A Pilot Study of the Real-World Impact of Digital Cognitive Behavioral Therapy for Inflammatory Bowel Disease (COMPASS-IBD) on Inflammation, Disease Activity, and Healthcare Use.

OBJECTIVE

Inflammatory bowel disease (IBD) is commonly accompanied by psychological distress, which may worsen disease activity through gut-brain axis mechanisms. Psychological interventions including cognitive behavioral therapy (CBT) seem to reduce distress and inflammation in IBD. However, accessibility to psychological care remains limited. COMPASS-IBD, a digital CBT intervention tailored to IBD, aims to address these gaps.This nested exploratory, real-world study (NCT05330299) assessed the effectiveness of COMPASS-IBD in reducing inflammation, disease activity, and health care use in IBD patients. In addition, it examined relationships between changes in psychological distress and disease indicators.

METHODS

Adults with IBD experiencing psychological distress were recruited from a large gastroenterology service, and enrolled in COMPASS-IBD. Disease-related primary outcomes were faecal calprotectin (FCP), C-reactive protein (CRP), and self-reported disease activity (SRDA). Secondary outcomes included other inflammatory biomarkers (neutrophils, monocytes, lymphocytes, white blood cells (WBC), ferritin, flare frequency, and health care usage. The Patient Health Questionnaire-Anxiety and Depression Scale (PHQ-ADS) measured distress. Mixed-effects models evaluated outcomes at baseline, 12 weeks, and 6 months.

RESULTS

Sixty-five participants were included. There were significant reductions in CRP ( d range: -0.47 to -0.53, P <.01), but not FCP ( d range: -0.38 to -0.44, P <.10) or SRDA ( d =-0.28, P =.08). Significant improvements were observed in WBC and neutrophil counts ( P <.05), flare frequency ( P <.01), and psychological distress ( P <.001). Some types of health care usage were reduced ( P <.05). Associations between distress and primary outcomes were nonsignificant.

CONCLUSIONS

This pilot suggests COMPASS-IBD may reduce inflammation levels, health care use, and psychological distress. However, analyses were underpowered. Larger randomized trials are needed to confirm findings, establish cost-effectiveness, and explore underlying gut-brain mechanisms.