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Healing Words: Using Affect Labeling to Reduce the Effects of Unpleasant Cues on Symptom Reporting in IBS Patients



The present study aimed to induce elevated symptom reports through the presentation of unpleasant cues in patients with irritable bowel syndrome (IBS) and examine whether applying an emotion regulation technique (affect labeling) can reduce symptom reporting in patients.


Patients diagnosed with IBS (N = 29) and healthy controls (N = 26) were presented with six picture series (three pleasant, three unpleasant) under three within-subject conditions: merely viewing, emotional labeling, or content (non-emotional) labeling. Each picture viewing trial was followed by affect ratings and a symptom checklist, consisting of general arousal and IBS-specific symptoms.


Viewing unpleasant pictures led to overall increased symptom reports, both for arousal and gastrointestinal symptoms, in both groups. Labeling the pictures did not reduce these effects significantly, although a trend toward less arousal symptoms after unpleasant cues emerged in the patient group only, especially during emotional labeling.


Current findings indicate that the mere presentation of unpleasant cues can induce elevated symptom reports in IBS patients. The results of the labeling manipulation provide modest support for the effectiveness of emotion regulation strategies in reversing these effects of unpleasant cues in patients suffering from functional syndromes. Methodological issues that may have confounded present results are discussed.

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Fig. 1
Fig. 2


  1. 1.

    Positive 1: 1463, 1920, 2550, 4574, 5201, 5260, 7330, 8030, 8080, 8185; positive 2: 1620, 2341, 5700, 5760, 5849, 7280, 8200, 8370, 8461, 8490; Positive 3: 1710, 2311, 2360, 5891, 7260, 8033, 8190, 8300, 8470, 8502; negative 1: 1114, 2095, 2520, 2692, 2900.1, 5971, 6315, 6821, 9181, 9611; negative 2: 1525, 6190, 6242, 9001, 9410, 9425, 9426, 9520, 9561, 9911; negative 3: 1932, 2800, 5972, 6300, 6370, 6800, 6838, 9041, 9140, 9421.

  2. 2.

    Positive pleasantness ratings (1–9): M1 = 7.50 SD1 = 0.36, M2 = 7.57 SD2 = 0.46, M3 = 7.55 SD3 = 0.60; positive arousal ratings (1–9): M1 = 5.39 SD1 = 1.30, M2 = 5.09 SD2 = 1.27, M3 = 5.14 SD3 = 1.09; negative pleasantness ratings (1–9): M1 = 2.72 SD1 = 0.79, M2 = 2.58 SD2 = 0.65, M3 = 2.72 SD3 = 0.71; negative arousal ratings (1–9): M1 = 5.80 SD1 = 0.77, M2 = 5.71 SD2 = 1.02, M3 = 5.77 SD3 = 0.75.

  3. 3.

    A parallel analysis procedure [36] was first conducted to determine the number of reliable factors, which suggested a two-factor structure for the checklist. A principal component analysis (PCA) with varimax rotation and factor extraction constrained to two factors (KMO = .57; χ2 (91) = 242.61, p < .001) confirmed the two-factor structure, which could explain 37.91 % of the variance. Items loading .60 or higher were retained for each of the two factors.


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Authors would like to thank the physicians and clinical trial coordinators at the gastrointestinal unit of the University Hospital Gasthuisberg (Leuven, Belgium) for the recruitment of IBS patients and Stéphanie Vandeweyer for her assistance in data collection.

Compliance with Ethical Standards

Each of the following authors, Elena Constantinou, Katleen Bogaerts, Lukas Van Oudenhove, Jan Tack, Ilse Van Diest, and Omer Van den Bergh, declares that s/he has no conflict of interest, that all procedures performed in this study were in accordance with the ethical standards of both the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards, and that informed consent was obtained from all individual participants included in the study.

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Correspondence to Omer Van den Bergh.

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Constantinou, E., Bogaerts, K., Van Oudenhove, L. et al. Healing Words: Using Affect Labeling to Reduce the Effects of Unpleasant Cues on Symptom Reporting in IBS Patients. Int.J. Behav. Med. 22, 512–520 (2015).

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  • Emotion regulation
  • Affect labeling
  • Symptom reporting
  • IBS patients