Understanding and intervening on Inflammatory Bowel Disease and comorbid psychological concerns: Innovations in Acceptance and Commitment Therapy

Inflammatory Bowel Disease (IBD) is characterised by chronic gastrointestinal issues, comorbidity with psychological concerns, and consequential impact to health-related quality-of-life (HRQoL) domains such as interpersonal relationships, working life, and sexual wellbeing. Despite recognition of psychological intervention in IBD care best-practice guidelines, few IBD support settings meet guidelines on staffing of psychological practitioners or delivery of psychological interventions. Further still, no one psychological intervention is considered evidence-based for those living with IBD while interventions trialled to-date tend to be high intensity and may not be accessible to or meet the psychological care needs of all persons with IBD. As such, the present research programme has two overarching aims. Firstly, to investigate IBD disease-related factors and indices of psychological health as they related to sexual health and functioning. Secondly, to trial and develop innovative Acceptance and Commitment Therapy (ACT) interventions for this population which are feasible within the context of system-level barriers to provision of and patient-level inaccessibility of psychological intervention. Chapter two focused on the first overarching aim of this research programme of research: investigating demographic, disease-related, and psychological predictors of an understudied domain of HRQoL, namely sexual health. Based on the nascent literature, a predictive model was proposed consisting of gender, IBD disease type, disease activity, depression, and body image disturbance while studied indices of sexual health were sexual satisfaction, avoidance of sexual activity, and infrequency of sexual activity. It was observed that the model significantly explained variance in the sexual satisfaction and avoidance data but not the sexual infrequency data with depression and body image and gender and depression making significant contributions respectively. Chapter three presents two trials investigated brief face-to-face (N=7) and brief digitally mediated ACT interventions (N=12) respectively. Both trials employed ecological sampling methodologies within single-case experimental designs (SCED). While it was observed that a single session face-to-face ACT intervention was largely ineffective in intervening on stress and psychological flexibility in people with IBD, a two session digitally mediated ACT intervention reduced stress and increased indices of psychological flexibility in approximately half of participants. Chapter four responds to concerns in the wider literature pertaining to chatbot-delivered psychological interventions including insufficient detail and transparency of their development, narrow deployment of psychological therapies, and use of study designs not well placed to detect harm or adverse events. As such this chapter details the development of a chatbot-delivered ACT intervention for people with IBD experiencing comorbid psychological concerns and presents a protocol to investigate the feasibility, acceptability, safety, and initial efficacy of this intervention. Overall, the present programme of research extends the literature on predictors of sexual health in people with IBD and the literature on brief, digitally mediated, and ACT interventions for this population group. Moreover, this research programme presents a framework to guide the development and trial of novel chatbot-delivered interventions for this population.