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Maladaptive Cognitions That Develop with Chronic GI Symptoms

Many people experience chronic pain or GI symptoms for months or even years without adequate relief. Experiencing chronic symptoms, just like other stressors, can impact our cognitions. Over time, those affected may develop maladaptive cognitions related to their symptoms that actually worsen their symptoms. Below are a few examples of common "thinking errors" that individuals with FGIDs engage in related to their symptoms.

Catastrophizing: This is the tendency to believe that something is worse than it is, dwelling on the worst aspects of a situation and believing you are helpless over the situation

Example: "My stomach pain ruins everything!"

Why it's unhelpful: Even if there are elements of truth to a thought, it isn't helpful to focus on the worst aspects of it. In this example, rather than dwelling on how terrible a symptom is, which will increase your negative mood, it may be better to consider how many things you have still been able to do and enjoy, even when you haven't felt your best.

Assuming the Worst: This is the tendency to assume we know the future and that the future is bleak. Sometimes it can be called mind-reading, when we assume we know what others are thinking.

Example: "I passed gas in my exercise class and now everyone thinks I'm gross."

Why it's unhelpful: Assuming the worst in things increases our stress level, which can lead to worsening of GI symptoms, creating a self-fulfilling prophecy. Also, it's usually better not to make assumptions about what other people are thinking. In this example, it may have been obvious to you that you passed gas, but others may not have even noticed! It can also be helpful to ask yourself, "what would I think if a friend passed gas in exercise class?"

Acceptance of Things One Cannot Change

In life we experience all kinds of stressful events, both good and bad. Many stressful events can be seen either as controllable, which we can prepare for before or repair after, or uncontrollable, or largely out of our hands. Similarly, we have two options for how to cope with stressful event. One option is problem-focused/active coping, where we focus our attention on addressing the problem, sometimes through pros and cons lists or action plans. Another option is to use emotion-focused/passive coping, where we divert our attention away from the problem, and toward our own emotional state, which includes activities such as reaching out to friends and family or relaxation strategies (Figure 3). 

Figure 3 – Adaptive coping strategies

Adaptive Coping 5

The term adaptive coping refers to the ability to use the most effective coping strategy based on the particular stressor. Choosing problem-focused/active coping in the face of controllable stressors and emotion-focused/passive coping in the face of uncontrollable stressors is considered the most effective way to approach stressful events. However, engaging in adaptive coping is a skill that some individuals with IBS and other FGIDs have difficulty with. In fact, many with FGIDs are excellent problem-solvers, but may have more difficulty shifting gears when a problem (i.e. GI symptoms) doesn't have an immediate solution. CBT can help those individuals learn to adaptively cope with their symptoms by helping them learn to strike the right balance.


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