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

Background: Inflammatory Bowel Disease (IBD) is commonly accompanied by psychological distress, which may worsen disease activity via gut-brain axis mechanisms. Psychological interventions including cognitive behavioural 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.<br/><br/>Objectives: This nested exploratory, real-world study (NCT05330299) assessed the effectiveness of COMPASS-IBD in reducing inflammation, disease activity and healthcare use in IBD patients. Additionally, it examined relationships between changes in psychological distress and disease indicators.<br/><br/>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) and 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 healthcare 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.<br/><br/>Results: Sixty-five participants were included. There were significant reductions in CRP (d range: -0.47- -0.53, p&lt;.01), but not FCP (d range: -0.38 to -0.44, p&lt;.10) or SRDA (d=-0.28, p=.08). Significant improvements were observed in WBC and neutrophil counts (p&lt;.05), flare frequency (p&lt;.01) and psychological distress (p&lt;.001). Some types of healthcare usage were reduced (p&lt;.05). Associations between distress and primary outcomes were nonsignificant.<br/><br/>Conclusions: This pilot suggests COMPASS-IBD may reduce inflammation levels, healthcare 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.<br/>