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The role of high expectations of self and social desirability in emotional processing in individuals with irritable bowel syndrome: A qualitative study

Research output: Contribution to journalArticle

Alice Sibelli, Trudie Chalder, Hazel Everitt, Paul Workman, Felicity L. Bishop, Rona Moss-Morris

Original languageEnglish
Pages (from-to)737-762
JournalBritish Journal of Health Psychology
Issue number4
Early online date1 Sep 2017
StatePublished - Nov 2017


King's Authors


Although high levels of distress are associated with the onset and severity of IBS, it is unclear how this relates to emotional processing, particularly in relation to maintenance of symptoms and treatment outcome. This qualitative study embedded within a randomised controlled trial aimed to explore how individuals with refractory IBS experience, express and manage their emotions after either therapist-delivered Cognitive Behavioural Therapy (TCBT) or web-based CBT (WBCBT) compared to Treatment as Usual (TAU).
Cross-sectional qualitative study.
Fifty two semi-structured interviews were conducted at post-treatment with 17 TCBT participants, 17 WBCBT and 18 TAU. The transcripts were analysed using inductive thematic analysis with grounded theory elements. NVivo 11 was used to compare themes across groups.
Across all groups, high expectations of self was a recurring reason for how participants experienced and expressed their emotions. Three themes with sub-themes captured how high expectations related to specific aspects of emotional processing: perceived causes of emotions, strategies for coping with emotions (bottling up, avoiding emotions and active coping strategies) and the perceived interplay between emotions and IBS symptoms.
Patients recognised that their IBS symptoms both triggered and were triggered by negative emotions. However, there was a tendency to bottle up or avoid negative emotions for reasons of social desirability regardless of whether patients had CBT for IBS or not. Future psychological interventions in IBS may benefit from addressing negative beliefs about expressing emotions, promoting assertive emotional expression and encouraging the experience of positive emotions.

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