An Evaluation of the Effectiveness of Psychotherapy in the Treatment of Ulcerative Colitis

Abstract

This 7 year study evaluates the effects of psychotherapy on the course of ulcerative colitis. Fifty-seven patients who received both medical and psychiatric treatment at Columbia-Presbyterian Medical Center were matched with the same number of ulcerative colitis patients who had received no psychotherapy, on the basis of 4 variables: severity of illness, sex, age at onset and use of steroids. The criteria used for evaluation were physiological, i.e., repeated proctoscopic examination and symptomatic ratings based on the activity of the disease process. There was a demonstrable difference in both proctoscopic and symptomatic ratings over the years of follow-up. Those patients treated psychotherapeutically showed more improvement on a year to year and over-all basis. The differences between treated and control groups in terms of operative and mortality rates were not significant. However, the psychiatrically treated group came to operation at a later date. Schizophrenic patients had a poor prognosis. Nineteen patients in the study group were diagnosed as schizophrenic as compared with only 3 in the control group. The operative rate of the schizophrenic patients compared to the non-schizophrenics was 3.5 to 2, the death rate 4 to 1. The investigators conclude that: psychotherapy has a demonstrably favorable effect on the somatic course of the disease, schizophrenic patients had a poorer prognosis than non-schizophrenic patients, in terms of patient survival, amelioration of disease, and adaptive response to chronic ulcerative colitis, a combined medical and psychiatric approach is more effective than medical management alone.