Fellow's Corner: Integrative Medicine: Where the Personal and Professional Intersect

Sindu Vellanki, MD

My journey into Integrative Medicine began before I even knew of it as a recognized medical subspecialty. As a stressed out third-year medical student nearing burnout, I knew I had to take drastic measures to decrease the symptoms I was experiencing so early into my career. My mother, a lifelong practitioner of meditation and yoga, introduced me to a few simple practices at this critical time, and the effect was profound. From there, I cultivated an interest in learning about various mind-body interventions and the role they may have in chronic illnesses. Learning how the mind affects the body, I was motivated to care for patients by incorporating these adjunctive therapies to help address stress that was potentially contributing to their ailments.

During my pediatrics residency, I was introduced to the field of Pediatric Integrative Medicine. I became interested in inflammatory bowel disease (IBD) and pursued a fellowship in Pediatric Gastroenterology at CHOP with a focus on IBD. Under the guidance of my mentors at CHOP, Lindsey Albenberg, DO, and Maria Mascarenhas, MBBS, I learned about various integrative health modalities and how to employ various mind-body strategies for my patients. Additionally, my mentors helped me carve out a niche interest in wanting to conduct high-quality research exploring the complex relationships between the brain, gut, immune system, and microbiome. In pursuit of these efforts, along with our team, I designed a prospective pilot study looking at the effects of a virtual mindfulness course for youth with IBD.

Patients with IBD are at higher risk of mental health comorbidities, such as anxiety and depression, compared with the general population, and often these mental health diagnoses are made after the diagnosis of IBD, arguing that chronic illness has a negative impact on overall quality of life and health. My hope and long-term goal is to improve these outcomes in children with IBD.

Our study explores if a virtual Mindfulness-based Stress Reduction (MBSR, a well-studied 8-week intervention designed to reduce stress) course for youth with IBD is feasible and acceptable and what effects it may have on health- related quality of life (HRQOL) and perceived stress. We have successfully recruited 44 patients and are in our final round of classes; response to recruitment and interest in the study from participants has been enthusiastic and robust.

Preliminary qualitative focus group analysis revealed the following themes. (1) IBD-specific benefits of the MBSR course include: (a) mindfulness techniques helped reduce stress, which some identified as an IBD trigger; (b) participants enjoyed connecting with peers with IBD; (2) participants experienced multiple mental health benefits (e.g., positive change in mood/energy and reframing unhelpful cognitions to stressful situations) as a result of the MBSR course; (3) the virtual MBSR course was overall feasible and well-liked, but challenges were identified, including technology issues, increased distractions at home, and virtual environment fatigue leading to decreased focus. We are excited with our results thus far and would like future research to study changes in the microbiome and disease activity. We are also brainstorming ways to address the challenges raised in the study and make MBSR more broadly accessible to IBD patients in our practice.

References and suggested readings

Mackner LM. Review: Psychosocial issues in pediatric inflammatory bowel disease. J Pediatr Psychol. 2004;29(4):243-257.

Vellanki S, Boateng A, Pressman N, Holbein C, Sibinga E, Mascarenhas M, Albenberg L. Live Video Mindfulness Program is a Safe, Feasible, and Acceptable Intervention for Youth with Inflammatory Bowel Disease. Abstract presented at the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition Annual Meeting, December 2021; Virtual conference.