Cognitive-behavioural therapy has no effect on disease activity but improves quality of life in subgroups of patients with inflammatory bowel disease: a pilot randomised controlled trial.

BACKGROUND: Studies have demonstrated usefulness of cognitive-behavioural therapy (CBT) in managing distress in inflammatory bowel disease (IBD); however, few have focused on IBD course. The present trial aimed to investigate whether adding CBT to standard treatment prolongs remission in IBD in comparison to standard therapy alone. METHODS: A 2-arm parallel pragmatic randomised controlled trial (+CBT - standard care plus either face-to-face (F2F) or online CBT over 10 weeks versus standard care alone (SC)) was conducted with adult patients in remission. IBD remission at 12 months since baseline was the primary outcome measure while the secondary outcome measures were mental health status and quality of life (QoL). Linear mixed-effect models were used to compare groups on outcome variables while controlling for baseline. RESULTS: Participants were 174 patients with IBD (90 +CBT, 84 SC). There was no difference in remission rates between groups, with similar numbers flaring at 12 months. Groups did not differ in anxiety, depression or coping at 6 or 12 months (p >0.05). When only participants classified as 'in need' (young, high baseline IBD activity, recently diagnosed; poor mental health) were examined in the post-hoc analysis (n = 74, 34 CBT and 40 controls), CBT significantly improved mental QoL (p = .034, d = .56) at 6 months. Online CBT group had a higher score on Precontemplation than the F2F group, which is consistent with less developed coping with IBD in the cCBT group (p = .045). CONCLUSIONS: Future studies should direct psychological interventions to patients 'in need' and attempt to recruit larger samples to compensate for significant attrition when using online CBT. TRIAL REGISTRATION: The protocol was registered on 21/10/2009 with the Australian New Zealand Clinical Trials Registry (ID: ACTRN12609000913279).

Engaging the ‘maximal’ intentions of the citizenship curriculum: one teacher’s story

Exploring how the transformative intentions within the mandated citizenship curriculum framework for English schools demand a particular kind of citizenship teacher – one who ‘acts against the grain’ of the inequities and injustices of the social world – this paper presents Mr C's story. Mr C is a secondary teacher at an Upper School located north of London. The paper considers the significance of his philosophies and knowledge in enabling practice aimed at developing students' socially inclusive but critical understandings of diversity and difference. Mr C's well‐defined personal philosophies about justice and the ‘common good’ and his capacity to translate these philosophies into practice are presented as central to mobilising the transformative or ‘maximal’ intentions of the citizenship curriculum. In highlighting the complexities and sophistication in Mr C's approach, however, the issues presented in this paper further strengthen the critique regarding the curriculum's depoliticised approach. While Mr C draws on the curriculum as a political device to support equity goals, it cannot be assumed that citizenship teachers more generally will have the requisite philosophies and knowledge necessary to do so.