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Hossein Haji Ali Akbari; Abbas Mokhtari
Abstract
Objective: The present study aimed to develop a structural equation model to predict life satisfaction based on the severity of irritable bowel syndrome (IBS) symptoms and perceived stress, with the mediating roles of pain catastrophizing, anxiety sensitivity, emotion regulation, and cognitive flexibility ...
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Objective: The present study aimed to develop a structural equation model to predict life satisfaction based on the severity of irritable bowel syndrome (IBS) symptoms and perceived stress, with the mediating roles of pain catastrophizing, anxiety sensitivity, emotion regulation, and cognitive flexibility in patients with IBS. Irritable bowel syndrome is considered one of the most prevalent functional gastrointestinal disorders and is characterized by persistent alterations in bowel habits, such as diarrhea, constipation, or a combination of both, accompanied by abdominal pain and discomfort. A defining feature of this disorder is the absence of identifiable structural or biochemical abnormalities in routine clinical examinations and laboratory tests. In other words, despite the substantial impact of these symptoms on patients’ quality of life, no clear organic cause has been established. In recent years, numerous studies have examined the influence of psychological factors on the experience and exacerbation of IBS symptoms. Findings from this body of research indicate a close association between IBS and variables such as perceived stress, pain catastrophizing, anxiety sensitivity, cognitive flexibility, and emotion regulation. Patients with IBS commonly experience high levels of psychological distress, anxiety, and mood disturbances in addition to physical pain, which can substantially diminish their overall life satisfaction. Method: The present study adopted a descriptive–correlational design and was conducted using structural equation modeling (SEM) with a path analysis framework. The target population included all individuals who were diagnosed with irritable bowel syndrome (IBS) by a gastroenterologist, based on endoscopic and colonoscopic examinations, and who referred to gastroenterology clinics and medical centers in Isfahan, Iran, during 2025. Participants were recruited using a convenience sampling method. Although there is no universally accepted guideline for determining sample size in SEM studies, methodological recommendations generally suggest a minimum of 200 participants to ensure adequate statistical power and model stability. Accordingly, an initial sample of 225 patients with IBS, aged 20 to 75 years, was recruited. After screening the data, 25 cases were excluded due to incomplete questionnaire responses. Consequently, data from 200 participants were retained for the final analyses. Data were collected using a battery of standardized self-report instruments, including the IBS Symptom Severity Questionnaire (Solati, 2008), the Perceived Stress Scale (Cohen et al., 1983), the Satisfaction with Life Scale (Diener et al., 1985), the Pain Catastrophizing Questionnaire (Rahmati et al., 2017), the Anxiety Sensitivity Index (Reiss & Peterson, 1986), the Emotion Regulation Questionnaire (Gross & John, 2003), and the Cognitive Flexibility Inventory (Dennis & Vander Wal, 2010). Data analyses were conducted using Pearson’s correlation coefficients and structural equation modeling with path analysis. All statistical analyses were performed using SPSS (Version 26) and AMOS (Version 24). Results: The results of the path analysis indicated that IBS symptom severity had a significant positive direct effect on pain catastrophizing (β=.25, p<.01) and anxiety sensitivity (β=.49, p<.01). However, the direct effect of IBS symptom severity on life satisfaction was not statistically significant (β = .03, p = .555). In addition, perceived stress demonstrated a significant positive direct effect on anxiety sensitivity (β= .18, p<.01), pain catastrophizing (β=.18, p<.01), and ife satisfaction (β = .21, p <.01). Thedirct effect of pain catastrophizing on emotion regulation was not significant (β=.02, p=.727). I contrast, emotion regulation had a significant positive direct effect on life satisfaction (β=.24, p<.01). Furthermore, anxiety sensitivity did not have a significant direct effect on cognitive flexibility (β=−.11, p=.106). However, cognitive flexibility showed a significant positive direct effect on life satisfaction (β=.23, p<.01). Overall, the findings supported the hypothesized structural model, confirming the proposed relationships among the study variables.Conclusion: The present study aimed to develop a structural equation model to predict life satisfaction based on the severity of irritable bowel syndrome (IBS) symptoms and perceived stress, with pain catastrophizing, anxiety sensitivity, emotion regulation, and cognitive flexibility as mediating variables. The results indicated that the proposed model demonstrated good fit. Findings showed that the severity of IBS symptoms directly increased pain catastrophizing and anxiety sensitivity but had no direct effect on life satisfaction. This suggests that the mere presence of physical symptoms does not necessarily reduce patients’ life satisfaction; rather, such reductions occur through intermediary psychological processes. According to cognitive pain processing and emotion regulation theories, individuals who focus on the negative aspects of physical symptoms and appraise them as threatening experience more intense pain and lower quality of life. Similar results have been reported by Carter et al. (2017), indicating that individuals with functional gastrointestinal disorders who experience high levels of stress and anxiety report lower quality of life. Considering the study’s findings and the significant role of mediating variables, it is essential to develop workshops and programs aimed at enhancing adaptive coping skills, such as problem-solving, mindfulness, and acceptance, for this population.
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Hengameh Boloorsaz Mashhadi; Eisa Jafari; Fereshteh Fereshteh Pourmohseni koluri
Abstract
Objective: Irritable bowel syndrome is the most common diagnosis among functional gastrointestinal disorders and is the cause of 25 to 50 percent of referrals to gastroenterologists (Frozanfar et al., 2023). In a review study, the prevalence of this syndrome in Iran was reported to be between 1.1 and ...
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Objective: Irritable bowel syndrome is the most common diagnosis among functional gastrointestinal disorders and is the cause of 25 to 50 percent of referrals to gastroenterologists (Frozanfar et al., 2023). In a review study, the prevalence of this syndrome in Iran was reported to be between 1.1 and 25 percent (Sheykhan and Goudarzi 2024). People with this syndrome report significant symptoms of psychological disorders and emotional disturbances. Among the symptoms that may be important in this disease, emotional dysregulation can be mentioned (Khoshchin Gol et al., 2021). A review of scientific reports over the past decade clearly shows that emotional dysregulation is of particular importance in the field of physical diseases (Boloorsaz Mashhadi et al., 2025). Irritable bowel syndrome does not lead to dangerous conditions in most patients, but due to side effects such as chronic pain and fatigue, it can increase the patient's medical costs and increase the patients' absence from work (Liu et al., 2025). In this context, Qian and Zhang (2024) showed in a study that stress and emotional dysregulation affect digestive function by activating the brain-gut axis, hormonal changes, and neuroimmune pathways, and thus, one of the most common health problems that causes patients with digestive disorders to seek medical care and treatment is abdominal pain. A review of the findings shows that sensitivity to pain and anxiety-related experiences are higher in patients with irritable bowel syndrome than in other digestive disorders (Prospero et al., 2025; Erfan et al., 2021). Because irritable bowel syndrome reduces the strength of the patient's immune system and muscles, the person may report high muscle and abdominal pain during the disease. For this reason, patients may sometimes experience greater pain intensity for various reasons, such as pain catastrophizing, which should be evaluated (Bagheri Sheykhangafshe et al., 2024). Various pharmacological and non-pharmacological treatments have been used for patients with irritable bowel syndrome. According to research evidence, one of the non-pharmacological treatments to reduce adverse psychological effects in these patients is mindfulness-based cognitive therapy, a type of cognitive therapy. This treatment, which uses mindfulness and includes various meditations, stretching yoga, education about stress management, anxiety, anger, and depression, and cognitive therapy practice (Seng et al., 2025). For example, Reilly et al (2025) concluded in a systematic review and meta-analysis that mindfulness-based cognitive therapy reduced perceived pain intensity and symptoms of depression and anxiety in patients with spinal cord injury. The present study aimed to investigate the effectiveness of mindfulness-based cognitive therapy on emotional dysregulation and pain indicators (acceptance-catastrophizing) in patients with irritable bowel syndrome. Method: The research method was a quasi-experimental study with a pre-test and post-test design with a control group and a two-month follow-up. All male patients with irritable bowel syndrome who referred to the internal medicine clinic of Moheb Hospital, Tehran, in 1404 constituted the statistical population of the study. For experimental and quasi-experimental studies, 15 people were recommended for each of the experimental and control groups. The Dysregulation of Emotion Questionnaire (DERS), Pain Acceptance Questionnaire (CPAQ), and Pain Catastrophizing Questionnaire (PCS) were among the instruments used in the present study. The statistical method used for data analysis was two-way analysis of variance with repeated measures. Before statistical analysis, the assumptions of parametric statistics related to analysis of variance were first examined and confirmed. Results: According to the results of Table 1, since the significance level related to time is less than 0.05, it can be accepted that there is a significant difference between the mean scores of emotional dysregulation and its components, as well as between the mean scores of pain acceptance, pain catastrophizing and their components in different stages of measurement (pre-test-post-test and follow-up).Conclusion: The present study was conducted with the aim of investigating the effectiveness of mindfulness-based cognitive therapy on emotional dysregulation and pain indices in patients with irritable bowel syndrome. The results showed that participating in mindfulness-based cognitive therapy sessions reduced emotional dysregulation in patients with irritable bowel syndrome, and this effect remained stable during the follow-up period. Another result of the study showed that participating in mindfulness-based cognitive therapy sessions increased pain acceptance in patients with irritable bowel syndrome, and this effect remained stable during the follow-up period. The final finding of the study indicated that participating in mindfulness-based cognitive therapy sessions reduced pain catastrophizing in patients with irritable bowel syndrome, and this effect remained stable during the follow-up period.
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Jamshid Hashemi; Majid Safarinia; Ahmad Alipour
Abstract
Objective: Postmenopausal women with irritable bowel syndrome have more severe symptoms of the condition than premenopausal women. It can also be said that, in addition to experiencing problems caused by menopause, such as hot flashes and a decrease in hormone levels, these women may experience more ...
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Objective: Postmenopausal women with irritable bowel syndrome have more severe symptoms of the condition than premenopausal women. It can also be said that, in addition to experiencing problems caused by menopause, such as hot flashes and a decrease in hormone levels, these women may experience more perceived stress than they did before menopause and when they did not have irritable bowel syndrome. Research has shown that women with irritable bowel syndrome experience higher levels of perceived stress, and stress in patients is one of the main reasons for the onset and continuation of the disease. Regarding the logical and scientific reasons for comparing these two treatments, it can be said that when one treatment can be identified as more effective than the other among the different and effective therapeutic approaches and interventions in terms of empirical studies, it can help psychologists and therapists who work in the field of reducing the problems of these patients to use the results of such research to determine which type of treatment is more effective. For this reason, this research has practical implications in this field for psychologists and therapists. The purpose of this study was to The compare the effectiveness of cognitive-behavioral therapy and hypnotherapy on perceived stress in postmenopausal women with irritable bowel syndrome. Method: This semi-experimental study was conducted with a pretest-posttest design with control group and follow-up 2 month. The statistical population of the research was all w postmenopausal women with irritable bowel syndrome of Tehran city in winter of year 2025. Then the number of 45 women patients diagnosed irritable bowel syndrome were randomly divided into two groups, including an cognitive-behavioral therapy group (15 women), hypnotherapy group (15 women) and a control group (15 women). Then the first experimental group underwent 8 sessions of 90 minute cognitive-behavioral therapy and the second experimental group underwent 8 sessions of 90 minute of hypnotherapy. To collect data perceived stress scale (PSC) of Cohen et al (1983). Menopause (permanent cessation of menstrual cycle), diagnosis of irritable bowel syndrome based on a specialist physician's diagnosis, and having at least a diploma degree were the criteria for inclusion in the study. Also, absence of more than 2 sessions in treatment sessions, simultaneous participation in other courses and therapeutic interventions concurrently with the study were the criteria for exclusion from the study. Explaining the objectives of the study to the participating women and providing intensive intervention sessions to the control group were the ethical principles observed in this study. Analysis of variance with repeated measures and Bonferroni post hoc test was used for data analysis. The data analysis software was SPSS version 28. Results: The mean and standard deviation of age in cognitive-behavioral therapy were 57.20 and 4.61; the mean and standard deviation in the hypnotherapy group were 61.07 and 5.34; and the mean and standard deviation of age in the control group were 60.80 and 5.02. The F statistic obtained from comparing the means of the 3 groups in the age variable was F = 2.96, which was not statistically significant (sig = 0.063), indicating that the 3 groups were similar in terms of age. The Chi-Square analysis statistic obtained from comparing the frequency and percentage of the 3 groups of postmenopausal women with irritable bowel syndrome in the education variable was Chi-Square = 4.68, which was not statistically significant (sig = 0.585), indicating that the three groups of women were similar in terms of education. Based on the results, cognitive-behavioral therapy and hypnotherapy had an effect on perceived stress and its dimensions in the post-test phase, and its therapeutic effects were persistent and stable after 2 months. The results also showed that the mean difference between the cognitive-behavioral therapy group and the control group was greater than the mean difference between hypnotherapy and the control group, which indicates that cognitive-behavioral therapy is more effective than hypnotherapy on perceived stress in postmenopausal women with irritable bowel syndrome. Conclusion: When people perceive a situation as an imminent threat (such as entering menopause and experiencing irritable bowel syndrome), stress becomes harmful. However, if they view it as a challenge, it becomes more manageable. By participating in cognitive-behavioral therapy sessions, these women learn to reduce their perceived stress by developing a calmer, more balanced approach to the stressors related to their illnesses and conditions and by changing the way they think about stress. But why cognitive-behavioral therapy has become more effective than hypnotherapy can be explained by the fact that, despite the efficiency and effectiveness of hypnotherapy, it is used less frequently for patients with irritable bowel syndrome. This may be due to a lack of interest on the part of doctors in using hypnotherapy to treat the problems of people with irritable bowel syndrome. It is also likely that this attitude is shared by the general public and some patients with irritable bowel syndrome. There were limitations in conducting the present study, the selection of a sample from Tehran requires caution in generalizing the findings. The limited data collection tool to a questionnaire and the lack of use of other measurement tools are other limitations and problems of this study. This is because there is a possibility that there is bias in the responses of postmenopausal women with irritable bowel syndrome, because the criterion for selecting the disease was the diagnosis of a specialist physician and the type of severity of the disease was not specified. Due to time constraints, this study was unable to conduct a longer-term follow-up phase to examine the continuity and durability of the effects of cognitive-behavioral therapy and hypnotherapy, and was limited to a two-month follow-up measurement phase. Based on the results of the present study, it can be said that cognitive-behavioral therapy and hypnotherapy can be used as a treatment method to on perceived stress in postmenopausal women with irritable bowel syndrome and priority of use in perceived stress women with postmenopausal women with irritable bowel syndrome is with cognitive-behavioral therapy.
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farzaneh frozanfar; sheida jabal ameli; Mohammad Soltanizadeh; seyyed mohammad hassan emami; mojtaba ansari shahidi
Abstract
Objective: The present study was conducted to offer the model of predicting psychosocial adaptation to disease according to health-promoting behaviors with the mediation role of self-compassion in the patients with Irritable Bowel Syndrome (IBS). Method: The research method was descriptive-correlational ...
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Objective: The present study was conducted to offer the model of predicting psychosocial adaptation to disease according to health-promoting behaviors with the mediation role of self-compassion in the patients with Irritable Bowel Syndrome (IBS). Method: The research method was descriptive-correlational and path analysis. The statistical population of the study included the patients with IBS who referred to therapy centers and gastroenterologists in the city of Isfahan in the autumn and winter of 2020-21. The statistical population included 340 patients with IBS who were selected through Convenience sampling method. The applied instruments included Psycho-Social Adaptation to Disease Scale (PSADS) (Drogits, 1986), Health Promoting Lifestyle Questionnaire (HPLQ) (Walker et al, 1987) and Self-Compassion Questionnaire (SCQ) (Neff, 2003). The data analysis was conducted via path analysis and Bootstrap test. Findings: The results showed that health-promoting behaviors and self-compassion have significant relationship with psychosocial adaptation to disease (p<0.01). Moreover, health-promoting behaviors and self-compassion have direct significant effect on psychosocial adaptation to disease (p<0.01). Furthermore, the results of Bootstrap showed that self-compassion has a significant mediation role in the relationship of health-promoting behaviors with psychosocial adaptation to disease (p<0.01). Finally, the model had a suitable goodness of fit. Conclusion: According to the results of the research, self-compassion has a significant mediating role between health-promoting behaviors and psychosocial adaptation to illness
asghar kamran; Roshanak Rostamifar; kamal moghtadaei
Abstract
Objective: Irritable bowel syndrome is one of the most common gastrointestinal disorders that is associated with abdominal pain, bloating and bowel disorders. The aim of this study was the effectiveness of acceptance and commitment based therapy on reducing avoidance behavior and improving emotional ...
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Objective: Irritable bowel syndrome is one of the most common gastrointestinal disorders that is associated with abdominal pain, bloating and bowel disorders. The aim of this study was the effectiveness of acceptance and commitment based therapy on reducing avoidance behavior and improving emotional processing in patients with irritable bowel syndrome. Method: This research was a quasi-experimental study and was conducted with pre-test-post-test and follow-up design and experimental and control groups. The statistical population included all women with irritable bowel syndrome in Isfahan in 2019, of whom 30 were randomly selected into two groups of 15 experimental and control. Data were collected using emotional processing questionnaires (Baker, 2007) and multidimensional experience avoidance questionnaire (Gomez, 2011). The experimental group participated in a 90-minute program based on acceptance and commitment therapy, but the control group did not undergo any intervention. Data were analyzed by analysis of covariance and repeated measures analysis. Findings: Acceptance and commitment based therapy was effective on emotional acceptance and avoidance of experience in two stages of follow-up and post-test (P<0.01). Conclusion: The results showed that acceptance and commitment based therapy is effective in avoiding experience and emotional processing in patients with irritable bowel syndrome and has important consequences for patients with irritable bowel syndrome.
Noura Khosh Chin Gol; bahman akbari; leila moghtader; iraj shakerinia
Abstract
Objective: the aim of this study was to compare the efficacy of Mindfulness Based Cognitive Therapy and neurofeedback on severity and intensity of somatic symptoms and emotional regulation in patients with irritable bowel syndrome. Method: the study was a quasi-experimental study with pretest-posttest ...
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Objective: the aim of this study was to compare the efficacy of Mindfulness Based Cognitive Therapy and neurofeedback on severity and intensity of somatic symptoms and emotional regulation in patients with irritable bowel syndrome. Method: the study was a quasi-experimental study with pretest-posttest design and follow-up with control group. The study population included all women with irritable bowel syndrome referred to gastroenterology clinics in Qazvin city in 2019. 45 patients were selected by convenience sampling and randomly assigned to two experimental and one control group. The Rome-III Diagnostic Criteria Form and the Emotional Regulation Questionnaire (Gross & John, 2003) were administered to all sample subjects before, after and two months after the intervention. The experimental groups underwent Mindfulness Based Cognitive Therapy and neurofeedback. Findings: The results showed that mindfulness-based cognitive therapy and neurofeedback were effective on reducing severity and intensity of somatic symptoms and increasing emotional regulation in patients with irritable bowel syndrome (p<0.01). Comparison of the means of the two experimental groups showed that there was no significant difference between their effectiveness on the extent and severity of physical symptoms and emotional regulation of patients (p>0.05). Conclusion: Both interventions can reduce the severity and intensity of patients' physical symptoms and increase their emotional regulation through their special techniques. Therefore, therapists can use these interventions to control the physical and emotional symptoms of patients with irritable bowel syndrome.
Fereshte Pourmohseni-Koluri; Fina Eslami
Volume 5, Issue 20 , January 2017, , Pages 48-67
Abstract
Abstract Object: Despite of prevalent and clear signs of irritable bowel syndrome (IBS), the causes of this illness is still unclear. It seems mental factors contribute in severity and incident of this illness, But still there is no cure for this disease The aim of this study was to investigate effectiveness ...
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Abstract Object: Despite of prevalent and clear signs of irritable bowel syndrome (IBS), the causes of this illness is still unclear. It seems mental factors contribute in severity and incident of this illness, But still there is no cure for this disease The aim of this study was to investigate effectiveness of group cognitive therapy based on mindfulness on mental health and quality of life of patients with bowel irritating syndrome. Method: This research was semi-experimental design pretest-posttest with control group that subjects were 40 people who diagnosed by physician as BIS that selected by available sampling method. And randomly assigned in experimental and control groups. Then two groups answered general health and quality of life questionnaires. Experimental group received 8 sessions of 90 –minute’s group cognitive therapy based on mindfulness and the control group did not receive any treatment. Both groups completed questionnaires after completing the treatment again. Data analyzed by Analysis of univariate and Multivariate Covariance. Results: Analysis of univariate and Multivariate Covariance revealed mental health and quality of life effectively higher in experimental group compared to the control group (p< 0/001). Conclusion: The findings have showed the group cognitive therapy based on mindfulness promote mental health and improve quality of life of patient with irritable bowel syndrome.
