Abstract
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.