The role of high expectations of self and social desirability in emotional processing in individuals with irritable bowel syndrome: A qualitative study

Abstract

ObjectivesAlthough high levels of distress are associated with the onset and severity of IBS, it is unclear how this relates to emotional processing, particularly in relation to maintenance of symptoms and treatment outcome. This qualitative study embedded within a randomised controlled trial aimed to explore how individuals with refractory IBS experience, express and manage their emotions after either therapist-delivered Cognitive Behavioural Therapy (TCBT) or webbased CBT (WBCBT) compared to Treatment as Usual (TAU). DesignCross-sectional qualitative study. MethodsFifty two semi-structured interviews were conducted at post-treatment with 17 TCBT participants, 17 WBCBT and 18 TAU. The transcripts were analysed using inductive thematic analysis with grounded theory elements. NVivo 11 was used to compare themes across groups. ResultsAcross all groups, high expectations of self was a recurring reason for how participants experienced and expressed their emotions. Three themes with sub-themes captured how high expectations related to specific aspects of emotional processing: perceived causes of Running head: EMOTIONAL PROCESSING IN IBS 2 emotions, strategies for coping with emotions (bottling up, avoiding emotions and active coping strategies) and the perceived interplay between emotions and IBS symptoms. ConclusionsPatients recognised that their IBS symptoms both triggered and were triggered by negative emotions. However, there was a tendency to bottle up or avoid negative emotions for reasons of social desirability regardless of whether patients had CBT for IBS or not. Future psychological interventions in IBS may benefit from addressing negative beliefs about expressing emotions, promoting assertive emotional expression and encouraging the experience of positive emotions.

Positive and negative affect mediate the bidirectional relationship between emotional processing and symptom severity and impact in irritable bowel syndrome

“…The biopsychosocial model of IBS maintains that symptom onset is then followed by unhelpful coping behaviours and illness cognitions, which can perpetuate symptoms and increase psychological distress [73][74][75]. This conceptualisation of IBS provides support for the relationships found between IBS related variables and distress in our alternate models, highlighting the psycho-emotional effects of IBS [76,77]. However, research does not provide definite evidence on how affect can impact on unhelpful beliefs about emotions and impoverished emotional experience (dependent variables in the reversed models).…”

Desperately seeking a cure: Treatment seeking and appraisal in irritable bowel syndrome

“…Semi‐structured interviews used a topic guide comprising broad, open‐ended questions clustered into three sections: experiences of the trial to date, treatment regimens for IBS, and daily experiences of emotions (findings from the latter have been published separately; see (Sibelli et al ., )). This study focuses on interviewee responses to questions exploring past treatment regimens for IBS.…”

Patients’ perspectives on GP interactions after cognitive behavioural therapy for refractory IBS: a qualitative study in UK primary and secondary care

“…Box 1 contains a detailed description of the analytical steps implemented. 21 – 23 NVivo (version 11) was used to facilitate data management and increase the transparency of the findings.…”