M.A. / Irritable Bowel Syndrome (IBS) can be described as a bodily idiom - a nonverbal language which may have its roots in unspeakable dilemmas (Griffiths & Griffiths, 1994). The splitting of languages and silencing of the body may be the soil in which such symptoms grow. Unutterable conflicts lead to the symptoms being trapped within the body until the body itself begins to "speak" (Griffiths & Griffiths, 1994). In essence, this study seeks to evaluate the effects of attaching language, feelings and awareness to these symptoms and communicating this with other IBS subjects within the group context. Psychiatric illness is often found in IBS health care seekers (Drossman & Thompson, 1992). The specific aim of this study was to ascertain the effects of a holistic short-term group intervention in the treatment of IBS with comorbid depression and anxiety. The sample consisted of 24 South African women who had been positively diagnosed with severe IBS by either a gastroenterologist or a general practitioner. Furthermore, each subject had to have associated moderate to severe depression and anxiety. Four questionnaires were utilised, namely the Biographical Questionnaire, the Irritable Bowel Syndrome Client Questionnaire, the Personality Assessment Inventory (PAI) and the Functional Bowel Disorder Severity Index (FBDSI). The Biographical Questionnaire mainly requested personal details and sought a family history of psychological disorders. The Irritable Bowel Syndrome Client Questionnaire, based on the standardised Rome Criteria (Drossman, 1994; Drossman, Zhiming, Toner, Creed, Thompson, Read et al., 1995; Talley, Phillips, Melton, Mulvihill, Wiltgen & Zinsmeister, 1989), verified a positive IBS diagnosis, while the Functional Bowel Disorder Severity Index rated the severity of the subject’s IBS. Lastly, the depression score was rated on the depression scale of the Personality Assessment Inventory (PAI) and the anxiety score was rated on the anxiety scale of the PAI. The subjects were divided into two groups of twelve members each - Group 1 was the experimental group and Group 2 was the control group. The group design was a pre-test, post-test control group design where subjects in Group 1 (the experimental group) received group intervention and subjects in Group 2 (the control group) were placed on a waiting list and received no intervention. The subjects in the control group were offered individual therapy once the post-tests were completed. All the subjects completed the IBS Severity Index Questionnaire and the Depression and Anxiety subscales of the Personality Assessment Inventory before commencement of group therapy for Group 1 and again one month after completion of this intervention. The effect of the intervention was determined utilising comparative statistics with reference to the pre-test versus post-test scores. The t-test for the equality of means for between group variance was utilised for two analyses. Firstly, it was used to determine the variance regarding the pre-test scores between Group 1 (the experimental group – who received intervention) versus Group 2 (the control group – who received no intervention) (Hypothesis 1). Secondly, it was utilised to determine the between group variance in terms of the post-test scores for Group 1 (the experimental group) versus Group 2 (the control group) (Hypothesis 2). The paired samples t-test was also used for two analyses. Firstly, it was used to determine the within group variance regarding the pre-intervention test scores versus the post-intervention test scores for Group 1 (the experimental group)(Hypothesis 3). Secondly, the paired samples t-test was also utilised to determine if there were statistically significant differences in terms of the pre-test scores versus the post-test scores of Group 2 (the control group) who did not receive the intervention (Hypothesis 4). A short-term holistic group therapy model was applied based on the work of Broom (1997), Crafford (1985), Pretorius (1996) and Yalom (1970). The results of the study showed that there was a statistically significant improvement in the anxiety scores of Group 1 (the experimental group) after completion of the intervention when compared with Group 2 (the control group) who received no intervention. The within group depression and anxiety scores in the experimental group also revealed a statistically significant improvement after the intervention. However, the IBS symptom severity remained unchanged. Thus, it is concluded that holistic short-term group therapy is indicated in the treatment of severe IBS with comorbid depression and anxiety even if the IBS symptoms are unaltered. It is recommended that further research be conducted to ascertain whether holistic group therapy of a moderate duration (approximately eight to ten weeks) has a greater impact on the IBS symptom severity.

published_or_final_version / abstract / Social Work and Social Administration / Doctoral / Doctor of Philosophy

M.A. / The purpose of this study was to ascertain whether patients suffering from irritable bowel syndrome (IBS) differed from non-IBS clients in terms of their coping styles. Gastrointestinal disorders are among the most common of all illnesses; half of the population suffers from acute gastrointestinal illnesses every year (Read, 1985). More than 10% have chronic illnesses, and these illnesses are a major cause of absenteeism from work. In view of this it is surprising that there is such a faucity of psychological and psychophysiological research focusing on gastrointestinal activity. Perhaps one reason for this is that investigators conceptualise the gastrointestinal tract as a system that is unresponsive to psychological intervention. Another reason may be the widespread belief that adequate techniques are not available for studying gastrointestinal psychology and psychophysiology (Haynes & Gannon, 1981). Today there is consensus that IBS is a psychosomatic disorder that accounts for between 40 to 70% of referrals to gastroenterologists. Unfortunately, this is a very misunderstood disorder. Sufferers are often misinformed or poorly educated by their physicians. Misunderstanding and lack of patient education often results in increased anxiety and physical distress. There are cases in which unnecessary surgery, expensive diagnostic procedures and addictive pain killers are mistakenly employed. In addition, IBS patients represent an expensive group because they use up a considerable amount of medical resources in money and time (Moser, 1986).

M.A. / The purpose of the study was to ascertain whether patients suffering from irritable bowel syndrome (IBS) differed from non- IBS clients in terms of their defense mechanisms. Although irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders encountered by primary care physicians and gastroenterologists, it is one of the least well understood. Part of the reason for this is the lack of real consensus of opinion regarding the nature of the complaint (Read, 1985). Today it is widely agreed that irritable bowel syndrome is a psychosomatic disorder, that is, a disorder of physiological functioning and anatomical structure, which are determined for most part by psychological factors (Lachman, 1972; Moser, 1986). Evidence linking psychological variables to gastrointestinal disorders is surprisingly sparse, and all too often confusing and contradicting. Such conflicting results probably reflect the many methodological weaknesses common to all areas of study (Bennett, .1989). Although evaluation of the impact of psychological interventions on both symptomatic and psychological relief has been pursued, its findings provide tangential support for the importance of psychological disorders. Nevertheless, these studies have shown a consistency of positive results not found in the etiological research (Read, 1985). Using a variety of techniques, most with the therapeutic goal of stress reduction, psychological therapy has been shown to produce. symptomatic relief, increase periods of remission, and to reduce the impact of stress resulting from severe symptomatic flare ups in IBS (Bennett, 1989). In .addition, most IBS patients may not identify their gut symptoms in psychological terms. Therefore, they inappropriately and repeatedly subject themselves to unnecessary, expensive and harmful medical procedures in search of an organic cause. Further research into the psychological factors of IBS, including the defense mechanisms underlying it may lead to a reduction in type of anxiety (Folkman, Lazarus, Gruen & DeLongis, 1986). The ways in which people cope with intense emotions may have a significant effect on their psychological and physical health. StresS factors and the suppression of emotions, for example through defense mechanisms, are thought to be especially relevant in the etiology and exacerbation of psychosomatic illness (Ogden & Von Sturmer, 1984). The role that defense mechanisms play in the development of IBS forms the cornerstone of the present research.