Abstract
In a 84-day long-term study involving 20 patients with active Crohn’s disease, the relation between daily stress and symptomatology was investigated. The diagnoses were verified clinically, endoscopically, radiologically, and histologically. The Crohn symptomatology was assessed by a daily symptoms diary. The degree of everyday stress was measured with a daily hassles scale. Additionally, the disease activity was measured 4 times. The data were evaluated using a time series analysis method following the ARIMA model (autoregressive integrative moving average model), which takes the autocorrelation of the data into account. In 55% of the cases, a significant correlation between daily hassles and disease activity was found. Patients whose symptomatology responded to stress did not differ from nonresponders in age, duration of the disease, disease activity, frequency of abdominal surgery, partnership situation, or statements concerning their average level of daily hassles. Disease activity in general did not change during the observation period. A verified influence of daily hassles on Crohn symptomatology as a rule occurs on the same day with time lag 0.
According to these results, the group of Crohn’s disease patients is not homogenous. The widely held assumption that daily hassles influence the symptomatology cannot generally be confirmed. Variations may result from different ways of coping with stress. Long-term effects of daily hassles on the disease are not clear.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Abraham, B., & Ledolter, J. (1983). Statistical methods for forecasting. New York: Wiley.
Andrews, H., Barczak, P., & Allan, R. N. (1987). Psychiatric illness in patients with inflammatory bowel disease. Gut, 28, 1600–1604.
Best, W. R., Becktel, J. M., & Singleton, J. W. (1979). Rederived values of the eight coefficients of the Crohn’s disease activity index (CDAI). Gastroenterology, 4, 843–846.
Best, W. R., Becktel, J. M., Singleton, J. W., & Kern, F. Jr. (1976). Development of a Crohn’s disease activity index. Gastroenterology, 70, 439–444.
Box, G. E. P., & Jenkins, G. M. (1976). Time series analysis: Forecasting and control. San Francisco: Holden Day.
Brantley, P., Waggoner, C. D., Jones, G. N., & Rappaport, N. B. (1987). A Daily Stress Inventory: Development, reliability, and validity. Journal of Behavioral Medicine, 10, 61–74.
Buéno, L. (1996). Brain-gut mechanisms of visceral motor activity. In E. Corazzioni (Ed.), NeuUroGastroenterology (pp. 1–15). Berlin: deGruyter.
Craig, T. K. J., & Brown, G. W. (1984). Goal frustration and life events in the etiology of painful gastrointestinal disorders. Journal of Psychosomatic Research, 5, 411–421.
Crohn, B. B., Ginzburg, L., & Oppenheimer, G. D. (1932). Regional Ileitis. A pathologic and clinical entity. Journal of American Medical Association, 99, 1323–1328.
Cummins, S. E., & Gevirtz, R. N. (1993). The relationship between stress and urinary Cortisol in a normal population: An emphasis on individual differences. Behavioral Medicine, 19, 129–134.
Duffy, L. C, Zielezny, M. A., Marshall, J. R., Weiser, M. M., Phillips, J. F., Byers, T. E., Calkins, B. M., Graham, S., & Ogra, P. L. (1991). Lag time between stress events and risk of recurrent episodes of inflammatory bowel disease. Epidemiology, 2, 141–144.
Drossman, D. A. (1996). Psychosocial aspects of the functional gastrointestinal disorders. In E Corazzioni (Ed.), NeUroGastroenterology (pp. 33–40). Berlin: deGruyter.
Drossman, D. A. (1998). Gastrointestinal illness and me biopsychosocial model. Psychosomatic Medicine, 60, 258–267.
Drossman, D. A., McKee, D. C., & Sandler, R. S. (1988). Psychosocial factors in the irritable bowel syndrome. A multivariate study of patients and non-patients with IBS. Gastroenterology, 95, 701–708.
Fava, G. A., & Freyberger, H. (Eds.). (1996). New developments in psychosomatic medicine. Madison, CT: International Universities Press.
Felten, D. L., Cohen, N., Ader, R., Felten, S. Y., Carlson, S. L., & Roszman, T. (1991). Central neural circuits involved in neural immune interactions. In R. Ader, D. L. Felten, & N. Cohen (Eds.), Psychoneuroimmunology (pp. 3–26). New York: Academic.
Garrett, V. D., Brantley, P. J., Jones, G. N., & MacKnight, G. T. (1991). The relation between daily stress and Crohn’s disease. Journal of Behavioral Medicine, 1, 87–96.
Gerbert, B. (1980). Psychological aspects of Crohn’s disease. Journal of Behavioral Medicine, 3, 41–58.
Grace, W. J. (1953). Life stress and regional enteritis. Gastroenterology, 23, 542–553.
Greene, B. R., Blanchard, E. B., & Wan, C. K. (1994). Long term monitoring of psychosocial stress and symptomatology in inflammatory bowel disease. Behaviour Research and Therapy, 2, 217–226.
Helzer, J. E., Chammas, S., Norland, C. C., Stillings, W. A., & Alpers, D. H. (1984). A study of the association between Crohn’s disease and psychiatric illness. Gastroenterology, 86, 324–330.
Hislop, J. G. (1974). Onset setting in inflammatory bowel disease. Medical Journal of Australia, 1, 981–984.
Janke, W., Erdmann, G., & Kallus, W. (1985). StrePverarbeitungsfragebogen. Göttingen: Hogrefe Verlag.
Kiecolt-Glaser, J. K., & Glaser, R. (1991). Stress and immune function in humans. In R. Ader, D. L. Felten, & N. Cohen (Eds.), Psychoneuroimmunology (pp. 849–868). New York: Academic.
Kosarz, P. (1995). Morbus Crohn und Alltagsstreβ. Berlin: Westkreuzverlag.
Kosarz, P. (1997). Ergebnisse psychotherapeutischer Behandlungsansätze bei chronisch-entzündlichen Darmerktankungen. In P. Kosarz & H. C. Traue (Eds.), Psychosomatik chronisch-entzündlicher Darmerkrankungen. (pp. 158–168). Bern, Switzerland: Huber.
Kosarz, P., Hrabal, V., & Traue, H. C. (1997). Ein Symptom- und Stresstagebuch für Patienten mit chronisch-entzündlichen Darmerkrankungen. In P. Kosarz & H. C. Traue, Psychosomatik chronisch-entzündlicher Darmerkrankungen. (pp. 143–157). Bern, Switzerland: Huber.
Kosarz, P., & Traue, H. C. (1997). Alltagsstreß und Colitis ulcerosa. Psychotherapie, Psychosmatik und Medizinische Psychologie, 47, 117–122.
Liu, L.-M., & Hudak, G. B. (1992). Forecasting and time series analysis using the SCA statistical system. Oakbrook, IL: Scientific Computing Associates Corporation.
Malchow, H., Ewe, K., Brandes, J. W., Goebell, H., Ehms, H., Sommer, H., & Jesdinsky, H. (1984). European Cooperative Crohn’s Disease Study (ECCDS): Results of drug treatment. Gastroenterology, 86, 249–266.
Mayer, E. E., Naliboff, B., Munakata, J., & Siverman, D. (1996). Brain-gut mechanisms of visceral sensitivity. In E. Corazzioni (Ed.), NeUroGastroenterology (pp. 17–32). Berlin: deGruyter.
McCleary, R., & Hay, R. A. Jr. (1980). Applied time series analysis for the social sciences. Newbury Park, CA: Sage.
McKegney, F. P., Gordon, R. O., & Levine, S. M. (1970). A psychosomatic comparison of patients with ulcerative colitis and Crohn’s disease. Psychosomatic Medicine, 32, 153–166.
Monk, M., Mendeloff, A. J., Siegel, C. J., & Lilienfeld, A. (1970). An epidemiological study of ulcerative colitis and regional enteritis among adults in Baltimore: III. Psychological and possible stress-precipitating factors. Journal of Chronic Diseases, 22, 565–578.
North, C. S., Alpers, D. H., Helzer, J. E., Spitznagel, E. L., & Clouse, R. E. (1991). Do life events or depression exacerbate inflammatory bowel disease? Annals of Internal Medicine, 5, 381–386.
Pennebaker, J. W., & Traue, H. C. (1993). Inhibition and psychosomatic processes. In: H. C. Traue & J. W. Pennebaker (Eds.), Emotion, inhibition, and health (pp. 146–163). Seattle, WA: Hogrefe & Huber.
Robertson, D. A., Ray, J., Diamond, I., & Edwards, J. G. (1989). Personality profile and affective state of patients with inflammatory bowel disease. Gut, 30, 623–626.
Schwarz, S. P., & Blanchard, E. B. (1990). Inflammatory bowel disease: A review of the psychological assessment and treatment literature. Annals of Behavioral Medicine, 12, 95–105.
Steinhausen, H. C., & Kies, H. (1982). Comparative studies of ulcerative colitis and Crohn’s disease in children and adolescents. Journal of Child Psychology and Psychiatry, 23, 33–42.
Summers, R. W., Switz, D. M., Sessions, J. T. Jr., Becktel, J. M., Best, W. R., Kern, F. Jr., & Singleton, J. W. (1979). National Cooperative Crohn’s Disease Study: Results of drug treatment. Gastroenterology, 77, 847–869.
Traue, H. C. (1998). Emotion und Gesundheit: Die psychobiologische Regulation durch Hemmungen. Heidelberg: Spektrum Akademischer Verlag.
Traue, H. C, Kessler, M., & Lee, V. (1997). Pathways linking emotional inhibition, psychosomatic disorders and pain. In Ad Vingerhoet (Ed.), The (non) expression of emotion and health (pp. 193–211). Tilburg, The Netherlands: Tilburg University Press.
Traue, H. C., & Pennebaker, J. W. (1993). Inhibition and arousal. In H. C. Traue & J. W. Pennebaker (Eds.), Emotion, inhibition and health (pp. 10–31). Seattle, WA: Hogrefe & Huber.
Twisk, J. W. R., Snel, J., Kemper, H. C. G., & van Mechelen, W. (1999). Changes in daily hassles and life events and the relationship with coronary heart disease risk factors: A 2-year longitudinal study in 27-29-year-old males and females. Journal of Psychosomatic Research, 46, 229–240.
Zakowski, S. G. (1995). The effects of stressor predictability on lymphocyte proliferation in humans. Psychology and Health, 10, 409–425.
Author information
Authors and Affiliations
Corresponding author
Additional information
This research was supported by a grant of the German Research Foundation (DFG) given to HCT (Tr 233/7-1).
Rights and permissions
About this article
Cite this article
Traue, H.C., Kosarz, P. Everyday stress and crohn’s disease activity: A time series analysis of 20 single cases. Int. J. Behav. Med. 6, 101–119 (1999). https://doi.org/10.1207/s15327558ijbm0602_1
Issue Date:
DOI: https://doi.org/10.1207/s15327558ijbm0602_1