Effect of cognitive behavior therapy combined with exercise intervention on the cognitive bias and coping styles of diarrhea-predominant irritable bowel syndrome patients

Table 1 General demographics of the subjects (n = 87, mean ± SD)

Group	Number	Sex, male/female	Age, yr	Time of education, yr	BMI, kg/m2	Course of disease, yr
CBT+E	28	7/21	33.75 ± 2.57	14.57 ± 2.54	21.67 ± 1.38	8.68 ± 1.80
Control	29	7/22	36.86 ± 2.54	15.03 ± 2.54	21.90 ± 1.36	8.66 ± 2.00
Healthy	30	7/23	35.30 ± 2.75	14.93 ± 2.55	22.27 ± 1.63	-
t/χ2		0.02	9.47	3.37	1.22	3.29
P value		0.98	0.48	0.18	0.29	0.77

Table 2 Irritable Bowel Syndrome Symptom Severity Scale scores before and after the intervention in each group of patients (mean ± SD)

Group	n	Baseline	6 wk	12 wk	24 wk
CBT+E	28	252.07 ± 2.32	184.75 ± 3.56	179.85 ± 4.05	177.14 ± 4.61
Control	29	253.13 ± 1.97	197.51 ± 9.04	205.68 ± 10.89	191.89 ± 9.39

Table 3 ANOVA of Irritable Bowel Syndrome Symptom Severity Scale scores in each test group (n = 57)

	Time main effect		Interaction		Group main effect
	F	P value	F	P value	F	P value
IBS-SSS	3292.810	< 0.001	115.158	< 0.001	71.795	< 0.001

Table 4 Comparison of the Automatic Thoughts Questionnaire, Dysfunctional Attitudes Scale and Pain Coping Style Questionnaire scores between the diarrhea-predominant irritable bowel syndrome patient and healthy control groups (mean ± SD)

Scale	Dimensions	IBS-D (n = 57)	Healthy control (n = 30)	t	P value
ATQ		63.32 ± 9.44	44.33 ± 3.51	10.609	0.000
DAS	Vulnerability	17.96 ± 2.36	14.67 ± 1.26	7.099	0.002
	Absorption/rejection	15.46 ± 3.67	11.17 ± 2.26	5.837	0.000
	Perfectionism	16.98 ± 2.98	15.87 ± 2.30	1.785	0.059
	Mandatory	17.89 ± 3.74	11.93 ± 2.19	8.019	0.000
	Seek approval	18.09 ± 3.47	13.40 ± 2.31	6.652	0.002
	Dependence	18.30 ± 2.62	13.20 ± 2.02	9.276	0.043
	Autonomous attitude	18.56 ± 3.74	12.83 ± 2.70	7.410	0.041
	Cognitive philosophy	17.16 ± 2.12	12.87 ± 2.86	7.915	0.007
	Total score	137.39 ± 17.30	113.67 ± 10.35	6.875	0.008
CSQ	f1 Reinterpret	9.42 ± 2.91	9.43 ± 2.27	-0.019	0.513
	f2 Overcome	17.42 ± 2.61	17.57 ± 2.14	-0.262	0.205
	f3 Ignore	13.27 ± 2.67	14.81 ± 3.00	-2.358	0.337
	f4 Catastrophization	19.82 ± 3.14	11.57 ± 4.76	9.689	0.004
	f5 Increase activity	12.74 ± 3.12	13.67 ± 3.85	-1.215	0.175
	f6 Pain behavior	13.93 ± 3.21	12.67 ± 3.20	1.744	0.890
	f7 Divert attention	9.68 ± 4.21	14.67 ± 3.25	-5.642	0.025
	f8 Pray	12.74 ± 3.12	9.27 ± 2.11	5.452	0.005

ATQ: Automatic Thoughts Questionnaire; DAS: Dysfunctional Attitudes Scale; CSQ: Pain Coping Style Questionnaire.

Table 5 Changes in cognitive bias scores before and after the intervention (mean ± SD)

		CBT+E (n = 28)				Control (n = 29)
		Baseline	6 wk	12 wk	24 wk	Baseline	6 wk	12 wk	24 wk
	ATQ	66.96 ± 2.02	66.75 ± 2.01	65.66 ± 1.03	64.98 ± 2.23	66.10 ± 2.39	65.85 ± 2.33	65.42 ± 2.45	65.14 ± 2.36
	Vulnerability	20.39 ± 1.66	18.25 ± 1.66	14.75 ± 1.97	12.75 ± 1.77	21.27 ± 1.68	21.10 ± 1.65	21.06 ± 1.68	20.99 ± 2.10
	Absorption/rejection	12.53 ± 1.52	13.60 ± 1.59	14.42 ± 1.28	14.60 ± 1.28	13.17 ± 1.94	13.37 ± 1.91	13.62 ± 1.91	13.86 ± 1.99
	Perfectionism	20.28 ± 1.46	19.39 ± 1.72	17.57 ± 1.98	17.35 ± 1.92	19.75 ± 1.72	19.41 ± 1.84	19.17 ± 1.69	19.00 ± 1.64
DAS	Mandatory	19.37 ± 1.76	18.00 ± 1.74	17.67 ± 1.78	17.46 ± 1.68	19.37 ± 1.59	18.48 ± 1.57	18.62 ± 1.54	18.43 ± 2.03
	Seek approval	21.35 ± 1.74	20.03 ± 1.55	19.17 ± 1.80	18.89 ± 1.68	21.58 ± 1.70	20.44 ± 1.74	20.27 ± 1.72	20.10 ± 1.69
	Dependence	21.67 ± 1.65	20.10 ± 1.42	16.32 ± 1.65	14.82 ± 1.41	22.55 ± 1.80	22.01 ± 1.45	21.90 ± 1.22	21.03 ± 1.65
	Autonomous attitude	21.57 ± 1.75	20.75 ± 1.95	20.00 ± 2.26	19.85 ± 2.36	21.72 ± 1.70	21.55 ± 1.72	21.37 ± 1.71	21.20 ± 1.69
	Cognitive philosophy	19.50 ± 1.75	18.25 ± 1.66	17.14 ± 1.64	16.60 ± 1.79	19.44 ± 1.70	18.37 ± 1.63	18.17 ± 1.60	17.96 ± 1.52
	Total score	192.32 ± 2.22	188.50 ± 1.71	168.67 ± 2.56	162.10 ± 2.33	192.89 ± 2.00	190.48 ± 2.38	189.48 ± 2.38	189.48 ± 2.38

ATQ: Automatic Thoughts Questionnaire; DAS: Dysfunctional Attitudes Scale.

Table 6 Repeated-measures ANOVA of the cognitive bias scores of each test group (n = 57)

	Time main effect		Interaction		Group main effect
	F	P value	F	P value	F	P value
ATQ	52.475	< 0.001	26.296	< 0.001	4.094	0.048
DAS	2240.350	< 0.001	2033.203	< 0.001	102.742	< 0.001
Vulnerability	190.521	< 0.001	59.642	< 0.001	0.409	0.525
Absorption/rejection	341.422	< 0.001	154.348	0.001	4.242	0.044
Perfectionism	246.569	< 0.001	35.920	< 0.001	2.321	0.133
Mandatory	432.932	< 0.001	33.320	< 0.001	2.722	0.105
Seek approval	1994.091	< 0.001	1859.358	< 0.001	94.206	< 0.001
Dependence	52.797	< 0.001	18.439	< 0.001	3.406	0.070
Autonomous attitude	526.055	< 0.001	66.836	< 0.001	2.001	0.163
Cognitive philosophy	24495.725	< 0.001	17739.892	< 0.001	456.001	< 0.001
Total score	52.475	< 0.001	26.296	< 0.001	4.094	0.048

ATQ: Automatic Thoughts Questionnaire; DAS: Dysfunctional Attitudes Scale.

Table 7 Coping styles of each group before and after intervention (mean ± SD)

Dimensions	CBT+E (n = 28)				Control (n = 29)
	Baseline	6 wk	12 wk	24 wk	Baseline	6 wk	12 wk	24 wk
Reinterpret	7.67 ± 1.80	8.82 ± 1.88	10.92 ± 2.03	11.92 ± 2.03	7.65 ± 1.81	8.41 ± 1.91	8.75 ± 2.21	9.17 ± 2.47
Overcome	15.03 ± 1.31	15.17 ± 1.30	16.10 ± 1.22	16.25 ± 1.20	14.82 ± 1.25	14.96 ± 1.26	15.17 ± 1.39	15.31 ± 1.31
Ignore	13.39 ± 1.79	14.50 ± 1.79	15.89 ± 1.44	16.17 ± 1.44	13.06 ± 2.03	13.41 ± 2.22	13.91 ± 2.46	14.03 ± 2.58
Catastrophization	27.57 ± 1.91	26.35 ± 1.66	23.32 ± 1.65	22.32 ± 1.51	28.79 ± 2.00	28.58 ± 1.97	27.89 ± 2.07	27.68 ± 2.05
Increase activity	14.96 ± 1.59	14.07 ± 2.22	13.35 ± 2.34	12.46 ± 2.28	15.58 ± 1.91	15.10 ± 1.98	14.89 ± 1.98	14.75 ± 1.82
Pain behavior	15.42 ± 1.59	14.67 ± 1.88	13.50 ± 2.57	13.21 ± 2.49	15.68 ± 1.49	15.48 ± 1.45	15.31 ± 1.44	15.13 ± 1.40
Divert attention	8.50 ± 1.87	10.57 ± 1.95	13.71 ± 1.76	15.17 ± 1.58	8.44 ± 1.74	8.62 ± 1.74	8.86 ± 1.82	9.06 ± 1.83
Pray	18.85 ± 1.43	17.28 ± 1.11	14.25 ± 1.62	12.75 ± 1.89	19.86 ± 1.92	19.65 ± 1.89	19.65 ± 1.89	19.58 ± 1.78

 

 

Table 8 Repeated-measures ANOVA of the coping style scores in each test group (n = 57)

	Time main effect		Interaction		Group main effect
	F	P value	F	P value	F	P value
Reinterpret	358.691	< 0.001	102.798	< 0.001	6.319	0.015
Overcome	118.479	< 0.001	30.007	< 0.001	2.944	0.092
Ignore	178.747	< 0.001	42.734	< 0.001	6.807	0.012
Catastrophization	1493.579	< 0.001	625.333	< 0.001	46.485	< 0.001
Increase activity	115.845	< 0.001	38.786	< 0.001	6.688	0.012
Pain behavior	54.750	< 0.001	19.504	< 0.001	6.326	0.015
Divert attention	1393.227	< 0.001	973.004	< 0.001	47.800	< 0.001
Pray	676.394	< 0.001	568.470	< 0.001	75.735	< 0.001

Table 9 Correlation of Irritable Bowel Syndrome Symptom Severity Scale scores with cognitive bias and coping styles (n = 28)

	ATQ	DAS	CSQ
IBS-SSS	-0.330a	-0.744b	0.763b

^aP < 0.05.

^bP < 0.01. ATQ: Automatic Thoughts Questionnaire; DAS: Dysfunctional Attitudes Scale; CSQ: Pain Coping Style Questionnaire; IBS-SSS: Irritable Bowel Syndrome Symptom Severity Scale.

Table 10 Regression equation significance test analysis of the Irritable Bowel Syndrome Symptom Severity Scale scores of the subjects in the experimental group

R	R2	Adjusted R2	Standard error	F	P value
0.838	0.702	0.665	0.649	18.872	0.000

Table 11 Linear regression analysis of the Irritable Bowel Syndrome Symptom Severity Scale scores in the experimental group

Variable	Regression coefficient	Standard error	Normalization coefficient	t	P value
Constant	-95.862	4.871	—	-19.681	0.000
ATQ	-0.261	0.115	-0.256	-2.269	0.033
DAS	-0.393	0.168	-0.420	-2.343	0.028
CSQ	0.305	0.138	0.400	2.215	0.036

ATQ: Automatic Thoughts Questionnaire; DAS: Dysfunctional Attitudes Scale; CSQ: Pain Coping Style Questionnaire.