Exploring beliefs about emotions, emotional expression and support-seeking in persistent physical symptoms

Hannah Bowers

Research output: ThesisDoctoral Thesis

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Persistent physical symptoms for which there is no clear physiological pathology can present problems for clinical practice in that they do not fit the biomedical model. Biopsychosocial models of persistent physical symptoms describe the interrelation of beliefs and behaviours which work to maintain symptoms, with early evidence implicating beliefs about the unacceptability of expressing and experiencing emotions in this model. The current thesis explored this in relation to irritable bowel syndrome (IBS) and fibromyalgia (FMS).
Chapters Three, Four and Five describe online cross-sectional research in IBS and FMS which found support for a mediation model where the relationship between beliefs about the unacceptability of emotions and outcomes was serially mediated first by emotional suppression and then by affective distress. The relationship was not mediated by support-seeking.
In Chapter Six a new measure of beliefs about sharing illness experiences was validated. This chapter demonstrated that the relationship between beliefs about sharing illness experiences and outcomes was mediated by support-seeking and by all-or-nothing behaviour in FMS.
Based on the mediation models of Chapters Three, Four and Five, Chapter Seven measured variables of the model before and after treatment for FMS in the NHS, finding that beliefs about emotions changed during intervention, though these changes did not predict changes in outcomes.
The final study in this thesis is presented in Chapter Eight. This study described a mixed methods single case series evaluating an intervention aimed at targeting beliefs about emotions and emotional suppression in IBS. Both quantitative and qualitative evidence suggests that changes in beliefs about emotions are beneficial to those with IBS.
This thesis concluded that while many beliefs and behaviours may be part of a maintain cycle of persistent physical symptoms, beliefs about the unacceptability of emotions and emotional suppression should be included in complex biopsychosocial models of IBS and FMS.
Original languageEnglish
Awarding Institution
  • Royal Holloway, University of London
Award date1 Jun 2017
Publication statusUnpublished - 2017

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