Emotional processing as mediator of positive/negative affect on social adjustment in Irritable Bowel Syndrome (IBS)

Abstract

Background: Although high levels of distress are associated with IBS symptom severity and related social disability, the mechanisms through which distress leads to IBS outcomes are unclear. The aim of this study was to investigate: (a) if emotional processing and positive affect (PA) are associated with IBS symptom experience and related disability (b) if emotional processing mediates the relationship between positive/negative affect and IBS outcome. Methods: Cross-sectional correlations and mediation analyses of baseline trial data. Adults meeting IBS Rome III criteria (n=558) completed standardised questionnaires measuring: beliefs about the unacceptability of experiencing and expressing negative emotions (BES); awareness of emotions (impoverished emotional experience, IEE); anxiety and depression; PA; IBS symptom severity and work/social adjustment. Findings: Symptom severity and poorer social adjustment were positively correlated with BES and IEE and negatively correlated with PA. Mediation analyses showed a small indirect effect of anxiety and depression on work/social adjustment (not on symptom severity) through IEE: b=0.26, 95%CI [0.15-0.37], p=0.00 (direct effect of anxiety b=0.34, p=0.00); b=0.17, 95%CI [0.04-0.37], p=0.00 (direct effect of depression b=0.84, p=0.00). Similar results found for BES. There was also a small indirect effect of PA on work/social adjustment through IEE, b=-0.11, 95%CI [-0.16--0.07], p=0.00 (direct effect b=-0.19, p=0.00). Similar results shown for BES. Discussion: Emotional processing partially explained the relationship between positive/negative affect and work/social adjustment in IBS. Future psychological interventions in IBS may benefit from addressing negative beliefs about expressing emotions and from encouraging emotional awareness and experience of positive emotions. This may reduce related social disability.