Emotional processing in individuals with Irritable bowel syndrome: a qualitative study

Abstract

Background There is little research on the role of emotional processing in the development and maintenance of symptoms in Irritable Bowel Syndrome (IBS). This study aimed to explore in depth how individuals with refractory IBS express, experience and manage their emotions after either standard Cognitive Behavioural Therapy (CBT) or low intensity web-based CBT (LICBT) compared to Treatment as Usual (TAU). Methods We conducted 41 semi-structured interviews at post-treatment (3 months post-baseline) with 15 CBT participants, 12 LICBT and 14 TAU. We analysed the transcripts using inductive thematic analysis with elements of grounded theory and framework analysis to compare themes across groups. Findings From the interviews, it was evident that participants had high expectations of themselves and that social desirability was a recurring reason for how they expressed their emotions to others. Five themes with sub-themes captured how these high expectations played out in relation to specific aspects of emotional processing: 1) Causes of emotions; 2) Bidirectional relationship between IBS and emotions; 3) Emotions related to general life; 4) Responses to negative emotions; 5) Responses to positive emotions. There were no major differences between groups. Discussion High standards of self seem to influence the way IBS patients experience, express and manage their emotions. Future psychological interventions in IBS may benefit from addressing negative beliefs about experiencing and expressing negative emotions, exploring the negative effects of emotional avoidance and bottling up, and promoting assertive expression of emotion. This may reduce negative effects of psychological distress on IBS symptoms and improve patients’ well-being.