Anxiety and Depression in Adolescents with IBD: A Mentoring Model

Anxiety and Depression in
Adolescents with Inflammatory
Bowel Disease (IBD)
A Mentoring Model
Jill M. Plevinsky
Tufts University
April 26, 2011

Rationale
 Pediatric patients with inflammatory bowel
disease (IBD) are more at risk for depression
and anxiety due to the nature of the illness
 Thus far, only psychiatric interventions have
been thoroughly researched and proven
effective on small scales
 Social support has been correlated with
better mental health outcomes, but is not
accessible at an ideal level

Inflammatory Bowel Disease
(IBD)
 IBD is a chronic illness affecting anywhere
along the digestive tract
 Characterized by unpredictable periods of
flare-ups and remission, embarassing
symptoms, and invasive treatments
 Over 1.4 million Americans have been
diagnosed, approximately 20-30% were
diagnosed as children

Relevance to adolescence
 Chronic illness as a stressful event
 Family stress model
 Negative self-image
 Misperceiving peer perceptions of oneself
 Decrease in school attendance
 Socialization, achievement, intrinsic motivation to
succeed, self-efficacy, self-confidence
 Cross-age mentoring
 Correcting the misperceptions of how peers with
IBD cope and feel

Review of literature: The
problem
 Greenley et al. (2010)
 The nature of IBD can cause adolescents to limit their social
activity and feel different than their healthy peers
 Hommel et al. (2010)
 Patients with gastrointestinal complaints have higher levels of
anxiety and depression
 Kovacs et al. (2010)
 Pediatric patients with IBD have high levels of irritable
depression and somatization
 Pao & Bosk (2011)
 Anxiety in medically ill children and adolescents affects medical
non-adherence, symptom management, medical outcomes, and
coping abilities
 Higher rates of anxiety in this population are accounted for by
interactions between disease-related and psychosocial factors

Review of literature: The
solution
 Szigethy et al. (2005)
 Adolescent IBD patients that received CBT showed
significant improvements in depressive symptoms,
global adjustment, and physical functioning from the
parent and child perspective
 Logan et al. (2010)
 Intervention incorporated CBT and social learning
theories to increase peer support, decrease feelings of
isolation, increase problem solving, and increase self-
efficacy in adolescents with chronic pain
 Depression accounted for more variance in functional
disabilities resulting from missed school than pain
severity

Mentoring
 Mentoring occurs when a more experienced person
transmits knowledge to a less experienced person
 Key dimensions
 Trust
 Mutuality
 Empathy
 Authenticity
 Engagement
 Empowerment
 Adolescence is “a particularly critical time for youth to have
a close connection with an adult” (Spencer, 2007, p. 110)
 Three levels of social support in a mentor-mentee
relationship
1. Instrumental support
2. Emotional support
3. Companionship

Cross-age peer mentoring
 A developmental relationship between a younger
and older peer within the same generation in
which the mentor’s focus is to facilitate positive
youth development
 Ex. Big Brothers Big Sisters
 Vygotsky, Piaget, and Sullivan
 Interaction between social context and cognitive
development and how social perspective-taking
capabilities may shape and be shaped by social
interaction
 Characteristics of a strong mentor
 Ability to share prior experience and capacity to relate
to others

E-mentoring
 “The use of e-mail or computer conferencing
systems to support a mentoring relationship
when a face-to-face relationship would be
impractical” (Miller & Griffiths, 2005, p. 300)
 Components
 Agreement regarding frequency of communication
between the mentor and mentee
 Full and open communication
 Social and task-based communication
 Self-disclosure from both parties
 Interactive communication style

Target audience and setting
 Adolescents with IBD experience symptoms
of depression and/or anxiety
 Regardless of disease activity
 Between the ages of 10 and 22
 Flexible setting
 To accommodate participation in the in-person
group-based session
 E-mentoring will take place online
 Accessibility and immediacy

Program goals
 Behavior change associated with positive health
outcomes with a focus on alleviating symptoms of
depression and anxiety
 Decrease feelings of isolation in adolescent patients with
IBD
 Alter patterns of negative thinking regarding their
illness/treatments
 Improve overall social and school functioning
 Teach behavioral coping skills to improve self-efficacy
 Provide role models who have IBD to show adolescents
that they can succeed beyond their illness

Program components
 Principals of cognitive-behavioral therapy
(CBT)
 Group-based in-person mentorship
 One-on-one virtual mentorship

A typical session
 Imagine that you are a 12-year-old boy who was diagnosed with ulcerative colitis at
age 9. You are entering 7th
grade in the fall; that means changing schools where you
don’t know the teachers, you don’t know the school nurse, and you have to change
clothes for gym class. You have to remember to go to the nurse at lunchtime for your
medicine and remember to wear an extra undershirt so that no one sees your scars
on your stomach and ostomy pouch when you change for gym in the locker room.
This a huge transition for you and frankly, you’re freaking out.
 At your last doctor’s appointment, you met with the clinical social worker with whom
you spoke about being nervous about this transition and that you felt overwhelmed by
all of the new responsibilities that come along with entering middle school. The social
worker tells you about a new mentoring program where you can meet other patients
with IBD and the first group meeting at the hospital next week, so you decide with
your parents that you’d really like to go.

In-person group-based
mentoring
 The following week, you arrive at the group meeting and meet four other
patients your age and five older patients. You all sit together around a table
and the older patients begin to share their stories. They’re all between 16
and 18 years old and have Crohn’s disease of ulcerative colitis. You admire
them for telling their stories as you quietly listen to each of them reveal their
past surgeries, treatments that weren’t effective, and everyday struggles. A
discussion begins between the other patients in the room, but you stay quiet
just listening to everyone. You start to feel a little overwhelmed; you’d never
really talked to any other patients your age before.
 The discussion starts to die down, and the clinical social worker asks the
older patients to go and introduce themselves to their mentees. One of the
older boys comes up to you and introduces himself. The two of you start
talking about school, sports, and your favorite bands. You shyly crack a joke
and smiles and tells you you’re funny. You exchange e-mail addresses and
he tells you that he’ll be sending you a message soon to see how your first
month in school goes. On the drive home from the hospital, you can’t stop
talking to your mom about all of the different people you met.

One-on-one virtual mentoring
 A couple of weeks later, you get an email from your mentor:
 Hey! How’s it going? I was thinking of you today when I got my class schedule
today. Is this the first year you’re gonna have to switch classrooms and use a
locker and stuff? I can’t wait for school to get going again, especially soccer. You
think you’re gonna try out for any teams this season? I remember you said you
really like tennis.. Hit me back when you have a sec!
 A few days later, you respond:
 Hey man, it’s going okay. I’m still nervous about school, but I’m in a few honors
classes, which I’m excited for. I don’t think I’m gonna do any sports... I haven’t
really been feeling that great. I’m tired all the time, it sucks. Do you ever get tired?
What if you get tired at soccer practice, doesn’t your coach get mad at you? I
don’t think I could keep up with my teammates... and what if I had to go to the
bathroom in the middle of a match? I really only like playing with my dad
anyway... Are you gonna be at the group session next week? Gotta go get ready
for church, see ya.

Cognitive-behavioral therapy
 The following week at the in-person group session, you sit next
to your mentor and you feel a little more comfortable talking to
everyone. The discussion turns to everyone talking about what
they hate about IBD. One patient talks about how she hates
having to place a nasal-gastrointestinal (NG) tube every night
and another complains about how her hair is thinning from the
steroids. One of the mentors interjects and starts to talk about
how much he hated having to place his NG tube every night too.
But then he added that he never would’ve grown to be 5’11”
without it. He told a story about how awful he used to feel before
NG therapy, and now looking back realizes that placing that tube
each night was better than being sick. You think about your
ostomy and how sometimes you just wanna rip it out, but then
you remember how you were even more sick before you got it…
and that it’s only temporary. You never thought of it that way
before.

Strengths
 Theoretical and academic justification for
program components
 Theories of adolescent development
 Peer socialization and influence
 Biopsychosocial-developmental framework
 IBD symptoms may cause or be partially caused
by psychological or psychosocial distress
 Adolescencts as being susceptible to poor self-
image due to value placed on peers’ perceived
impressions of themselves

Limitations
 Cost
 CBT training and supervision
 Matching mentors and mentees
 Maintenance of mentor-mentee relationships

Conclusion
 Program evaluation and future directions
 Focus groups, interviews, participant observation
 Pre and post measures
 Depression
 Anxiety
 Health-related quality of life
 Self-esteem
 Social support

Anxiety and Depression in Adolescents with IBD: A Mentoring Model

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Anxiety and Depression in Adolescents with IBD: A Mentoring Model