Interest in mind-body modalities for symptom management in GI conditions has been growing both in the public and healthcare arenas.6, 7, 9, 12, 23
Our study found that adolescents with IBD regularly used and would consider using prayer, relaxation and imagery for symptom management more commonly than previously reported in pediatric IBD samples.10, 12
Each of those mind-body CAM modalities is relatively simple to learn and can be easily integrated into daily life (e.g., an adolescent could use deep breathing for relaxation while sitting in class). Mindfulness-based mind-body programs such as stress reduction and biofeedback, which typically involve relaxation training and imagery, have been shown to be effective in reducing pain, improving HRQOL, and improving symptoms in other chronically ill populations.24, 25
In the GI literature, the evidence for effectiveness of mind-body CAM use in alleviating GI symptoms is best for hypnotherapy and cognitive behavioral therapy, primarily in adults with irritable bowel syndrome.6, 26
Rigorous controlled studies are sorely needed to examine the effectiveness of mind-body modalities for alleviating GI symptoms or improving HRQOL in children and adolescents with IBD.
Based on our findings, relaxation programs targeting girls and patients with more severe IBD may attract the greatest amount of interest. Previous studies have found that females and older adolescents use CAM more regularly.27, 28
In our study, it was actually younger adolescents who were more interested in meditating than were older adolescents - a consideration for developing future programs/interventions. Interestingly, while fewer than 20% of adolescents actually reported using meditation or yoga on a regular basis for symptom management, over 40% were willing to consider using those modalities in the future. A recent randomized controlled trial of yoga therapy for 25 adolescents with irritable bowel syndrome found that adolescents doing yoga had less functional disability and less anxiety than the control group.29
Mind-body programs (e.g., relaxation or yoga) aimed at reducing GI symptoms and improving HRQOL should be assessed for feasibility and effectiveness in adolescents with IBD.
Contrary to our study hypotheses, there were virtually no significant relationships between adolescents regularly using CAM and their self-reported HRQOL. The one exception was that those adolescents who used yoga had poorer school functioning. In contrast, Markowitz and colleagues found that CAM use was inversely associated with quality of life in patients with IBD ages 6 to 16 years.12
We speculate that adolescents currently using CAM may have had poorer HRQOL at baseline in hopes that their use of CAM would mitigate some of the effects of IBD on their HRQOL. In potential support of this hypothesis, we found that adolescents with poorer HRQOL were more willing to consider using mind-body CAM modalities (specifically, prayer and meditation) in the future. Poor HRQOL or dissatisfaction with traditional treatment is often cited as a reason for considering CAM use.11, 12
Such information should be used when developing IBD symptom reduction interventions for adolescents.
Future studies of adolescents with IBD should evaluate whether engaging in a brief program of learning a mind-body modality is feasible and effective in improving symptoms and HRQOL. One of the key challenges in conducting mind-body CAM research is that many interventions use multiple modalities (e.g., biofeedback often includes deep breathing, relaxation training, and imagery), making it difficult to distill the critical ingredient or mediating mechanism driving the success of the intervention. Still, given the large number of adolescents with IBD that not only use but would consider using mind-body CAM modalities, the inherent brain-body connection, and the low-cost and mobile nature of these modalities, future research in this area is critical.
Our study had several limitations. First, it was cross-sectional, precluding assessing the temporal nature of relationships among our study variables or drawing causal inferences. In addition, because we only assessed adolescents’ practices and attitudes regarding CAM use, we are not able to draw any conclusions about whether parental CAM use, often a predictor of child CAM use,11
was related to CAM usage in these adolescents. Finally, our sample size was small, represented a single IBD clinic in the midwest, and was mostly from economically advantaged families (as represented by parental education level). Therefore, it may not be generalizable to other areas of the country where the use of such mind-body modalities may be more or less common.
Despite these limitations, important conclusions can be drawn. Mind-body CAM use for symptom management in adolescents with IBD is prevalent, and regardless of whether they have used these modalities before, many adolescents would consider using these modalities in the future. Girls, patients with more severe disease, younger adolescents, and patients with worse HRQOL may be most open to trying CAM. Because these modalities are fairly simple, easy to teach, inexpensive, and can be practiced alone, they should be considered as adjunct approaches to symptom management. A mental health practitioner could routinely teach these modalities via a psychoeducational model of self care. This would be an initial short term investment for clinics that could provide long-term benefits to their patient population. A better understanding of the prevalence and correlates of mind-body CAM use provides the groundwork for conducting randomized controlled trials to determine the the effect of mind-body CAM use on health outcomes in adolescents with IBD.