Tuesday, March 13, 2007

Cognitive Behavioural Model and IBS

I came across a paper that conducted a study on IBS onset after Campylobacter infection. It goes into some cognitive/psychological aspects and I found it rather interesting as opposed to what has mostly been done in terms of simply that which looks for a medical perspective as to why else(?) something happens.

It has long been known that "stress" can be a trigger for IBS and can exacerbate its symptoms but I believe this is the first time, or so the paper claims, that anyone has actually tried to measure cognitive factors.

It was published in the Journal Gut in February 2007 but I couldn't gain access. However, I did find a PDF copy of it online here.

Some of the more interesting points:

There is some evidence for the risk factors outlined in this
model. In support of biological infections, a number of studies
have shown that various forms of gastroenteritis are risk factors
for the development of IBS. Psychology also plays a role.
Sykes et al showed that people with premorbid psychiatric
diagnoses, particularly anxiety disorders, were at greater risk of
developing IBS after gastroenteritis. Similarly, depression,
neuroticism, somatisation and stress have all been linked to
the onset of IBS. Finally, Parry et al found that patients
with gastroenteritis who had more negative perceptions of their
infection were more likely to develop IBS.

Significance of the psychological variables: (sic. within study)

Six of the eight psychological variables were predictors of IBS
caseness, the exceptions being depression and perfectionism. In
accordance with the model, IBS cases reported significantly
higher levels of anxiety, somatisation, perceived stress, negative
illness beliefs and all-or-nothing behaviour at the time of
the acute infection. IBS cases were also significantly less likely
to have limited their activity levels in response to their

This study is the first to prospectively investigate a combination of emotional, cognitive and behavioural risk factors relevant for the development of IBS after Campylobacter gastroenteritis. The results generally supported the cognitive–behavioural model,
with higher levels of anxiety, somatisation, perceived stress and negative illness beliefs all found to be significant risk factors for the development of IBS 6 months after infection. IBS were also more likely to have reported a tendency to be overactive in the face of their symptoms until they could no longer carry on (all-or-nothing behaviour), and less likely to
initially rest or reduce activity in response to their acute illness (limiting behaviour). Depression and perfectionism were not significant risk factors in the development of IBS.

Relative importance of the psychological variables

When considering the relative importance of these variables, multivariate analysis of four factors identified using principal components analysis found that an anxious-achievement
cluster of variables (made up of anxiety, stress and perfectionism) and an all-or-nothing behaviour on its own were the most important predictors of IBS along with female gender. These results support the hypothesis that the predisposition to IBS may be mediated by unrealistic personal expectations in the context of high levels of perceived stress and anxiety. These predispositions lead patients to respond to illness by initially not allowing themselves time to recover, which ultimately leads to an all-or-nothing pattern of responses.

Stress has also been considered an important precipitant in the cognitive behavioural model of IBS; however, the empirical evidence from retrospective and cross-sectional studies has
been inconsistent.

One other prospective study of postinfectious IBS found that higher levels of life events in the 12 months prior to gastroenteritis were associated with the development of IBS. The current study has further clarified the role of stress with the finding that levels of perceived stress are also strongly associated with the development of IBS, indicating that the individual’s interpretation of stressful events may be as important as the nature of those events.

The cognitive behavioural model of irritable bowel syndrome: a prospective investigation of patients with gastroenteritis

Meagan J Spence, Rona Moss-Morris

Gut 2007;0:1–6. doi: 10.1136/gut.2006.108811


Cathy said...

Wow, thats interesting! Thanks for posting all of this. Myself I think that IBS is a diagnosis that Doc's just give people when they don't know what is wrong with them. I had a cousin that had terrible GI problems.

At some point some Doc told her it was IBS. She finally had a colonoscopy and she had severe ulcerative colitis. She ended up having to have a Colostomy. I worry about this IBS diagnosis.

When they stick a diagnosis on something, then they no longer have to look for a diagnosis.

Patient Anonymous said...

Hi Cathy, thanks. IBS is yet another diagnosis of exclusion. It is hard as there are no definitive tests etc... They are still doing further work to try and figure out exactly *why* it happens (i.e. current physiological hypothesis is problems with the Vagus nerve and the gut and communication.)

However, does that actually filter down to all of the diagnosing professionals out there? And if so, what exactly are they going to do about it? No one really knows? As I joked to someone once, could I get some VNS (Vagus Nerve Stimulation) for my gastro issues please?) I don't think they're quite ready to move in that direction yet and it also might not be a good idea with my Bipolar and seizure issues?

So the above is nice for the body but yes, what about the mind? It can very often be either neglected, misunderstood or even worse, treated negatively in medicine (i.e. like the stigma of psychiatric diagnoses.)

I'm sorry to hear about your friend. That's a shame that she had to go through all of that. I can *sort of* relate.

Although I didn't formally receive a diagnosis of IBS my ex-GP, when I suggested it, agreed and said yes, it sounded like IBS. He just wanted to throw me on a med for a month and that was it. Nope. I was still feeling too sick.

A new GP later and finally I have an upper endoscopy and a colonoscopy scheduled for early next month. I really can't wait. I wish I could do it TOMORROW but alas...

I think if you're still having severe problems, you need to persevere and as your cousin did, go for further testing. I mean, IBS can be bad but if you are in serious pain and/or having other symptoms and things aren't improving then it probably warrants further investigation. And really, scopes aren't problematic for doctors to perform. In fact, they are rather routine for gastro issues, anyway. I've known people with IBS issues who have had them done.

I don't know why they didn't give her one from the outset but I guess some care given is not ideal?

Take care,