General Dysfunctional Thinking Worsens Anxiety, Depression in Patients With Inflammatory Bowel Disease

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The study examined the importance of confronting general dysfunctional beliefs, particularly notions of low self-efficacy and failure, in short-term therapy for patients with IBD.

General dysfunctional beliefs may influence anxiety and depressive symptomatology in patients with inflammatory bowel disease (IBD), according to a cross-sectional study published in Behavioural and Cognitive Psychotherapy. The study examined the importance of confronting general dysfunctional beliefs, particularly notions of low self-efficacy and failure, in short-term therapy for a major patient population.

Investigators at the Academic Medical Centers at the Vrije University of Amsterdam in The Netherlands sought to clarify the relationship between IBD and psychiatric symptoms. They abstracted baseline data from an existing clinical trial of Dutch patients with IBD and self-reported poor mental quality of life who were recruited from 4 hospitals in The Netherlands (N=118; 63.6% women; mean age, 39 years; range, 19.4 to 76.5 years).

To ascertain psychiatric diagnoses, the investigators conducted structured interviews and measured dysfunctional beliefs with the 40-item Dysfunctional Attitude Scale (DAS). The DAS assesses dysfunctional thinking patterns (eg, “‘If a person asks for help, it is a sign of weakness”) on a 7-point Likert scale ranging from “strongly disagree” to “strongly agree.” The investigators also assessed specific illness-related beliefs with the Revised Illness Perception Questionnaire (IPQ-R) and anxiety and depression symptomatology with the Hospital Anxiety and Depression Scale (HADS).

The prevalence of comorbid psychiatric disorders in the sample was high (70.3%), with mood (45.8%), anxiety (31.4%), and adjustment (30.5%) disorders most commonly reported. General dysfunctional beliefs and specific illness beliefs were found to account for 14.9% and 25.0% of the variance in HADS total score, respectively. In univariate analyses, DAS total score was significantly associated with HADS total score (B, 0.123; P =.000), suggesting that general dysfunctional thinking may induce worse anxiety and depressive symptoms in patients with IBD.

In addition, 4 IPQ-R subscale scores were predictive of HADS total score in univariate models: “consequences,” or the perceived physical, psychological, and social effects of IBD (B, 0.802; P =.000); “treatment control,” the belief that medical interference can modify illness effects (B, −0.716; P =.001); “emotional representations,” the extent of negative emotions caused by illness (B, 0.774; P =.000); and “personal control,” the belief that personal interference can have an impact on IBD symptoms  (B, −0.516; P =.008).

However, in multivariable analysis, only DAS total score (B, 0.102; P =.001) and the emotional consequences IPQ-R subscale (B, 0.506; P =.003) remained significant. When the cohort was restricted to patients with a diagnosed psychiatric disorder (n=78), only DAS total score was significantly predictive of HADS results (P =.025).

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The findings implicate negative thinking patterns in the mental wellbeing of patients with IBD. Study limitations include its cross-sectional design and relatively small sample size. The investigators noted that “psychological interventions in patients with IBD with a co-morbid depressive disorder, anxiety disorders, and adjustment disorders might have to specifically target general dysfunctional beliefs especially instead of specific illness beliefs.”

Disclosure: One study author declared affiliations with the pharmaceutical industry.

Please see the original reference for a full list of disclosures.


Bennebroek Evertsz’ F, Sprangers MAG, de Vries LM, et al. I am a total failure: associations between beliefs and anxiety and depression in patients with inflammatory bowel disease with poor mental quality of life. Behav Cogn Psychother. 2020;48(1):91-102.