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Resilience

How Resilience-Based Care Can Improve Mental Health

A person's resiliency can predict how well they deal with adversity.

Key points

  • For patients with IBD or other chronic illnesses, those with low resilience may struggle at work or have a hard time maintaining relationships.
  • The good news is that resilience can be built through training and practice.
  • Providers should continuously monitor a patient’s resilience and incorporate resilience training into personalized care plans.
  • Resilience-based care can also potentially reduce health care costs.

This post was co-authored by Dr. Laurie Keefer.

Patients with inflammatory bowel disease (IBD), which includes Crohn’s disease and ulcerative colitis, can experience anxiety, depression, and other mental health issues related to their condition. A disease like IBD often cycles between relapse and remission, which in turn generates feelings of uncertainty and stress in a patient, who can never be sure what symptoms they may have on any given day. For these patients, resilience plays a key role in managing both their mental and physical health.

A person’s level of resilience can predict how well they will deal with adversity.

In the case of IBD patients, those with low resilience may struggle at work, have a hard time maintaining relationships, and even face worsening health. The good news is that, like a muscle, resilience can be built through training and practice.

Resilience-based care incorporates principles of positive psychology into all aspects of chronic disease management. This integrated model of care, when coordinated with the right medication and other treatments, can be an effective approach to managing IBD and other chronic illnesses, with the added benefits of potentially reducing health care costs and improving a patient’s overall health. To ensure that patients can successfully navigate the mental and physical challenges of IBD, patients and providers must continuously monitor the patient’s resilience and incorporate resilience training into their personalized care plan.

Resilience training for IBD patients goes beyond managing physical symptoms. It helps patients use positive psychology to maintain a healthy mind-gut connection. Those with high levels of resilience can self-regulate their attitude and behavior towards their disease and, in turn, partly influence how their brain and gut communicate. As a result, people’s quality of life improves, and they become self-confident, self-aware, and still feel a sense of fulfillment in life.

One resilience-based model of care leverages the GRITT (Gaining Resilience Through Transitions) methodology, which is currently offered at Mount Sinai. To measure resilience, researchers created the “GRITT” score, focusing on categories like disease management skills, social support, physical and psychological symptom experience, and nutritional status. In a recent study, 126 IBD patients who had completed a personalized GRITT training program experienced a 90 percent reduction in emergency department visits and an 88 percent reduction in hospitalizations at a one-year follow-up. On average, their GRITT scores increased by 33 points, indicating patients were successfully able to train and improve their resilience.

Resilience-based care takes a team-based and patient-centered approach to helping patients.

For example, in the GRITT methodology, a multidisciplinary team of providers designs a customized IBD care program tailored to a patient’s unique needs. The program can include a variety of strategies, such as pain and nutritional management, cognitive behavioral therapy, and peer mentorship. As the person learns how to make crucial positive changes to their behavior, the hope is to see improvements across all aspects of their life, including physical, mental, and even social: It’s no coincidence that highly resilient patients often have a stronger support network than those with low resilience.

To best meet their patients’ needs, providers must recognize that everyone has different goals when it comes to work, relationships, and health. A truly personalized care plan takes into consideration the person’s age, culture, as well as any major life events, such as pregnancy or retirement.

In helping manage their patients’ care plans, providers shouldn’t exclusively focus on symptom remission. They should continuously monitor a patient’s resilience, asking questions including—Is my patient happy? Do they feel like they are meeting their potential in life? As more health care providers recognize the importance of holistic IBD well-being, there is greater potential for long-term patient benefits. Importantly, high resilience is independently associated with lower disease activity. Additionally, low resilience in IBD patients is linked to higher costs of care, worse disease outcomes, and more psychological distress.

When coordinated with the right treatment and medicine, a resilience-based treatment model aims to reduce medical expenses for patients and lessen the overall burden on the health care system. IBD patients with anxiety or depression face an increased risk of hospitalization, readmission to a hospital, and outpatient services. By building resilience, patients can be better equipped to avoid unplanned visits.

How someone copes and lives with their chronic disease can impact their physical, mental, social, and even financial wellness. It's critical for providers to assess a patient’s resilience and incorporate resilience training into a personalized care plan. By doing so, providers can help patients achieve holistic well-being while potentially reducing health care costs.

Today’s co-author is Dr. Laurie Keefer, an academic health psychologist and the Director for Psychobehavioral Research within the Division of Gastroenterology at Mount Sinai. Dr. Keefer specializes in the psychosocial care of patients with chronic digestive diseases, specifically inflammatory bowel diseases such as Crohn's or ulcerative colitis.

References

Keefer L, Gorbenko K, Siganporia T, Manning L, Tse S, Biello A, Ungaro R, Cohen LJ, Cohen BL, Dubinsky MC. Resilience-based Integrated IBD Care Is Associated With Reductions in Health Care Use and Opioids. Clin Gastroenterol Hepatol. 2021 Nov 16:S1542-3565(21)01225-8. doi: 10.1016/j.cgh.2021.11.013. Epub ahead of print. PMID: 34798332.

Priya Sehgal, MD, MPH, Ryan C Ungaro, MD, MS, Carol Foltz, PhD, Brian Iacoviello, PhD, Marla C Dubinsky, MD, Laurie Keefer, PhD, High Levels of Psychological Resilience Associated With Less Disease Activity, Better Quality of Life, and Fewer Surgeries in Inflammatory Bowel Disease, Inflammatory Bowel Diseases, Volume 27, Issue 6, June 2021, Pages 791–796, https://doi.org/10.1093/ibd/izaa196

Marla C. Dubinsky, Iris Dotan, David T. Rubin, Mark Bernauer, Dipen Patel, Raymond Cheung, Irene Modesto, Mark Latymer & Laurie Keefer (2021) Burden of comorbid anxiety and depression in patients with inflammatory bowel disease: a systematic literature review, Expert Review of Gastroenterology & Hepatology, 15:9, 985-997, DOI: 10.1080/17474124.2021.1911644

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