Implicit Identification with Illness in Patients with Irritable Bowel Syndrome (IBS)

Abstract

Identification with pain has been linked to symptom severity in chronic pain conditions. However, the role of identification with illness in patients with Irritable Bowel Syndrome (IBS) is unknown. We investigated whether participants with IBS show identification with illness and if the degree of illness identification is related to IBS symptom severity and additional physical and psychological variables. In this cross-sectional study, 42 participants with IBS and 41 healthy participants completed an Implicit Association Test (IAT) to measure their level of identification with illness and health. Data on illness duration, explicit illness associations, IBS severity, depression, anxiety, stress and additional symptoms were obtained. IBS participants scored significantly lower on identification with health than healthy participants. The level of health identification was negatively correlated with 'Nonspecific Somatic Symptoms'. Reduced health identification may be a maintaining factor of IBS that could be targeted with psychological treatments to reduce symptoms. Further, it may be possible to use the IAT to monitor the course of recovery.

A randomized clinical trial of mindfulness-based cognitive therapy for women with irritable bowel syndrome—Effects and mechanisms.

“…Based on Jacobson and Truax’s (1991) approach, clinically significant change in symptom severity was considered to have occurred, if (1) the participant’s follow-up score was within the range of the functional healthy population and (2) the participant presented a statistically reliable reduction in scores from baseline to follow-up using the reliable change index (RCI). For criterion (1) a cut-off score of 33.82 on the GSRS-IBS was established, based on the mean (18.66) and standard deviation (7.58) of healthy participants (Henrich et al, 2018). In the PP sample of the MG ( n = 23), 14 participants (60.8%) displayed symptom scores in the functional range, and seven (50.0%) of these displayed a reliable reduction in GSRS-IBS scores (RCI < −1.96).…”

“…It has satisfactory psychometric properties and internal consistency with Cronbach’s alpha ranging from .70 to .90 (Greenwald, Poehlman, Uhlmann, & Banaji, 2009; Nosek, Greenwald, & Banaji, 2005; Schnabel, Asendorpf, & Greenwald, 2008). The self-health self-illness IAT employed in this study was previously described in detail by Henrich et al (2018). Participants were asked to classify target words that belonged to the concepts me (i.e., me, my, self, I), not me (i.e., not me, other, them, they), health (i.e., healthy, healing, strong, vitality), and illness (i.e., illness, pain, chronic, sick) into one of two concept pairs.…”

“…RTs to classify targets are typically faster when pairs of concepts match the individual’s own associations (e.g., me and illness) compared with those that contradict their associations (e.g., me and health). RT data were scored using the algorithm of the IAT-D6 index developed by Greenwald, Nosek, and Banaji (2003) using the procedure described in Henrich et al (2018). A positive IAT-D index reflects relatively faster RTs for self-illness associations and a negative IAT-D index reflects relatively faster RTs for self-health associations.…”

“…This implies that the maladaptive relationships that patients develop toward their symptoms maintain symptom severity and impairments in quality of life, even if they may not have caused IBS. New evidence suggests that patients with IBS implicitly process health related information less self-referentially when compared with healthy participants (Henrich, Gjelsvik, & Martin, 2018). This indicates that as a result of having the illness, IBS patients become implicitly self-conscious of health deficits and may appraise positive health related information as not belonging to their self-concept.…”

“…Particularly, evidence of early treatment induced changes in implicit cognition in IBS patients may provide valuable information about the treatment’s underlying mechanisms. We predicted that the mindfulness practices in the early stages of treatment which are expected to shift awareness toward sensory, nonreactive and accepting processing of stimuli arising within the body (e.g., the body scan meditation; Farb et al, 2015) would attenuate impaired self-related processing of health related information (Henrich et al, 2018). This bias in self-referential processing was considered an implicit IBS specific form of self-related appraisal tendencies whereas low nonjudgmental awareness (i.e., low self-acceptance) was considered to be an explicit form of self-related appraisal tendencies.…”