Anxiety Sensitivity and Metacognition in Iranian Patients with Functional Gastrointestinal Disorders and Healthy Individuals

Assistant Professor, Department of Psychiatry, School of Medicine AND Behavioral Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

MSc Student, Department of Clinical Psychology, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran

Postdoc Student in Psychosomatic Disorders AND Assistant Professor, Behavioral Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran


Abstract

Background: Psychosomatic disorders are a group of psychiatric disorders in which psychological factors play an important role in the development, maintenance, and exacerbation of medical conditions. The most important category of psychosomatic disorders is functional gastrointestinal disorders (FGID). The present study aimed to compare anxiety sensitivity (AS) and metacognitions between patients with FGID and healthy individuals in Isfahan, Iran.

Methods: This case-control study was conducted on 50 patients (13 men and 37 women) with FGID who were diagnosed by a gastroenterologist and had the study inclusion criteria and 50 matched healthy individuals (15 men and 35 women). The subjects were randomly selected. The data collection tools consisted of the Anxiety Sensitivity Index‎-Revised (ASI-R) and Metacognitive Beliefs Questionnaire (MCQ-30). The data were analyzed in SPSS software.

Results: The results showed that there were significant differences in all subscales of ASI-R and MCQ-30, except the fear of publicly observable symptoms subscale in the ASI-R and negative beliefs about the uncontrollability of thoughts and corresponding danger (UD) subscale in MCQ-30 between patients with FGID and healthy individuals.

Conclusion: The results showed that AS and metacognitive beliefs about worry play a crucial role in psychosomatic disorders such as FGID. Anxiety has appeared as the common component between FGID. Hence, the management of anxiety in FGID by clinicians in the treatment of these disorders is recommended.

Keywords


  • Psychosomatic disorder
  • Anxiety sensitivity (AS)
  • Metacognitive beliefs
  • Functional gastrointestinal disorders

Full Text


References


Allott, R., Wells, A., Morrison, A. P., & Walker, R. (2005). Distress in Parkinson's disease: contributions of disease factors and metacognitive style. Br J Psychiatry, 187, 182-183. doi:187/2/182 [pii];10.1192/bjp.187.2.182 [doi]. Retrieved from PM:16055832

Cook, S. A., Salmon, P., Dunn, G., & Fisher, P. (2014). Measuring metacognition in cancer: validation of the Metacognitions Questionnaire 30 (MCQ-30). PLoS.One., 9(9), e107302. doi:10.1371/journal.pone.0107302 [doi];PONE-D-14-08019 [pii]. Retrieved from PM:25215527

Dowden, S. L., & Allen, G. J. (1997). Relationships between anxiety sensitivity, hyperventilation, and emotional reactivity to displays of facial emotions. J Anxiety Disord., 11(1), 63-75. doi:S0887618597849833 [pii]. Retrieved from PM:9131882

Fisher, P. L., & Wells, A. (2005). Experimental modification of beliefs in obsessive-compulsive disorder: a test of the metacognitive model. Behav Res Ther, 43(6), 821-829. doi:S0005-7967(04)00226-8 [pii];10.1016/j.brat.2004.09.002 [doi]. Retrieved from PM:15890171

Kashdan, T. B., Zvolensky, M. J., & McLeish, A. C. (2008). Anxiety sensitivity and affect regulatory strategies: individual and interactive risk factors for anxiety-related symptoms. J Anxiety Disord., 22 (3), 429-440. doi:S0887-6185(07)00093-X [pii];10.1016/j.janxdis.2007.03.011 [doi]. Retrieved from PM:17449221

Kavoosi, M. (2014). Compare anxiety sensitivity, metacognitive beliefs and acceptance of internal experiences in patients with gastrointestinal disease, cardiovascular disease and healthy people in Isfahan [MSc Thesis]. Isfahan, Iran: Isfahan (Khorasgan) Branch, Islamic Azad University. [In Persian].

Labus, J. S., Bolus, R., Chang, L., Wiklund, I., Naesdal, J., Mayer, E. A. et al. (2004). The Visceral Sensitivity Index: development and validation of a gastrointestinal symptom-specific anxiety scale. Aliment.Pharmacol.Ther, 20(1), 89-97. doi:10.1111/j.1365-2036.2004.02007.x [doi];APT2007 [pii]. Retrieved from PM:15225175

Lackner, J. M., & Gurtman, M. B. (2005). Patterns of interpersonal problems in irritable bowel syndrome patients: a circumplex analysis. J Psychosom.Res, 58(6), 523-532. doi:S0022-3999(05)00035-8 [pii];10.1016/j.jpsychores.2005.02.015 [doi]. Retrieved from PM:16125519

Lenzo, V., Buccheri, T., Sindorio, C., Belvedere, A., Fries, W., & Quattropani, M. C. (2013). Metacognition and negative emotions in clinical practice. A preliminary study with patients with bowel disorder. Mediterr J Clin Psychol., 1(2), 1-11.

Mayer, E. A., Craske, M., & Naliboff, B. D. (2001). Depression, anxiety, and the gastrointestinal system. J Clin Psychiatry, 62(Suppl 8), 28-36. Retrieved from PM:12108819

Mazaheri, M., Afshar, H., Weinland, S., Mohammadi, N., & Adibi, P. (2012). Alexithymia and functional gastrointestinal disorders (FGID). Med Arh., 66(1), 28-32. Retrieved from PM:22482339

Morrison, A. P., Shryane, N., Fowler, D., Birchwood, M., Gumley, A. I., Taylor, H. E. et al. (2015). Negative cognition, affect, metacognition and dimensions of paranoia in people at ultra-high risk of psychosis: a multi-level modelling analysis. Psychol Med, 45(12), 2675-2684. doi:S0033291715000689 [pii];10.1017/S0033291715000689 [doi]. Retrieved from PM:26165380

Naliboff, B. D., Kim, S. E., Bolus, R., Bernstein, C. N., Mayer, E. A., & Chang, L. (2012). Gastrointestinal and psychological mediators of health-related quality of life in IBS and IBD: a structural equation modeling analysis. Am J Gastroenterol, 107(3), 451-459. doi:ajg2011377 [pii];10.1038/ajg.2011.377 [doi]. Retrieved from PM:22085819

Olatunji, B. O., & Wolitzky-Taylor, K. B. (2009). Anxiety sensitivity and the anxiety disorders: a meta-analytic review and synthesis. Psychol Bull., 135(6), 974-999. doi:2009-19763-008 [pii];10.1037/a0017428 [doi]. Retrieved from PM:19883144

Quattropani, M. C., Lenzo, V., Fries, W., & Belvedere, A. (2014). Dysfunctional metacognitive beliefs and gastrointestinal disorders. Beyond an 'organic'/'functional' categorization in the clinical practice. Mediterr J Clin Psychol, 2(1), 1-19.

Quattropani, M. C., Lenzo, V., Mucciardi, M., & Toffle, M. E. (2015). The role of metacognitions in predicting anxiety and depression levels in cancer patients ongoing chemotherapy. Procedia Soc. Behav. Sci., 205, 463-473. Retrieved from http://www.sciencedirect.com/science/article/pii/S1877042815050600

Reiss, S., & McNally, R. J. (1985). The expectancy model of fear. In Reiss S & Bootzin RR (Eds.), theoretical issues in behavior therapy. London, UK: Academic Press.

Sabourin, B. C., Stewart, S. H., Watt, M. C., & Krigolson, O. E. (2015). Running as Interoceptive Exposure for Decreasing Anxiety Sensitivity: Replication and Extension. Cogn Behav Ther, 44(4), 264-274. doi:10.1080/16506073.2015.1015163 [doi]. Retrieved from PM:25730341

Sadock, B. J., & Sadock, V. A. (2007). Kaplan and Sadock's synopsis of psychiatry: Behavioral sciences/clinical psychiatry (10th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

Saigo, T., Tayama, J., Hamaguchi, T., Nakaya, N., Tomiie, T., Bernick, P. J. et al. (2014). Gastrointestinal specific anxiety in irritable bowel syndrome: validation of the Japanese version of the visceral sensitivity index for university students. Biopsychosoc.Med, 8(1), 10. doi:1751-0759-8-10 [pii];10.1186/1751-0759-8-10 [doi]. Retrieved from PM:24655428

Schmidt, N. B., Keough, M. E., Mitchell, M. A., Reynolds, E. K., Macpherson, L., Zvolensky, M. J. et al. (2010). Anxiety sensitivity: prospective prediction of anxiety among early adolescents. J Anxiety Disord., 24(5), 503-508. doi:S0887-6185(10)00054-X [pii];10.1016/j.janxdis.2010.03.007 [doi]. Retrieved from PM:20399075

Shirinzadeh Dastgiri, S., Goudarzi, M. A., Rahimi, C., & Naziri, G. (2009). Study of factor structure, validity and reliability OF Metacognition Questionnaire-30. Journal of Psychology, 12(1), 445-461. [In Persian].

Spada, M. M., & Wells, A. (2008). Metacognitive beliefs about alcohol use: development and validation of two self-report scales. Addict.Behav., 33(4), 515-527. doi:S0306-4603(07)00299-7 [pii];10.1016/j.addbeh.2007.10.011 [doi]. Retrieved from PM:18054174

Stewart, S., Watt, M., & Taylor, S. (2009). Overcoming the fear of fear: How to reduce anxiety sensitivity. Oakland, CA: New Harbinger Publications.

Taylor, S., Zvolensky, M. J., Cox, B. J., Deacon, B., Heimberg, R. G., Ledley, D. R. et al. (2007). Robust dimensions of anxiety sensitivity: development

and initial validation of the Anxiety Sensitivity Index-3. Psychol Assess, 19(2), 176-188. doi:2007-07953-002 [pii];10.1037/1040-3590.19.2.176 [doi]. Retrieved from PM:17563199

Vujanovic, A. A., Zvolensky, M. J., Bernstein, A., Feldner, M. T., & McLeish, A. C. (2007). A test of the interactive effects of anxiety sensitivity and mindfulness in the prediction of anxious arousal, agoraphobic cognitions, and body vigilance. Behav Res Ther, 45(6), 1393-1400. doi:S0005-7967(06)00134-3 [pii];10.1016/j.brat.2006.06.002 [doi]. Retrieved from PM:16949030

Wells, A., & Cartwright-Hatton, S. (2004). A short form of the metacognitions questionnaire: properties of the MCQ-30. Behav Res Ther, 42(4), 385-396. doi:10.1016/S0005-7967(03)00147-5 [doi];S0005796703001475 [pii]. Retrieved from PM:14998733

Wells, A. (2011). Metacognitive Therapy for Anxiety and Depression. Guilford Press. New York, NY: Guilford Press.

Yilmaz, A. E., Gencoz, T., & Wells, A. (2011). The temporal precedence of metacognition in the development of anxiety and depression symptoms in the context of life-stress: a prospective study. J Anxiety Disord., 25(3), 389-396. doi:S0887-6185(10)00219-7 [pii];10.1016/j.janxdis.2010.11.001 [doi]. Retrieved from PM:21144700