Academic journal article Journal of Cognitive Psychotherapy

Towards A Better Understanding of Anxiety in Irritable Bowel Syndrome: A Preliminary Look at Worry and Intolerance of Uncertainty

Academic journal article Journal of Cognitive Psychotherapy

Towards A Better Understanding of Anxiety in Irritable Bowel Syndrome: A Preliminary Look at Worry and Intolerance of Uncertainty

Article excerpt

Although it has been fairly well established that symptoms of anxiety are often present in patients with irritable bowel syndrome (IBS), less is known about the role of worry and intolerance of uncertainty in this population. This study investigates the relations among these variables in a sample of treatment-seeking IBS patients. Although the results are preliminary, worry does seem to predict gastrointestinal symptom severity and, when combined with a measure of current anxiety, accounts for almost 30% of the variance. Intolerance of uncertainty differentiated diarrhea-predominant IBS patients from constipation-predominant IBS patients. Earlier research has taken a psychiatric perspective on anxiety in IBS patients-the current study may provide some support for shifting our focus to the cognitive biases that may be operating in IBS patients, regardless of the presence of an anxiety disorder. Implications for a cognitive therapy approach to IBS treatment are discussed.

Keywords: irritable bowel syndrome; anxiety; worry; intolerance of uncertainty; cognitive treatment

Anxiety is believed to play some role in the onset and/or maintenance (see Sykes, Blanchard, Lackner, Keefer, & Krasner, 2003) of irritable bowel syndrome (IBS), a functional disorder of the lower gastrointestinal (GI) tract. Patients with IBS experience recurrent abdominal pain and/or cramping that is accompanied by altered bowel habit (diarrhea, constipation, or both); these symptoms can create marked impairment in functioning and quality of life (Drossman, Corrazziari, Taller, Thompson, & Whitehead, 2000). Although GI symptoms have a high degree of instability, physicians can often classify their patients into one of three IBS subtypes: diarrheapredominant, constipation-predominant, and mixed type. Research studies rarely examine differences among these three groups of patients, which may partially explain the marked variability seen in IBS assessment and treatment outcome research.

As IBS is a GI illness that has no known organic cause (and is therefore considered functional), it has commonly been thought of as a psychosomatic disorder. In support of this hypothesis are several studies that have shown that between 33% and 94% of IBS patients have a diagnosable psychiatric disorder (Blewett et al, 1996; Jarret et al, 1998; Lydiard, Fosset, Marsh, & Ballenger, 1993; for a summary see Blanchard, 2001). Further, although depression and somatization were also commonly diagnosed conditions within IBS patients, it is likely that between 4% and 60% of IBS patients meet criteria for a current anxiety disorder (Blanchard, 1990; Lydiard et al.; Folks & Kinney, 1992; Blanchard et al, 1990).

Unfortunately, although most clinicians would agree that anxiety is an important component of an IBS patient's presentation, the measurement of such anxiety has resulted in inconsistent findings. When measured categorically (i.e., through DSM-III-R or DSM-IV diagnoses), IBS patients exhibit significantly higher rates of anxiety disorders than normal controls or individuals with inflammatory bowel disease (Blanchard, Scharff, Schwatz, Suis, & Barlow, 1990). On the other hand, when measured dimensionally, IBS patients, on average, suffer from only mild to moderate anxiety when measured by the State-Trait Anxiety Inventory (STAI; Speilberger, 1983; see Blanchard & Keefer, 2003). This is somewhat surprising, given the high rate of anxiety disorders seen in IBS patients. It is possible that measurement of anxiety by the STAI excludes some of the other components of anxiety that IBS patients may manifest.

The most commonly diagnosed anxiety disorder among our IBS treatment-seeking population is Generalized Anxiety Disorder (GAD). GAD, a disorder characterized by chronic, uncontrollable worry and multiple CNS-mediated complaints, was found in 37% of our population in earlier research (Blanchard et al., 1990) and between 26% and 32% of our population more recently (Blanchard & Keefer, 2003; Sykes et al. …

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