The goals of this study are to test the effectiveness of a virtually delivered, group-based coping skills treatment program incorporating heart rate variability biofeedback to target autonomic dysfunction in youth diagnosed with inflammatory bowel disease (IBD). The investigators will enroll participants with IBD in a biofeedback enhanced cognitive behaviorally based coping skills treatment. Participants will be randomized to biofeedback enhanced treatment or wait-list control.

The goals of this study are to test the effectiveness of a virtually delivered, group-based coping skills treatment program incorporating heart rate variability biofeedback to target autonomic dysfunction in youth diagnosed with inflammatory bowel disease (IBD).

Patients are youth ages 13-18 recruited through IBD clinics at Children's Healthcare of Atlanta. Enrollment will include up to 128 children with at least 1 parent. This study will last 7-months and will have 4 in person study visits, lasting about 1 hour each, as well as 6 virtual treatment sessions lasting about 45 minutes each.

Study procedures will include surveys, chart/record review, blood sampling, and non-invasive assessments of psychophysiological functioning. Stool samples will be collected and stored. Informed consent and assent will be obtained in-person or remote signed.

Inclusion Criteria:

• Diagnosis with biopsy-confirmed IBD for at least 4 months,
• ages 13 through 18 years inclusive,
• speak English,
• enrolling with at least 1 parent/guardian who is willing to participate by completing surveys,
• positive depression or anxiety screens using the PHQ-4, - access to home internet to participate in virtual intervention,
• youth and parent agree to the conditions of study participation, including randomization, participation in intervention, and follow-up assessments,
• youth is medically approved to engage in normal daily activities (e.g., attend school, extracurricular activities)

Exclusion Criteria:

• previous diagnosis of developmental disabilities that require full-time special education or that impair the ability to respond to treatment,
• diagnosis with any other chronic disease (e.g., diabetes, epilepsy, etc.),
• diagnosis of abnormal thyroid function,
• treatment with any drug with known autonomic cardiovascular influences including beta-blockers, central sympatholytic agents, or antidepressants.

Data will be shared with Researchers who provide a methodologically sound proposal. The research team will share individual participant data that underlie the results reported in a published article, after deidentification (text, tables, figures, and appendices).

Beginning 3 months and ending 36 months following article publication.

Proposals should be directed to ebreed@emory.edu To gain access, data requestors will need to sign a data access agreement. Data are available for 5 years at a third party website, Vivli.