1. Altered Visual Attention in IBS and IBD Patients Tkalčić M, Rupčić A, Pletikosić S, Domijan D, Šetić M, Hauser G Department of Psychology University of Rijeka Croatia 29 th European Conference on Psychosomatic Research

2. In two experiments we sought to explore the pattern of attention engagement in patients with IBS and IBD versus healthy control

3. IBS vs IBD Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Diseases (IBD) - chronic gastrointestinal disorders that have significant effects on patients' quality of life

4. PSYCHO SOCIAL IBS and IBD are a result of interaction between various physical and psychosocial factors Abnormal motility, visceral hypersensitivity and psychosocial factors may all play a role in the development of functional GI symptoms in IBS and IBD patients Emotional and cognitive factors can alter the function of the gut BIO

5. Role of attention/perception? Attention is an important cognitive function that directs the flow of information from sensory receptors to higher-level processes Enhanced attention to (or perception of) visceral stimuli could serve as a possible pathophysiological mechanism in IBS Altered perception of abdominal symptoms - extreme self-awarness – elevated activity of insula, anterior cinguli, OFC – depends on cognitive and emotional input!

6. Patients with functional GI disorders show attention- dependent alterations of CNS processing as well as a generally negative emotional tendency in their cognitive processing strategies (Musial et al., 2008) Naliboff and Rudy (2009) - anxiety-related processes may influence the development and persistence of somatic symptoms

7. The aim of this study to determine whether IBS and IBD patients show any signs of altered visual attentional functioning compared to healthy controls using Navon's and Neisser's classical experimental tasks

8. Methods o Stimuli : o Global/local attention – Navon’s experiment - each stimulus consisted of a large letter composed of small letters (A, H, L and T) - the participant's task was to decide whether the letter A or the letter H was presented on the screen - response latency and accuracy were collected

9. Global/local task global responselocal response Generally, participants identify the figures more rapidly when the global rather than the local level is relevant - the global-precedence effect (Navon, 1977).

10. Hypothesis IBS and IBD patients might show an effect of local precedence (response to a target letter is faster when it is presented at the local compared to the global level) Such a reverse pattern might arise as a consequence of altering attention set to the local level due to anxiety symptoms or chronic pain

11. Visual search task – replication of Neisser's letter search study – the letter Z was designated as a target letter that appeared in an array of distractor letters – the participant's task was to indicate whether the target letter was present or not – response latency and accuracy were collected

12. Visual search task “Find Z” ODUGCR RCDUGO CUOGRD OUGCDR URDCGO GRUZDO DUCGRO UCGROD DORCGU RDOCGU IVMXEW EWVMIX EXWMVI IXEMWV VXWEMI MXVZWI XVWMEI MWXVIE VIMEXW EXVWIM

13. Hypothesis IBS and IBD patients would put more emphasis on accuracy over speed in a chronometric analysis of their performance because such a strategy might be related to their heightened anxiety and an attempt to approach the task with more scrutiny

14. Methods o Participants were 93 participants: 29 with IBS 32 with IBD 32 healthy control o Age was ranging from 18 to 60 years

15. Results Two-way ANOVA with - Group (3 levels: IBS, IBD, Control) as a between subject factor and Attention (2 levels: Global, Local) or Target position (5 levels: 3 rd, 6 th, 9 th, 12 th or 15 th raw) as a within subject factor for Reaction time and Accuracy (DVs) - were conducted.

16. Differences in global/local attention paradigm among IBS, IBD and control - reaction time - there is no overall difference in processing speed among groups (F(2, 90)=2.50, p>.05) there is no global precedence effect (F< 1)! significant Group x Attention interaction (F(2,90)=3.19, p<.05) IBS and IBD groups show no difference between global and local attention!

17. Differences in global/local attention paradigm among IBS, IBD and control - accuracy - a significant main effect of the Group, F(2,90) = 7.26; p <.05 IBD and IBS patients showed greater accuracy compared to the Control group

18. Differences in visual search strategy among IBS, IBD and control - accuracy - a significant main effect of the Group, F(2,89)=3.67; p<.05, and a significant main effect of the Target position, F(4,356)=3.76; p<.05 the Control exibits lower accuracy compared to IBD and IBS and accuracy was lower when the target was in the 3 rd row compared to the 9 th, 12 th and 15 th row

19. Discussion Main result - altered attentional functioning in patients with IBS and IBD It seems that IBS and IBD patients are able to allocate an equal amount of attention at both the global and local level Unusual focus on details can have a detrimental effect on both groups of patients

20. Discussion unpleasant signals from the abdomen in IBS and IBD patients could be enhanced due to a narrow attention focus attention might lead to an exaggeration of painful visceral signals the tendency to focus on details in IBS and IBD patients might be mediated by anxiety

21. Discussion IBS and IBD patients approach the visual search task with more scrutiny that may also be interpreted as a sign of enhanced anxiety It would be interesting to see if other patient groups with persistent pain such as patients with fibromyalgia and chronic fatigue syndrome express a similar attention pattern as IBS and IBD patients

22. Conclusion IBS and IBD patients showed a clear sign of absence of global precedence suggesting a different attention bias compared to the control; IBS and IBD patients in general exhibit greater accuracy in solving the global/local and the visual search task; a possible important role of attention in generating abdominal symptoms These results could be used as a strategy to create a novel approach to the treatment of IBS and IBD