|
1
|
Akbari R, Salimi Y, Dehghani-Aarani F, Rezayat E. Attention in irritable bowel syndrome: A systematic review of affected domains and brain-gut axis interactions. J Psychosom Res 2025; 191:112067. [PMID: 40048890 DOI: 10.1016/j.jpsychores.2025.112067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2025] [Revised: 01/29/2025] [Accepted: 02/17/2025] [Indexed: 03/16/2025]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a disorder characterized by gut-brain interactions, leading to abdominal pain and altered stool patterns, which significantly affect patients' quality of life. Recent research suggests that attention may be impaired in individuals with IBS, potentially influencing symptom perception and emotional distress. OBJECTIVE This systematic review aims to examine the relationship between attention and IBS, focusing on the affected domains of attention and the interactions within the brain-gut axis. METHODS A comprehensive search was conducted across MEDLINE/PubMed, PsychINFO, and Scopus from January 1990 to December 2024. Studies included were those that assessed attention in adult IBS patients using valid measurement tools. A total of 24 studies were analyzed, incorporating neuroimaging and behavioral methods. RESULTS IBS individuals exhibit specific attentional impairments, including deficits in sustained attention, selective attentional biases toward gastrointestinal (GI)-related and symptom-specific stimuli, and heightened vigilance to threat and pain cues. Neurofunctional studies reveal altered brain activity in areas such as the insula, anterior cingulate cortex, and amygdala, indicating increased interoceptive awareness and cognitive load. Pre-attentive processing and sensory gating show exaggerated responses, while sustained attention and attentional control demand additional cognitive resources. These patterns reflect an interplay between heightened sensitivity to internal stimuli and cognitive processing challenges in IBS. CONCLUSION This review highlights specific attentional deficits and biases in IBS, suggesting they may contribute to symptom exacerbation and emotional distress. Further research is needed to explore the underlying mechanisms and potential therapeutic interventions.
Collapse
Affiliation(s)
- Reyhaneh Akbari
- Department of Psychology, Faculty of Psychology and Education, University of Tehran, Tehran, Iran
| | - Yeganeh Salimi
- Department of Cognitive Sciences, Faculty of Psychology and Education, University of Tehran, Tehran, Iran
| | - Fateme Dehghani-Aarani
- Department of Psychology, Faculty of Psychology and Education, University of Tehran, Tehran, Iran.
| | - Ehsan Rezayat
- Department of Cognitive Sciences, Faculty of Psychology and Education, University of Tehran, Tehran, Iran; School of Cognitive Sciences, Institute for Research in Fundamental Sciences (IPM), Niavaran, Tehran, Iran.
| |
Collapse
|
|
2
|
Abudoush AN, Poliakoff E, Panagioti M, Hodkinson A, Husain N. Investigating attention toward pain-related cues in an Arabic-speaking population with and without chronic pain. Exp Brain Res 2024:10.1007/s00221-024-06789-9. [PMID: 38424370 DOI: 10.1007/s00221-024-06789-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/22/2024] [Indexed: 03/02/2024]
Abstract
There is some evidence for attentional biases in individuals with chronic pain (CP). Cultural and linguistic differences might affect the manifestation of these processes across populations. However, such attentional biases have not been explored in the Arabic-speaking population. The current study investigated these attentional biases and possible associations with resilience. Two matched groups of Arabic-speaking participants with (58) and without (58) CP were recruited from Jordan and the United Kingdom. They completed emotionally modified versions of the Posner cueing and Stroop tasks, alongside questionnaires. Significant group differences were found for the Posner task, with the CP group exhibiting disengagement revealed by the inhibition of return (IOR) effect for sensory pain-related cues compared to delayed disengagement for the other cue types. The control group showed IOR across cue types. No group differences were found on the Stroop task. The CP group had lower resilience scores than healthy controls, and resilience moderated performance on the Posner task. The study provides preliminary evidence about the attentional processes in the Arabic population; the speed of disengagement is affected in the CP group with early disengagement for sensory pain-related information compared to affect pain and neutral stimuli. Furthermore, resilience levels in the CP and control group moderated the performance on the Posner task, suggesting that it influences attentional allocation. This study can help in understanding how the phenomenon of attention bias intertwines with the cultural and linguistic factors. Future research should further explore attentional dynamics across different time points in this population and the modulatory effect of resilience.
Collapse
Affiliation(s)
- Ahmad N Abudoush
- Department of Psychology, Faculty of Arts, School of Arts, The University of Jordan, Amman, Jordan.
- School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK.
| | - Ellen Poliakoff
- School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Maria Panagioti
- School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Alexander Hodkinson
- School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Nusrat Husain
- School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| |
Collapse
|
|
3
|
Jones MP, Yun G, Wass F, Rixon H, Shah A, Walker MM, Koloski NA, Holtmann G, Talley NJ, Beath AP. The role of mood state and emotion regulation in the discrepancy between gastrointestinal symptom burden recorded prospectively and via recall questionnaire. Neurogastroenterol Motil 2022; 34:e14304. [PMID: 34854512 DOI: 10.1111/nmo.14304] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/17/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is limited empirical evidence of the magnitude of the discrepancy between prospectively recorded gastrointestinal symptom burden and that reported in recall questionnaires. Further, potential sources of the discrepancy are largely unknown. This study sought to quantify the discrepancy and to evaluate the potential role of mood disorder and emotion regulation in the discrepancy. METHODS One hundred and forty nine subjects (mean age 20 years, 75% female) who met Rome IV criteria for irritable bowel syndrome and/or functional dyspepsia completed a 7-day prospective recording of the symptoms on a smartphone implemented ecological momentary assessment app, and then on day 8 were asked to recall their symptoms for the preceding 7 days. KEY RESULTS Gastrointestinal symptom burden assessed by recall was exaggerated relative to that recorded prospectively. The discrepancy was moderate for overall score (Cohen d = 0.52), abdominal pain (d = 0.61) and indigestion (d = 0.49). The discrepancy was generally larger among subjects who reported a physician diagnosis of a gastrointestinal condition with d = 0.87 for overall score and d = 0.89 for abdominal pain. A number of correlations between the discrepancy and psychological traits were identified, including neuroticism with diarrhea discrepancy (r = 0.23, p = 0.004) and visceral-specific anxiety with abdominal pain discrepancy (r = -0.18, p = 0.03). There was no evidence of recency or Hawthorne (observer) effects. CONCLUSIONS AND INFERENCES Reports of gastrointestinal symptoms obtained via recall are likely to be exaggerated relative to the actual patient experience, particularly among healthcare seekers. While psychological traits are likely to play some role, much more needs to be understood about the discrepancy.
Collapse
Affiliation(s)
- Michael P Jones
- School of Psychological Sciences, Macquarie University, North Ryde, New South Wales, Australia
| | - Grace Yun
- School of Psychological Sciences, Macquarie University, North Ryde, New South Wales, Australia
| | - Fiona Wass
- School of Psychological Sciences, Macquarie University, North Ryde, New South Wales, Australia
| | - Hayley Rixon
- School of Psychological Sciences, Macquarie University, North Ryde, New South Wales, Australia
| | - Ayesha Shah
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital and Translational Research Institute (TRI), Woolloongabba, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Marjorie M Walker
- College of Health, Medicine and Well Being, University of Newcastle, Newcastle, New South Wales, Australia
| | - Natasha A Koloski
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital and Translational Research Institute (TRI), Woolloongabba, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,College of Health, Medicine and Well Being, University of Newcastle, Newcastle, New South Wales, Australia
| | - Gerald Holtmann
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital and Translational Research Institute (TRI), Woolloongabba, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Nicholas J Talley
- College of Health, Medicine and Well Being, University of Newcastle, Newcastle, New South Wales, Australia
| | - Alissa P Beath
- School of Psychological Sciences, Macquarie University, North Ryde, New South Wales, Australia
| |
Collapse
|
|
4
|
Matisz C, Gruber A. Neuroinflammatory remodeling of the anterior cingulate cortex as a key driver of mood disorders in gastrointestinal disease and disorders. Neurosci Biobehav Rev 2022; 133:104497. [DOI: 10.1016/j.neubiorev.2021.12.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 11/10/2021] [Accepted: 12/09/2021] [Indexed: 02/08/2023]
|
|
5
|
Ejova A, Badcock NA, McKerchar S, Beath AP, Swift C, Talley NJ, Holtmann G, Walker MM, Jones MP. Electroencephalographic evidence of unconscious and conscious attentional bias in people with functional gastrointestinal disorders: A pilot study. Int J Psychophysiol 2021; 170:30-42. [PMID: 34560170 DOI: 10.1016/j.ijpsycho.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 09/12/2021] [Accepted: 09/14/2021] [Indexed: 10/20/2022]
Abstract
Debate continues as to whether an attentional bias towards threat displayed by sufferers of functional gastrointestinal disorders (FGIDs) is conscious and, thus, more amenable to change through psychological therapy. We compared the amplitudes of early (unconscious) and later (conscious) electroencephalographic (EEG) event-related potentials following silent reading of symptom-related, emotionally neutral, and emotionally negative nouns across two participant groups: 30 female FGID-sufferers who met diagnostic criteria for irritable bowel syndrome or functional dyspepsia, and 30 female healthy controls. Analogous indices based on alpha desynchronization were also examined, as were correlations between the EEG-based indices and a range of psychosocial variables. FGID-sufferers displayed marginally significantly higher occipital EPN amplitudes for all nouns, indicating marginally higher levels of unconscious attention in the task. FGID-sufferers also displayed, for negative as compared to neutral nouns, significantly lower central N400 amplitudes indicative of higher conscious attention. The result was only apparent in post-hoc pairwise comparisons, however. Uniquely among FGID-sufferers, central N400 was strongly negatively correlated with a range of negative psychosocial traits and states. The findings provide preliminary evidence of hypervigilance to general (as opposed to symptom-specific) threat among FGID-sufferers. Amidst concerns over Type I error, recommendations are made for fine-tuning the operationalisation of unconscious and conscious attentional bias in this population.
Collapse
Affiliation(s)
- Anastasia Ejova
- Department of Psychology, Macquarie University, Sydney, Australia; School of Psychology, University of Adelaide, Adelaide, Australia.
| | - Nicholas A Badcock
- School of Psychological Science, University of Western Australia, Perth, Australia; Department of Cognitive Science, Macquarie University, Sydney, Australia
| | - Sarah McKerchar
- School of Psychology, University of Adelaide, Adelaide, Australia
| | - Alissa P Beath
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Claire Swift
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Nicholas J Talley
- Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia; NHMRC Centre of Research Excellence in Digestive Health, Newcastle, Australia
| | - Gerald Holtmann
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital and Translational Research Institute, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Marjorie M Walker
- Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia; NHMRC Centre of Research Excellence in Digestive Health, Newcastle, Australia
| | - Michael P Jones
- Department of Psychology, Macquarie University, Sydney, Australia
| |
Collapse
|
|
6
|
Guadagnoli L, Yadlapati R, Taft T, Pandolfino JE, Tye M, Keefer L. Esophageal hypervigilance is prevalent across gastroesophageal reflux disease presentations. Neurogastroenterol Motil 2021; 33:e14081. [PMID: 33432708 PMCID: PMC8272741 DOI: 10.1111/nmo.14081] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 12/16/2020] [Accepted: 12/23/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND There is a need to identify factors outside of abnormal reflux that contribute to gastroesophageal reflux disease (GERD). Esophageal hypervigilance is a psychological process impacting symptom experience in esophageal disease. However, little is known about the presence of hypervigilance in GERD phenotypes, especially in those with abnormal acid exposure or symptom index scores. The primary aim was to assess differences in self-reported esophageal hypervigilance across different GERD presentations. The secondary aim was to evaluate esophageal hypervigilance as a predictor of symptom severity. METHODS We conducted retrospective data analyses on a cohort of adult patients with reflux symptoms that underwent 96-hour wireless pH monitoring from 9/2015 to 9/2017. Patients were stratified into groups based on the number of days they exhibited positive acid exposure time (AET; 0 days, 1-2 days, 3+ days), and symptom index scores (SI; 0 days, 1-day, 2+ days). Esophageal hypervigilance and anxiety, and symptom frequency and severity were assessed between groups. KEY RESULTS A total of 123 AET cases and 116 SI cases were included for analysis. Esophageal hypervigilance and anxiety scores did not significantly differ based on the number of days of positive AET (p = 0.311) or SI (p = 0.118). Symptom severity and perceived symptom frequency differed between groups. Hypervigilance significantly predicted symptom severity, when controlling for symptom-specific anxiety. CONCLUSIONS Esophageal hypervigilance is persistent across patients with reflux, irrespective of acid burden and symptom index, and significantly predicts symptom severity. Hypervigilance should be considered as an independent factor contributing to esophageal symptom perception.
Collapse
Affiliation(s)
- Livia Guadagnoli
- Northwestern University Feinberg School of Medicine, Chicago IL
- Katholieke Universiteit Leuven, Leuven, Belgium
| | | | - Tiffany Taft
- Northwestern University Feinberg School of Medicine, Chicago IL
| | | | - Michael Tye
- University of Illinois College of Medicine, Chicago IL
| | - Laurie Keefer
- Icahn School of Medicine at Mount Sinai. New York, NY
| |
Collapse
|
|
7
|
Atanasova K, Lotter T, Reindl W, Lis S. Multidimensional Assessment of Interoceptive Abilities, Emotion Processing and the Role of Early Life Stress in Inflammatory Bowel Diseases. Front Psychiatry 2021; 12:680878. [PMID: 34248716 PMCID: PMC8264143 DOI: 10.3389/fpsyt.2021.680878] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/28/2021] [Indexed: 12/12/2022] Open
Abstract
Perception of internal bodily sensations includes three dissociable processes: interoceptive accuracy, interoceptive sensibility, and interoceptive awareness. Interoceptive abilities play a crucial role in emotion processing and impairments of these processes have been reported in several psychiatric disorders. Studies investigating interoceptive abilities and their role in emotional experience in individuals with somatic disorders such as inflammatory bowel diseases (IBD) are sparse. Recent findings suggested an association between adverse childhood experiences (ACE) and the development of gastrointestinal disorders. The aim of the current study was to investigate the associations between the different dimensions of interoception and emotional processing in IBD while taking ACE into account. We recruited IBD patients in clinical remission (n = 35) and 35 healthy control participants (HC) matched for age, education and IQ. Interoception was measured as a three-dimensional construct. Interoceptive accuracy was assessed with the heartbeat tracking task and interoceptive sensibility with a self-report measure (Multidimensional Assessment of Interoceptive Awareness questionnaire). Emotional processing was measured using an experimental task, where participants were asked to rate the subjectively perceived valence and arousal when presented with positive, neutral and negative visual stimuli. IBD patients significantly differed in two interoceptive sensibility domains, Emotional awareness and Not-distracting. Patients reported greater awareness of the connection between bodily sensations and emotional states, while showing a stronger tendency to use distraction from unpleasant sensations compared with HC. Higher emotional awareness was linked to higher perceived intensity and arousal of negative stimuli. The strength of this relation was dependent on the severity of ACE, with severer traumatization being associated with a stronger association between emotional awareness and perceived valence and arousal. Our findings suggest that it is the subjective component of interoception, especially the one assessing interoceptive abilities within the scope of emotional experience, which affects emotional processing in IBD. This is the first study providing evidence that IBD patients did not differ in their perception of visceral signals per se but only in the subjective ability to attribute certain physical sensations to physiological manifestations of emotions. Our findings support the hypothesis that ACE affect the association between interoception and emotional processing.
Collapse
Affiliation(s)
- Konstantina Atanasova
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Tobias Lotter
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Department of Psychosomatic Medicine, Central Institute for Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Wolfgang Reindl
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Stefanie Lis
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| |
Collapse
|
|
8
|
Stressful Life Events Moderate the Relationship Between Changes in Symptom Severity and Health-related Quality of Life in Patients With Irritable Bowel Syndrome. J Clin Gastroenterol 2020; 54:445-451. [PMID: 31503051 DOI: 10.1097/mcg.0000000000001261] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The relationship between changes in symptom severity and health-related quality of life (HRQOL), which may be impacted by stressful life events, in irritable bowel syndrome (IBS), is unclear. Therefore, we investigated the relationship between changes in symptom severity and HRQOL and examined the moderating role of stressful life events in patients with IBS. METHODS This study is part of a cohort follow-up study on psychological factors in patients with IBS in tertiary care, and it included 158 patients. In addition to symptom severity and HRQOL, stressful life events were assessed by the Social Readjustment Rating Scale (SRRS). The relationship between symptom severity and HRQOL and the moderating role of stressful life events (in the 12 mo before the follow-up assessment) were analyzed. RESULTS The majority of participants had moderate levels of stressful life events (41.8%), followed by those who had mild levels (39.2%) and severe levels (19.0%) of stressful life events. Symptom severity could predict HRQOL, and the relationship between symptom severity and HRQOL was affected by the level of stressful life events. Compared with mild levels of stressful life events, a severe level of stressful life events significantly affected the relationship between changes in symptom severity and HRQOL (Z=-3.048, P<0.01). A similar result was found when comparing moderate and severe levels of stressful life events (Z=-1.810, P<0.10). CONCLUSIONS The study demonstrated that symptom severity predicted HRQOL during the progression of IBS and that stressful life events moderated the impact of symptom severity on HRQOL. The more stressful life events an IBS patient experiences, the less predictable the relationship is between changes in symptom severity and HRQOL.
Collapse
|
|
9
|
Labrenz F, Knuf-Rtveliashvili S, Elsenbruch S. Sex Differences Linking Pain-Related Fear and Interoceptive Hypervigilance: Attentional Biases to Conditioned Threat and Safety Signals in a Visceral Pain Model. Front Psychiatry 2020; 11:197. [PMID: 32265756 PMCID: PMC7105724 DOI: 10.3389/fpsyt.2020.00197] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 02/28/2020] [Indexed: 12/19/2022] Open
Abstract
Although the broad role of fear and hypervigilance in conditions of the gut-brain axis like irritable bowel syndrome is supported by converging evidence, the underlying mechanisms remain incompletely understood. Even in healthy individuals, it remains unclear how pain-related fear may contribute to pain-related attentional biases for acute visceral pain. Building on our classical fear conditioning work in a clinically relevant model of visceral pain, we herein elucidated pain-related attentional biases shaped by associative learning in healthy women and men, aiming to elucidate possible sex differences and the role of psychological traits. To this end, we compared the impact of differentially conditioned pain-predictive cues on attentional biases in healthy women and men. Sixty-four volunteers accomplished a visual dot-probe task and subsequently underwent pain-related fear conditioning where one visual cue (CS+) was contingently paired with a painful rectal distention (US) while another cue remained unpaired (CS-). During the following test phase, the dot-probe task was repeated to investigate changes in attentional biases in response to differentially valenced cues. While pain-related learning was comparable between groups, men revealed more pronounced attentional engagement with the CS+ and CS- whereas women demonstrated stronger difficulties to disengage from the CS+ when presented with a neutral cue. However, when both CS+ and CS- were presented together, women revealed stronger difficulties to disengage from the CS-. Regression analyses revealed an interaction of sex, with negative affect predicting stronger avoidance of the CS+ and stronger difficulties to disengage attention from the CS- in men. These results provide first evidence that pain-related fear conditioning may induce attentional biases differentially in healthy women and men. Hence, sex differences may play a role in attentional mechanisms underlying hypervigilance, and may be modulated by psychological vulnerability factors relevant to chronic visceral pain.
Collapse
Affiliation(s)
- Franziska Labrenz
- Institute of Medical Psychology & Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sopiko Knuf-Rtveliashvili
- Institute of Medical Psychology & Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sigrid Elsenbruch
- Institute of Medical Psychology & Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| |
Collapse
|
|
10
|
Wong KMF, Mak ADP, Yuen SY, Leung ONW, Ma DY, Chan Y, Cheong PK, Lui R, Wong SH, Wu JCY. Nature and specificity of altered cognitive functioning in IBS. Neurogastroenterol Motil 2019; 31:e13696. [PMID: 31389109 DOI: 10.1111/nmo.13696] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 07/17/2019] [Accepted: 07/23/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND It is unknown whether cognitive dysfunction found in patients with irritable bowel syndrome (IBS) was attributable to the different subtypes, ongoing pathophysiological processes, trait characteristics, or psychiatric comorbidity. METHODS Forty Rome-III patients with IBS (20 diarrhea-predominant [IBS-D] and 20 constipation-predominant [IBS-C]) and 40 age-, sex-, education-matched healthy controls were systematically recruited and compared on their cognitive function with continuous performance test (CPT), Wisconsin Card Sorting Test (WCST) and emotional Stroop test. Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II), Patient Health Questionnaire-15 (PHQ-15) and a structured bowel symptom questionnaire were performed to measure anxiety, depressive, somatization, and bowel symptoms, respectively. Psychiatric diagnoses were ascertained with SCID-I (Structured Clinical Interview for DSM-IV Axis I Disorders). KEY RESULTS Patients with IBS showed significantly increased standard deviation of reaction time (SDRT) (P = .003) on CPT, increased failure to maintain set (FMS) (P=.002), and percentage of perseverative errors (P = .003) on WCST. SDRT did not correlate with illness chronicity or bowel symptoms. FMS correlated with bowel symptom severity. In logistic regression models controlled for BAI, BDI-II, and PHQ-15, SDRT (AOR = 1.08, P = .025), but not FMS (P = .25) or percentage of perseverative errors (P = .24), significantly differentiated IBS from controls. Cognitive function was not significantly different between IBS-C and IBS-D (P > .05), or between pure IBS (n = 22) and IBS with generalized anxiety disorder (GAD) (n = 17) (P > .05). CONCLUSIONS & INFERENCES Patients with IBS showed attentional and executive function impairment irrespective of subtypes but otherwise heterogeneous in terms of its state-trait correlations and overlap with anxiety comorbidity.
Collapse
Affiliation(s)
| | - Arthur Dun Ping Mak
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Suet Ying Yuen
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Owen Ngo Wang Leung
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Duan Yang Ma
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Yawen Chan
- Institute of Digestive Diseases, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Pui Kuan Cheong
- Institute of Digestive Diseases, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Rashid Lui
- Institute of Digestive Diseases, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Sunny Hei Wong
- Institute of Digestive Diseases, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Justin Che-Yuen Wu
- Institute of Digestive Diseases, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| |
Collapse
|
|
11
|
Cognitive impairment in Irritable Bowel Syndrome (IBS): A systematic review. Brain Res 2019; 1719:274-284. [PMID: 31150650 DOI: 10.1016/j.brainres.2019.05.036] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 05/26/2019] [Accepted: 05/27/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Irritable Bowel Syndrome (IBS) is a common functional gastrointestinal disorder which is characterized by altered bowel habits. A growing number of studies investigate the association between IBS and cognitive impairments. Current studies report conflicting results regarding cognitive impairment in IBS patients. We therefore conducted the first systematic review to examine the association between IBS and cognitive impairment and identify the types of cognitive domain involved. STUDY DESIGN Eight databases (MEDLINE, CINAHL, EMBASE, Cochrane Library, PsycINFO, ScienceDirect, China National Knowledge Infrastructure (CNKI), and Chinese Biomedical Literature Database (CBM)) were searched from the inception date up till 15 February 2018. Observational studies published in English or Chinese were independently appraised, and data was extracted, by two reviewers using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Analytical Cross-Sectional Studies. The findings were synthesized using a narrative approach. RESULTS Twelve studies met the inclusion criteria. Our findings suggested that IBS patients exhibited attentional bias towards GI sensation words and emotionally negative words. There was insufficient evidence of evidences to show that IBS patients had cognitive deficits in memory, intelligence, executive functions and general cognitive functions. A number of limitations were identified, including small sample, limited cognitive domain inclusion, lack of study details, and management of confounding variables. CONCLUSION There is evidence of attentional bias in individuals with IBS; the evidence on cognitive impairment was either inconclusive or insufficient in other cognitive domains. Further studies are needed to confirm prevalence rates and examine potential mechanisms.
Collapse
|
|
12
|
Chan Y, So SHW, Mak ADP, Siah KTH, Chan W, Wu JCY. The temporal relationship of daily life stress, emotions, and bowel symptoms in irritable bowel syndrome-Diarrhea subtype: A smartphone-based experience sampling study. Neurogastroenterol Motil 2019; 31:e13514. [PMID: 30450780 DOI: 10.1111/nmo.13514] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 10/17/2018] [Accepted: 10/24/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND The current study aimed to model the moment-to-moment relationship between daily life stress, emotions, and bowel symptoms among patients with irritable bowel syndrome-diarrhea subtype (IBS-D) in the flow of daily life using a smartphone-based experience sampling method (ESM). METHODS Patients with IBS-D (N = 27) and healthy controls (HC; N = 30) completed ESM ratings of their real-time daily life stress, which was defined as subjective stress related to daily activities, both positive and negative emotions, as well as bowel symptoms eight times a day for 14 consecutive days, following a baseline interview measuring bowel and mood symptoms. Moment-to-moment association between ESM variables was tested within and between groups using multilevel regression modeling. KEY RESULTS Patients with IBS-D reported more severe bowel symptoms and lower positive affect than HCs, but levels of daily life stress and negative affect were comparable between groups. Time-lagged analysis of ESM data revealed that, among patients with IBS-D, daily life stress predicted a decrease in abdominal pain and urgency to defecation at a subsequent time point, whereas severity of bowel symptoms and occurrence of diarrhea predicted a subsequent increase in negative affect and daily life stress. The above associations were not found among HCs. CONCLUSIONS AND INFERENCES ESM unveiled the dynamic relationship between bowel symptoms, stress, and emotionality. Patients with IBS-D responded to bowel symptoms with more stress and distress momentarily. Counter-intuitively, daily life activity stress appeared to ameliorate bowel symptoms, although a more rigorous study design is required to testify this claim. Psychological understanding of IBS-D is discussed.
Collapse
Affiliation(s)
- Yawen Chan
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Suzanne Ho-Wai So
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Arthur Dun Ping Mak
- Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Kewin Tien Ho Siah
- Division of Gastroenterology and Hepatology, National University Health System, Singapore City, Singapore
| | - Wai Chan
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Justin C Y Wu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| |
Collapse
|
|
13
|
Schoth DE, Beaney R, Broadbent P, Zhang J, Liossi C. Attentional, interpretation and memory biases for sensory-pain words in individuals with chronic headache. Br J Pain 2019; 13:22-31. [PMID: 30671235 PMCID: PMC6327358 DOI: 10.1177/2049463718789445] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Cognitive biases in attention, interpretation and less consistently memory have been observed in individuals with chronic pain and play a critical role in the onset and maintenance of chronic pain. Despite operating in combination cognitive biases are typically explored in isolation. AIM The primary aim of this study was to explore attentional, interpretation and memory biases and their interrelationship in individuals with chronic headache. METHODS Twenty-eight participants with chronic headache and 34 healthy controls completed paradigms assessing attentional, interpretation and memory biases with ambiguous sensory-pain and neutral words. RESULTS Individuals with chronic pain showed significantly greater pain-related attentional and interpretation biases relative to controls, with no differences in memory bias. No significant correlation was found between any of the three forms of cognitive bias assessed. DISCUSSION AND CONCLUSION The clinical implications of cognitive biases in individuals with chronic pain remain to be fully explored, although one avenue for future research would be specific investigation of the implications of biased interpretations considering the consistency of results found across the literature for this form of bias.
Collapse
Affiliation(s)
- Daniel E Schoth
- Pain Research Laboratory, Department of Psychology, University of Southampton, Southampton, UK
| | - Rebecca Beaney
- Pain Research Laboratory, Department of Psychology, University of Southampton, Southampton, UK
| | - Philippa Broadbent
- Pain Research Laboratory, Department of Psychology, University of Southampton, Southampton, UK
| | - Jin Zhang
- Pain Research Laboratory, Department of Psychology, University of Southampton, Southampton, UK
| | - Christina Liossi
- Pain Research Laboratory, Department of Psychology, University of Southampton, Southampton, UK
| |
Collapse
|
|
14
|
Chapman A, Poliakoff E, Chew-Graham CA, Brown RJ. Attending away from the body predicts increased physical symptom reports at six months in primary care patients. J Psychosom Res 2018; 113:81-88. [PMID: 30190054 DOI: 10.1016/j.jpsychores.2018.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/01/2018] [Accepted: 08/02/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE High symptom reporting (HSR) and medically unexplained symptoms (MUS) are associated with considerable distress, disability, healthcare utilization and costs, but are poorly understood, and current treatments are of limited benefit. Most models of HSR and MUS implicate cognitive-perceptual factors, such as increased body-focused attention, reduced perceptual thresholds and a tendency to experience somatic misperception, but little is known about the causal role of these variables. We investigated this issue by studying whether there is a longitudinal relationship between perceptual-attentional variables and later clinical outcomes in primary care patients. METHOD Primary care patients (N = 102) completed clinical (physical symptom reporting, health anxiety and healthcare utilization) and perceptual-attentional (body-focused attention, perceptual threshold, somatic misperception) measures at baseline and then again six months later (N = 72). Hierarchical regression was used to examine cross-lagged relationships between baseline and follow-up scores. RESULTS Contrary to expectation, attending away from the body at baseline predicted increased not decreased symptom reporting six months later. Neither perceptual threshold nor somatic misperception predicted clinical outcomes at six months. CONCLUSIONS These findings suggest that body avoidance, rather than increased body focus, contribute to the development of HSR. Future studies should consider the potential clinical benefits of reducing bodily avoidance, via techniques that promote adaptive engagement with bodily sensations.
Collapse
Affiliation(s)
- Anna Chapman
- Northumberland, Tyne and Wear NHS Foundation Trust, United Kingdom
| | | | | | - Richard J Brown
- University of Manchester, United Kingdom; University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, United Kingdom.
| |
Collapse
|
|
15
|
Henrich JF, Martin M. Altered attentional control linked to catastrophizing in patients with irritable bowel syndrome. Br J Health Psychol 2018; 23:612-629. [PMID: 29573051 DOI: 10.1111/bjhp.12307] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 01/15/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Our study aimed to investigate differences in attentional control between patients with irritable bowel syndrome (IBS) and healthy participants and to examine the link between attentional control and IBS catastrophizing. Previous research has shown that patients with chronic functional illnesses have lower levels of attentional control. However, no previous study has found altered attentional control in patients with IBS or directly investigated the link between attentional control and catastrophizing. We also aimed to establish whether anxiety is associated with attentional functions in patients with IBS. DESIGN AND METHODS In this cross-sectional study, we compared 41 IBS patients with 39 healthy-matched control participants on attentional functions using an attention network task. IBS catastrophizing (Gastrointestinal Cognitions), IBS symptom severity (GSRS-IBS), Depression, Anxiety, and Stress (DASS-21), and Visceral Anxiety Sensitivity were assessed using self-report measures. RESULTS Patients with IBS had lower attentional control compared to healthy participants, t (78) = -2.75, p = .007, d = .62. Groups did not differ in alerting or orienting attention. IBS patients with lower attentional control scored higher on IBS catastrophizing than those with higher attention control, t (38.59) = 2.19, p = .032, d = .66. Anxiety was related to orienting attention in the IBS group (ρ = .38, p = .015). CONCLUSIONS Patients with IBS displayed reduced attentional control. Crucially, those patients with lower attentional control also had more catastrophizing thoughts than patients with better attentional control. These findings suggest that improving attentional control could be a valid target for psychological interventions for IBS. Statement of contribution What is already known on this subject? It has been hypothesised that psychological processes play a role in the maintenance of irritable bowel syndrome (IBS), and altered levels of attentional control have been found in patients with other functional illnesses but not yet in patients with IBS. Pain catastrophizing, a maladaptive thinking pattern, has been linked with IBS symptom severity, and previous research has shown an association between attentional control and intrusive thoughts. Whether there is an association between catastrophizing thoughts and attentional control in patients with IBS is unknown. What does this study add? Patients with irritable bowel syndrome show reduced levels of attentional control. IBS patients with lower levels of attentional control have more catastrophizing thoughts. Therapies emphasizing attentional control training may help reduce catastrophizing.
Collapse
Affiliation(s)
- Julia F Henrich
- Department of Experimental Psychology, University of Oxford, UK
| | - Maryanne Martin
- Department of Experimental Psychology, University of Oxford, UK
| |
Collapse
|
|
16
|
Hughes AM, Chalder T, Hirsch CR, Moss-Morris R. An attention and interpretation bias for illness-specific information in chronic fatigue syndrome. Psychol Med 2017; 47:853-865. [PMID: 27894380 DOI: 10.1017/s0033291716002890] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Studies have shown that specific cognitions and behaviours play a role in maintaining chronic fatigue syndrome (CFS). However, little research has investigated illness-specific cognitive processing in CFS. This study investigated whether CFS participants had an attentional bias for CFS-related stimuli and a tendency to interpret ambiguous information in a somatic way. It also determined whether cognitive processing biases were associated with co-morbidity, attentional control or self-reported unhelpful cognitions and behaviours. METHOD A total of 52 CFS and 51 healthy participants completed self-report measures of symptoms, disability, mood, cognitions and behaviours. Participants also completed three experimental tasks, two designed specifically to tap into CFS salient cognitions: (i) visual-probe task measuring attentional bias to illness (somatic symptoms and disability) v. neutral words; (ii) interpretive bias task measuring positive v. somatic interpretations of ambiguous information; and (iii) the Attention Network Test measuring general attentional control. RESULTS Compared with controls, CFS participants showed a significant attentional bias for fatigue-related words and were significantly more likely to interpret ambiguous information in a somatic way, controlling for depression and anxiety. CFS participants had significantly poorer attentional control than healthy individuals. Attention and interpretation biases were associated with fear/avoidance beliefs. Somatic interpretations were also associated with all-or-nothing behaviour and catastrophizing. CONCLUSIONS People with CFS have illness-specific biases which may play a part in maintaining symptoms by reinforcing unhelpful illness beliefs and behaviours. Enhancing adaptive processing, such as positive interpretation biases and more flexible attention allocation, may provide beneficial intervention targets.
Collapse
Affiliation(s)
- A M Hughes
- Psychology Department,King's College London,Institute of Psychiatry, Psychology and Neuroscience,London,UK
| | - T Chalder
- Department of Psychological Medicine,King's College London,London,UK
| | - C R Hirsch
- Psychology Department,King's College London,Institute of Psychiatry, Psychology and Neuroscience,London,UK
| | - R Moss-Morris
- Psychology Department,King's College London,Institute of Psychiatry, Psychology and Neuroscience,London,UK
| |
Collapse
|
|
17
|
Hughes AM, Gordon R, Chalder T, Hirsch CR, Moss-Morris R. Maximizing potential impact of experimental research into cognitive processes in health psychology: A systematic approach to material development. Br J Health Psychol 2017; 21:764-780. [PMID: 27659260 DOI: 10.1111/bjhp.12214] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/19/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is an abundance of research into cognitive processing biases in clinical psychology including the potential for applying cognitive bias modification techniques to assess the causal role of biases in maintaining anxiety and depression. Within the health psychology field, there is burgeoning interest in applying these experimental methods to assess potential cognitive biases in relation to physical health conditions and health-related behaviours. Experimental research in these areas could inform theoretical development by enabling measurement of implicit cognitive processes that may underlie unhelpful illness beliefs and help drive health-related behaviours. However, to date, there has been no systematic approach to adapting existing experimental paradigms for use within physical health research. Many studies fail to report how materials were developed for the population of interest or have used untested materials developed ad hoc. The lack of protocol for developing stimuli specificity has contributed to large heterogeneity in methodologies and findings. PURPOSE In this article, we emphasize the need for standardized methods for stimuli development and replication in experimental work, particularly as it extends beyond its original anxiety and depression scope to other physical conditions. METHOD We briefly describe the paradigms commonly used to assess cognitive biases in attention and interpretation and then describe the steps involved in comprehensive/robust stimuli development for attention and interpretation paradigms using illustrative examples from two conditions: chronic fatigue syndrome and breast cancer. CONCLUSIONS This article highlights the value of preforming rigorous stimuli development and provides tools to aid researchers engage in this process. We believe this work is worthwhile to establish a body of high-quality and replicable experimental research within the health psychology literature. Statement of contribution What is already known on this subject? Cognitive biases (e.g., tendencies to attend to negative information and/or interpret ambiguous information in negative ways) have a causal role in maintaining anxiety and depression. There is mixed evidence of cognitive biases in physical health conditions and chronic illness; one reason for this may be the heterogeneous stimuli used to assess attention and interpretation biases in these conditions. What does this study add? Steps for comprehensive/robust stimuli development for attention and interpretation paradigms are presented. Illustrative examples are provided from two conditions: chronic fatigue syndrome and breast cancer. We provide tools to help researchers develop condition-specific materials for experimental studies.
Collapse
Affiliation(s)
- Alicia M Hughes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Rola Gordon
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Trudie Chalder
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Colette R Hirsch
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Rona Moss-Morris
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| |
Collapse
|
|
18
|
Symptoms and the body: Taking the inferential leap. Neurosci Biobehav Rev 2017; 74:185-203. [PMID: 28108416 DOI: 10.1016/j.neubiorev.2017.01.015] [Citation(s) in RCA: 335] [Impact Index Per Article: 41.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 12/01/2016] [Accepted: 01/11/2017] [Indexed: 12/19/2022]
Abstract
The relationship between the conscious experience of physical symptoms and indicators of objective physiological dysfunction is highly variable and depends on characteristics of the person, the context and their interaction. This relationship often breaks down entirely in the case of "medically unexplained" or functional somatic symptoms, violating the basic assumption in medicine that physical symptoms have physiological causes. In this paper, we describe the prevailing theoretical approach to this problem and review the evidence pertaining to it. We then use the framework of predictive coding to propose a new and more comprehensive model of the body-symptom relationship that integrates existing concepts within a unifying framework that addresses many of the shortcomings of current theory. We describe the conditions under which a close correspondence between the experience of symptoms and objective physiology might be expected, and when they are likely to diverge. We conclude by exploring some theoretical and clinical implications of this new account.
Collapse
|
|
19
|
Trost Z, Van Ryckeghem D, Scott W, Guck A, Vervoort T. The Effect of Perceived Injustice on Appraisals of Physical Activity: An Examination of the Mediating Role of Attention Bias to Pain in a Chronic Low Back Pain Sample. THE JOURNAL OF PAIN 2016; 17:1207-1216. [DOI: 10.1016/j.jpain.2016.08.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 07/18/2016] [Accepted: 08/10/2016] [Indexed: 11/29/2022]
|
|
20
|
Schoth DE, Parry L, Liossi C. Combined cognitive biases for pain and disability information in individuals with chronic headache: A preliminary investigation. J Health Psychol 2016; 23:1610-1621. [DOI: 10.1177/1359105316664136] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Pain-related cognitive biases have been demonstrated in chronic pain patients, yet despite theoretical predictions are rarely investigated in combination. Combined cognitive biases were explored in individuals with chronic headache ( n = 17) and pain-free controls ( n = 20). Participants completed spatial cueing (attentional bias), sentence generation (interpretation bias) and free recall tasks (memory bias), with ambiguous sensory-pain, disability and neutral words. Individuals with chronic headache, relative to controls, showed significantly greater interpretation and memory biases favouring ambiguous sensory-pain words and interpretation bias favouring ambiguous disability words. No attentional bias was found. Further research is needed exploring the temporal pattern of cognitive biases.
Collapse
|
|
21
|
Muscatello MRA, Bruno A, Mento C, Pandolfo G, Zoccali RA. Personality traits and emotional patterns in irritable bowel syndrome. World J Gastroenterol 2016; 22:6402-15. [PMID: 27605876 PMCID: PMC4968122 DOI: 10.3748/wjg.v22.i28.6402] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 05/26/2016] [Accepted: 06/15/2016] [Indexed: 02/06/2023] Open
Abstract
The review focuses on those personality traits (neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness), constructs (alexithymia and distressed - Type D personality) and emotional patterns (negative and positive) that are of particular concern in health psychology, with the aim to highlight their potential role on the pathogenesis, onset, symptom clusters, clinical course, and outcome of irritable bowel syndrome (IBS). Personality traits and emotional patterns play key roles in affecting autonomic, immune, inflammatory, and endocrine functions, thus contributing not only to IBS clinical expression and symptomatic burden, but also to disease physiopathology. In this sense, psychological treatments should address those personality traits and emotional features that are constitutive of, and integral to IBS. The biopsychosocial model of illness applied to IBS acknowledges the interaction between biological, psychological, environmental, and social factors in relation to pain and functional disability. A holistic approach to IBS should take into account the heterogeneous nature of the disorder, and differentiate treatments for different types of IBS, also considering the marked individual differences in prevalent personality traits and emotional patterns. Beyond medications, and lifestyle/dietary interventions, psychological and educational treatments may provide the optimal chance of addressing clinical symptoms, comorbid conditions, and quality of life in IBS patients.
Collapse
|
|
22
|
Mogoaşe C, David D, Dumitraşcu DL. Irrational Beliefs and Attention Bias Towards Symptoms-Related Stimuli in Maintaining Gastrointestinal Symptoms: Results from a Pilot Study. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2016; 34:100-113. [DOI: 10.1007/s10942-015-0226-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
|
23
|
Cockle SG, Ogden J. The 'radiation vacation': Parents' experiences of travelling to have their children's brain tumours treated with proton beam therapy. Health Psychol Open 2016; 3:2055102916649767. [PMID: 28070403 PMCID: PMC5193290 DOI: 10.1177/2055102916649767] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Proton beam therapy is a new form of radiotherapy. Little is known about patients' experiences of proton beam therapy and less about parents' experiences of children receiving treatment. Semi-structured interviews explored 10 parents' experiences of travelling from the United Kingdom to the United States to have their children's brain tumours treated with proton beam therapy. Thematic analysis uncovered themes of 'adjusting to the PBT routine', 'finding benefit in the situation' and 'readjusting upon returning home'. Parents' initial worries were elevated by travel, but they found benefit in their experiences, describing them positively. The periods before and after treatment were most difficult, illustrating a cycle from upset to calm, back to upset upon their return home.
Collapse
|
|
24
|
Hubbard CS, Hong JY, Jiang Z, Ebrat B, Suyenobu B, Smith S, Heendeniya N, Naliboff BD, Tillisch K, Mayer EA, Labus JS. Increased attentional network functioning related to symptom severity measures in females with irritable bowel syndrome. Neurogastroenterol Motil 2015; 27:1282-94. [PMID: 26087779 PMCID: PMC4550526 DOI: 10.1111/nmo.12622] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 05/24/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND Increased attention to gastrointestinal (GI) symptoms and disease-specific contexts may play an important role in the enhanced perception of visceral stimuli frequently reported in patients with irritable bowel syndrome (IBS). In this study, we test the hypothesis that altered attentional mechanisms underlie central pain amplification in IBS. METHODS To evaluate brain networks that support alerting, orienting, and executive attention, we employed the attention network test (ANT), a modified flanker task which measures the efficiency of functioning of core attentional networks, during functional magnetic resonance imaging in 15 IBS patients (mean age = 31 [11.96]) and 14 healthy controls (HCs; mean age = 31 [10.91]). KEY RESULTS Patients with IBS, compared to HCs, showed shorter reaction times during the alerting and orienting conditions which were associated with greater activation of anterior midcingulate and insular cortices, and decreased activity in the right inferior frontal junction and supplementary motor cortex. Patients also showed activation in the dorsal medial prefrontal cortex and concurrent thalamic deactivation during the executive control portion of the ANT relative to HCs, but no group difference in reaction times were found. The activity in brain regions showing group differences during the ANT were associated with measures of GI-specific anxiety, pain catastrophizing, and fear of uncertainty. In IBS, activity in the anterior midcingulate during alerting correlated with duration of GI-symptoms and overall symptom severity. CONCLUSIONS & INFERENCES Together, these results suggest that IBS patients have specific abnormalities in attentional network functioning and these deficits may underlie symptom-related anxiety, hypervigilance, and visceral hypersensitivity.
Collapse
Affiliation(s)
- Catherine S. Hubbard
- Gail and Gerald Oppenheimer Family Center for the Neurobiology of Stress, Los Angeles, CA,Department of Medicine, UCLA, Los Angeles, CA,Department of Neural and Pain Sciences, School of Dentistry, University of Maryland, Baltimore, MD,Center for Pain and the Brain, Boston Children’s Hospital
| | - Jui-Yang Hong
- Gail and Gerald Oppenheimer Family Center for the Neurobiology of Stress, Los Angeles, CA,Department of Medicine, UCLA, Los Angeles, CA,Department of Biomedical Engineering, UCLA, Los Angeles, CA,Pain and Interoceptive Network (PAIN)
| | - Zhiguo Jiang
- Gail and Gerald Oppenheimer Family Center for the Neurobiology of Stress, Los Angeles, CA
| | - Bahar Ebrat
- Gail and Gerald Oppenheimer Family Center for the Neurobiology of Stress, Los Angeles, CA,Department of Medicine, UCLA, Los Angeles, CA
| | - Brandall Suyenobu
- Gail and Gerald Oppenheimer Family Center for the Neurobiology of Stress, Los Angeles, CA,Department of Medicine, UCLA, Los Angeles, CA
| | - Suzanne Smith
- Gail and Gerald Oppenheimer Family Center for the Neurobiology of Stress, Los Angeles, CA,Department of Medicine, UCLA, Los Angeles, CA
| | - Nuwanthi Heendeniya
- Gail and Gerald Oppenheimer Family Center for the Neurobiology of Stress, Los Angeles, CA,Department of Medicine, UCLA, Los Angeles, CA
| | - Bruce D. Naliboff
- Gail and Gerald Oppenheimer Family Center for the Neurobiology of Stress, Los Angeles, CA,Department of Medicine, UCLA, Los Angeles, CA,VA Greater Los Angeles Healthcare System, Los Angeles, CA,Pain and Interoceptive Network (PAIN)
| | - Kirsten Tillisch
- Gail and Gerald Oppenheimer Family Center for the Neurobiology of Stress, Los Angeles, CA,Department of Medicine, UCLA, Los Angeles, CA,Pain and Interoceptive Network (PAIN)
| | - Emeran A. Mayer
- Gail and Gerald Oppenheimer Family Center for the Neurobiology of Stress, Los Angeles, CA,Department of Medicine, UCLA, Los Angeles, CA,Department of Physiology, UCLA, Los Angeles, CA,Department of Psychiatry, UCLA, Los Angeles, CA,Pain and Interoceptive Network (PAIN)
| | - Jennifer S. Labus
- Gail and Gerald Oppenheimer Family Center for the Neurobiology of Stress, Los Angeles, CA,Department of Medicine, UCLA, Los Angeles, CA,Department of Psychiatry, UCLA, Los Angeles, CA,Pain and Interoceptive Network (PAIN)
| |
Collapse
|
|
25
|
El-Salhy M. Recent developments in the pathophysiology of irritable bowel syndrome. World J Gastroenterol 2015; 21:7621-7636. [PMID: 26167065 PMCID: PMC4491952 DOI: 10.3748/wjg.v21.i25.7621] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 03/31/2015] [Accepted: 05/21/2015] [Indexed: 02/06/2023] Open
Abstract
Irritable bowel syndrome (IBS) is a common gastrointestinal disorder, the pathophysiology of which is not completely known, although it has been shown that genetic/social learning factors, diet, intestinal microbiota, intestinal low-grade inflammation, and abnormal gastrointestinal endocrine cells play a major role. Studies of familial aggregation and on twins have confirmed the heritability of IBS. However, the proposed IBS risk genes are thus far nonvalidated hits rather than true predisposing factors. There is no convincing evidence that IBS patients suffer from food allergy/intolerance, with the effect exerted by diet seemingly caused by intake of poorly absorbed carbohydrates and fiber. Obesity is a possible comorbidity of IBS. Differences in the microbiota between IBS patients and healthy controls have been reported, but the association between IBS symptoms and specific bacterial species is uncertain. Low-grade inflammation appears to play a role in the pathophysiology of a major subset of IBS, namely postinfectious IBS. The density of intestinal endocrine cells is reduced in patients with IBS, possibly as a result of genetic factors, diet, intestinal microbiota, and low-grade inflammation interfering with the regulatory signals controlling the intestinal stem-cell clonogenic and differentiation activities. Furthermore, there is speculation that this decreased number of endocrine cells is responsible for the visceral hypersensitivity, disturbed gastrointestinal motility, and abnormal gut secretion seen in IBS patients.
Collapse
|
|
26
|
Keefer L, Mandal S. The potential role of behavioral therapies in the management of centrally mediated abdominal pain. Neurogastroenterol Motil 2015; 27:313-23. [PMID: 25428520 DOI: 10.1111/nmo.12474] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 10/27/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Chronic abdominal pain carries a substantial health care burden but little is known about best practices for it management across ambulatory, hospital, and emergency room settings. This is especially true when abdominal pain presents in the absence of peripheral triggers like tissue injury (e.g. appendicitis) or altered bowel movements (e.g. IBS). Unfortunately, once central sensitization has occurred, pain can present without any stimulation or with minimal peripheral stimulation (feeling of clothing on the area) to the abdominal region. Several studies have proven the superior efficacy of behavioral interventions on many centrally mediated pain conditions including headaches and musculoskeletal problems. However, behavioral treatment of centrally mediated abdominal pain is less investigated due to the complexity of the patients involved and the poor understanding of the factors which either initiate or maintain persistent GI pain. PURPOSE We examine the evidence for a range of psychological and behavioral interventions in the context of centrally mediated abdominal pain. In addition to a strong rationale for a behavioral approach tied to the fear avoidance model of pain, we describe the structure, therapeutic targets, current evidence and relevance for each class of behavioral interventions.
Collapse
Affiliation(s)
- L Keefer
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | |
Collapse
|
|
27
|
Kennedy PJ, Cryan JF, Dinan TG, Clarke G. Irritable bowel syndrome: A microbiome-gut-brain axis disorder? World J Gastroenterol 2014; 20:14105-14125. [PMID: 25339800 PMCID: PMC4202342 DOI: 10.3748/wjg.v20.i39.14105] [Citation(s) in RCA: 217] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 04/18/2014] [Accepted: 05/26/2014] [Indexed: 02/07/2023] Open
Abstract
Irritable bowel syndrome (IBS) is an extremely prevalent but poorly understood gastrointestinal disorder. Consequently, there are no clear diagnostic markers to help diagnose the disorder and treatment options are limited to management of the symptoms. The concept of a dysregulated gut-brain axis has been adopted as a suitable model for the disorder. The gut microbiome may play an important role in the onset and exacerbation of symptoms in the disorder and has been extensively studied in this context. Although a causal role cannot yet be inferred from the clinical studies which have attempted to characterise the gut microbiota in IBS, they do confirm alterations in both community stability and diversity. Moreover, it has been reliably demonstrated that manipulation of the microbiota can influence the key symptoms, including abdominal pain and bowel habit, and other prominent features of IBS. A variety of strategies have been taken to study these interactions, including probiotics, antibiotics, faecal transplantations and the use of germ-free animals. There are clear mechanisms through which the microbiota can produce these effects, both humoral and neural. Taken together, these findings firmly establish the microbiota as a critical node in the gut-brain axis and one which is amenable to therapeutic interventions.
Collapse
|
|
28
|
Hunt MG, Ertel E, Coello JA, Rodriguez L. Empirical Support for a Self-help Treatment for IBS. COGNITIVE THERAPY AND RESEARCH 2014. [DOI: 10.1007/s10608-014-9647-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
|
29
|
Tkalcic M, Domijan D, Pletikosic S, Setic M, Hauser G. Attentional biases in irritable bowel syndrome patients. Clin Res Hepatol Gastroenterol 2014; 38:621-628. [PMID: 24679665 DOI: 10.1016/j.clinre.2014.02.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 02/01/2014] [Accepted: 02/10/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVE According to the cognitive behavioural model of irritable bowel syndrome (IBS) selective attention to visceral stimuli is one of the pathophysiological mechanisms in IBS. We aimed to investigate attentional biases in patients with IBS and to explore the relationship between neuroticism, trait anxiety, visceral anxiety and indices of attentional biases. METHODS Twenty-seven patients completed the global/local task and the modified Stroop task (using 4 word categories: neutral, symptom-related, emotionally and situationally relevant) while 28 healthy persons completed the Stroop task only. Both groups also filled out a set of psychological questionnaires. RESULTS The results show two distinct attentional biases in patients with irritable bowel syndrome. The index of global precedence was negatively correlated with neuroticism (r=-.41, P<.05) while there was no correlation of global precedence with trait and visceral anxiety. We found Stroop facilitation (F[3,81]=3.98, P<.02) specifically for situational threat words. Also, there were positive correlations between trait anxiety, visceral anxiety and the Stroop facilitation index for situational threat words (r=.43 and r=.47, P<.05). In the control group, we found neither Stroop facilitation nor interference. But, facilitation index of emotional words was positively correlated with neuroticism (r=.40, P<.05), which is in line with the "emotion congruent attentional bias" in the general population. CONCLUSIONS Neuroticism was associated with the reduction in global precedence observed in the global/local task. Trait anxiety and visceral anxiety were associated with Stroop facilitation elicited by situational threat words, which are of particular concern for patients with irritable bowel syndrome. These specific situations do not elicit an attentional bias in healthy participants, which might indicate that the observed facilitation to situational threat words is unique for IBS patients.
Collapse
Affiliation(s)
- Mladenka Tkalcic
- Department of Psychology, Faculty of Humanities and Social Sciences, University of Rijeka, Sveucilisna avenija 4, 51000 Rijeka, Croatia
| | - Drazen Domijan
- Department of Psychology, Faculty of Humanities and Social Sciences, University of Rijeka, Sveucilisna avenija 4, 51000 Rijeka, Croatia
| | - Sanda Pletikosic
- Department of Psychology, Faculty of Humanities and Social Sciences, University of Rijeka, Sveucilisna avenija 4, 51000 Rijeka, Croatia
| | - Mia Setic
- Department of Psychology, Faculty of Humanities and Social Sciences, University of Rijeka, Sveucilisna avenija 4, 51000 Rijeka, Croatia
| | - Goran Hauser
- Department of Internal Medicine, Division of Gastroenterology, Clinical Hospital Centre Rijeka, Kresimirova 42, 51000 Rijeka, Croatia.
| |
Collapse
|
|
30
|
Muscatello MRA, Bruno A, Scimeca G, Pandolfo G, Zoccali RA. Role of negative affects in pathophysiology and clinical expression of irritable bowel syndrome. World J Gastroenterol 2014; 20:7570-7586. [PMID: 24976697 PMCID: PMC4069288 DOI: 10.3748/wjg.v20.i24.7570] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 01/18/2014] [Accepted: 04/03/2014] [Indexed: 02/06/2023] Open
Abstract
Irritable bowel syndrome (IBS) is regarded as a multifactorial disease in which alterations in the brain-gut axis signaling play a major role. The biopsychosocial model applied to the understanding of IBS pathophysiology assumes that psychosocial factors, interacting with peripheral/central neuroendocrine and immune changes, may induce symptoms of IBS, modulate symptom severity, influence illness experience and quality of life, and affect outcome. The present review focuses on the role of negative affects, including depression, anxiety, and anger, on pathogenesis and clinical expression of IBS. The potential role of the autonomic nervous system, stress-hormone system, and immune system in the pathophysiology of both negative affects and IBS are taken into account. Psychiatric comorbidity and subclinical variations in levels of depression, anxiety, and anger are further discussed in relation to the main pathophysiological and symptomatic correlates of IBS, such as sensorimotor functions, gut microbiota, inflammation/immunity, and symptom reporting.
Collapse
|
|
31
|
Hauser G, Pletikosic S, Tkalcic M. Cognitive behavioral approach to understanding irritable bowel syndrome. World J Gastroenterol 2014; 20:6744-6758. [PMID: 24944466 PMCID: PMC4051915 DOI: 10.3748/wjg.v20.i22.6744] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 12/19/2013] [Accepted: 03/05/2014] [Indexed: 02/06/2023] Open
Abstract
Irritable bowel syndrome (IBS) is considered a biopsychosocial disorder, whose onset and precipitation are a consequence of interaction among multiple factors which include motility disturbances, abnormalities of gastrointestinal sensation, gut inflammation and infection, altered processing of afferent sensory information, psychological distress, and affective disturbances. Several models have been proposed in order to describe and explain IBS, each of them focusing on specific aspects or mechanisms of the disorder. This review attempts to present and discuss different determinants of IBS and its symptoms, from a cognitive behavioral therapy framework, distinguishing between the developmental predispositions and precipitants of the disorder, and its perpetuating cognitive, behavioral, affective and physiological factors. The main focus in understanding IBS will be placed on the numerous psychosocial factors, such as personality traits, early experiences, affective disturbances, altered attention and cognitions, avoidance behavior, stress, coping and social support. In conclusion, a symptom perpetuation model is proposed.
Collapse
|
|
32
|
Kennedy PJ, Clarke G, O‘Neill A, Groeger JA, Quigley EMM, Shanahan F, Cryan JF, Dinan TG. Cognitive performance in irritable bowel syndrome: evidence of a stress-related impairment in visuospatial memory. Psychol Med 2014; 44:1553-1566. [PMID: 23985155 PMCID: PMC3967841 DOI: 10.1017/s0033291713002171] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 07/30/2013] [Accepted: 08/04/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Central nervous system (CNS) dysfunction is a prominent feature of the functional gastrointestinal (GI) disorder, irritable bowel syndrome (IBS). However, the neurobiological and cognitive consequences of key pathophysiological features of IBS, such as stress-induced changes in hypothalamic-pituitary-adrenal (HPA)-axis functioning, is unknown. Our aim was to determine whether IBS is associated with cognitive impairment, independently of psychiatric co-morbidity, and whether cognitive performance is related to HPA-axis function. METHOD A cross-sectional sample of 39 patients with IBS, a disease control group of 18 patients with Crohn's disease (CD) in clinical remission and 40 healthy age- and IQ-matched control participants were assessed using the Paired Associates Learning (PAL), Intra-Extra Dimensional Set Shift (IED) and Spatial Working Memory (SWM) tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB) and a computerized Stroop test. HPA-axis function was determined by measuring the cortisol awakening response (CAR). RESULTS IBS patients exhibited a subtle visuospatial memory deficit at the PAL six- pattern stage (p = 0.03), which remained after psychiatric co-morbidity was controlled for (p = 0.04). Morning cortisol levels were lower in IBS (p = 0.04) and significantly associated with visuospatial memory performance within IBS only (p = 0.02). CONCLUSIONS For the first time, altered cognitive function on a hippocampal-mediated test of visuospatial memory, which was related to cortisol levels and independent of psychiatric co-morbidity, has been identified in IBS. Visuospatial memory impairment may be a common, but currently neglected, component of IBS. Further elucidation of the nature of this impairment may lead to a greater understanding of the underlying pathophysiology of IBS, and may provide novel therapeutic approaches.
Collapse
Affiliation(s)
- P. J. Kennedy
- Alimentary Pharmabiotic Centre, University College Cork, Ireland
- Department of Psychiatry, University College Cork, Ireland
| | - G. Clarke
- Alimentary Pharmabiotic Centre, University College Cork, Ireland
- Department of Psychiatry, University College Cork, Ireland
| | - A. O‘Neill
- Alimentary Pharmabiotic Centre, University College Cork, Ireland
| | | | - E. M. M. Quigley
- Alimentary Pharmabiotic Centre, University College Cork, Ireland
- Department of Medicine, University College Cork, Ireland
| | - F. Shanahan
- Alimentary Pharmabiotic Centre, University College Cork, Ireland
- Department of Medicine, University College Cork, Ireland
| | - J. F. Cryan
- Alimentary Pharmabiotic Centre, University College Cork, Ireland
- Department of Anatomy and Neuroscience, University College Cork, Ireland
| | - T. G. Dinan
- Alimentary Pharmabiotic Centre, University College Cork, Ireland
- Department of Psychiatry, University College Cork, Ireland
| |
Collapse
|
|
33
|
Tomé-Pires C, Miró J. Electrodermal responses and memory recall in migraineurs and headache-free controls. Eur J Pain 2014; 18:1298-306. [DOI: 10.1002/j.1532-2149.2014.490.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2014] [Indexed: 11/06/2022]
Affiliation(s)
- C. Tomé-Pires
- Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment (CRAMC); Department of Psychology and Institut d'Investigació Sanitària Pere Virgili; Universitat Rovira i Virgili; Catalonia Spain
| | - J. Miró
- Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment (CRAMC); Department of Psychology and Institut d'Investigació Sanitària Pere Virgili; Universitat Rovira i Virgili; Catalonia Spain
| |
Collapse
|
|
34
|
Mogoaşe C, David D, Koster EHW. Clinical efficacy of attentional bias modification procedures: an updated meta-analysis. J Clin Psychol 2014; 70:1133-57. [PMID: 24652823 DOI: 10.1002/jclp.22081] [Citation(s) in RCA: 232] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
CONTEXT Attentional bias modification (ABM) treatment is a promising intervention tool for a variety of clinical conditions. OBJECTIVES This study provides an updated review of the clinical effect of ABM by employing standard meta-analytic procedures to (a) estimate the average effect size of ABM in reducing both attention bias (AB) and symptoms, (b) estimate the average effect size for different conditions (e.g., anxiety, depression, and substance abuse), (c) test possible variables that may moderate the effect sizes, and (d) investigate the relationship between preexistent AB and the reduction in AB and symptoms. METHOD We included 43 controlled trials with a total of 2,268 participants providing 47 group comparisons (i.e., training vs. control condition). Inclusion criteria were as follows: AB was specifically targeted to reduce symptomatology and emotional vulnerability; participants were randomized to the experimental conditions; a control condition (defined as sham training) existed; symptoms were assessed at least postintervention; sufficient data were provided to allow effect size estimation. RESULTS We obtained a small overall effect size on symptoms postintervention, g = 0.160, 95% confidence interval (CI) = [0.055, 0.265], driven by anxiety studies, g = 0.260, 95% CI = [0.132, 0.388], and studies conducted in healthy participants, g = 0.211, 95% CI = [0.046, 0.375]; no significant effect sizes were found postintervention for other symptom categories. CONCLUSION The therapeutic benefit of ABM is rather small for anxiety, while the amount of data for other symptom categories is limited. We argue that more efficient, psychometrically sound procedures are needed for assessing and modifying AB.
Collapse
|
|
35
|
Garland EL, Howard MO. Mindfulness-oriented recovery enhancement reduces pain attentional bias in chronic pain patients. PSYCHOTHERAPY AND PSYCHOSOMATICS 2014; 82:311-8. [PMID: 23942276 DOI: 10.1159/000348868] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 02/10/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Chronic pain involves hypervigilance for pain-related stimuli. Selective attention to pain-related stimuli, known as pain attentional bias (AB), can exacerbate chronic pain, prolong suffering, and undermine quality of life. The aim of this study was to determine if a multimodal mindfulness-oriented intervention could significantly reduce pain AB among chronic pain patients receiving opioid analgesics. METHODS A total of 67 chronic pain patients were randomized to an 8-week Mindfulness-Oriented Recovery Enhancement (MORE) intervention or a social support group intervention and began treatment. A dot probe task was used to measure pain AB. Primary outcomes were pain AB scores for cues presented for 2,000 and 200 ms. RESULTS Prior to intervention, participants exhibited a significant bias towards pain-related cues presented for 2,000 ms, but no bias for cues presented for 200 ms. A statistically significant time × intervention condition interaction was observed for 2,000 ms pain AB, such that participants in MORE evidenced significantly reduced posttreatment pain AB relative to pretreatment levels, whereas no significant pre-post treatment changes in pain AB were observed for support group participants. Decreases in pain AB were associated with increased perceived control over pain and attenuated reactivity to distressing thoughts and emotions. CONCLUSION Study findings provide the first indication that a mindfulness-oriented intervention may reduce pain AB among adults suffering from chronic pain. Given the magnitude of chronic pain in postindustrial societies, coupled with the dramatic escalation in prescription opioid misuse, future studies should evaluate MORE as a nonpharmacological means of addressing factors linked with chronic pain.
Collapse
|
|
36
|
van Tilburg MA, Palsson OS, Whitehead WE. Which psychological factors exacerbate irritable bowel syndrome? Development of a comprehensive model. J Psychosom Res 2013; 74:486-92. [PMID: 23731745 PMCID: PMC3673027 DOI: 10.1016/j.jpsychores.2013.03.004] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 03/07/2013] [Accepted: 03/13/2013] [Indexed: 12/13/2022]
Abstract
OBJECTIVE There is evidence that psychological factors affect the onset, severity and duration of irritable bowel syndrome (IBS). However, it is not clear which psychological factors are the most important and how they interact. The aims of the current study are to identify the most important psychological factors predicting IBS symptom severity and to investigate how these psychological variables are related to each other. METHODS Study participants were 286 IBS patients who completed a battery of psychological questionnaires including neuroticism, abuse history, life events, anxiety, somatization and catastrophizing. IBS severity measured by the IBS Severity Scale was the dependent variable. Path analysis was performed to determine the associations among the psychological variables, and IBS severity. RESULTS Although the hypothesized model showed adequate fit, post hoc model modifications were performed to increase prediction. The final model was significant (Chi(2)=2.2; p=0.82; RMSEA<.05) predicting 36% of variance in IBS severity. Catastrophizing (standardized coefficient (β)=0.33; p<.001) and somatization (β=0.20; p<.001) were the only two psychological variables directly associated with IBS severity. Anxiety had an indirect effect on IBS symptoms through catastrophizing (β=0.80; p<.001); as well as somatization (β=0.37; p<.001). Anxiety, in turn, was predicted by neuroticism (β=0.66; p<.001) and stressful life events (β=0.31; p<.001). CONCLUSION While cause-and-effect cannot be determined from these cross-sectional data, the outcomes suggest that the most fruitful approach to curb negative effects of psychological factors on IBS is to reduce catastrophizing and somatization.
Collapse
|
|
37
|
Crombez G, Van Ryckeghem DM, Eccleston C, Van Damme S. Attentional bias to pain-related information: A meta-analysis. Pain 2013; 154:497-510. [DOI: 10.1016/j.pain.2012.11.013] [Citation(s) in RCA: 199] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 09/15/2012] [Accepted: 11/21/2012] [Indexed: 12/22/2022]
|
|
38
|
Van Ryckeghem DM, Crombez G, Goubert L, De Houwer J, Onraedt T, Van Damme S. The predictive value of attentional bias towards pain-related information in chronic pain patients: A diary study. Pain 2013; 154:468-475. [DOI: 10.1016/j.pain.2012.12.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Revised: 11/14/2012] [Accepted: 12/12/2012] [Indexed: 10/27/2022]
|
|
39
|
Kennedy PJ, Clarke G, Quigley EMM, Groeger JA, Dinan TG, Cryan JF. Gut memories: towards a cognitive neurobiology of irritable bowel syndrome. Neurosci Biobehav Rev 2012; 36:310-40. [PMID: 21777613 DOI: 10.1016/j.neubiorev.2011.07.001] [Citation(s) in RCA: 135] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 06/30/2011] [Accepted: 07/04/2011] [Indexed: 01/06/2023]
Abstract
The brain and the gut are engaged in continual crosstalk along a number of pathways collectively termed the 'brain-gut axis'. Over recent years it has become increasingly clear that dysregulation of the axis at a number of levels can result in disorders such as irritable bowel syndrome (IBS). With recent advances in neuroimaging technologies, insights into the neurobiology of IBS are beginning to emerge. However the cognitive neurobiology of IBS has remained relatively unexplored to date. In this review we summarise the available data on cognitive function in IBS. Moreover, we specifically address three key pathophysiological factors, namely; stress, immune activation and chronic pain, together with other factors involved in the manifestation of IBS, and explore how each of these components may impact centrally, what neurobiological mechanisms might be involved, and consider the implications for cognitive functioning in IBS. We conclude that each factor addressed could significantly impinge on central nervous system function, supporting the view that future research efforts must be directed towards a detailed assessment of cognitive function in IBS.
Collapse
Affiliation(s)
- Paul J Kennedy
- Alimentary Pharmabiotic Centre, University College Cork, Cork, Ireland
| | | | | | | | | | | |
Collapse
|