A Biopsychosocial Treatment Model for Inflammatory Bowel Disease

Closeup showing a hand checking off goals that were accomplished.Absent of a cure for inflammatory bowel disease (IBD), physicians at Brigham and Women’s Hospital have pioneered a broader approach to improving the health of patients with ulcerative colitis and Crohn’s by focusing on lifestyle, health education and psychosocial aspects of disease.

“We felt something was missing in the approach to care for IBD. We were seeing our patients’ medical issues become more complex by personal issues and lifestyle choices. We would discuss their medical problems in a brief visit and not have enough time to discuss the other concerns impacting their IBD,” said  Joshua R. Korzenik, MD, Director of the Crohn’s and Colitis Center.

To address the biopsychosocial contributors to IBD, Dr. Korzenik created the CIRCLE Program that offers patients personalized therapies, including virtual visits, education programs about nutrition, exercise and sleep, as well as mind-body interventions to manage stress, anxiety, depression and flares. Physicians from New England hospitals have visited the Brigham to observe this revolutionary approach to IBD treatment.

“Being healthy means more than taking medication.” — Joshua Korzenik, MD, Director of the Crohn’s and Colitis Center at Brigham and Women’s Hospital

“The Crohn’s and Colitis Center combines lifestyle adjustments with the latest, evidence-based medicine. The best results occur when we have a complete understanding of each individual’s medical, cognitive, social and psychological issues and how they impact one’s overall functioning,” said Dr. Korzenik.

The 3-month-long CIRCLE Program gives patients access to an online platform, phone app, educational videos, books and articles. Behavioral health services are offered by a psychiatrist. Patients also work with a nutritionist, health coach and a nurse educator. The program also provides mind-body instruction and services to Brigham patients.

In 2018, the Crohn’s and Colitis Center received a 5-year grant from the Patient-Centered Outcomes Research Institute (PCORI) to expand the CIRCLE Program into the Specialized Team-Based Approach for Achieving Remission (STAAR) Program for patients with IBD.

The STAAR Program is a three-month intervention that exposes patients to topics that range from nutrition to stress management and even general IBD care information that may not be accessible to most patients. The program aims to enroll 300 patients over the next four years.

Those who participate in the STAAR Program are connected with a nutritionist, IBD specialists, nurse health educators and mind-body health and stress management experts. They also have access to self-guided materials and tools to help manage stress, anxiety and other psychiatric problems, as these have been shown to worsen IBD and increase the likelihood of hospitalization and requiring surgery or prescription medications, as shown in a paper Dr. Korzenik published in a 2019 issue of Gastroenterology.

In this video, Joshua R. Korzenik, MD, Director of the Crohn’s and Colitis Center, explains how Brigham and Women’s Hospital combines lifestyle adjustments with the latest, evidence-based medical therapies to treat patients with inflammatory bowel disease (IBD).

“A typical person with IBD spends less than three hours a year with their gastroenterologist and much of those discussions focus on symptoms and medications. Most of the time, patients are their own provider, so our programs give them the tools and guidance to be able to care for themselves,” said Dr. Korzenik.

The Crohn’s and Colitis Center’s philosophy is to treat the whole person and develop an individualized plan for each patient. Improving outcomes starts with lifestyle adjustments. Patients at the Center work with a dietician to eat better and break unhealthy nutrition habits. They also learn exercise routines and receive instruction about healthy sleep hygiene.

These behavioral changes are combined with the latest, evidence-based medical therapies, including in-house infusions (e.g., Remicade, Tysabri and newer IV treatments offered in clinical trials), surgery (e.g., Ileoanal J-pouch for ulcerative colitis), and diagnostic and therapeutic endoscopy procedures (e.g., balloon dilation of strictures).

“At the Brigham, the patient is an active participant in their care, and we work together to design a personalized treatment plan that can improve the patients’ quality of life and, in many cases, positively affect the course of their disease,” said Dr. Korzenik.