Development of an Internet-delivered Cognitive Behavioral Program for Inflammatory Bowel Disease: A Pilot Study

Inflammatory bowel disease (IBD), which includes Crohn's disease (CD) and ulcerative colitis (UC), is a chronic condition that affects the gastrointestinal tract [1].The prevalence of IBD varies worldwide and is rapidly rising, with the highest rates being reported in Europe and North America [2].The approximately 2 million individuals with IBD in the US and Canada are projected to double over the next decade [3].The disease has a high burden for patients, with unpredictable, painful symptoms that can interfere with home and work life.There is also a high cost to the health system, related predominantly to biologic medications, hospitalization rates, surgeries, and emergency department visits [4,5].It is well established that individuals with IBD have significantly higher rates of anxiety and depression than the general population [6][7][8][9].A bidirectional impact of the disease on mental health and mental health on the disease has been identified, with stress notably associated with symptomatic disease flares [10][11][12].Persistent high levels of stress predict worsening IBD symptoms, which in turn increases the risk of developing chronic anxiety and depression [13].Further, large cohort studies demonstrate that symptoms of anxiety and depression are significantly associated with clinical recurrence of disease in IBD [14].In addition to disease course, health care utilization can be increased by comorbid distress and mental health concerns [15].