Academic journal article Journal of Cognitive Psychotherapy

Dysfunctional Attitudes, Gender, and Psychopathology as Predictors of Pain Affect in Patients with Irritable Bowel Syndrome

Academic journal article Journal of Cognitive Psychotherapy

Dysfunctional Attitudes, Gender, and Psychopathology as Predictors of Pain Affect in Patients with Irritable Bowel Syndrome

Article excerpt

This cross-sectional study investigated the relationship between dysfunctional attitudes and the emotional unpleasantness of pain (pain affect) in a large sample (N = 281) of severely affected patients with irritable bowel syndrome (IBS). Subjects completed measures of pain, dysfunctional attitudes, and psychopathology as part of baseline assessment of an NIH-funded clinical trial featuring cognitive therapy for IBS. Drawing from the cognitive model of emotion, we predicted that patients with IBS would have a propensity toward negative thinking, as measured by the Dysfunctional Attitude Scale (DAS), and as a result rate pain affect as higher than patients with healthier cognitions. Consistent with these predictions, DAS scores for a sizable proportion of IBS patients were elevated compared to those from normative samples. Further, multiple regression analyses showed that dysfunctional attitudes account for approximately 11% of the variance in pain affect when control variables (gender, age, psychopathology) were held constant. These data are discussed in light of clinical implications for treating patients from a cognitive therapy orientation.

Keywords: irritable bowel syndrome; pain; emotion; cognition schema

Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal (GI) disorder whose expression and course are strongly influenced by psychological factors (Drossman et al., 1999). Of these factors, cognitive processes (thought, memory, attention) play a particularly important role in presentation of IBS. Cognitive processes have, by virtue of the neural connections between the brain and gut (Mayer, Naliboff, Chang, & Coutinho, 2001), an influence on biological systems that mediate gut sensation and function (e.g., Almy, Kern, & Tulin, 1949; Naliboff et al., 2001). Health outcomes of IBS patients are also subject to the influence of cognitive processes. Drossman (1999) found that two cognitive factors (i.e., "catastrophizing," self-efficacy) measured at baseline predicted subsequent (12-month) health outcome as measured using a composite health status of six variables (current pain, bed disability days, psychological distress, daily dysfunction, number of physician visits, number of surgeries and procedures). Another measure of the influence of cognitive processes comes from outcome research showing that psychological treatments featuring a cognitive therapy component are associated with clinically significant improvement in GI symptoms (Blanchard, 2001). Interestingly, in efforts to identify change mechanisms of cognitive therapy, Blanchard and colleagues (Greene & Blanchard, 1994; Payne & Blanchard, 1995) found that total scores on the Dysfunctional Attitude Scale (DAS), a measure of maladaptive beliefs, decreased significantly from pre- to posttreatment in patients who underwent cognitive therapy but not in patients assigned to control conditions.

Drawing from Beck's cognitive model of emotion (A. T. Beck, 1976; A. T. Beck, Rush, Shaw, & Emery, 1979), cognitive therapy for IBS seeks to modify or eliminate automatic thoughts and underlying assumptions (core beliefs) that underlie excessive emotional or physiological reactions associated with GI symptoms. Automatic thoughts refer to "the actual words or images that go through a person's mind" (J. S. Beck, 1995, p. 16), while core beliefs are relatively stable assumptions and beliefs about the self, the world, the future (A. T. Beck et al., 1979). These attitudes presumably "organize prior experience, guide the interpretation of new experiences, and shape expectancies and predictions" (A. T. Beck, Brown, Steer, & Weissman, 1991, p. 478). Metaphorically, automatic thoughts can be likened to a "snapshot" of a situation or image that elicits an emotional or somatic response, while core beliefs are the "lens" through which one sees the world. Foa and Rothbaum (1998) differentiate negative automatic thoughts from dysfunctional beliefs in the following manner: Dysfunctional beliefs are "general assumptions people hold about the world and about themselves that cause them to interpret specific events in an excessively negatively and dysfunctional manner," while negative thoughts are those "thoughts or images that go through a person's mind during a situation that provokes [a] response . …

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