OBJECTIVE: Irritable bowel syndrome has no observable symptom markers and there is little that the medical profession can do to help sufferers. Psychotherapy, antidepressants and drugs aimed at the most problematic symptoms have been shown to have limited efficacy. In an attempt to help understand the illness better, and to suggest alternative forms of intervention, the study tested whether outcome might be influenced by patients' representation of their illness and by their coping strategies. METHOD: All members of the IBS Network (an independent charitable support network based in the UK) were invited to participate via their quarterly newsletter, and 209 completed questionnaires were returned. Participants completed the Illness Perception Questionnaire (IPQ), the COPE, and the Hospital Anxiety and Depression Scale (HADS), and rated their quality of life and their satisfaction with their health. RESULTS: The reporting of serious consequences was associated with lower quality of life and lower satisfaction with health, and with higher scores for anxiety and depression (p <.001). Weaker control beliefs were related to lower quality of life, lower satisfaction with health, and higher depression scores (p <.01). Lower illness scores were associated with more satisfaction with health (p <.01), but not with quality of life (p >.05). Psychological causal attribution of IBS was positively correlated with anxiety (p <.001) and depression (p <.01). Path analyses based on multiple linear regression demonstrated that (1) the reporting of serious consequences was a strong independent predictor of outcome; (2) coping mediated the link between representation and outcome; and (3) when predicting depression, coping strategies predicted coping independently of representation dimensions. CONCLUSIONS: The findings indicate that the illness representations of IBS sufferers can have significant implications for outcome. Therapeutic interventions based on illness representations may prove useful for treatment.

Three picture naming experiments are reported which examine the relationship between the apparent inhibition of a response on one trial, and naming latency on the subsequent trial. The design of each experiment involves the presentation of prime and target pairs, either presented in succession (Lag 1 condition), or separated by two intervening unrelated trials (Lag 3 condition). A control condition is also included. In Experiment 1, a speeded picture naming task is used, and naming errors are analysed. Target pictures are misnamed at above chance rates with the name of the semantically related prime picture in the Lag 3 condition. In contrast, these prime-related errors do not occur in the Lag 1 condition, suggesting a brief inhibitory effect. If primes are briefly inhibited, then target naming latencies immediately following a related prime should be quicker than target latencies in the Lag 3 condition. Experiment 2 confirms this pattern of results, using exactly the same stimuli and design, but standard naming instructions. Experiment 3 examines whether the inferred inhibition is the result of a self-inhibitory mechanism, using a repetition priming paradigm. If Lag 1 prime representations are self-inhibited, then facilitatory effects from prime/target repetition should be stronger in the Lag 3 condition, than in the Lag 1 condition. The data from Expt 3 were not consistent with this prediction. Taken together, the results of the three experiments suggest that a brief inhibitory effect occurs after retrieval of an object name, and that the inhibition may be accomplished by mechanisms other than self-inhibition.

A prospective longitudinal study explored the illness representation model of patients with irritable bowel syndrome: how representations may change; whether they predict subsequent psychological outcome; and whether any link between representation and outcome may be mediated by coping. Patients were recruited from primary care. Representations were found to be stable over time, and they did predict outcome to some extent, but coping played no part in mediating the link. The findings raise important questions about using the illness representation model with chronic illness, and about the role of coping in the model.

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