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Preliminary outcomes from a national telehealth group psychotherapy program combining CBT-GI and gut-directed hypnotherapy for adults with IBD: A pilot evaluation of symptom control, quality of life, and feasibility

Ali Navidi, PsyD1, Ellen Joseph, PhD1, Ayesha Williams, MPA2, Mary Harkins-Schwarz, MPH2, Catherine Soto, MPA2, J.L. Culbreth, BS1, & Tiffany Duffing, PhD1 

1GI Psychology, PLLC, 2Crohn’s & Colitis Foundation

Introduction

  • Roughly a quarter to a third of patients with IBD experience symptoms of anxiety or depression; posttraumatic stress symptoms related to medical experiences are also common.1,2
  • Nearly 40% of patients with IBD report IBS-type symptoms, which are associated with psychological comorbidity, reduced quality of life, and greater health care use.3,4
  • Psychotherapy, particularly Cognitive Behavioral Therapy (CBT), can improve quality of life in IBD,5 and gut-directed hypnotherapy (GDH) has been shown to prolong remission in ulcerative colitis.6 Access is limited, with only 26% of patients reporting available emotional support where they receive IBD care.7
  • To our knowledge, a structured group model integrating CBT for gastrointestinal disorders (CBT-GI) and GDH has not been evaluated in patients with IBD.8
  • Aims: (1) Evaluate the feasibility and acceptability of an 8-week telehealth group integrating CBT-GI and GDH for adults with IBD; (2) examine preliminary changes in patient-reported psychological and IBD-specific outcomes.

Methods

  • Design: Single group pre-post test design. Conducted in partnership with the Crohn’s & Colitis Foundation; approved by Northstar Review Board (protocol NB500280). Three cohorts; data cutoff August 1, 2026.
  • Participants: Adults (18+) with Crohn’s disease or ulcerative colitis, referred by providers or self-referred. Eligibility was confirmed by phone consultation. Exclusions: serious mental illness, disordered eating, suicidality, substance use, or planned hospitalization.
  • Intervention: Eight weekly 75-minute self-pay telehealth group sessions (up to 10 participants), with integrated CBT-GI and “gut-directed” hypnotherapy, led by a licensed clinician specializing in GI psychology (Figure 1).
  • Measures (baseline and week 8): IBD-Control-8, PROMIS Global Health, PHQ-8, GAD-7, Self-Compassion Scale–Short Form, and 4 internalized stigma items adapted from I-HEARTS (0–16). CSQ-4 at week 8 only. Feasibility was assessed through recruitment, attendance, retention, and satisfaction.
  • Analysis: Paired t-tests with Cohen’s d and Wilcoxon signed-rank tests as a sensitivity analysis. Analyses included participants with both time points.

Figure 1. Session Structure

Table 1. Participant Characteristics (n=17)

Figure 2. Recruitment Flow

Results

  • Feasibility: Of 185 referrals, 23 (12%) enrolled, including 42% of eligible patients (Figure 2). Two cohort launches were postponed due to insufficient registration.
  • Acceptability: Participants attended 93% of sessions, 100% completed week-8 measures, and satisfaction was high (CSQ-4 M = 13.9/16).
  • Outcomes: All outcomes improved in the expected direction (Table 2). Self-compassion (d = 1.16) and anxiety (d = 0.62) improved significantly. Other outcomes showed small-to-moderate, non-significant gains (d = 0.31–0.49), consistent with a pilot not powered for efficacy. The share of participants in the well-controlled IBD range rose from 31% to 56%.

Table 2. Outcomes

References

  1. Barberio, B., Zamani, M., Black, C. J., Savarino, E. V., & Ford, A. C. (2021). Prevalence of symptoms of anxiety and depression in patients with inflammatory bowel disease: A systematic review and meta-analysis. The Lancet Gastroenterology & Hepatology, 6(5), 359–370.
  2. Taft, T. H., Quinton, S., Jedel, S., Simons, M., Mutlu, E. A., & Hanauer, S. B. (2022). Posttraumatic stress in patients with inflammatory bowel disease: Prevalence and relationships to patient-reported outcomes. Inflammatory Bowel Diseases, 28(5), 710–719.
  3. Halpin, S. J., & Ford, A. C. (2012). Prevalence of symptoms meeting criteria for irritable bowel syndrome in inflammatory bowel disease: Systematic review and meta-analysis. The American Journal of Gastroenterology, 107(10), 1474–1482.
  4. Gracie, D. J., Hamlin, P. J., & Ford, A. C. (2018). Longitudinal impact of IBS-type symptoms on disease activity, healthcare utilization, psychological health, and quality of life in inflammatory bowel disease. The American Journal of Gastroenterology, 113(5), 702–712.
  5. Paulides, E., Boukema, I., van der Woude, C. J., & de Boer, N. K. H. (2021). The effect of psychotherapy on quality of life in IBD patients: A systematic review. Inflammatory Bowel Diseases, 27(5), 711–724.
  6. Keefer, L., Taft, T. H., Kiebles, J. L., Martinovich, Z., Barrett, T. A., & Palsson, O. S. (2013). Gut-directed hypnotherapy significantly augments clinical remission in quiescent ulcerative colitis. Alimentary Pharmacology & Therapeutics, 38(7), 761–771.
  7. Ehrlich, O., Harkins-Schwarz, M., Brunskill, S., Clusen, N., Sun, X., & Moise, C. (2023). Survey data on healthcare access for patients with inflammatory bowel disease in the United States: A survey by the Crohn’s & Colitis Foundation [Unpublished data file]. Crohn’s & Colitis Foundation.
  8. Wang, H., Ding, J., Liu, G., Sun, G., Zhang, X., Xiao, W., Cai, Y., & Lin, A. (2025). Efficacy of different psychological interventions for the treatment of inflammatory bowel disease: A systematic review and network meta-analysis. Frontiers in Medicine, 12, Article 1630034.