International Journal of Behavioral Medicine

, Volume 19, Issue 3, pp 308–315 | Cite as

Relationship Between Cognitive Factors and Anxiety in Individuals with Irritable Bowel Syndrome

  • Nagisa Sugaya
  • Shinobu Nomura
  • Hironori Shimada



Individuals with irritable bowel syndrome (IBS) have high anxiety. There is insufficient information about the relationships between concrete cognitive contents and anxiety in IBS.


The present study investigated the relationship between cognitive factors and anxiety in individuals with IBS.


The participants were 1,087 college students (male, 506; female, 576; unidentified, 5; age, 19.72 ± 1.76 years) who completed a set of questionnaires that included the Rome II Modular Questionnaire (based on diagnostic criteria for IBS), Anxiety Sensitivity Index (ASI), Cognitive Appraisal Rating Scale (CARS; subscales: commitment, appraisal of effect, appraisal of threat, and controllability) for measuring symptom-related cognition, an item about attention to abdominal symptoms, the Hospital Anxiety and Depression Scale-Anxiety Scale (HADS-A), and an item regarding the presence of avoidant behavior due to anxiety of IBS symptoms.


The participants included 881 individuals without IBS and 206 individuals with IBS. Individuals with IBS had higher ASI and HADS-A scores than those of the individuals belonging to the control group (p < 0.001). Subscale scores of CARS (except those of controllability and attention to IBS symptoms) significantly correlated with the ASI and HADS-A scores (p < 0.01). Individuals with IBS and avoidant behavior had higher subscale scores of CARS (except those of controllability and attention to IBS symptoms) and higher HADS-A scores (p < 0.05). The hypothetical models containing ASI scores, subscale scores of CARS (except those of controllability), and HADS-A scores with and without attention to IBS symptoms exhibited a good fit.


Severe anxiety sensitivity in individuals with IBS related to their symptom-related cognition, and the altered cognition increases anxiety, leading to the possible development of a disabling condition.


Irritable bowel syndrome Cognitive factor Anxiety 



The copyright of Japanese version of the Rome II Modular Questionnaire attributes to Dr. S. Fukudo and Dr. M. Kanazawa. We thank them for granting us permission to use it.


The data for this paper was extracted from a database that contained data used in the following paper:

Sugaya N, Nomura S. Relationship between cognitive appraisals of symptoms and negative mood for subtypes of irritable bowel syndrome. BPS Med 2008; 2: 1–6.

The extracted data was reanalyzed with different dependent and independent variables than those in the abovementioned paper.


  1. 1.
    Drossman DA. Presidential address: gastrointestinal illness and the biopsychosocial model. Psychosom Med. 1998;60:258–67.PubMedGoogle Scholar
  2. 2.
    Cho H, Park J, Lim C, Cho Y, Lee I, Kim S, et al. Anxiety, depression and quality of life in patients with irritable bowel syndrome. Gut and Liver. 2011;5:29–36.PubMedCrossRefGoogle Scholar
  3. 3.
    Lydiard RB. Irritable bowel syndrome, anxiety, and depression: what are the links? J Clin Psychiat. 2001;62:38–45.Google Scholar
  4. 4.
    Lydiard BR, Greenwald S, Weissman MM, Johnson J, Droeeman DA, Ballenger JC. Panic disorder and gastrointestinal symptoms: findings from the NIMH Epidemiologic Catchment Area project. Am J Psychiat. 1994;151:64–70.PubMedGoogle Scholar
  5. 5.
    Yoshizawa M, Endo Y, Fukudo S, Tanno Y, Maruyama F, Sasaki M, et al. The relationship of panic disorder and irritable bowel syndrome. Jpn J Psychosom Med. 2000;40:283–9.Google Scholar
  6. 6.
    Lackner JM, Coad ML, Mertz HR, Wack DS, Katz LA, Krasner SS, et al. Cognitive therapy for irritable bowel syndrome is associated with reduced limbic activity, GI symptoms, and anxiety. Behav Res Ther. 2006;44:621–38.PubMedCrossRefGoogle Scholar
  7. 7.
    Toner BB, Stuckless N, Ali A, Downie F, Emmott S, Akman D. The development of a cognitive scale for functional bowel disorders. Psychosom Med. 1998;60:492–7.PubMedGoogle Scholar
  8. 8.
    Chandler M, Kennedy P, Sandhu N. The association between threat appraisals and psychological adjustment in partners of people with spinal cord injuries. Rehabil Psychol. 1995;52:470–7.CrossRefGoogle Scholar
  9. 9.
    McCartney HC. Mind over matter: cognitive–behavioral determinants of emotional distress in multiple sclerosis patients. Psychol Health Med. 2007;12:556–66.CrossRefGoogle Scholar
  10. 10.
    Hazlett-Stevens H, Craske MG, Mayer EA, Chang L, Naliboff BD. Prevalence of irritable bowel syndrome among university students—the roles of worry, neuroticism, anxiety sensitivity and visceral anxiety. J Psychosom Res. 2003;55:501–5.PubMedCrossRefGoogle Scholar
  11. 11.
    Gros DF, Antony MM, McCabe RE, Swinson RP. Frequency and severity of the symptoms of irritable bowel syndrome across the anxiety disorders and depression. J Anxiety Disord. 2009;23:290–6.PubMedCrossRefGoogle Scholar
  12. 12.
    Vancleef LMG, Peters ML, Gilissen SMP, De Jong PJ. Interpreting ambiguous health and bodily threat: are individual differences in pain-related vulnerability constructs associated with an on-line negative interpretation bias? J Behav Ther Exp Psychiat. 2009;40:59–69.CrossRefGoogle Scholar
  13. 13.
    Peterson RA, Reiss S. Anxiety Sensitivity Index manual. 2nd ed. Worthington: International Diagnostic Systems; 1992.Google Scholar
  14. 14.
    Crane C, Martin M. Illness schema and level of reported gastrointestinal symptoms in irritable bowel syndrome. Cognit Ther Res. 2003;27:185–203.CrossRefGoogle Scholar
  15. 15.
    Keough ME, Timpano KR, Zawilinski LL, Schmidt NB. The association between irritable bowel syndrome and the anxiety vulnerability factors body vigilance and discomfort intolerance. J Health Psychol. 2011;16:91–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Keogh E, Dillon C, Georgiou G, Hunt C. Selective attentional biases for physical threat in physical anxiety sensitivity. J Anxiety Disord. 2001;15:299–315.PubMedCrossRefGoogle Scholar
  17. 17.
    McNally R. Anxiety sensitivity and panic disorder. Biol Psychiatry. 2002;52:938–46.PubMedCrossRefGoogle Scholar
  18. 18.
    Lees A, Mogg K, Bradley BP. Health anxiety, anxiety sensitivity, and attentional biases for pictorial and linguistic health-threat cues. Cogn Emot. 2005;19:453–62.PubMedCrossRefGoogle Scholar
  19. 19.
    Wilson E, MacLeod C. Contrasting two accounts of anxiety-linked attentional bias: selective attention to varying levels of stimulus threat intensity. J Abnorm Psychol. 2003;112:212–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Gaab J, Blattler N, Menzi T, Pabst B, Stoyer S, Ehlert U. Randomized controlled evaluation of the effects of cognitive–behavioral stress management on cortisol responses to acute stress in healthy subjects. Psychoneuroendocrinology. 2003;28:767–77.PubMedCrossRefGoogle Scholar
  21. 21.
    Drossman DA, Talley NJ, Whitehead WE, Corazziari E. Research diagnostic questions for functional gastrointestinal disorders: Rome II Modular Questionnaire: Investigations and respondent forms. In: Drossman DA, Corazziari E, Talley NJ, Thompson WG, editors. Rome II The functional gastrointestinal disorders. 2nd ed. McLean: Degnon Associates; 2000. p. 669–714.Google Scholar
  22. 22.
    Shinozaki M, Kanazawa M, Sagami Y, Endo Y, Hongo M, Drossman DA, et al. Validation of the Japanese version of the Rome II modular questionnaire and irritable bowel syndrome severity index. J Gastroenterol. 2006;41:491–4.PubMedCrossRefGoogle Scholar
  23. 23.
    Matsuoka H, Sakano Y. Factor structure of Japanese version of Anxiety Sensitivity Index. The 34th Annual Convention of Japanese Association of. Behavior Therapy. 2004;30:218–9.Google Scholar
  24. 24.
    Suzuki S, Sakano Y. Development of a Cognitive Appraisal for Rating Scale (CARS) and its validation. Hum Sci Res. 1998;7:113–24.Google Scholar
  25. 25.
    Lazarus RS, Folkman S. Stress, appraisal, and coping. NewYork: Springer Publishing Company; 1984.Google Scholar
  26. 26.
    Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand. 1983;67:361–70.PubMedCrossRefGoogle Scholar
  27. 27.
    Zigmond AS, Snaith RP, Kitamura T. Hospital Anxiety and Depression Scale (HAD). Arch Psychiatr Diagn Clin Eval. 1993;4:371–2.Google Scholar
  28. 28.
    Leibbrand R, Hiller W. Cognitive behavior therapy for functional gastrointestinal disorders: is group treatment effective? Acta Neuropsychiatr. 2003;15:242–8.CrossRefGoogle Scholar
  29. 29.
    Drossman DA. The functional gastrointestinal disorders and the Rome III process. Gastroenterology. 2006;130:1377–90.PubMedCrossRefGoogle Scholar

Copyright information

© International Society of Behavioral Medicine 2011

Authors and Affiliations

  • Nagisa Sugaya
    • 1
  • Shinobu Nomura
    • 2
  • Hironori Shimada
    • 2
  1. 1.Research Project for Addictive SubstancesTokyo Metropolitan Institute of Medical ScienceSetagaya-kuJapan
  2. 2.Faculty of Human SciencesWaseda UniversitySaitamaJapan

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