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Attention bias has been suggested as an etiological and maintaining factor in anxiety.

According to Clark and Wells, self-focused attention is an important maintaining factor in the disorder because it increases access to negative thoughts and feelings, can interfere with performance, and prevents the individual from observing external information that might disconfirm his or her fears.

Negative self-images are a maintaining factor in social phobia.

Ehlers and Clark (2000) suggested that one important maintaining factor in posttraumatic stress disorder (PTSD) is rumination about the trauma and/or its consequences.

Rumination has been identified as a maintaining factor in a number of emotional disorders and it remains unclear whether different types of perseverative thinking identified in different emotional disorders represent similar or different processes (Harvey et al., 2004).

This finding is in line with the proposed role of GSA as a maintaining factor in IBS and it could therefore be expected that patients who score high on the VSI would benefit more from the treatment than patients with low VSI scores.

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Cognitive styles are important maintaining factors in cognitive models of psychopathology (Harvey et al. 2004), and we propose that the cognitive style of perfectionism may be an explanatory factor in the high co-occurrence of BD and AD's.

Thus, the effect in the stress management arm may have been due to non-specific factors rather than specific symptom maintaining factors in IBS.

These data are in line with Kaye's hypothesis of a vicious cycle of symptoms as maintaining factors in EDs [ 102].

The cognitive model of depression includes both the negative thinking styles about self and the world [ 45] and the recognition of predisposing, precipitating and maintaining factors in influencing the likelihood of someone having a diagnosis of depression in adulthood [ 46].

Similarly, there is a large overlap between IBS and other functional somatic disorders, e.g., fibromyalgia, chronic pain, and chronic fatigue syndrome [ 8], and worry, fear, hypervigilance, and avoidance in response to the disorder-specific symptoms have also been suggested to be important maintaining factors in these disorders as well as IBS [ 50].

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