برنامه های مدیریت استرس برای بیماری کرون

The present study was designed to assess the effectiveness of techniques of behavioural assessment and treatment of Crohn’s disease (CD). On the assumption that stress events have a pronounced influence on the life of Crohn’s patients, we proposed stress management treatment. This is intended to control stress and improve patients’ personal and social competence. Forty-five patients with Crohn’s disease were randomly assigned to one of three treatment groups, two experimental groups: stress management and self-directed stress management, and a control group: conventional medical treatment. The subjects underwent eight individual sessions which were specific to each condition. All subjects completed symptom monitoring diaries. The subjects who received training in stress management experienced a significant post-treatment reduction of tiredness (P<0.1), constipation (P<0.1), abdominal pain (P<0.5) and distended abdomen (P<0.5). The subjects who received training in self-directed stress management experienced a significant reduction in tiredness (P<0.1) and abdominal pain (P<0.5). No significant changes were observed in symptomatology in the conventional medical treatment group. Similar results were obtained in the 12 month follow-up.

Crohn’s disease (CD) involves an inflammatory process which begins under the mucosa and spreads outward, penetrating all layers of the bowel, causing submucosal inflammation and edema. This leads to thickening of the bowel wall, which, along with scarring, may cause bowel obstruction. CD usually affects the lower ileum, but may occur in any part of the gastrointestinal tract from the esophagus to the rectum. It may also occur in two or more sites separated by healthy tissue. The clinical course of the disease is commonly marked by periods of remission and exacerbation. CD is primarily characterized by diarrhoea, abdominal pain, weight loss and fever. Patients also frequently develop fistulas extending to the bladder or/and to the surface of the skin. CD affects about 56% of patients before the age of 22, with a similar incidence in both sexes. Evidence suggests that the global incidence of this disease is on the increase (Irvine, Farrokhyar and Swarbrick, 2001, Pajares and Gisbert, 2001 and Sonnenberg, McCarty and Jacobsen, 1991). In Asturias (Spain), the incidence from 1965 to 1975 was 0.48 per 100,000 inhabitants/year whereas from 1975 to 1985 this figure had increased to 1.9 (Martínez, Fernández, Rodrigo and Martínez, 1983 and Saro, Argüelles, Alvarez and Diaz, 1986).

The objective of this study was, first of all, to assess the effectiveness of a stress management treatment programme, comparing it with the effectiveness of conventional medical treatment; and second, to identify the differential effectiveness of a self-applied stress management programme and stress management treatment supervised by a therapist. According to the results of patients’ demographic data (age: 31.7±7.6, and sex: 64% women and 36% males) and clinical data (symptoms, number of outbreaks/year: 1±1, associated complications: 27%, family antecedents: 28.8%, medication, etc.), the sample can be considered representative of CD patients, as described in the literature. Results on the course of the symptomatology were very revealing, though are open to several interpretations. On the whole, medical treatment plus psychological treatment is seen to be more effective than medical intervention alone. The benefits of psychological treatment were confirmed by the fact that the good results obtained at the end of the psychological treatment were maintained, with only a very slight variation, after the 1 year of follow-up compared to no improvement in patient course in the control group (Table 2). In the latter group, some patients worsened and others improved, but all cases fell within normal clinical evolution (with periods of remission and other of relapse). The MANOVA contrast polynomial in Table 7 showed this cubic or linear tendency. The following section includes a detailed description of the results obtained for the different treatment groups at the different assessment times (Table 4 and Table 5).