Selective Recall of Gastrointestinal-Sensation Words: Evidence for a Cognitive-Behavioral Contribution to Irritable Bowel Syndrome Natalie Gibbs-Gallagher, Ph.D., Olaffur S. Palsson, Psy.D., Rona L. Levy, Ph.D., Kimberly Meyer, B.A., Douglas A. Drossman, M.D., F.A.C.G., and William E. Whitehead, Ph.D., F.A.C.G. Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Behavioral Medicine, Eastern Virginia Medical School, Norfolk, Virginia; and School of Social Work, University of Washington, Seattle, Washington OBJECTIVE: Selective attention to GI sensations has been suggested as an important mechanism that affects symptom perception in patients with irritable bowel syndrome (IBS), but this hypothesis has not yet been tested empirically. Differential recall of words describing negative affect has been used to demonstrate that depressed patients selectively attend to negative affect words. This technique may be useful for examining selective attention to somatic sensa- tions. The aim of this study was to determine whether patients with IBS demonstrate selective recall of GI sensa- tions compared with neutral words and words describing respiratory sensations. METHODS: A total of 16 IBS patients, nine asthmatic pa- tients (medical controls), and eight healthy controls were shown 10 GI sensation words or phrases, 10 respiratory sensation words or phrases, and 10 neutral words in random order for 3 s each. After a distraction task, subjects wrote down all of the words or phrases they could remember. RESULTS: As predicted, IBS patients were more likely to recall GI words than other categories. Asthmatic patients were more likely to recall respiratory words in comparison with healthy controls. CONCLUSIONS: IBS patients selectively recall words de- scribing GI sensations; this suggests that they may selec- tively attend to GI sensations, thus supporting the cognitive- behavioral theory of IBS. (Am J Gastroenterol 2001;96: 1133–1138. © 2001 by Am. Coll. of Gastroenterology) INTRODUCTION Cognitive-behavioral theories (1–3) have been proposed to account for the etiology and course of irritable bowel syn- drome (IBS). One central feature of cognitive-behavioral theory is that individuals have organized sets of beliefs (cognitive schema) that affect their perception and learning. Specifically, individuals have a tendency to selectively at- tend to information that is consistent with their beliefs; conversely, they tend to ignore and forget information that is inconsistent with these beliefs. In IBS, it is hypothesized that the cognitive schema includes a belief by individuals that they have an organic GI disease. This belief selectively biases information processing, resulting in increased atten- tion and hypervigilance to GI sensations. This theoretical formulation of IBS is described in greater detail elsewhere (3) and is the foundation for effective cognitive-behavioral treatment programs that have been described in the literature (2, 4–6) for IBS. Previously, authors (1–3) have speculated that IBS pa- tients selectively attend to GI sensations and that selective attention (3) or hypervigilance (7) may contribute to the hyperalgesia seen in IBS. However, there has been no direct support for this hypothesis because there is no psychometric test available for objectively assessing selective attention to GI sensations. One technique (8), which has been used extensively in depression research to demonstrate the exis- tence of organized belief systems influencing perception, consists of presenting word lists including some words that are consistent with the subjects’ presumed belief system and other words that are inconsistent with their belief system. For example, in studies of depression, subjects are presented with adjectives that are either positively or negatively emo- tionally charged. Subjects are later asked to recall as many of these words as they can. The recall of a greater proportion of words in one category is taken as evidence for selective attention, and therefore as evidence for the existence of cognitive schema that are presumed to result in selective attention. This method has been used by two research groups (9 –10) to demonstrate the existence of depression- related cognitive schema in patients with IBS. We extended this methodology to assess selective atten- tion for somatic sensations. We predicted that in a recall task in which subjects were presented with a word list consisting of GI sensations, other types of somatic sensations, and This work was presented in part at the meeting of the American Gastroenterologi- cal Association, New Orleans, Louisiana, May 17–20, 1998, and published as an abstract (Gastroenterology 1998;114:A859). THE AMERICAN JOURNAL OF GASTROENTEROLOGY Vol. 96, No. 4, 2001 © 2001 by Am. Coll. of Gastroenterology ISSN 0002-9270/01/$20.00 Published by Elsevier Science Inc. PII S0002-9270(01)02322-X