The Impact of Ulcerative-Colitis Surgery on Psychological and Cognitive Factors in Individuals with Ileostomies and Ileal Pouch Anal Anastomosis

  • Zeina Bushnaq

Student thesis: Doctoral Thesis


The aim of this research was to examine the differences in psychological (depression, anxiety, and body image) and cognitive factors (attentional control and metacognitions), coping strategies, help-seeking behaviours, and attitudes towards therapy in individuals with ileostomies (ILEOs) and ileal pouch anal anastomosis (IPAAs). The main hypotheses state that the ILEO group will have significantly greater levels of depression, anxiety, and body image dissatisfaction, lower attentional control, more maladaptive metacognitions, will endorse higher emotion-focused and maladaptive coping and lower problem-focused coping strategies than the IPAA group. Additionally, the ILEO group will endorse fewer informal help-seeking behaviours, more formal help seeking behaviours, and hold more negative attitudes towards therapy than the IPAA group. The secondary hypotheses aimed to examine the associations between depression, trait anxiety, attentional control, metacognitions, age, sex, and time since surgery with coping strategies and body image. One hundred and fifty-two participants (ILEO n = 78; IPAA n =74) electronically completed the Patient Health Questionnaire–8, the Generalised Anxiety Disorder–7, the Body Image Scale, the State-Trait Anxiety Inventory, the Attentional Control Scale, the Meta-Cognitions–30, Brief COPE, the General Help-Seeking Questionnaire, and Attitudes Towards Seeking Help After Cancer Scale. There were no significant differences between the ILEO and IPAA groups, except on problem-focused coping strategies, where the IPAA group utilised problem-focused strategies more than the ILEO group. Higher levels of metacognitions were associated with greater use of problem-focused coping strategies; lower levels of trait anxiety predicted greater use of emotion-focused coping strategies; higher levels of depression, trait anxiety, and metacognitions and being of younger age predicted maladaptive coping strategies; higher levels of depression, trait anxiety, and younger age were associated with greater body image dissatisfaction. These findings may inform clinical practice, where similar psychological interventions can be implemented for both groups, rather than treating each group separately.
Date of Award25 Oct 2022
Original languageEnglish
Awarding Institution
  • University of Roehampton
SupervisorLeigh Gibson (Director of Studies) & George Georgiou (Co-Supervisor)


  • IBD
  • attitudes towards therapy
  • Ulcerative Colitis
  • help seeking
  • ileostomy
  • coping strategies
  • stoma
  • metacognitions
  • ileal pouch anal anastomosis
  • attentional control
  • depression
  • anxiety body image
  • internal pouch

Cite this