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
gastroenteritis.

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