Efficacy of psychotherapies in individuals with inflammatory bowel disease: A systematic review and meta-analysis

Abstract

BACKGROUND

Previous systematic reviews focused mainly on psychological health outcomes, with limited and non-systematic evaluations of biological markers reflecting gut-brain interactions. As psychotherapies are increasingly used as adjunctive treatments for inflammatory bowel disease (IBD), a multidimensional evaluation of outcomes is warranted. This systematic review and meta-analysis examined quality of life, psychological symptoms, and clinical/inflammatory outcomes in patients with IBD. We hypothesized that psychotherapy primarily affects subjective outcomes rather than objective clinical or inflammatory measures.

AIM

To investigate the efficacy of psychotherapies vs control conditions in patients with IBD.

METHODS

A comprehensive search of the EMBASE, PubMed, and Cochrane Library databases was conducted, and randomized controlled trials comparing the efficacy of psychotherapeutic interventions with that of usual interventions in patients with IBD were included. Two reviewers independently screened the records and extracted the data. Effect estimates were synthesized using a random-effects model, and heterogeneity was quantified by the I² statistic; risk of bias was assessed using the Cochrane Risk of Bias tool. In total, 29 studies involving 2426 patients were included.

RESULTS

Psychotherapies improved the IBD Questionnaire total score [standardized mean difference (SMD) = 0.23, 95%CI: 0.06-0.40; P = 0.007; I² = 29%]. This overall gain was driven by significant improvements in the emotional (SMD = 0.43, 95%CI: 0.19-0.67; P = 0.0006; I² = 50%) and systemic domains (SMD = 0.30, 95%CI: 0.08-0.52; P = 0.007; I² = 39%), while there was no significant difference in bowel symptoms, and the heterogeneity was high (I² = 90%). Social function was not significantly different. Psychotherapy also modestly reduced anxiety (SMD = -0.29, 95%CI: -0.51 to -0.07; P = 0.01) and depression (SMD = -0.26, 95%CI: -0.41 to -0.11; P = 0.0006).

CONCLUSION

Psychotherapy improves quality of life in patients with IBD and reduces anxiety and depression, supporting its use as an adjunct to standard care to enhance overall well-being.

Key Words: Inflammatory bowel disease; Psychotherapy; Cognitive behavioral therapy; Quality of life; Anxiety; Depression; Randomized controlled trials; Systemic review; Meta-analysis

Core Tip: The gut-brain axis may explain why psychotherapies benefit patients with inflammatory bowel disease beyond symptom control. This meta-analysis integrates randomized evidence across disease-specific quality of life and psychological, clinical, and inflammatory outcomes. Psychotherapy shows the most consistent gains in patient-reported outcomes, particularly in the emotional and systemic quality-of-life domains, with modest improvements in anxiety and depression. In contrast, the effects on disease activity and systemic inflammatory markers are limited. These findings support psychotherapy as adjunctive inflammatory bowel disease care and underscore priorities for future trials, including standardized outcomes, longer follow-up, and gut-specific biomarkers.

INTRODUCTION

Inflammatory bowel disease (IBD), encompassing Crohn’s disease (CD) and ulcerative colitis (UC), is a chronic relapsing inflammatory condition of the gastrointestinal tract[1]. In the first half of the 20^th century, IBD was regarded as a “Western disease” due to its extreme rarity in Asia and Africa[2]. However, over the past decade, several countries have shown epidemiological trends, and IBD has become a growing global public health challenge[3,4]. The increasing prevalence of IBD places a significant burden on individuals and health care systems: Patients suffer from chronic symptoms such as abdominal pain, diarrhea, fatigue, and psychological problems, which can severely impair quality of life[5-7], and health care systems are under pressure owing to the costs of frequent medical follow-up, hospitalization, and surgery[8,9]. Although multiple therapeutic options are available for IBD, achieving sustained disease remission remains challenging[10]. Conventional medications provide some relief of symptoms and control of inflammation, but a significant percentage of patients continue to suffer from psychological problems[11]. Some studies suggest that the underlying mechanism is bidirectional communication of the gut-brain axis[12]. The human intestine is inhabited by various microorganisms that coexist in a mutually beneficial symbiosis under normal conditions. However, the intestines of IBD patients are subject to chronic inflammation, and the balance of the intestinal microflora is disrupted, resulting in the abnormal synthesis of neurotransmitters that act on the enteric nervous system and indirectly affect the brain[13]. Therefore, psychological therapy has become an important focus in IBD management and is widely accepted as a complementary therapy to conventional drug treatment[14].

Previous systematic reviews and meta-analyses have focused mainly on mental health outcomes, with limited attention and a lack of systematic evaluation of biomarkers that may reflect gut-brain axis interactions. To advance beyond existing work, we integrate the available literature data through systematic review and meta-analysis methods to explore the effects of psychotherapeutic interventions on multidimensional outcomes in patients with IBD. In addition to psychological indicators (anxiety, depression, and stress), we synthesized disease-specific quality of life not only as an overall measure but also in terms of four key domains [the IBD Questionnaire (IBDQ) total score and subscales] and further evaluated clinical and inflammatory outcomes where available, including the CD Activity Index (CDAI), C-reactive protein (CRP), and interleukin-6 (IL-6). By integrating findings across these different levels, this study clarifies the outcome profile of psychotherapy in IBD and highlights the clinical relevance of gut-brain interactions, thereby informing future research on therapeutic strategies that complement inflammation-focused treatment with interventions targeting psychosocial and neurobiological pathways.

MATERIALS AND METHODS

Search strategy

This systematic review and meta-analysis was conducted in accordance with the PRISMA 2020 statement[15], and the protocol was registered in PROSPERO. We searched PubMed, EMBASE, and the Cochrane Library from inception to October 4, 2025. Only articles published in English were included. A comprehensive literature search was conducted using the terms “cognitive therapy”, “behavior therapy”, “relaxation techniques”, “mindfulness”, “meditation”, “hypnosis”, “hypnotherapy”, “music therapy”, and “psychothera” as Title/Abstract free-text terms, together with the MeSH heading “psychotherapy”. These terms were combined via the set operator AND, with studies identified using the MeSH headings “colitis, ulcerative” and “inflammatory bowel diseases” and the Title/Abstract free-text terms “colitis gravis”, “idiopathic proctocolitis”, “inflammatory bowel disease, ulcerative colitis type”, “ulcerative colitis”, “inflammatory bowel disease”, “bowel diseases, inflammatory”, “colitis”, and “ileitis”. Two reviewers independently screened the titles/abstracts and full texts. Any disagreements were resolved through discussion between the two reviewers.

Study selection

Studies that met the following PICOS criteria were included: (1) P: Patients with IBD (UC or CD); (2) I: Psychological interventions, including cognitive behavioral therapy, relaxation therapy, mindfulness-based interventions, meditation, or hypnotherapy; (3) C: Conventional treatment, routine care, waiting-list control, health education, or other psychotherapeutic interventions; (4) O: Outcomes related to quality of life, anxiety, depression, and stress; and (5) S: Randomized controlled trials (RCTs).

Data extraction and risk of bias assessment

Two reviewers independently extracted data from each included RCT using a standardized data extraction form. The extracted information included study characteristics; participant information; intervention and comparator details; and primary outcomes such as quality of life, anxiety, depression, stress, and clinical disease activity. Where available, outcome data were extracted according to the intention-to-treat principle; per-protocol data were used when the intention-to-treat results were not reported.

The risk of bias for each included RCT was assessed by the Cochrane Risk of Bias tool, covering bias from the randomization process, deviations from intended interventions, missing outcome data, outcome measurement, and selection of the reported results[16]. Each domain was rated as having low risk, some concerns, or high risk of bias[17]. The details are shown in Supplementary Figures 1 and 2[18-46]. Any discrepancies between the two reviewers were resolved by discussion or consultation with a third reviewer.

Statistical analysis

All the statistical analyses were performed using Review Manager (version 5.4; Cochrane Collaboration). For continuous outcomes such as quality of life, anxiety, depression, and stress scores, standardized mean differences (SMDs) with 95%CI were calculated. The therapeutic effects of the psychological interventions compared with those of the control conditions were evaluated using risk ratios and corresponding 95%CIs. A random-effects model was used to account for potential heterogeneity among the studies. Statistical heterogeneity was assessed using the χ² test and quantified with the I² statistic, with I² values of 0%-24%, 25%-49%, 50%-74%, and ≥ 75% indicating no, low, moderate, and high heterogeneity, respectively[47]. Publication bias was visually assessed using funnel plots. A P value < 0.05 was considered to indicate statistical significance.

RESULTS

Study selection and characteristics

As shown in Figure 1, 2030 records were initially retrieved from three electronic databases, namely, PubMed (n = 641), the Cochrane Library (n = 452), and EMBASE (n = 937). After 305 duplicates were removed, 1725 records were screened on the basis of titles and abstracts, resulting in the exclusion of 1690 articles that did not meet the inclusion criteria. The full texts of the remaining 35 articles were reviewed in detail for eligibility. Among these, four studies were excluded because they contained no usable numerical data (n = 4), and one was a meta-analysis that had already incorporated all eligible studies (n = 1) or used data already included in another study (n = 1). Ultimately, 29 studies involving 2426 patients were included in this analysis[18-46].

Figure 1 Preferred Reporting Items for Systematic Reviews and Meta-analyses flow diagram of study selection. Flowchart showing the number of records identified, screened, excluded (with reasons), and included in the review and meta-analysis.

Figure 2 Forest plots of randomized controlled trials reporting the effect of psychological therapy vs control on Inflammatory Bowel Disease Questionnaire subscale scores in individuals with inflammatory bowel disease at completion of therapy. A: Inflammatory Bowel Disease Questionnaire (IBDQ) bowel score; B: IBDQ emotional score; C: IBDQ social score; D: IBDQ systemic score. Squares represent study-specific effect sizes, horizontal lines represent 95%CIs, and diamonds represent pooled effects. Positive standardized mean differences favor psychological therapy.

Figure 3 Forest plot of randomized controlled trials reporting the effect of psychological therapy vs control on anxiety scores and depression scores in individuals with inflammatory bowel disease at completion of therapy. A: Anxiety scores; B: Depression scores. Negative standardized mean differences favor psychological therapy.

An overview of the characteristics of the 29 studies is shown in Supplementary Table 1[18-46]. The included studies were conducted across a wide range of countries, most frequently the United Kingdom (n = 4), the Netherlands (n = 5), and the United States (n = 5), followed by Germany (n = 2), Israel (n = 2), Australia (n = 3), New Zealand (n = 1), Ireland (n = 1), Spain (n = 1), Canada (n = 1), China (n = 1), and Italy (n = 1). Some studies were multinational, including one trial conducted across Norway and Germany and one conducted jointly in Australia and New Zealand. The study incorporated a broad range of psychological interventions. For clarity, these interventions are generally categorized into five types: (1) Cognitive behaviour-based therapies; (2) Mindfulness-based or acceptance-based programs; (3) Stress-management or coping skills training; (4) Supportive or counselling approaches; and (5) Internet-delivered or blended psychological interventions. These categories varied in terms of intervention dose, delivery format, baseline characteristics, and control conditions, which may have contributed to heterogeneity across outcomes.

Primary outcome

As shown in Supplementary Figure 3[20,21,23,25-28,30,32,33,36,40], 12 RCTs reported data on the effect of psychological therapy on disease-specific quality of life. At the completion of treatment, data from a total of 927 individuals were available for analysis. The results revealed a significant improvement in the overall IBDQ score for the experimental group compared with that for the control group (SMD = 0.23, 95%CI: 0.06-0.40; P = 0.007). Heterogeneity across studies was negligible (I² = 29%), indicating low variability among trials. Apart from a few studies that demonstrated a significant positive effect, most studies showed only a small, nonsignificant effect.

Secondary outcomes

IBDQ subscales: The IBDQ is a multidimensional scale specifically designed to assess the disease-specific quality of life of patients with IBD and consists of four dimensions: (1) Intestinal symptoms; (2) Systemic symptoms; (3) Emotional function; and (4) Social function. The subscale scores together constitute the total IBDQ score. Each dimension reflects patients’ impaired functioning and changes in disease activity in different life domains. Therefore, on the basis of an analysis of the IBDQ total score as the primary outcome, this study further examined the results of the four IBDQ subscales to explore the effects of psychotherapy on the various dimensions.

As shown in Figure 2A, a total of six RCTs reported the effect of psychotherapy on the IBDQ bowel score in patients with IBD[20,23,26,27,32,40]. Compared with patients receiving usual care, patients receiving psychotherapy had slightly higher IBDQ bowel symptom scores (SMD = 0.34), suggesting a trend towards improvement. However, as the confidence interval included zero and the P value exceeded 0.05, the difference was not statistically significant. In addition, the heterogeneity test yielded I² = 90%, indicating considerable variability among the studies. Therefore, while psychotherapy may offer modest improvements in bowel symptoms, the evidence to date is insufficient to establish its significant efficacy in patients with IBD.

IBD patients who received psychological therapy showed a significant positive improvement in the emotional dimension score of the IBDQ (SMD = 0.43; 95%CI: 0.19-0.67; P = 0.0006; Figure 2B)[20,23,26,27,32,36,40]. Most studies reported superior outcomes in the psychological therapy group. Heterogeneity analysis revealed I² = 50%, suggesting moderate heterogeneity across studies, and the χ² test (χ² = 12.03, P = 0.06) did not indicate significant heterogeneity. Therefore, despite some internal study variability, the overall findings consistently support the beneficial effect of psychological therapy on improving emotional functioning in patients with IBD.

Patients with IBD who underwent psychological therapy exhibited slight improvements in the social function dimension score of the IBDQ, but these improvements were not statistically significant (SMD = 0.15, 95%CI: -0.01 to 0.32; P = 0.07; Figure 2C)[20,23,26,27,32,36,40]. Across individual trials, effect estimates generally favored psychological therapy but were small and not statistically significant, with good consistency across studies (I² = 0%). Overall, psychological therapy may provide a modest benefit in improving social functioning, but the current evidence remains insufficient to support a significant effect.

A total of seven RCTs reported the effects of psychological therapy on IBDQ systemic scores in patients with IBD at the end of treatment. On the basis of pooled data from 591 participants, psychological therapy significantly improved IBDQ systemic scores (SMD = 0.30, 95%CI: 0.08-0.52; P = 0.007; Figure 2D), suggesting that it has a positive effect on alleviating overall IBD symptoms[20,23,26,27,32,36,40]. The study by Keefer et al[23] reported the greatest effect size. Other studies showed a tendency towards improvement, although the differences were not statistically significant. Heterogeneity analysis indicated a low level of variability across studies (I² = 39%, P = 0.007). Overall, despite some differences among individual studies, psychological therapy consistently significantly improved overall symptoms in patients with IBD.

Psychological outcomes: In addition to disease-specific quality-of-life measures, several psychological outcomes were assessed to further evaluate the effects of psychological therapy on the mental health of patients with IBD. These included anxiety, depression, and stress scores, which provide complementary insight into the psychological dimensions of treatment efficacy.

In evaluating the impact of psychological therapy on anxiety symptoms in IBD patients, the results revealed that compared with the control group, the psychotherapy group had better outcomes (SMD = -0.29, 95%CI: -0.51 to -0.07; P = 0.01; Figure 3A)[19,29,31,32,34-36,39,40,43-45]. Some studies, such as that of Wynne et al[34], showed significant negative effect sizes, indicating that psychological therapy markedly reduces anxiety symptoms. Heterogeneity analysis revealed I² = 76%, indicating considerable variability between studies, and determining that χ² = 46.72 (P < 0.00001) further confirmed the significant heterogeneity. In summary, the results still support the effectiveness of psychological therapy in improving anxiety symptoms in IBD patients, particularly in studies showing significant positive effects.

A total of 13 RCTs reported on the effect of psychotherapy on depression scores in patients with IBD, and after pooling the results from 1453 subjects, depression scores were significantly lower in the psychotherapy group than in the control group (SMD = -0.26; 95%CI: -0.41 to -0.11; P = 0.0006; Figure 3B)[19,24,29,31,32,34-36,39,40,43-45]. Almost all the studies reported negative SMD values, suggesting lower depression scores in the psychological therapy group than in the control group. I² indicated low between-study heterogeneity (48%), and the χ² test indicated some variability (χ² = 23.30, df = 12, P = 0.03), although effect estimates generally pointed in the same direction across trials. Visual inspection of the funnel plot did not suggest marked small-study effects or publication bias for this outcome (Supplementary Figure 4). Overall, these findings indicate that psychotherapy modestly alleviates depressive symptoms.

With respect to stress symptoms, current evidence is insufficient to confirm that psychological therapy has a significant effect on reducing stress in IBD patients. The results revealed some improvement in stress reduction in the experimental group (SMD = -0.44; 95%CI: -1.39 to 0.50; P = 0.36; Supplementary Figure 5), but the difference did not reach statistical significance[24,29,34,45]. Although some studies have shown that psychological therapy significantly reduces stress, the confidence interval crosses zero, suggesting that the effect of psychological therapy on stress reduction is weak and not statistically significant. Moreover, the heterogeneity between studies is high (I² = 93%), indicating substantial variation in results across different studies.

Clinical and inflammatory outcomes: Following the assessment of psychological and quality-of-life outcomes, this section focuses on clinical and inflammatory parameters to determine whether psychological therapy exerts measurable effects on disease activity and systemic inflammation in patients with IBD.

The CDAI is one of the gold-standard measures for assessing disease activity in patients with CD, with lower scores indicating reduced symptom burden and greater clinical stability. As shown in Supplementary Figure 6A, compared with the control group, the psychotherapy group had slightly lower overall CDAI scores (SMD = -0.44, 95%CI: -1.26 to 0.37), suggesting a potential trend towards reduced disease activity[29,30,36,42]. However, as the confidence interval crossed zero and the P value was 0.29, this difference did not reach statistical significance. Although some studies, such as that of Schoultz et al[30], have reported a significant reduction in the CDAI among participants receiving psychological therapy, the overall evidence does not confirm a definitive improvement in disease activity. Moreover, heterogeneity across the included studies was high (I² = 91%). Therefore, the current evidence remains insufficient to support a significant effect of psychological therapy on the CDAI in patients with IBD.

Compared with the control group, patients who received psychological therapy exhibited a modest decrease in CRP levels at the end of treatment (SMD = -0.19, 95%CI: -0.40 to 0.01; Supplementary Figure 6B)[22,27,29,37,38]. Nevertheless, this reduction did not reach statistical significance, and the heterogeneity analysis indicated a high level of consistency across the results. A similar trend was observed for IL-6. The overall results revealed virtually no difference between the psychological therapy and control groups (SMD = 0.03, 95%CI: -0.28 to 0.34, P = 0.85; Supplementary Figure 6C)[27,37,38]. Some individual studies reported slight reductions in IL-6 levels following therapy, but none of these findings reached statistical significance. The heterogeneity for IL-6 was also negligible (I² = 0%), further supporting the consistency of the results. Overall, the current evidence does not substantiate a significant effect of psychological therapy on inflammatory biomarkers such as CRP and IL-6 in individuals with IBD. While psychological interventions may hold value in areas such as emotional well-being or symptom relief, their influence on systemic inflammation remains unproven.

In terms of physical quality of life, the psychotherapy group scored slightly higher than the control group did, but the difference was not statistically significant (SMD = 0.26, 95%CI: -0.22 to 0.74; P = 0.29; Supplementary Figure 7)[18,24,29,39,41,46]. Substantial heterogeneity was observed across studies (I² = 86%).

Taken together, neither disease activity (CDAI), inflammatory markers (CRP, IL-6), nor physical quality of life showed sustained clinical benefits from psychotherapy. This evidence suggests that psychotherapy has some potential to improve these indicators, but further validation is needed to draw definitive conclusions.

DISCUSSION

In this study, we conducted a systematic review and meta-analysis investigating the impact of psychotherapy on multiple outcomes in patients with IBD. The key findings of this study can be summarized in four key points: (1) Regarding the primary outcome, psychotherapy has a positive effect on overall disease-specific quality of life; (2) Regarding the IBDQ subscales, psychotherapy demonstrated the most consistent and robust improvement in the emotional and systemic dimensions. The bowel domain showed a tendency towards moderate improvement that did not reach statistical significance, whereas the social domain demonstrated no significant differences overall; (3) In terms of psychological outcomes, psychotherapy effectively alleviated anxiety and depressive symptoms but lacked sufficient evidence to confirm a significant impact on stress; and (4) Concerning clinical and inflammatory outcomes, no sustained or convincing improvements were observed in disease activity (CDAI), inflammatory markers (CRP and IL-6), or physical quality of life indicators.

The results indicate that the overall improvement in the IBDQ total score corresponds with the differences in the improvements seen in the IBDQ subscale scores. Psychotherapy has significant advantages in alleviating emotional distress and systemic symptoms. Its mechanism lies in adjusting cognitive patterns through neuroplasticity, breaking the negative cycle, and establishing positive feedback, thereby reshaping brain function, restoring patients’ social connections, and ultimately reducing subjective suffering and relieving systemic discomfort[48-50]. In contrast, improvements in the intestinal and social dimensions are relatively limited. On the one hand, IBD is a chronic gastrointestinal disorder characterized by pathological changes within the intestinal tract[1]. Psychotherapy focuses more on the psychological aspect and cannot restore the balance of the microbiota or reverse mucosal injury. On the other hand, social functioning is influenced by many external and real-world factors, making it difficult for short-term psychological interventions to yield quick effects in this dimension[51,52]. In summary, the differences in improvements in the IBDQ subscales suggest that psychotherapy has a more direct effect on emotional and systemic symptoms, while its impact on organic symptoms and social functioning is less pronounced. These findings indicate that psychotherapy can be used as an auxiliary treatment for IBD patients, especially for patients with obvious anxiety and depression, but it cannot replace drugs to control inflammation.

With respect to psychological outcomes, psychotherapy can moderately improve anxiety and depressive symptoms. Psychological interventions such as mindfulness and cognitive behavioral therapy enhance emotional regulation, reduce fear of the disease, and improve self-awareness, thereby improving related psychological indicators[27,53-56]. These changes correspond to increases in the emotional and systemic subscale scores of the IBDQ. In contrast, the stress index exhibited greater fluctuations, characterized by a wide confidence interval and high heterogeneity, which is broadly consistent with recent evidence from Riggott et al[57]. One plausible explanation is that the definition of stress is not as consistent with the measurement scales used to measure anxiety and depression. A recent study reported that IBD-related research has used at least 36 different instruments to assess psychological stress, making it difficult to determine the true strength of the relationship between stress and disease outcomes[58]. Second, stress indices are highly sensitive to environmental factors, fluctuations in disease activity, and major life events[32]. Consequently, when patients across trials are at different stages of disease and followed for varying durations, the observed changes in stress may diverge substantially even under similar intervention protocols, resulting in the high variability seen in our pooled estimates[59-61].

With respect to disease activity and inflammatory markers, psychotherapy did not significantly improve them, which may be related to the hierarchical structure of the gut-brain axis. Neuroimaging research has indicated that psychotherapy first alters activity in prefrontal-limbic networks that support emotional regulation and self-related thinking, leading to reduced anxiety and stress responses at the level of the central nervous system[49,62]. These changes in the brain are then transmitted to the gut through hormonal and autonomic nerve pathways, where they can gradually influence intestinal permeability, the balance of the gut microbiota and immune activity in the intestinal mucosa[63-65]. As these biological changes in the gut usually develop slowly, short-term psychological interventions and limited follow-up may not be enough to produce obvious changes in objective inflammatory markers, which could explain the nonsignificant changes in CDAI, CRP, and IL-6. Future trials could test whether improvements in psychological outcomes precede and are related to changes in gut-specific inflammatory activity with longer follow-up.

This meta-analysis had several limitations that should be considered. First, substantial heterogeneity was observed for several outcomes, particularly the IBDQ bowel score domain. This likely reflects between-study differences in intervention and control conditions, outcome measurement time points, and baseline patient characteristics. Although we conceptually pooled psychotherapies as a single intervention category, the included trials encompassed a broad range of approaches (classified into five types), which may have further contributed to variability. Formal subgroup analyses by psychotherapy type were not conducted due to limited trials within each category and incomplete reporting. Therefore, the pooled estimates should be interpreted with caution. Second, CD and UC were analyzed together, and the disease activity state (active vs remission) was rarely reported consistently across trials. As a result, we were unable to perform robust subgroup analyses by either IBD subtype or disease activity, and potential differential effects across these subgroups may have been obscured. Future RCTs should prespecify and report outcomes by IBD subtype and disease activity state to clarify which subgroups benefit most. Third, the follow-up periods in most studies were relatively short, and the effects of psychotherapy may vary across disease stages, limiting the ability to observe changes in inflammatory biomarkers. Moreover, serum markers such as CRP and IL-6 are systemic and relatively nonspecific indicators that may not capture subtle or localized intestinal mucosal inflammation[66]. Future trials should include longer follow-up periods and incorporate more gut-specific measures (e.g., faecal calprotectin and endoscopic indices) and neuroendocrine markers (e.g., cortisol) that might be more responsive to psychotherapy-related changes[67,68]. Standardized outcomes and assessment schedules, together with microbiome or immune-related measurements where feasible, may improve comparability and help clarify gut-brain axis-related biological changes.

In summary, the benefits of psychotherapy are more consistently observed in patient-reported outcomes than in inflammatory indices. Conceptually, this finding supports a patient-centered benefit profile of psychotherapy in IBD, positioning it as an adjunct intervention that improves well-being without replacing anti-inflammatory therapy. Clinically, psychotherapy may serve as an adjunct to standard treatment and may be particularly suitable for patients with clinically significant anxiety/depression, as well as for those in remission who continue to experience persistent symptom burden or a fear of relapse[69]. In contrast, during active disease, changes in clinical and inflammatory indices are more likely to be driven by the pharmacologic control of inflammation, and psychotherapy should be viewed as a complementary treatment rather than a substitute for anti-inflammatory therapy[70]. Therefore, screening during follow-up helps identify suitable candidates, enabling the timely provision or referral for psychological intervention, which may improve the integration of psychotherapy into routine IBD care.

CONCLUSION

Psychotherapy provides moderate benefits for patients with IBD, mainly by improving disease-specific quality of life and alleviating anxiety and depression, while it exerts limited effects on intestinal symptoms, social functioning, disease activity, and inflammatory markers. The definitive efficacy of psychotherapy for IBD requires further evaluation in high-quality trials. Next, we aim to develop more detailed, symptom-based guidelines for psychological care in IBD patients to relieve symptoms and improve outcomes. Substantial work remains to be done.

ACKNOWLEDGEMENTS

We gratefully acknowledge Professor Zhen-Zhen Hu for her strong support of this study.