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High Demand for Psychotherapy in Patients with Inflammatory Bowel Disease

Klag, Thomas MD*; Mazurak, Nazar MD; Fantasia, Laura*; Schwille-Kiuntke, Juliane MD; Kirschniak, Andreas MD; Falch, Claudius MD; Goetz, Martin MD*; Malek, Nisar P. MD*; Enck, Paul Dip Psych; Wehkamp, Jan MD*

doi: 10.1097/MIB.0000000000001216
Original Clinical Articles

Background: The relative contribution of psychological factors to the onset and course of inflammatory bowel diseases (IBD) is a matter of constant debate since its beginning, as is the clinical need and the efficacy of psychotherapeutic interventions. However, the perspective of patients with IBD has largely been ignored in this debate.

Methods: Psychometric tests including the Short-Form IBD Questionnaire (SIBDQ), the ADAP test measuring demand for psychotherapy, and the Fear-of-Progression Questionnaire Short Form as well as disease-related questions were positioned on the internet between December 2014 and January 2016. The study was advertised through DCCV (German branch of the European Federation of Crohn's and Ulcerative Colitis Associations).

Results: n = 631 patients responded, and complete data from n = 578 (356 Crohn's disease, 219 ulcerative colitis, 3 unclear) were available for analysis. n = 296 had previous experiences with psychotherapy, whereas n = 282 had not. This distribution clearly determined the factor “demand for psychotherapy” (chi-square = 23.7, P < 0.001). When all available data were entered into a (stepwise-forward) regression model, psychotherapy demand was dependent on previous experience (P < 0.001), fear of progression (P < 0.001), quality of life (P = 0.001), smoking (P = 0.003), and previous surgery (P = 0.005) with the total model explaining 29.7% of the variance. The total explained variance of this model was higher in ulcerative colitis (37.6%) than in Crohn's disease alone (25.4%).

Conclusions: The demand for psychotherapy as additional therapy in IBD depends on previous experience with psychotherapy, fear for disease progression but also other disease or social characteristics and quality of life.

Article first published online 16 August 2017.

Departments of *Internal Medicine I (Gastroenterology, Hepatology, Infectious Diseases),

Internal Medicine VI (Psychosomatic Medicine and Psychotherapy), and

Surgery, University Hospital Tübingen, Tübingen, Germany.

Address correspondence to: Paul Enck, Dip Psych, Department of Internal Medicine VI, University Hospital, Osianderstr 5, 72076 Tübingen, Germany (e-mail:, or Jan Wehkamp, MD, Department of Internal Medicine I, University Hospital Otfried-Müller-Str. 10, 72076 Tübingen, Germany (e-mail:

Supported by the Deutsche Forschungsgemeinschaft, Germany, (Heisenberg Program).

The authors have no conflict of interest to disclose.

Received January 10, 2017

Accepted May 26, 2017

© Crohn's & Colitis Foundation
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