The Role of Psychotherapy with Integrated Hypnosis in Treating Depression in Adolescents with Chronic Inflammation
Eva Szigethy, MD, PhD
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Crohn's disease (CD) is a chronic immune-mediated illness that can serve as a model for inflammatory depression.

Objective: To compare cognitive behavioral therapy (CBT) to supportive non-directive therapy (SNDT) in improving depression, physical disease activity and course.

Method: 163 youth ages 9-17 with depression and CD were randomly assigned to receive a weekly 12 session course of CBT (including hypnosis) or SNDT. Main outcome measures were depression using the Children's Depression Rating Scale-Revised (CDRS-R), and CD activity using the Pediatric CD Activity Index (PCDAI) and time to next CD flare. Youth were followed 15 months post treatment and evaluated at 3, 9, 18 months for outcomes. Psychiatric treatment (antidepressant use) and medical treatment (use of steroids or biologic agents) were evaluated as covariates.

Results: Both psychotherapies resulted in a statistically significant improvement in total CDRS-R score over 3 months, but there was no difference between two treatments (p=0.10). In the subset without steroids, CBT had a significantly greater impact on total CDRS-R (p=.04), observed somatic symptoms (p=.05) and PCDAI. When controlling for site and biologics, there was a statistical significant impact of treatment on time to next CD flare. For males, CBT was statistically significantly superior in reducing flares even after controlling depression, antidepressant use or medical treatment.

Conclusion: These results suggest that CBT has a significant impact on somatic depressive symptoms as well as CD activity, suggesting a beneficial clinical impact for inflammatory depression. CBT may also have a protective effect on disease course, particularly in males.