Complementary and alternative medicine use in Irritable Bowel Syndrome: an examination of the influence of illness and treatment representations

Irritable Bowel Syndrome (IBS) is a chronic functional disorder of the gastrointestinal system with prevalence in adults of 10-20%. IBS is characterised by a number of troublesome symptoms including abdominal bloating, pain and excess gas, and has substantial impact on quality of life in addition to wider economic implications. Conventional medical treatment can be problematic however, due to the lack of established aetiology and the number of symptoms reported. Concurrently, use of complementary and alternative medicine (CAM) to relieve IBS symptoms is reported to be as high as 50%, although the benefits and impact of such treatments are not fully substantiated by primary research data. However, evidence has shown that people affected may benefit from psychological interventions in terms of reduced use of health care services and reported symptoms. This thesis has examined psychological factors that influence the use of CAM and quality of life in individuals affected by IBS. These factors were explored within the theoretical framework of an extended common-sense model of illness representations (CSM), which incorporated treatment beliefs. The main aim of the thesis was twofold: to examine the illness perceptions and treatment beliefs that influence CAM use and to explore pathways from illness and treatment representation to quality of life in CAM-users and those not using CAM (non-users). A web-based cross-sectional study and minimum six month time-period follow-up study were conducted. Participants were primarily recruited from an IBS self-help network in the UK and other online message boards. The cross-sectional study (n=63) considered illness perceptions and treatment beliefs associated with CAM use and how these factors differed in influencing coping strategies and quality of life in CAM-users and non-users. The follow-up study (n=197) focused on exploration of the influence of illness perceptions and treatment beliefs at study time one, on coping strategies and quality of life at study time two. The findings demonstrated that components of illness perceptions influenced CAM use, coping strategies and quality of life. Treatment beliefs were more strongly implicated in influencing the use of CAM. At the cross-sectional stage, stronger perceptions of illness consequences and emotional representations were major influences on reduced reported quality of life measures and poorer emotional outcomes in both survey groups, where similar strength effects were observed. There were many observed instances of of partial mediation of maladaptive and dysfunctional coping strategies such as self-blame and behavioural disengagement. In addition, follow up data demonstrated a reduction of the influence of illness perceptions (time one) on quality of life (time two)compared to the cross-sectional data. Moreover, evidence of mediation effects was only detected in CAM-users in the follow-up study. These results highlight the importance of psychological factors, in particular illness perceptions, and to an extent, treatment beliefs in influencing coping strategies, quality of life and emotional outcome in those affected by IBS. Practical and theoretical implications of the findings are considered and future applications discussed. This thesis concludes with the proposal of a novel conceptual model to utilise a mulitconvergent approach to enhance the quality of life and emotional outcomes in those affected bt IBS.