1 5 Attentional Bias in Irritable Bowel Syndrome

#1 -5 Attentional Bias in Irritable Bowel Syndrome: Implications for Acceptance and Commitment Therapy 1 Masataka 1 Ito , Takashi 2 Muto Graduate school of Psychology, Doshisha university 2 Faculty of Psychology, Doshisha University E-mail: ito. mstka@gmail. com Background & Objective The biopsychosocial model suggests that attention plays a role in the mechanism of Irritable Bowel Syndrome (IBS). The modified Stroop task has been used to demonstrate attentional bias toward threat cues in anxious individuals (Williams et al. 1996). Afzal et al. (2007) found that IBS patients have an attentional bias to IBS-related words, but the study used only IBS-related and neutral words. The objective of this study is to examine whether IBS show an attentional bias that is specific to IBS related stimuli. Method Participants Screening by IBS-SI n = 331 • Participants with IBS: 35 undergraduates who scored above the clinical cutoff on an IBS-SI screening. • Healthy Controls (HC): 35 undergraduates who scored below the clinical cutoff on an IBS-SI screening. IBS (n= 68) IBS n=38 We used the modified Stroop task for measuring attentional bias. We measured participants’ Reaction Time (RT) and errors in each session. This task consisted of a practice session and a test session. Task stimuli were words displayed at random in 4 colors (red, blue, green, yellow). Participants pressed the corresponding key on a ten-key pad. Attentional bias score was calculated as the difference between each category RT and neutral RT (3 conditions; IBSrelated, negative, positive). Practice session (Fig. 2 -a) • Words: “red” ”blue” ”green” ”yellow” in Japanese • Trials: 2 – 5 blocks • (each block had 16 trials: 4 colors * 4 words). • Criteria: 80% correct responses in the latest block Test session (Fig. 2 -b) • Words: 10 words in each of the 4 categories (IBSrelated, negative, positive, neutral). Words were matched for length and frequency. • Trials: 160 trials (4 colors*4 categories*10 words). Each word appeared four times in each color in a random order. HC (n=103) Exclude n=30 The modified Stroop task ＋ Red 1000 ms 5000 ms/ response Exclude n=59 + HC n=44 1000 ms Fig. 2 -a Training session ・ Questionnaires (IBSSI, IBSQOL, SF-36, BDI-II, STAI, ASI, AAQ-II, CFQ, FFMQ) ＋ ・The modified Stroop Task Training / Test session Exclude ・Getting better (n=3) Correct/Incorr ect/Time over Exclude ・Getting worse (n=3) Stomach 1000 ms 5000 ms/ response Analyzed IBS n=35 (Male =12 ) HC n=35 (Male = 14) Fig. 1 Procedure ＋ Anxiety 1000 ms Fig. 2 -b Test session Questionnaires • • • IBSSI (Irritable Bowel Syndrome Severity Index) IBSQOL (Irritable Bowel Syndrome Quality Of Life) SF-36 (Medical outcomes Study Short Form 36) BDI (Beck’s Depression Inventory – II) STAI (State-Trait Anxiety Inventory) ASI (Anxiety Sensitivity Inventory) AAQ (Acceptance and Action Questionnaire – II) CFQ (Cognitive Fusion Questionnaire) FFMQ (Five-Facet Mindfulness Questionnaire) Results ◆The modified Stroop task Attentional bias score (Fig. 3): A 2 (group) *3 (word category) ANOVA showed no significant main effects or interactions (all ps >. 10). Attentional bias score (ms) 16 IBS 14 Healthy Control 12 10 category) ANOVA showed no significant main effects or interactions (all ps >. 10). Trial error: A 2 (group) * 4 (word category) ANOVA analysis showed that the IBS group made significantly more errors (p <. 05). There were no significant interactions among category factors (ps >. 10). These results showed that participants with IBS do not have attentional biases in any category. They produced more errors, but not shorter RTs. ◆Questionnaires (Table 2) 8 6 4 2 0 -2 -4 Reaction time: A 2 (group) * 4 (word IBS-related negative positive Fig. 3 Attentional bias score Note: Attentional bias score, calculated as the difference between each category RT and neutral RT, reflects the effect of word type, with positive values indicating a greater bias. Table 1. Mean and standard deviations RT and trial errors in the modified Stroop task (p<. 05) (p<. 10) Table 2. Mean and standard deviations for the questionnaires We used t-tests to compare participants questionnaire scores with IBS and HCs. Participants with IBS showed worse scores on the QOL, BDI, STAI, ASI, and AAQ. Discussion These results show that IBS patients do not have an attentional bias toward IBS-related stimuli. They did not show speed-accuracy trade off, because although they had significantly higher error rates than HCs, their RTs were not shorter. These results suggest that attention does not play an important role in IBS symptoms. The results of ASI and AAQ suggested IBS patients tend to avoid or escape aversive stimuli. Task performance was consistent with this tendency.