Randomised clinical trial: Psychological intervention improves work productivity and daily activity by reducing abdominal pain and fatigue in Crohn's disease.

BACKGROUND: Chronic abdominal pain and fatigue are characteristics of Crohn's disease (CD) and contribute to functional impairments. AIMS: To examine whether CD-tailored cognitive-behavioural and mindfulness intervention (COBMINDEX) is effective in reducing abdominal pain and fatigue in patients with CD and whether changes in abdominal pain and fatigue mediate any beneficial effects of COBMINDEX on impairments in work productivity and daily activities. METHODS: This is a secondary analysis of a parallel-group multicentre randomised controlled trial. Patients with mild-to-moderate CD (n = 142) were randomised into either intervention group receiving COBMINDEX, or control group receiving treatment-as-usual for 3 months followed by COBMINDEX. Complete data were collected from 120 patients (34.0 ± 10.7 years, 62.5% female, intervention = 60, control = 60). Analysis of covariance assessed group differences in 3-month follow-up scores, controlling for baseline scores. Multiple parallel mediation analysis assessed the proposed mechanisms for the entire sample. RESULTS: The intervention group demonstrated significantly lower levels of abdominal pain (F = 17.46, p < 0.001, η2 p  = 0.13), fatigue (F = 7.26, p = 0.008, η2 p  = 0.06) and impairments at work (F = 4.82, p = 0.032, η2 p  = 0.07) and daily activities (F = 6.26, p = 0.014, η2 p  = 0.05), compared with treatment-as-usual. Moreover, changes in abdominal pain and fatigue significantly mediated the beneficial effects of COBMINDEX on patients' work productivity (b = -9.90, SE = 2.86, 95% CI: -16.11 to -4.94) and daily activities (b = -9.65, SE = 1.91, 95% CI: -13.77 to 6.35), independent of changes in disease activity. CONCLUSIONS: COBMINDEX is effective at reducing abdominal pain and fatigue in patients with CD, which in turn leads to improvement in functioning. Clinicians should incorporate screening for severe abdominal pain and fatigue and consider offering cognitive-behavioural and mindfulness training. CLINICALTRIALS: gov, Number: NCT05085925. Ministry of Health in Israel (https://my.health.gov.il/CliniTrials/Pages/MOH_2020-02-24_008721.aspx).

Brain-immune axis regulation is responsive to cognitive behavioral therapy and mindfulness intervention: Observations from a randomized controlled trial in patients with Crohn's disease.

BACKGROUND AND AIMS: Crohn's disease (CD) is a chronic inflammatory bowel disease associated with psychological stress that is regulated primarily by the hypothalamus-pituitary-adrenal (HPA) axis. Here, we determined whether the psychological characteristics of CD patients associate with their inflammatory state, and whether a 3-month trial of cognitive-behavioral and mindfulness-based stress reduction (COBMINDEX) impacts their inflammatory process. METHODS: Circulating inflammatory markers and a wide range of psychological parameters related to stress and well-being were measured in CD patients before and after COBMINDEX. Inflammatory markers in CD patients were also compared to age- and sex-matched healthy controls (HCs). RESULTS: CD patients exhibited increased peripheral low-grade inflammation compared with HCs, demonstrated by interconnected inflammatory modules represented by IL-6, TNFα, IL-17, MCP-1 and IL-18. Notably, higher IL-18 levels correlated with higher score of stress and a lower score of wellbeing in CD patients. COBMINDEX was accompanied by changes in inflammatory markers that coincided with changes in cortisol: changes in serum levels of cortisol correlated positively with those of IL-10 and IFNα and negatively with those of MCP-1. Furthermore, inflammatory markers of CD patients at baseline predicted COBMINDEX efficacy, as higher levels of distinct cytokines and cortisol at baseline, correlated negatively with changes in disease activity (by Harvey-Bradshaw Index) and psychological distress (global severity index measure) following COBMINDEX. CONCLUSION: CD patients have a characteristic immunological profile that correlates with psychological stress, and disease severity. We suggest that COBMINDEX induces stress resilience in CD patients, which impacts their well-being, and their disease-associated inflammatory process.

Normative data for the Brief Symptom Inventory for patients with Crohn's disease.

OBJECTIVE: The Brief Symptom Inventory (BSI) is a self-report measure of psychological symptoms in clinical and non-clinical populations. However, norms for BSI are lacking for patients with chronic illness, such as Crohn's disease (CD). This study aimed to provide BSI clinical norms using a cohort of CD patients. DESIGN: Adult Israeli CD patients (n = 430) completed questionnaires regarding clinical, demographic and psychological aspects of disease, including BSI. Their BSI data were compared with published norms from adult Israeli population and British psychiatric outpatients. RESULTS: CD patients in active disease state had higher levels of mental health symptoms than those in remission. Interestingly, levels of symptomatology did not differ with respect to disease duration. No significant sex differences in BSI dimensions were found, with the exception of somatization. Being younger than 60 years and having lower economic status were associated with more severe psychological symptoms. Psychological symptom levels in CD patients were high in comparison to the Israeli general population, but low compared to British psychiatric outpatients. CONCLUSION: Results confirm the link between CD and elevated psychological symptoms. The findings highlight the need to use appropriate BSI norms when assessing clinically significant levels of psychological symptoms in non-psychiatric patients with chronic illness.

Randomized Controlled Trial of Cognitive-Behavioral and Mindfulness-Based Stress Reduction on the Quality of Life of Patients With Crohn Disease.

BACKGROUND: Patients with Crohn disease have debilitating psychological symptoms, mental fatigue, and poor quality of life. Psychological intervention may improve these symptoms. METHODS: We performed a randomized parallel-group physician-blinded trial of cognitive-behavioral and mindfulness-based stress reduction (COBMINDEX) on quality of life and psychological symptoms in adults with mild-moderate Crohn disease. COBMINDEX was taught by social workers in one-on-one video conferences over 3 months; quotidian home practice was mandated. RESULTS: Fifty-five COBMINDEX and 61 waitlist control patients completed the study; mean age was 33 years and 65% of participants were women. At 3 months, COBMINDEX patients had significantly reduced disease activity (per Harvey-Bradshaw Index score, C-reactive protein level, and calprotectin level), increased quality of life (Short Inflammatory Bowel Disease Questionnaire [SIBDQ] score increased from baseline 41 to 50; P < 0.001), decreased psychological symptoms (Global Severity Index [GSI], 0.98-0.70; P < 0.001), reduced fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue, 26-33; P < 0.001), and increased mindfulness disposition (Freiburg Mindfulness Inventory, 33-38; P < 0.001). Waitlist patients had a significant but small change in Harvey-Bradshaw Index, SIBDQ, and GSI scores, without improvement in fatigue or mindfulness. There were significant correlations (0.02 > P < 0.002) in COBMINDEX patients between baseline SIBDQ, GSI, Freiburg Mindfulness Inventory, and Functional Assessment of Chronic Illness Therapy-Fatigue scores with a relative change (baseline to 3 months) of the SIBDQ score, but none among waitlist patients. Predictors of relative change of the SIBDQ score in COBMINDEX patients included the GSI score (90% quantile; coefficient 0.52; P < 0.001), somatization (90%; 0.20; P = 0.001), depression (75%; 0.16; P = 0.03), and phobic anxiety (75%; 0.31; P = 0.008). CONCLUSIONS: COBMINDEX was effective in increasing patients' quality of life and reducing psychological symptoms and fatigue. Patients with severe baseline psychological symptoms benefited the most from COBMINDEX.

Differential relationships of somatization, depression, and anxiety to severity of Crohn's disease.

Patients with Crohn's disease, an inflammatory bowel disease, struggle with chronic somatic symptoms that could bring about emotional distress. This study assessed the relative role of somatization, and depressive and anxiety symptoms in disease activity among 619 Crohn's patients (18-79 years; 58.3% women). Structural equation modeling revealed that somatization was the only unique predictor of disease activity beyond depression and anxiety. In addition, the effect of somatization on disease activity was stronger in men compared to women. Findings suggest that somatization represents a distinct domain of psychological distress that may play a role in the health of patients with Crohn's disease.

Sorrow shared is halved? War trauma experienced by others and mental health among Darfuri asylum seekers.

Research suggests that the ethnic community plays a major role in the mental health of traumatized refugees arriving from collective societies. This study explored the relationships between war-related trauma and mental health separately for direct trauma exposure (i.e., events directly endorsed by asylum-seekers) and indirect trauma exposure (i.e., events endorsed by family, friends and other community members). Data for 300 Darfuri asylum-seekers living in Israel were obtained in a cross-sectional design. Hierarchical regressions were used to examine how direct versus indirect trauma exposure were associated with posttraumatic stress disorder (PTSD), depressive and anxiety symptoms and psychological well-being. Results showed that direct trauma exposure was associated with worse mental health symptoms and reduced well-being. In contrast, indirect trauma exposure to similar events of others was linked with fewer PTSD, depressive and anxiety symptoms and improved well-being. These findings offer preliminary insights into the nature of trauma and mental health in asylum-seekers from collective cultures: While trauma directly experienced by the individual is associated with increased risk for poor mental health; exposure to others' similar experiences may be associated with reduced emotional distress. Findings are discussed in terms of their potential implications for culturally sensitive assessment and group therapy in refugees.

Trauma and mental health in Darfuri asylum seekers: The effect of trauma type and the mediating role of interpersonal sensitivity.

BACKGROUND: Previous research has well documented the negative effect of exposure to war trauma on refugees' mental health. However, few prior investigations have examined the nature of the traumatic events and the potential mechanisms involved. METHODS: This study explored the mediating role of interpersonal sensitivity in the relationship between exposure to different types of war traumas and psychological stress in a community sample of 300 Darfuri asylum seekers living in Israel. RESULTS: A principal component analysis on a set of 17 traumatic experiences identified four trauma dimensions: War-exposure, Life-threat, Torture-Assault and Sexual-violence. Hierarchical regressions showed that only degree of exposure to Life-threat trauma was a significant predictor of PTSD and depressive symptom severity. Mediation analyses further revealed that interpersonal sensitivity partially mediated the association between exposure to life threat and PTSD symptoms and fully mediated the relation between exposure to life threat and depressive symptoms. LIMITATIONS: The current study was limited by the use of self-report measures and cross-sectional design. CONCLUSIONS: Our findings stress the importance of taking into account the nature of war events and the presence of negative beliefs about oneself within interpersonal interactions when studying mental health outcomes in traumatized refugees. Implications for theory, clinical practice and future research are discussed.

Crash risk by driver age, gender, and time of day using a new exposure methodology.

INTRODUCTION: Concerns have been raised that the nonlinear relation between crashes and travel exposure invalidates the conventional use of crash rates to control for exposure. A new metric of exposure that bears a linear association to crashes was used as basis for calculating unbiased crash risks. This study compared the two methods - conventional crash rates and new adjusted crash risk - for assessing the effect of driver age, gender, and time of day on the risk of crash involvement and crash fatality. METHOD: We used police reports of single-car and multi-car crashes with fatal and nonfatal driver injuries that occurred during 2002-2012 in Great Britain. RESULTS: Conventional crash rates were highest in the youngest age group and declined steeply until age 60-69 years. The adjusted crash risk instead peaked at age 21-29 years and reduced gradually with age. The risk of nighttime driving, especially among teenage drivers, was much smaller when based on adjusted crash risks. Finally, the adjusted fatality risk incurred by elderly drivers remained constant across time of day, suggesting that their risk of sustaining a fatal injury due to a crash is more attributable to excess fragility than to crash seriousness. CONCLUSIONS: Our findings demonstrate a biasing effect of low travel exposure on conventional crash rates. This implies that conventional methods do not yield meaningful comparisons of crash risk between driver groups and driving conditions of varying exposure to risk. The excess crash rates typically associated with teenage and elderly drivers as well as nighttime driving are attributed in part to overestimation of risk at low travel exposure. Practical Applications: Greater attention should be directed toward crash involvement among drivers in their 20s and 30s as well as younger drivers. Countermeasures should focus on the role of physical vulnerability in fatality risk of elderly drivers.

What are the factors that contribute to road accidents? An assessment of law enforcement views, ordinary drivers' opinions, and road accident records.

What are the main contributing factors to road accidents? Factors such as inexperience, lack of skill, and risk-taking behaviors have been associated with the collisions of young drivers. In contrast, visual, cognitive, and mobility impairment have been associated with the collisions of older drivers. We investigated the main causes of road accidents by drawing on multiple sources: expert views of police officers, lay views of the driving public, and official road accident records. In Studies 1 and 2, police officers and the public were asked about the typical causes of road traffic collisions using hypothetical accident scenarios. In Study 3, we investigated whether the views of police officers and the public about accident causation influence their recall accuracy for factors reported to contribute to hypothetical road accidents. The results show that both expert views of police officers and lay views of the driving public closely approximated the typical factors associated with the collisions of young and older drivers, as determined from official accident records. The results also reveal potential underreporting of factors in existing accident records, identifying possible inadequacies in law enforcement practices for investigating driver distraction, drug and alcohol impairment, and uncorrected or defective eyesight. Our investigation also highlights a need for accident report forms to be continuously reviewed and updated to ensure that contributing factor lists reflect the full range of factors that contribute to road accidents. Finally, the views held by police officers and the public on accident causation influenced their memory recall of factors involved in hypothetical scenarios. These findings indicate that delay in completing accident report forms should be minimised, possibly by use of mobile reporting devices at the accident scene.

Cue response dissociates inhibitory processes: task identity information is related to backward inhibition but not to competitor rule suppression.

In task switching, a conflict between competing task-sets is resolved by inhibiting the interfering task-set. Recent models have proposed a framework of the task-set as composed of two hierarchical components: abstract task identity (e.g., respond to quantity) and more concrete task rules (e.g., category-response rules mapping the categories "one" and "three" to the left and right keys, respectively). The present study explored whether task-set inhibition is the outcome of a general control process or whether it reflects multiple inhibitory processes, each targeting a different component of the competing task-set. To this end, two effects of task-set inhibition were examined: backward inhibition (BI), reflecting the suppression of a just-performed task-set that is no longer relevant; and, competitor rule suppression (CRS), reflecting the suppression of an irrelevant task-set that generates a response conflict. In two task switching experiments, each involving three tasks, we asked participants to make two responses: a cue response, indicating the identity of the relevant task (e.g., "Color"), and a target response requiring the implementation of the task rule (e.g., "Red"). The results demonstrate that BI, but not CRS, appears in cue responses, and thus, suggests that BI reflects inhibition that influences representations related to abstract task identity, rather than (just) competing responses or response rules. These results support a dissociation between inhibitory processes in task switching. The current findings also provide further evidence for a multi-component conceptualization of task-set and task-set inhibition.

Cue-type manipulation dissociates two types of task set inhibition: backward inhibition and competitor rule suppression.

Backward inhibition (BI) reflects the suppression of a recently abandoned task set to allow for smooth transition to a new task even when the rules do not generate a response conflict. Competitor rule suppression (CRS) reflects the inhibition/suppression of irrelevant task rules when these rules generate a response conflict even if they have not recently been abandoned. We assessed whether BI and CRS are differentially affected by the difficulty in retrieving category-response mappings from memory. Retrieval demands were manipulated via the information provided by the task cues, which either indicated the relevant dimension (dimension cues; "color") or the relevant dimension with its category-to-key mapping (mapping cues; "red green", indicating that "red" and "green" go with the left/right responses, respectively). CRS was larger with dimension compared to mapping cues when cue-type varied between groups and was larger after trials involving dimension cues when cue-type varied on a trial-by-trial basis. In contrast, BI was not influenced by cue-type. These results suggest that task switching involve at least two distinct inhibitory processes, with CRS being related to the ease of retrieval of category-response mappings from memory.

Post-error slowing is influenced by cognitive control demand.

Post-error slowing (PES) has been shown to reflect a control failure due to automatic attentional capture by the error. Here we aimed to assess whether PES also involves an increase in cognitive control. Using a cued-task-switching paradigm (Experiment 1) and a Stroop task (Experiment 2), the demand for top down control was manipulated. In Experiment 1, one group received dimension cues indicating the relevant stimulus dimension (e.g., "number") without specifying the response-category-to-key mapping, hence requiring considerable top down control. Another group was shown mapping cues providing information regarding both the relevant task identity and its category-to-key mapping (e.g., "one three"), requiring less top down control, and the last group received both types of cues, intermixed. In Experiment 2, one group performed a pure incongruent Stroop condition (name ink color of incongruent color names, high control demand), and another group received a pure neutral Stroop condition (name color patches, low control demand). In Experiment 2a, participants received the two conditions, intermixed. A larger PES was observed with dimension cues as compared with mapping cues, and with incongruent Stroop stimuli as compared to neutral stimuli, but not when the conditions were intermixed. These findings reveal that PES is influenced by the control demands that characterize the given block-wide experimental context and show that proactive cognitive control is involved in PES.