The temporal relationship of daily life stress, emotions, and bowel symptoms in irritable bowel syndrome-Diarrhea subtype: A smartphone-based experience sampling study

Neurogastroenterol Motil. 2019 Mar;31(3):e13514. doi: 10.1111/nmo.13514. Epub 2018 Nov 18.


Background: The current study aimed to model the moment-to-moment relationship between daily life stress, emotions, and bowel symptoms among patients with irritable bowel syndrome-diarrhea subtype (IBS-D) in the flow of daily life using a smartphone-based experience sampling method (ESM).

Methods: Patients with IBS-D (N = 27) and healthy controls (HC; N = 30) completed ESM ratings of their real-time daily life stress, which was defined as subjective stress related to daily activities, both positive and negative emotions, as well as bowel symptoms eight times a day for 14 consecutive days, following a baseline interview measuring bowel and mood symptoms. Moment-to-moment association between ESM variables was tested within and between groups using multilevel regression modeling.

Key results: Patients with IBS-D reported more severe bowel symptoms and lower positive affect than HCs, but levels of daily life stress and negative affect were comparable between groups. Time-lagged analysis of ESM data revealed that, among patients with IBS-D, daily life stress predicted a decrease in abdominal pain and urgency to defecation at a subsequent time point, whereas severity of bowel symptoms and occurrence of diarrhea predicted a subsequent increase in negative affect and daily life stress. The above associations were not found among HCs.

Conclusions and inferences: ESM unveiled the dynamic relationship between bowel symptoms, stress, and emotionality. Patients with IBS-D responded to bowel symptoms with more stress and distress momentarily. Counter-intuitively, daily life activity stress appeared to ameliorate bowel symptoms, although a more rigorous study design is required to testify this claim. Psychological understanding of IBS-D is discussed.

Keywords: ambulatory assessment; daily life stress; experience sampling; irritable bowel syndrome; negative emotions.

MeSH terms

  • Abdominal Pain / etiology
  • Abdominal Pain / psychology
  • Adolescent
  • Adult
  • Anxiety / etiology
  • Anxiety / psychology
  • Defecation
  • Depression / etiology
  • Depression / psychology
  • Diarrhea / etiology
  • Diarrhea / psychology*
  • Ecological Momentary Assessment
  • Emotions*
  • Female
  • Humans
  • Irritable Bowel Syndrome / complications
  • Irritable Bowel Syndrome / psychology*
  • Male
  • Middle Aged
  • Self Report
  • Smartphone*
  • Stress, Psychological / psychology*
  • Surveys and Questionnaires
  • Young Adult