effect of MBCT has never been researched in IBD. The aim of this study is to obtain the information required to design a full scale randomised controlled trial (RCT) that will examine the effectiveness of MBCT in improving quality of life for IBD patients.Methods/Design: This is an exploratory RCT with embedded process evaluation. Forty IBD patients will be recruited from NHS outpatient gastroenterology clinics and will be randomised to either a MBCT (intervention) group or to await-list (control) group. All participants will undergo 16 h of structured group training over an 8-week period, with the control group starting 6 months later than the intervention group. Primary outcomes are recruitment, completion/retention rates and adherence and adaptation to the MBCT manual for IBD patients. The secondary outcome is to assess the feasibility of collecting reliable and valid data on proposed outcome measures such as quality of life, anxiety, depression, disease activity and mindful awareness. The process evaluation will use a survey and focus groups to assess the acceptability of the intervention and trial procedures for IBD patients.Discussion: The outcomes of this study will help define the barriers, uptake and perceived benefits of MBCT program for IBD patients. This information will enable the design of a full-scale study assessing the effect of MBCT on quality of life for IBD patients

Cross-National Study of Mental Health and Employment Status Nine Months Post Social Distancing Implementation Practices

This cross-national study examined the mental health between those individuals working and those not working nine months post initial COVID-19 social distancing implementation. Respondents (N = 3,474) were recruited through social media (e.g. Facebook, Twitter) and completed an online survey in October/November 2020. The respondents were from Norway, the UK, the USA and Australia. The mental health of those working and not working were analysed using t tests and socio-demographics were compared using one-way analysis of variance. Respondents who were working were significantly more likely to experience better mental health, were younger, report higher levels of education, and significantly less likely to worry about their own situation, health or financial situation than respondents who were not employed. Respondents who were retired reported better mental health than respondents who were not working for other reasons (laid off/dismissed, receiving benefits, studying, other). These findings raise the importance for social workers and other health service providers to monitor the overall mental health of individuals especially when social distancing protocols are in place and as countries begin to recover from the pandemic.publishedVersio

Loneliness and its association with social media use during the COVID-19 outbreak

Social distancing rules during the COVID-19 pandemic changed social interaction for many and increased the risk of loneliness in the general population. Social media use has been ambiguously related to loneliness, and associations may differ by age. The study aimed to examine loneliness and its association with social media use within different age groups during the COVID-19 pandemic. A cross-sectional online survey was conducted in Norway, the United Kingdom, the United States, and Australia during April/May 2020, and 3,810 participants aged 18 years or above were recruited. Multiple regression analyses were conducted to examine associations between social media use and social and emotional loneliness within separate age groups. Emotional loneliness was higher among young adults and among those who used social media several times daily. Adjusting by sociodemographic variables, using more types of social media was associated with lower social loneliness among the oldest participants, and with higher emotional loneliness among the youngest participants. Among middle-aged participants, using social media more frequently was associated with lower social loneliness. We found that the associations between social media use and loneliness varied by age. Older people’s engagement on social media may be a resource to reduce loneliness during the COVID-19 pandemic. We observed higher levels of loneliness among high-frequent social media users of younger age.publishedVersio

Cross-national study of worrying, loneliness, and mental health during the COVID-19 pandemic: a comparison between individuals with and without infection in the family.

Objective: The objective of this study was to examine differences in worry, loneliness, and mental health between those individuals infected by COVID-19 or having someone their family infected, and the rest of the population. Methods: A cross-sectional online survey was conducted in Norway, UK, USA, and Australia during April/May 2020. Participants (n = 3810) were recruited via social media postings by the researchers and the involved universities. Differences between those with and without infection in the family were investigated with chi-square tests and independent t-tests. Multiple regression analyses were used to assess associations between sociodemographic variables and psychological outcomes (worry, loneliness, and mental health) in both groups. Results: Compared to their counterparts, participants with infection in the family reported higher levels of worries about themselves (p < 0.05) and their family members (p < 0.001) and had poorer mental health (p < 0.05). However, the effect sizes related to the differences were small. The largest effect (d = 0.24) concerned worries about their immediate family. Poorer psychological outcomes were observed in those who were younger, female, unemployed, living alone and had lower levels of education, yet with small effect sizes. Conclusions: In view of the small differences between those with and without infection, we generally conclude that the mental health effects of the COVID-19 situation are not limited to those who have been infected or have had an infection within the family but extend to the wider population

Willingness to take the COVID-19 vaccine as reported nine months after the pandemic outbreak: A cross-national study

Although vaccination has been identified as an effective measure of reducing the spread of COVID-19, hesitancy to obtain a vaccine for COVID-19 has been shared. The aim of this cross-national study was to examine (i) the willingness in the general population to take the COVID-19 vaccine nine months after the pandemic outbreak and (ii) the willingness to take the vaccine in relation to sociodemographic variables, whether one has experienced COVID-19 infection, concerns about health and family, and trust in the authorities’ information about the pandemic. A cross-sectional survey design was used to collect data online in Norway, the UK, the USA, and Australia. Chi-Square tests or Fisher’s Exact test were used to analyze the data. Logistic regression analysis was used to assess direct associations between the independent variables and the outcome. Within the total sample (n = 3474), living in a city, having a college education, being concerned about your own health and the health of next of kin, and trusting information provided by authorities increased the likelihood of reporting willingness to take the COVID-19 vaccine. Across all countries, participants who reported trust in the authorities’ information about COVID-19 demonstrated a significantly higher plausibility of taking the COVID-19 vaccine.publishedVersio

Video-based communication and its association with loneliness, mental health and quality of life among older people during the COVID-19 outbreak

The aim of the study was to examine the use of video-based communication and its association with loneliness, mental health and quality of life in older adults (60–69 years versus 70+ years) during the COVID-19 pandemic. A cross-sectional online survey was conducted in Norway, UK, USA and Australia during April/May 2020, and 836 participants in the relevant age groups were included in the analysis. Multiple regression analyses were conducted to examine associations between the use of video-based communication tools and loneliness, mental health and quality of life within age groups, while adjusting by sociodemographic variables. Video-based communication tools were found to be more often used among participants aged 60–69 years (60.1%), compared to participants aged 70 or above (51.8%, p < 0.05). Adjusting for all variables, the use of video-based communication was associated with less loneliness (β = −0.12, p < 0.01) and higher quality of life (β = 0.14, p < 0.01) among participants aged 60–69 years, while no associations were observed for participants in the oldest age group. The use of video-based communication tools was therefore associated with favorable psychological outcomes among participants in their sixties, but not among participants in the oldest age group. The study results support the notion that age may influence the association between the use of video-based communication tools and psychological outcomes amongst older people.publishedVersio