Journal of Applied Psychological Research

Attention Bias Patterns toward Bodily Signals in Patients with Irritable Bowel Syndrome, Individuals with High-Anxiety, and a Healthy Control Group

Document Type : Research Paper

Authors

1 Department of Psychology, Faculty of Psychology and Education, University of Tehran, Tehran, Iran.

2 Department of Cognitive Sciences, Faculty of Psychology and Education, University of Tehran, Tehran, Iran.

3 Department of Psychiatry, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

4 Assistant Professor, Department of Cognitive Sciences, Faculty of Psychology and Education, University of Tehran, Tehran, Iran.

Abstract

The objective of the current study was to compare and investigate attentional bias toward physiological symptoms in healthy individuals, high-anxiety individuals, and patients with irritable bowel syndrome. In 2024, a convenient sample of 15 patients with IBS who visited clinics, 15 high-anxiety individuals, and 15 healthy individuals who resided in Tehran was selected. The three groups were matched for sex, age, and education level. Participants were evaluated using the Spielberger State-Trait Anxiety Inventory (STAI), Beck Depression Inventory (BDI-II), Irritable Bowel Syndrome Severity Scale (IBS-SSS), and a computerized Dot-Probe task with a stimulus presentation duration of 500 milliseconds. SPSS 27 software was employed to analyze the results using mixed analysis of covariance (ANCOVA). The results revealed that patients with IBS had a substantial attentional avoidance of bloating-related pictorial stimuli in comparison to the healthy group (p=0.013). However, this difference was not observed for pain-related stimuli. Additionally, patients with IBS generally exhibited a slower overall reaction time than the healthy group (p=0.024). The results suggest that attentional bias in irritable bowel syndrome is characterized by the selective avoidance of specific bodily stimuli. Nevertheless, anxiety could perpetuate this avoidance, and it was not the sole exponent of the cognitive pattern of IBS. An independent role for the gut-brain axis in the cognitive-emotional processing of IBS is suggested by these results.

Keywords

دهقانی، س.، بشارت، م.ع.، رستمی، ر.، زمردی، ر.، و واحدی، ه. (۱۳۹۹). مقایسۀ طیف توان الکتروانسفالوگرافی بین بیماران مبتلا به سندرم رودۀ تحریک‌پذیر و افراد سالم. فصل‌نامه پژوهش‌های کاربردی روانشناختی، ۱۱(۱)، 65-49. https://doi.org/10.22059/japr.2020.297071.643428
رضایی، م.، کلانتری، م.، و عابدی، م. ر. (۱۴۰۱). مقایسۀ اثربخشی درمان شناختی-رفتاری و درمان مبتنی بر تعهد و پذیرش (بستۀ درمانی مبتنی بر تجربه‌ها) بر اضطراب، افسردگی و کیفیت زندگی بیماران زن مبتلا به سندرم روده تحریک‌پذیر. فصل‌نامه پژوهش‌های کاربردی روانشناختی، ۱۳(۳)، 412-395. https://doi.org/10.22059/japr.2022.321055.643803
عزتی، ز.، شهابی‌زاده، ف.، سلیمان‌نژاد، ک.، و نصری، م. (۱۴۰۱). اثربخشی مداخله‌های پذیرش و تعهد و شناختی-رفتاری عدم تحمل بلاتکلیفی بر تیپ شخصیتی D و کیفیت خواب بیماران با سندرم رودۀ تحریک‌پذیر دارای اختلال اضطراب فراگیر. مجله علوم روانشناختی، ۲۱(۱۱۷)، ۱۸50-۱۸33. https://doi.org/10.52547/JPS.21.117.1833
References
Abdoli, N., Farnia, V., Salemi, S., Davarinejad, O., & Behrouz, B. (2020). Reliability and validity of Persian version of state-trait anxiety inventory among high school students. East Asian Archives of Psychiatry, 30(2), 44-47.https://doi.org/10.3316/informit.310630282471904
Afzal, M., Potokar, J. P., Probert, C. S., & Munafò, M. R. (2006). Selective processing of gastrointestinal symptom-related stimuli in irritable bowel syndrome. Psychosomatic Medicine, 68(5), 758-761. https://doi.org/10.1097/01.psy.0000232270.78071.28
Aizawa, E., Sato, Y., Kochiyama, T., Saito, N., & Hongo, M. (2012). Altered cognitive function of prefrontal cortex during error feedback in patients with irritable bowel syndrome, based on FMRI and dynamic causal modeling. Gastroenterology, 143(5), 1188-1198. https://doi.org/10.1053/j.gastro.2012.07.104
Akbari, R., Salimi, Y., Dehghani-Aarani, F., & Rezayat, E. (2025). Attention in irritable bowel syndrome: A systematic review of affected domains and brain-gut axis interactions. Journal of Psychosomatic Research, 191, 112067. https://doi.org/10.1016/j.jpsychores.2025.112067
Azriel, O., & Bar-Haim, Y. (2020). Attention bias. In J. S. Abramowitz & S. M. Blakey (Eds.), Clinical handbook of fear and anxiety: Maintenance processes and treatment mechanisms (pp. 203–218). American Psychological Association Attention bias. https://doi.org/10.1037/0000150-012
Barnes, L. L., Harp, D., & Jung, W. S. (2002). Reliability generalization of scores on the Spielberger state-trait anxiety inventory. Educational and Psychological Measurement, 62(4), 603-618. https://doi.org/10.1177/0013164402062004005 ‎
Beck, A. T., & Clark, D. A. (1997). An information processing model of anxiety: Automatic and strategic processes. Behaviour Research and Therapy, 35(1), 49-58. https://doi.org/10.1016/S0005-7967(96)00069-1
Canakis, A., Haroon, M., & Weber, H. C. (2020). Irritable bowel syndrome and gut microbiota. Current Opinion in Endocrinology, Diabetes and Obesity, 27(1), 28-35. https://doi.org/10.1097/MED.0000000000000523
Canavan, C., West, J., & Card, T. (2014). The economic impact of the irritable bowel syndrome. Alimentary Pharmacology & Therapeutics, 40(9), 1023-1034. https://doi.org/10.1111/apt.12938
Cannito, L., Di Crosta, A., Palumbo, R., Ceccato, I., … & Di Domenico, A. (2020). Health anxiety and attentional bias toward virus-related stimuli during the COVID-19 pandemic. Scientific Reports, 10(1), 16476. https://doi.org/10.1038/s41598-020-73599-8
Chapman, S., & Martin, M. (2011). Attention to pain words in irritable bowel syndrome: Increased orienting and speeded engagement. British Journal of Health Psychology, 16(1), 47-60. https://doi.org/10.1348/135910710X505887
Chiarioni, G. (2019). Concise commentary: Bloating makes a comeback in IBS. Digestive Diseases and Sciences, 64, 1296-1296. https://doi.org/10.1007/s10620-018-5439-z
Chiou, E., & Nurko, S. (2010). Management of functional abdominal pain and irritable bowel syndrome in children and adolescents. Expert Review of Gastroenterology & Hepatology, 4(3), 293-304. https://doi.org/10.1586/egh.10.28
Cisler, J. M., & Koster, E. H. (2010). Mechanisms of attentional biases towards threat in anxiety disorders: An integrative review. Clinical Psychology Review, 30(2), 203-216. https://doi.org/10.1016/j.cpr.2009.11.003
Dehghani, S., Besharat, M. A., Roustami, R., Zomorodi, R., & Vahedi, H. (2020). Comparison of EEG power spectrum between patients with irritable bowel syndrome and healthy individuals. Journal of Applied Psychological Research, 11(1), 49-65. https://doi.org/10.22059/japr.2020.297071.643428 (In Persian)
Dennis, C.-L., Coghlan, M., & Vigod, S. (2013). Can we identify mothers at-risk for postpartum anxiety in the immediate postpartum period using the State-Trait Anxiety Inventory? Journal of Affective Disorders, 150(3), 1217-1220. https://doi.org/10.1016/j.jad.2013.05.049
Drossman, D. A., & Hasler, W. L. (2016). Rome IV—functional GI disorders: Disorders of gut-brain interaction. Gastroenterology, 150(6), 1257-1261. https://doi.org/10.1053/j.gastro.2016.03.035
Ebrahimi, A., Forghani, M., Bababkhanian, M., Ebrahimi, M., & Sedeh, P. A. (2023). Psychometric properties of Persian version of irritable bowel syndrome-behavioral responses questionnaire (IBS-BRQ). Gastroenterology and Hepatology from Bed to Bench, 16(3), 326. https://doi.org/10.22037/ghfbb.v16i2.2440 
Ejova, A., Badcock, N. A., McKerchar, S., Beath, A. P., … & Jones, M. P. (2021). Electroencephalographic evidence of unconscious and conscious attentional bias in people with functional gastrointestinal disorders: A pilot study. International Journal of Psychophysiology, 170, 30-42. https://doi.org/10.1016/j.ijpsycho.2021.09.006
Ezzati, Z., Shahabizadeh, F., Soleimannejad, K., & Nasri, M. (2022). The effectiveness of acceptance and commitment therapy and cognitive-behavioral therapy of intolerance of uncertainty on type D personality and sleep quality in patients with irritable bowel syndrome and generalized anxiety disorder. Journal of Psychological Science, 21(117), 1833-1850. https://doi.org/10.52547/JPS.21.117.1833 (In Persian)
Fichna, J., & Storr, M. A. (2012). Brain-gut interactions in IBS. Frontiers in Pharmacology, 3, 127. https://doi.org/10.3389/fphar.2012.00127
Francis, C. Y., Morris, J., & Whorwell, P. J. (1997). The irritable bowel severity scoring system: A simple method of monitoring irritable bowel syndrome and its progress. Alimentary Pharmacology & Therapeutics, 11(2), 395-402. https://doi.org/10.1046/j.1365-2036.1997.142318000.x
Ghassemzadeh, H., Mojtabai, R., Karamghadiri, N., & Ebrahimkhani, N. (2005). Psychometric properties of a Persian‐language version of the Beck Depression Inventory‐Second edition: BDI‐II‐PERSIAN. Depression and Anxiety, 21(4), 185-192. https://doi.org/10.1002/da.20070 
Gomborone, J., Dewsnap, P., Libby, G., & Farthing, M. (1993). Selective affective biasing in recognition memory in the irritable bowel syndrome. Gut, 34(9), 1230-1233. https://doi.org/10.1136/gut.34.9.1230
Hesser, H., Hedman-Lagerlöf, E., Andersson, E., Lindfors, P., & Ljótsson, B. (2018). How does exposure therapy work? A comparison between generic and gastrointestinal anxiety–specific mediators in a dismantling study of exposure therapy for irritable bowel syndrome. Journal of Consulting and Clinical Psychology, 86(3), 254-267. https://doi.org/10.1037/ccp0000273
Holtmann, G. J., Ford, A. C., & Talley, N. J. (2016). Pathophysiology of irritable bowel syndrome. The Lancet Gastroenterology & Hepatology, 1(2), 133-146. https://doi.org/10.1016/S2468-1253(16)30023-1 
Hong, J. Y., Naliboff, B., Labus, J. S., Gupta, A., … & Mayer, E. A. (2016). Altered brain responses in subjects with irritable bowel syndrome during cued and uncued pain expectation. Neurogastroenterology & Motility, 28(1), 127-138. https://doi.org/10.1111/nmo.12710
Hubbard, C. S., Hong, J., Jiang, Z., Ebrat, B., … & Labus, J. S. (2015). Increased attentional network functioning related to symptom severity measures in females with irritable bowel syndrome. Neurogastroenterology & Motility, 27(9), 1282-1294. https://doi.org/10.1111/nmo.12622
Jones, M. P., Van Oudenhove, L., & Talley, N. J. (2012). Mo1007 functional gastrointestinal disorders (FGIDs) and psychological disorders: Strong evidence that the link is bidirectional, but psychological distress is more likely to precede a new diagnosis of an FGID. Gastroenterology, 142(5), S-570. https://doi.org/10.1016/S0016-5085(12)62189-1
Kanazawa, M., Miwa, H., Nakagawa, A., Kosako, M., Akiho, H., & Fukudo, S. (2016). Abdominal bloating is the most bothersome symptom in irritable bowel syndrome with constipation (IBS-C): a large population-based Internet survey in Japan. BioPsychoSocial Medicine, 10, 19. https://doi.org/10.1186/s13030-016-0070-8
Kennedy, P. J., Clarke, G., Quigley, E. M., Groeger, J. A., Dinan, T. G., & Cryan, J. F. (2012). Gut memories: Towards a cognitive neurobiology of irritable bowel syndrome. Neuroscience & Biobehavioral Reviews, 36(1), 310-340. https://doi.org/10.1016/j.neubiorev.2011.07.001
Koloski, N., Jones, M., & Talley, N. (2016). Evidence that independent gut‐to‐brain and brain‐to‐gut pathways operate in the irritable bowel syndrome and functional dyspepsia: A 1‐year population‐based prospective study. Alimentary Pharmacology & Therapeutics, 44(6), 592-600. https://doi.org/10.1111/apt.13738
Lam, N. C., Yeung, H. Y., Li, W. K., Lo, H.-Y., … & Ho, Y. S. (2019). Cognitive impairment in irritable bowel syndrome (IBS): A systematic review. Brain Research, 1719, 274-284. https://doi.org/10.1016/j.brainres.2019.05.036
Larsson, M. B., Tillisch, K., Craig, A., Engström, M., … & Walter, S. A. (2012). Brain responses to visceral stimuli reflect visceral sensitivity thresholds in patients with irritable bowel syndrome. Gastroenterology, 142(3), 463-472. e3. https://doi.org/10.1053/j.gastro.2011.11.022
Lovell, R. M., & Ford, A. C. (2012). Global prevalence of and risk factors for irritable bowel syndrome: A meta-analysis. Clinical Gastroenterology and Hepatology, 10(7), 712-721. e4. https://doi.org/10.1016/j.cgh.2012.02.029
MacLeod, C., Grafton, B., & Notebaert, L. (2019). Anxiety-linked attentional bias: Is it reliable? Annual Review of Clinical Psychology, 15(1), 529-554. https://doi.org/10.1146/annurev-clinpsy-050718-095505
MacLeod, C., Mathews, A., & Tata, P. (1986). Attentional bias in emotional disorders. Journal of Abnormal Psychology, 95(1), 15-20. https://doi.org/10.1037/0021-843X.95.1.15
Mönnikes, H. (2011). Quality of life in patients with irritable bowel syndrome. Journal of Clinical Gastroenterology, 45, S98-S101. https://doi.org/10.1097/MCG.0b013e31821fbf44
Nisticò, V., Rossi, R. E., D’arrigo, A. M., Priori, A., Gambini, O., & Demartini, B. (2022). Functional neuroimaging in irritable bowel syndrome: A systematic review highlights common brain alterations with functional movement disorders. Journal of Neurogastroenterology and Motility, 28(2), 185-203. https://doi.org/10.5056/jnm21079 
Oka, P., Parr, H., Barberio, B., Black, C. J., Savarino, E. V., & Ford, A. C. (2020). Global prevalence of irritable bowel syndrome according to Rome III or IV criteria: A systematic review and meta-analysis. The Lancet Gastroenterology & Hepatology, 5(10), 908-917. https://doi.org/10.1016/S2468-1253(20)30217-X
Phillips, K., Wright, B. J., & Kent, S. (2014). Irritable bowel syndrome and symptom severity: Evidence of negative attention bias, diminished vigour, and autonomic dysregulation. Journal of Psychosomatic Research, 77(1), 13-19. https://doi.org/10.1016/j.jpsychores.2014.04.009
Posserud, I., Svedlund, J., Wallin, J., & Simrén, M. (2009). Hypervigilance in irritable bowel syndrome compared with organic gastrointestinal disease. Journal of Psychosomatic Research, 66(5), 399-405. https://doi.org/10.1016/j.jpsychores.2008.09.020
Price, R. B., Kuckertz, J. M., Siegle, G. J., Ladouceur, C. D., … & Amir, N. (2015). Empirical recommendations for improving the stability of the dot-probe task in clinical research. Psychological Assessment, 27(2), 365-376. https://doi.org/10.1037/pas0000036
Quigley, E. M. (2018). The gut-brain axis and the microbiome: Clues to pathophysiology and opportunities for novel management strategies in irritable bowel syndrome (IBS). Journal Of Clinical Medicine, 7(1), 6. https://doi.org/10.3390/jcm7010006
Rezaei, M., Kalantari, M., & Abedi, M. R. (2022). Comparison of the effectiveness of cognitive-behavioral therapy and acceptance and commitment therapy (experience-based therapy package) on anxiety, depression and quality of life in female patients with irritable bowel syndrome. Journal of Applied Psychological Research, 13(3), 395-412. https://doi.org/10.22059/japr.2022.321055.643803 (In Persian)
Schatz, P., Legido, G., Womble, M., & Elbin, R. (2022). A-41 establishing empirically-based normative cut-offs for identifying anxiety following sports-related concussion. Archives of Clinical Neuropsychology, 37(5), 1082. https://doi.org/10.1093/arclin/acac32.41
Schmulson, M. J., & Drossman, D. A. (2017). What is new in Rome IV. Journal Of Neurogastroenterology and Motility, 23(2), 151-163. https://doi.org/10.5056/jnm16214
Schoth, D. E., Beaney, R., Broadbent, P., Zhang, J., & Liossi, C. (2018). Attentional, interpretation and memory biases for sensory-pain words in individuals with chronic headache. British Journal of Pain, 13(1), 22-31. https://doi.org/10.1177/2049463718789445
Sperber, A. D. (2021). Review article: epidemiology of IBS and other bowel disorders of gut–brain interaction (DGBI). Alimentary Pharmacology & Therapeutics, 54(S1), S1-S11. https://doi.org/10.1111/apt.16582
Spiegel, B., Bolus, R., Harris, L., Lucak, S., … & Chang, L. (2009). Measuring irritable bowel syndrome patient‐reported outcomes with an abdominal pain numeric rating scale. Alimentary Pharmacology & Therapeutics, 30(11‐12), 1159-1170. https://doi.org/10.1111/j.1365-2036.2009.04144.x
Spielberger, C. D. (1983). State-Trait Anxiety Inventory for Adults (STAI-AD) [Database record]. APA PsycTests. https://doi.org/10.1037/t06496-000
Tayama, J., Saigo, T., Ogawa, S., Takeoka, A., … & Shirabe, S. (2018). Effect of attention bias modification on event‐related potentials in patients with irritable bowel syndrome: A preliminary brain function and psycho‐behavioral study. Neurogastroenterology & Motility, 30(10), e13402. https://doi.org/10.1111/nmo.13402
Tkalcic, M., Domijan, D., Pletikosic, S., Setic, M., & Hauser, G. (2014). Attentional biases in irritable bowel syndrome patients. Clinics and Research in Hepatology and Gastroenterology, 38(5), 621-628. https://doi.org/10.1016/j.clinre.2014.02.002
Todd, J., van Ryckeghem, D. M., Sharpe, L., & Crombez, G. (2018). Attentional bias to pain-related information: A meta-analysis of dot-probe studies. Health Psychology Review, 12(4), 419-436. https://doi.org/10.1080/17437199.2018.1521729
Van Bockstaele, B., Verschuere, B., Tibboel, H., De Houwer, J., Crombez, G., & Koster, E. H. (2014). A review of current evidence for the causal impact of attentional bias on fear and anxiety. Psychological Bulletin, 140(3), 682-721. https://doi.org/10.1037/a0034834
Wang, M., Han, B., Liu, Q., Liu, C., Li, W., Teng, S., … & Song, Y. (2021). Attentional bias of subliminal emotional faces in adolescents with obsessive-compulsive disorder. Neurocase, 27(1), 22-29. https://doi.org/10.1080/13554794.2020.1861303
Wang, Y. P., & Gorenstein, C. (2013). Psychometric properties of the Beck Depression Inventory-II: A comprehensive review. Revista Brasileira de Psiquiatria, 35(4), 416-431. https://doi.org/10.1590/1516-4446-2012-1048
Weaver, K. R., Sherwin, L. B., Walitt, B., Melkus, G. D. E., & Henderson, W. A. (2016). Neuroimaging the brain-gut axis in patients with irritable bowel syndrome. World Journal of Gastrointestinal Pharmacology and Therapeutics, 7(2), 320-333. https://doi.org/10.4292/wjgpt.v7.i2.320 
Wieser, M. J., & Keil, A. (2020). Attentional threat biases and their role in anxiety: A neurophysiological perspective. International Journal of Psychophysiology, 153, 148-158. https://doi.org/10.1016/j.ijpsycho.2020.05.004
Willenbockel, V., Sadr, J., Fiset, D., Horne, G. O., Gosselin, F., & Tanaka, J. W. (2010). Controlling low-level image properties: The SHINE toolbox. Behavior Research Methods, 42, 671-684. https://doi.org/10.3758/BRM.42.3.671
Williams, V., Nelson, L., Fehnel, S., MacDougall, J., … & Johnston, J. (2014). Psychometric validation of symptom severity measures in irritable bowel syndrome with constipation. Alimentary Pharmacology & Therapeutics, 40(3), 298-308. https://doi.org/10.1111/apt.12830
Wong, K. M. f., Yuen, S. S. Y., & Mak, A. D. P. (2019). Neurocognitive characteristics of individuals with irritable bowel syndrome. East Asian Archives of Psychiatry, 29(2), 48-56. https://doi.org/10.12809/eaap1877
Zamani, M., Alizadeh‐Tabari, S., & Zamani, V. (2019). Systematic review with meta‐analysis: The prevalence of anxiety and depression in patients with irritable bowel syndrome. Alimentary Pharmacology & Therapeutics, 50(2), 132-143. https://doi.org/10.1111/apt.15325
Journal of Applied Psychological Research
Volume 17, Issue 2
July 2026
Pages 111-130
  • Receive Date: 03 September 2025
  • Revise Date: 08 October 2025
  • Accept Date: 01 November 2025
  • First Publish Date: 25 January 2026
  • Publish Date: 22 June 2026