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Cognitive Appraisal and Psychological Distress Among Patients with Irritable Bowel Syndrome

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Cognitive Appraisal and Psychological Distress Among Patients with Irritable Bowel Syndrome Isr J Psychiatry Relat Sci - Vol. 52 - No 1 (2015) Cognitive Appraisal and Psychological Distress Among Patients with Irritable Bowel Syndrome Menachem Ben-Ezra, PhD,1 Yaira Hamama-Raz, PhD,1 Sharon Palgi, MA,2 and Yuval Palgi, PhD3 1 School of Social Work, Ariel University, Ariel, Israel 2 Department of Psychology, University of Haifa, Haifa, Israel 3 Department of Gerontology, University of Haifa, Haifa, Israel in reducing their helplessness appraisal and increasing ABSTRACT the appraisal of their ability to cope with the symptoms Background: Irritable Bowel Syndrome (IBS) is a debilitating of their illness. condition that affects mainly the patient’s mental health and quality of life. There is a gap in the literature regarding the relationship between cognitive appraisals and adjustment to physical and psychological aspects resulting from IBS. The aim of the current study was to INTRODUCTION explore the psycho-social factors that are associated Irritable bowel syndrome (IBS) is considered a significant with psychological distress among IBS patients and the functional gastrointestinal disorder, with prevalence contribution of cognitive appraisal to their adjustment. ranging from 10% to 15% (1). It occurs more often in women than in men, and it begins before the age of 35 in Methods: One hundred and three patients diagnosed with about 50% of people (2). IBS is also regarded as a chronic Irritable Bowel Syndrome participated in the study. Each illness that can dramatically affect the quality of life (3). participant filled a battery of questionnaires targeting Psychiatric disorders, especially depression and anxiety, demographic and psycho-social factors. The study occur in up to 94% of IBS patients (2). Psycho-social variables were analyzed via hierarchical regression along factors may play an important role in the development with supplementary analyses of multiple mediation tests as well as in the outcome and prognosis of the disorder of indirect effects. (4). The aim of the present study was to explore the Results: The findings showed that psychological psycho-social factors that are associated with psychologi- distress and depressive symptoms among IBS patients cal distress among IBS patients and the contribution of are better predicted by their global positive illness cognitive appraisal to their adjustment. cognition appraisal, specific illness cognition appraisal The study is based on the theoretical framework of of helplessness, resilience and to a lesser extent by social Lazarus and Folkman’s model of adjustment to stress (5-8). support, perceived optimism, illness cognitions appraisals This theory proclaims that cognitive appraisal, personal of acceptance and perceived benefit. Global positive resources and social resources might alleviate or exacerbate illness cognition appraisal gives us a sum of positive and the perceived stress experienced by an individual. negative appraisals into one unified appraisal. Cognitive appraisal has been defined as a “process through which the person evaluates whether a particular Conclusions: Our findings highlight the salience of encounter with the environment is relevant to his or cognitive appraisal and resilience in IBS psychological her well being, and if so, in what ways” (9). This pro- adjustment. It seems that IBS patients might benefit from cess involves both primary and secondary appraisals psycho-educational interventions designed to assist them that occur at the same time and interact in order to determine the significance and meaning of the event Address for Correspondence: Prof. Menachem Ben-Ezra, School of Social Work, Ariel University, Ariel 40700, Israel [email protected] 54 MENACHEM BEN-EzRA ET AL. in regard to well being (7). Primary appraisal considers individual’s ability to use familial, social, and external the perceived implications of the stressor for well being support in order to cope better with stressful events (26, through interpretation of stressful situation in one of 27). In light of this, we aim to explore the contribution three possible outcomes: irrelevant, challenge or threat. of social support to the IBS patients’ health. Secondary appraisal refers to a cognitive-evaluative pro- The relationship between social support and health, cess that focuses on minimizing harm or maximizing functioning, and quality of life is well established in the gains through coping responses. It involves purposeful literature (28-30). Two types of mechanisms have been evaluations of cognitive, affective and behavioral efforts described when studying this relationship: The direct to manage the perceived stress (7-9). Empirical studies positive path that relates to support and the buffering show that cognitive appraisal affects adjustment to ill- effect, by which social support moderates the impact of ness, including HIV (10), cardio-vascular disease (11), acute and chronic stressors on health (31). In the general and cancer (12). However, there is a gap in the literature population, social support buffers against stressful life regarding the relationship between cognitive appraisal events, increases adherence to medical treatments, and and adjustment to physical and psychological aspects improves recovery from medical illness, among other among IBS patients. The main difference between IBS health-promoting effects (28, 32-35). A recent study (4) has patients and the aforementioned medical conditions is found that among IBS patients, feelings of social isolation the existence of life threatening conditions in comparison existed regardless of the efforts of the family, friends and to IBS which is a debilitating condition that affects qual- some physicians to be supportive. The reasons were lack ity of life without the component of threat for one’s life. of understanding relating to the complexity and severity Other factors mentioned in Lazarus and Folkman’s of the disorder. Additive strain from relative and friends model are personal resources which may contribute telling the patients to ignore or minimize their experience, to the cognitive appraisal component and to adjust- telling them to ‘‘relax’’ or ‘‘do something else.” These actions ment. We chose two coping resources – optimism and have facilitated the creation of a social barrier impeding resilience, which may be especially relevant in the case normal functioning. of IBS patients due to the association between physical The goal of the current study was to further explore the condition and mental condition. psycho-social factors that are associated with psychological Optimism is described as a relatively stable, general distress among IBS patients and to gain more information tendency of individuals to expect positive outcomes (13). on psychiatric symptoms and cognitive attitudes, which can Individuals high in optimism typically have better psy- be further utilized in the development of psychotherapeutic chological adjustment to negative life events, report less treatment strategies. More specifically, we assessed the distress across a broad range of stressful situations, have relationships between psychological distress and depressive more positive social networks, and enjoy better physical symptoms among IBS patients and their socio-demographic health (14-16). Optimistic individuals are prone to show and medical variables, personal resources – resilience and higher self efficacy, and adapt to stressors more effectively perceived optimism, interpersonal resource - social sup- during time of crisis (17). Studies with various ethnicities port and cognitive appraisal. Based on the aforementioned have demonstrated that higher levels of optimism predict studies, we hypothesize that IBS patients with higher resil- lower levels of depression and stress (18-20). Optimism ience, perceived optimism, and perceived social support also may serve as a protective factor that promotes resilient will exhibited less psychological distress and depressive adaptation, as found among individuals with cancer (21), symptoms. Our second hypothesis predicted that partici- and coronary heart disease (22, 23). pants with the highest combination of positive cognitions Resilience is defined as the ability to resist, cope with, regarding their illness will have lower psychological distress recover from, and succeed in the face of adverse life expe- and depressive symptoms in comparison to those with riences (24). Resilience represents “the ability of adults lower positive cognitions. in otherwise normal circumstances who are exposed to an isolated and potential highly disruptive event to maintain relatively stable, healthy levels of psychological METHOD and physical functioning as well as the capacity for genera- PARTICipaNTS tive experiences and positive emotions” (25). Resilience One hundred and three patients diagnosed with Irritable also refers to important psychological skills and to the Bowel Syndrome participated in the study. The sample 55 Isr J PsychiatryCOGNITIVE Relat Appraisa Sci - Vol. 52L AND - No 1P (2015)syCHOLOGICAL Distress AMONG Patients WITH IrritabLE BOWEL SYNDROME consisted of 69 men and 34 women, aged 18-50. The aver- “Do you perceived yourself as reviewing enough social age age was 24.53 (S.D. =6.243), 79.6% of the sample were support.” This item was coded as 0 = no, 1 = yes. unmarried (n=82). No history of previous medical condi- • Depressive symptoms were measured by the Short Center tions or psychiatric illnesses was reported by the subjects. for Epidemiologic Studies Depression Scale (SCES-D) which is a 10-item
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