Structural Equation Modeling of the Mediating Role of Self-Efficacy in the Relationship between Cognitive Flexibility and Psychological Well-Being of Patients with Irritable Bowel Syndrome

Document Type : Original Article

Authors

1 M.A in Psychology, Department of Psychology, Faculty of Humanities, University of Kashan, Kashan, Iran.

2 Associate Professor, Department of Psychology, Faculty of Humanities, Kashan University, Kashan, Iran

3 Assistant Professor of Internal Medicine, Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

10.22075/jcp.2024.33619.2869

Abstract

 
Background: Irritable bowel syndrome is one of the most well-known gut-brain interaction disorders and is characterized by symptoms of chronic abdominal pain along with changes in bowel habits. This disease has a significant impact on the quality of life of patients. The aim of the present study was to investigate the mediating role of self-efficacy in the relationship between cognitive flexibility and psychological well-being in patients with irritable bowel syndrome.
Method: The present study was descriptive-correlational using structural equation modeling. The statistical population was patients with irritable bowel syndrome who referred to Gastrointestinal Health Center, Alzahra Hospital in Isfahan city in year 2023. The sample size was selected based on Kline model and with convenience sampling of 300 patients. Using psychological well-being scale, cognitive flexibility inventory (CFI) and self-efficacy questionnaire data was collected. Using SPSS version 28 and AMOS software data were analyzed.
Results: The results indicated that Problem solving process (sig= 0.001,
β=.62) and perception of controllability (sig= 0.001, β=.49) predict psychological well-being and self-efficacy has a mediating role in the relationship between cognitive flexibility and psychological well-being.
Conclusion: The findings of this research have practical implications for therapeutic interventions focusing on cognitive flexibility and self-efficacy to improve the psychological well-being of patients with irritable bowel syndrome.

Keywords

Main Subjects


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    1. Faeli A, Mohammadifar M, Azizpour M, Dabiri R. Comparison of Personality Traits and Quality of Life between Patients with Irritable Bowel Syndrome and Normal Individuals. Journal of Clinical Psychology, 2017; 9(1): 1-10. https://doi.org/10.22075/jcp.2017.9769.
    2. Oka P, Parr H, Barberio B, Black CJ, Savarino EV, Ford AC. Global prevalence of irritable bowel syndrome according to Rome III or IV criteria: a systematic review and meta-analysis. The lancet Gastroenterology & hepatology. 2020; 5(10): 908-17. https://www.thelancet.com/journals/langas/article/PIIS2468-1253(20)30217-X/abstract
    3. Sperber AD, Bangdiwala SI, Drossman DA, Ghoshal UC, Simren M, Tack J, Whitehead WE, Dumitrascu DL, Fang X, Fukudo S, Kellow J. Worldwide prevalence and burden of functional gastrointestinal disorders, results of Rome Foundation Global Study. Gastroenterology. 2021; 160(1): 99-114. https://doi.org/10.1053/j.gastro.2020.04.014
    4. Goodoory VC, Tuteja AK, Black CJ, Ford AC. Systematic review and meta-analysis: efficacy of mesalamine in irritable bowel syndrome. Clinical Gastroenterology and Hepatology. 2024; 22(2): 243-51. https://doi.org/10.1016/j.cgh.2023.02.014
    5. Gargari G, Mantegazza G, Cremon C, Taverniti V, Valenza A, Barbaro MR, Marasco G, Duncan R, Fiore W, Ferrari R, De Vitis V. Collinsella aerofaciens as a predictive marker of response to probiotic treatment in non-constipated irritable bowel syndrome. Gut Microbes. 2024; 16(1): 1-10. https://doi.org/10.1080/19490976.2023.2298246
    6. Bai C, Wang J, Wang Y, Liu H, Li J, Wang S, Bai Z, Guo R. Exploration of the mechanism of Traditional Chinese Medicine for anxiety and depression in patients with diarrheal irritable bowel syndrome based on network pharmacology and meta-analysis. Frontiers in Pharmacology. 2024; 15(1): 1-10. https://doi.org/10.3389/fphar.2024.1404738
    7. Kamp K, Yang PL, Friedman E, Lopez A, Iribarren S, Barney P, Munson S, Heitkemper M, Levy R. Formative Evaluation of a Comprehensive Self-Management Intervention for Irritable Bowel Syndrome, Comorbid Anxiety, and Depression: Mixed Methods Study. JMIR Formative Research. 2024; 8(1): 1-10. https://doi.org/10.2196/43286
    8. Billing J, Berentsen B, Lundervold A, Hillestad EM, Lied GA, Hausken T, Lundervold AJ. Cognitive function in patients with irritable bowel syndrome: impairment is common and only weakly correlated with depression/anxiety and severity of gastrointestinal symptoms. Scandinavian Journal of Gastroenterology. 2024; 59(1): 25-33. https://doi.org/10.1080/00365521.2023.2256916
    9. Mayer EA, Ryu HJ, Bhatt RR. The neurobiology of irritable bowel syndrome. Molecular psychiatry. 2023; 28(4): 1451-65. https://doi.org/10.1038/s41380-023-01972-w
    10. Reed S, Bugwadia AK, Dave S, Wilson H.E, Ramesh P, Michel HK. Sexual and reproductive health considerations in the care of young adults with inflammatory bowel disease: A multidisciplinary conversation. Health Care Transitions, 2024; 2(1): 1-10. https://doi.org/10.1016/j.hctj.2023.100033
    11. Vekara L, Kantanen S, Kolho KL, Räsänen K, Lakka T, Huhtala H, Piippo‐Savolainen E, Arikoski P, Hiltunen P. Psychological well‐being of children and adolescents with inflammatory bowel disease. Journal of Pediatric Gastroenterology and Nutrition. 2024; 1(2): 1-10. https://doi.org/10.1002/jpn3.12220
    12. Tamannaeifar, M. R., & Shirani, Z. Mediating Role of Self-Efficacy in Relationship Cognitive Emotion Regulation and Psychological Well-Being of Patients with Irritable Bowel Syndrome. Applied Psychology, 2024; 18(2); 107-130. https://doi.org/10.48308/apsy.2024.234465.1608
    13. Fernández-Abascal EG, Martín-Díaz MD. Longitudinal study on affect, psychological well-being, depression, mental and physical health, prior to and during the COVID-19 pandemic in Spain. Personality and Individual Differences, 2021; 172(2): 21-35. https://doi.org/10.1016/j.paid.2020.110591
    14. Erisian Z, Torkan H, Mokarian, F. Simple and Multiple Relationships of Emotional Regulation, Pain Self-efficacy and Perception of Disease with Psychological Well-being in Breast Cancer Women. Journal of Clinical Psychology, 2019; 11(1): 49-59. https://doi.org/10.22075/jcp.2019.16415.1567
    15. Can A, Poyrazl S, Pillay Y. Eleven Types of Adjustment Problems and Psychological Well-Being among International Students. Eurasian Journal of Educational Research, 2021; 91(2): 1-20. https://doi.org/10.14689/ejer.2021.91.1
    16. Özmen S, Özkan O, Özer Ö, Yanardağ MZ. Investigation of COVID-19 fear, well-being and life satisfaction in Turkish society. Social work in public health, 2021; 36(2): 164-177. https://doi.org/10.1080/19371918.2021.1877589
    17. Madva E.N, Harnedy LE, Longley R.M, Rojas Amaris A, Castillo C, Bomm,M.D, Celano CM. Positive psychological well‐being: A novel concept for improving symptoms, quality of life, and health behaviors in irritable bowel syndrome. Neurogastroenterology & Motility, 2023; 35(4): 1-10. https://doi.org/10.1111/nmo.14531
    18. Madva EN, Sadlonova M, Harnedy LE, Longley RM, Amonoo HL, Feig EH, Millstein RA, Zambrano J, Amaris AR, Jurayj J, Murray HB. Positive psychological well-being and clinical characteristics in IBS: A systematic review. General hospital psychiatry. 2023; 81)1): 1-4. https://doi.org/10.1016/j.genhosppsych.2023.01.004
    19. Klein RJ, Jacobson NC, Robinson MD. A psychological flexibility perspective on well-being: Emotional reactivity, adaptive choices, and daily experiences. Emotion. 2023; 23(4): 911-924. https://psycnet.apa.org/buy/2022-95087-001
    20. Cañas J, Quesada J, Antolí A, Fajardo I. Cognitive flexibility and adaptability to environmental changes in dynamic complex problem-solving tasks. Ergonomics, 2003; 46(5): 482–501. https://doi.org/10.1080/0014013031000061640
    21. Musslick S, Bizyaeva A. Examining cognitive flexibility and stability through the lens of dynamical systems. Current Opinion in Behavioral Sciences. 202; 57(1): 1-10. https://doi.org/10.1016/j.cobeha.2024.101375
    22. Bilgiç R, Bilgin M. Ergenlerin cinsiyet ve öğrenim kademesi düzeylerine göre bilişsel esneklik düzeyleri ile karar stratejileri arasındaki ilişkinin incelenmesi. Uşak Üniversitesi Eğitim Araştırmaları Dergisi, 2016; 2(2): 39–55. https://doi.org/10.29065/usakead.232432
    23. Hildebrandt LK, Mccall C, Engen HG, Singer T. Cognitive flexibility, heart rate variability, and resilience predict fine-grained regulation of arousal during prolonged threat. Psychophysiology, 2016; 53(1): 880–890. https://doi.org/10.1111/psyp.12632
    24. Lackner JM, Gudleski GD, Radziwon CD, Krasner SS, Firth RS, Naliboff BD, Vargovich AM, Borden AB, Mayer EA. Cognitive flexibility improves in cognitive behavioral therapy for irritable bowel syndrome but not nonspecific education/support. Behaviour Research and Therapy. 2022; 154(1): 1-10. https://doi.org/10.1016/j.brat.2022.104033
    25. Spillebout A, Dechelotte P, Ladner J, Tavolacci MP. Mental health among university students with eating disorders and irritable bowel syndrome in France. Revue d'epidemiologie et de sante publique. 2019; 67(5): 295-301. https://doi.org/10.1016/j.respe.2019.04.056
    26. Karami, M., Pourkamali, T. Efficacy of Cognitive Therapy Based on Mindfulness on the Psychological Flexibility and Resilience in the Patients with Irritable Bowel Syndrome. Journal of Modern Psychological Researches, 2023; 18(69): 211-219. https://doi.org/10.22034/jmpr.2023.16247
    27. Negahdari S, Seyfe MH. Peresenting The Causal Model of Cognitive Flexibility and Addiction to Social Networks; The Mediating Role of Self-Efficacy, Cognitive Well-Being and Cognitive Empathy among Second Year High School Students in Shiraz. Social Cognition, 2022; 11(22): 53-65. https://doi.org/10.30473/sc.2023.66356.2828
    28. Fan L, Cui F. Mindfulness, self-efficacy, and self-regulation as predictors of psychological well-being in EFL learners. Frontiers in Psychology. 2024; 1(1): 1-10. https://doi.org/10.3389/fpsyg.2024.1332002
    29. Kingsford-Smith AA, Alonzo D, Beswick K, Loughland T, Roberts P. Perceived autonomy support as a predictor of rural students’ academic buoyancy and academic self-efficacy. Teaching and Teacher Education, 2024’ 142(1): 1-10. https://doi.org/10.1016/j.tate.2024.104516
    30. Bandura A. Guide for constructing self-efficacy scales. Self-efficacy beliefs of adolescents, 2006; 5(1): 307-337. https://books.google.com/books?
    31. Sezgintürk M, Sungur S. A multidimensional investigation of students’ science self-efficacy: The role of gender. İlköğretim Online, 2020; 19(1): 208-218. http://dx.doi.org/10.17051/ilkonline.2020.653660
    32. Keefer, L., Kiebles, J. L., & Taft, T. H. (2011). The role of self-efficacy in inflammatory bowel disease management: preliminary validation of a disease-specific measure. Inflammatory bowel diseases17(2): 614-620. https://doi.org/10.1002/ibd.21314
    33. Khalifesoltani F, Hajializadeh K, Ahadi H. Evaluation of the Impact of Self-Efficacy-Based Training on Depression, Self-Care Behaviors, and Quality of Life in Patients with Irritable Bowel Syndrome. Avicenna J Neuro Psycho Physiology 2021; 8 (2): 90-95. http://dx.doi.org/10.32592/ajnpp.2021.8.2.105
    34. Kline RB. Principles and practice of structural equation modeling. Fourth Edition, Guilford publications. 2023. https://books.google.com/books?
    35. Ryff CD. Happiness is everything, or is it? Explorations on the meaning of psychological well-being. Journal of personality and social psychology, 1989; 57 (6): 1-10. https://psycnet.apa.org/doi/10.1037/0022-3514.57.6.1069
    36. Rosenberg M. Determinants of self-esteem-a citation classic commentary on society and the adolescent self-image by Rosenberg, M. Current Contents/Social & Behavioral Sciences, 1989; 1(11): 16-16. https://garfield.library.upenn.edu/classics1989/A1989T475800001.pdf
    37. Khanjani M, Shahidi S, Fathabadi J, Mazaheri MA, Shokri O. Factor structure and psychometric properties of the Ryff’s scale of Psychological well-being, short form (18-item) among male and female students. Thoughts and Behavior in Clinical Psychology, 2014; 9 (32): 27-36. [Persian] https://jtbcp.riau.ac.ir/article_67.html
    38. Dennis JP, Vander Wal JS. The cognitive flexibility inventory: Instrument development and estimates of reliability and validity. Cognitive therapy and research, 2010; 34(1): 241-253. https://doi.org/10.1007/s10608-009-9276-4
    39. Beck AT, Steer RA. Brown GK. Manual for Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation. 1996. https://psycnet.apa.org/doi/10.1037/t00742-000
    40. Kohandani M, Abolmaali Alhosseini K. Factor structure and psychometric properties of Persian version of cognitive flexibility of Dennis, Vander Wal and Jillon. Psychological Models and Methods, 2017; 8(29): 53-70. [Persian] https://dorl.net/dor/20.1001.1.22285516.1396.8.29.3.2
    41. Rajabi, G. (2006). Reliability and Validity of the General Self-Efficacy Beliefs Scale (GSE-10) in Psychology Students of the Faculty of Educational Sciences and Psychology, Shahid Chamran University, Ahvaz and Azad University, Maroodasht. Journal of New thoughts on Education, 2006; 2(1 and 2): 111-122. https://doi.org/10.22051/jontoe.2006.287
    42. Sevari K, Mombini S. The effect of positive emotions and self-efficacy on imagination through intrinsic motivation. Journal of School Psychology, 2020; 9(2): 63-83. [Persian] https://jsp.uma.ac.ir/article_941.html
    43. Delavar A, Najafi M. The psychometric properties of the general self efficacy scale among university staff. Quarterly of Educational Measurement, 2013; 3(12): 87-104. [Persian] https://jem.atu.ac.ir/article_5663.html
    44. Pardar C, Rezakhani S. Effectiveness of communication skills training on increasing self-efficacy and hope of veterans' wives. Journal of Veterinary Medicine, 2017; 38(1): 45-42. [Persian] https://ijwph.ir/article-1-703-en.html&sw=Pardar
    45. Conner M, Davidson JR. Development of a new resilience scale. Depression and Anxiety, 2003; 18(1): 76-82. https://doi.org/10.1002/da.10113
    46. Keyhani M, Taghvaei D, Rajabi A, Amirpour B. Internal Consistency and Confirmatory Factor Analysis of the Connor-Davidson Resilience Scale (CD-RISC) among Nursing Female. Iranian Journal of Medical Education, 2015; 4 (10): 857-865. [Persian] http://ijme.mui.ac.ir/article-1-3254-fa.html
    47. Indregard AMR, Nielsen M, Knardahl S. Emotional dissonance, mental health complaints, and sickness absence among health-and social workers. The moderating role of self-efficacy. Frontiers in psychology, 2018; 9(1): 592-602. https://doi.org/10.3389/fpsyg.2018.00592
    48. Veisi S, Kashefi F, Imani S. Fittness the Causal-Structural Relationships of Successful Intelligence with Wisdom with the Mediation of Musical Intelligence in Piano Players. Social Psychology Research, 2024; 14(54): 1-14. https://doi.org/10.22034/spr.2024.424119.1877
    49. Schermelleh-Engel K, Moosbrugger H, Müller H. Evaluating the fit of structural equation models: Tests of significance and descriptive goodness-of-fit measures. Methods of psychological research online, 2003; 8(2): 23-74. https://psycnet.apa.org/record/2003-08119-003
    50. Daks JS. Rogge RD. Examining the correlates of psychological flexibility in romantic relationship and family dynamics: A meta-analysis. Journal of Contextual Behavioral Science, 2020; 1(1): 1-10. http://dx.doi.org/10.1016/j.jcbs.2020.09.010
    51. Twohig MP, Vilardaga JCP, Levin ME, Hayes SC. Changes in psychological flexibility during acceptance and commitment therapy for obsessive compulsive disorder. Journal of Contextual Behavioral Science, 2015; 4(3): 196-202. https://psycnet.apa.org/doi/10.1016/j.jcbs.2015.07.001
    52. Wu Y, Koutstaal W. Charting the contributions of cognitive flexibility to creativity: Self-guided transitions as a process-based index of creativity-related adaptivity. Plos one, 2020; 15(6): 1-10. https://doi.org/10.1371/journal.pone.0234473
    53. Berghoff CR, McDermott MJ, Dixon-Gordon K.L. Psychological flexibility moderates the relation between PTSD symptoms and daily pain interference. Personality and Individual Differences, 2018; 124(1): 130-134. https://doi.org/10.1016/j.paid.2017.12.012
    54. Grégoire S, Chénier C, Doucerain M, Lachance L, Shankland R. Ecological momentary assessment of stress, well-being, and psychological flexibility among college and university students during acceptance and commitment therapy. Canadian Journal of Behavioural Science/Revue canadienne des sciences du comportement, 2020; 52(3): 231-245. https://psycnet.apa.org/buy/2020-01346-001
    55. Zhang F, Welch EW. More than just managerial self-efficacy: conceptualizing and predicting top managers' means efficacy about the organization under extreme events. Journal of Managerial Psychology, 2021; 2(2): 21-35. http://dx.doi.org/10.1108/JMP-11-2020-0584
    56. Holzberger D, Prestele E. Teacher self-efficacy and self-reported cognitive activation and classroom management: A multilevel perspective on the role of school characteristics. Learning and Instruction, 2021; 5(2): 12-35. https://doi.org/10.1016/j.learninstruc.2021.101513
    57. Tucker S, Zadvinskis IM, Connor L. Development and psychometric testing of the Implementation Self-Efficacy for EBP (ISE4EBP) Scale. Western Journal of Nursing Research, 2020; 43(1): 45-52. https://doi.org/10.1177/0193945920925032
    58. Hussain MS, Khan SA, Bidar MC. Self-efficacy of teachers: a review of the literature. Jamshedpur Research Review, 2022; 1(50): 110-116. https://www.researchgate.net/publication/358368223
    59. Chen XY, Usher EL, Roeder M, Johnson AR, Kennedy MS, Mamaril NA. Mastery, models, messengers, and mixed emotions: Examining the development of engineering self‐efficacy by gender. Journal of Engineering Education, 112(1): 64-89. https://doi.org/10.1002/jee.20494
    60. Hamidi F, Otoufati Roudi M. Design and Effectiveness of Philosophizing on Cognitive Flexibility and Proactive Inhibition of Preschool Children. Health Education and Health Promotion, 2021; 9(1), 1-10. http://hehp.modares.ac.ir/article-5-47956-en.html
    61. Laureiro‐Martínez D, Brusoni S. Cognitive flexibility and adaptive decision‐making: Evidence from a laboratory study of expert decision makers. Strategic Management Journal. 2018; 39(4):1031-58. https://doi.org/10.1002/smj.2774