Cognitive-Behavioral Therapy for Somatization Disorder

Allen, Lesley A.; Woolfolk, Robert L.; Escobar, Javier I.; Gara, Michael A.; Hamer, Robert M.

doi:10.1001/archinte.166.14.1512

Cited by 200 publications

(135 citation statements)

References 20 publications

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“…tients with functional symptoms who seek it, 24,25 we have found that CBT based on a functional explanation can be acceptable to relatively unselected neurology patients. Second, where should treatment be delivered?…”

Section: Data Collectionmentioning

confidence: 97%

Guided self-help for functional (psychogenic) symptoms

Sharpe¹,

Walker²,

Williams³

et al. 2011

Neurology

184

108

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Objectives: Functional (psychogenic or somatoform) symptoms are common in neurology clinics.Cognitive-behavioral therapy (CBT) can be an effective treatment, but there are major obstacles to its provision in practice. We tested the hypothesis that adding CBT-based guided self-help (GSH) to the usual care (UC) received by patients improves outcomes. Methods:We conducted a randomized trial in 2 neurology services in the United Kingdom. Outpatients with functional symptoms (rated by the neurologist as "not at all" or only "somewhat" explained by organic disease) were randomly allocated to UC or UC plus GSH. GSH comprised a self-help manual and 4 half-hour guidance sessions. The primary outcome was self-rated health on a 5-point clinical global improvement scale (CGI) at 3 months. Secondary outcomes were measured at 3 and 6 months. Results:In this trial, 127 participants were enrolled, and primary outcome data were collected for 125. Participants allocated to GSH reported greater improvement on the primary outcome (adjusted common odds ratio on the CGI 2.36 [95% confidence interval 1.17-4.74; p ϭ 0.016]). The absolute difference in proportion "better" or "much better" was 13% (number needed to treat was 8). At 6 months the treatment effect was no longer statistically significant on the CGI but was apparent in symptom improvement and in physical functioning. Conclusions: CBT-based GSH is feasible to implement and efficacious. Further evaluation is indicated. Classification of evidence:This study provides Class III evidence that CBT-based GSH therapy improves self-reported general health, as measured by the CGI, in patients with functional neurologic symptoms. Neurology ® 2011;77:564-572 GLOSSARY CBT ϭ cognitive-behavioral therapy; CGI ϭ clinical global improvement scale; CPS ϭ change in presenting symptoms scale; GSH ϭ guided self-help; NNT ϭ number needed to treat; OR ϭ odds ratio; SF-12 ϭ Medical Outcomes Short Form 12-Item Scale; UC ϭ usual care.

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Section: Data Collectionmentioning

confidence: 97%

Guided self-help for functional (psychogenic) symptoms

Sharpe¹,

Walker²,

Williams³

et al. 2011

Neurology

184

108

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“…14, 15 Smith et al 14 reported on an intervention that led to more effective recognition and treatment of these patients in primary care. Allen et al 15 performed a controlled study of a time-limited cognitive behavior therapy (CBT)-type intervention on somatization disorder as defi ned by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) in a mental health clinic.…”

Section: In T Erv En T Ion F or Une X Pl A Ined Sy Mp To Msmentioning

confidence: 99%

“…Allen et al 15 performed a controlled study of a time-limited cognitive behavior therapy (CBT)-type intervention on somatization disorder as defi ned by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) in a mental health clinic. This intervention yielded signifi cant effects beyond those associated with a traditional consultation letter, ameliorating medically unexplained physical symptoms, improving functional status, and decreasing health care costs in a chronically ill population.…”

Section: In T Erv En T Ion F or Une X Pl A Ined Sy Mp To Msmentioning

confidence: 99%

Effectiveness of a Time-Limited Cognitive Behavior Therapy Type Intervention Among Primary Care Patients With Medically Unexplained Symptoms

Escobar

Gara²,

Díaz-Martínez³

et al. 2007

The Annals of Family Medicine

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PURPOSE Patients seeking care for medically unexplained physical symptoms pose a major challenge at primary care sites, and there are very few wellaccepted and properly evaluated interventions to manage such patients. METHODSWe tested the effectiveness of a cognitive behavior therapy (CBT)-type intervention delivered in primary care for patients with medically unexplained physical symptoms. Patients were randomly assigned to receive either the intervention plus a consultation letter or usual clinical care plus a consultation letter. Physical and psychiatric symptoms were assessed at baseline, at the end of treatment, and at a 6-month follow-up. All treatments and assessments took place at the same primary care clinic where patients sought care.RESULTS A signifi cantly greater proportion of patients in the intervention group had physical symptoms rated by clinicians as "very much improved" or "much improved" compared with those in the usual care group (60% vs 25.8%; odds ratio = 4.1; 95% confi dence interval, 1.9-8.8; P <.001). The intervention's effect on unexplained physical symptoms was greatest at treatment completion, led to relief of symptoms in more than one-half of the patients, and persisted months after the intervention, although its effectiveness gradually diminished. The intervention also led to signifi cant improvements in patient-reported levels of physical symptoms, patient-rated severity of physical symptoms, and clinician-rated depression, but these effects were no longer noticeable at follow-up.CONCLUSIONS This time-limited, CBT-type intervention signifi cantly ameliorated unexplained physical complaints of patients seen in primary care and offers an alternative for managing these common and problematic complaints in primary care settings.

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“…3,4 The evidence base for CBT, in particular, includes effective support for patients with medically unexplained symptoms. 5 Due to clinical need and the presence of sound treatment options, this review is a welcome and timely exploration of non-invasive psychosocial treatments for patients suffering from orofacial pain.The authors start the presentation of their findings by stating that with respect to short-term outcomes, usual care performed better than psychosocial interventions in reducing pain intensity. However, in the long-term and after follow up, Dworkin selfcare interventions, habit reversal, and particularly CBT approaches (either with or without biofeedback) are significantly more effective in reducing pain intensity than usual care (or no care in the case of habit reversal).…”

mentioning

confidence: 99%

mentioning

confidence: 99%

Weak evidence supports the use of psychosocial interventions for chronic orofacial pain

Themessl‐Huber

2012

Evid Based Dent

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The prevalence of TMDs ranges between 5-12% of the population, with a relatively higher rate among younger cohorts. 1 Apart from the commonality of orofacial pain, patients afflicted by chronic pain are likely to have experienced a complex and multi-staged journey through the health care system. 2 At some stage, often after patients have endured multiple tests and treatments, the possibility of psychosocial determinants or contributors to the pain is entertained.By this time, as Aggarwal et al. point out, the 'anxiety-pain-tension' cycle is likely to have led to an increased perception of pain or to the presence of debilitating avoidance behaviours.While this synthesis of the relevant evidence base is original, the efficacy of a range of psychosocial interventions has been widely established. Cognitive behaviour therapy (CBT), for example, has accumulated a considerable body of evidence with respect to its efficacy across a range of mental and physical disorders, illnesses and diseases. 3,4 The evidence base for CBT, in particular, includes effective support for patients with medically unexplained symptoms. 5 Due to clinical need and the presence of sound treatment options, this review is a welcome and timely exploration of non-invasive psychosocial treatments for patients suffering from orofacial pain.The authors start the presentation of their findings by stating that with respect to short-term outcomes, usual care performed better than psychosocial interventions in reducing pain intensity. However, in the long-term and after follow up, Dworkin selfcare interventions, habit reversal, and particularly CBT approaches (either with or without biofeedback) are significantly more effective in reducing pain intensity than usual care (or no care in the case of habit reversal). CBT and Dworkin self-care interventions were also outperforming usual care in reducing the impact of pain on daily living activities. In terms of reducing symptoms of depression, CBT alone or in combination with biofeedback and hypnosis were significantly more effective than usual care. This endorsement of psychosocial interventions is moderated by the fact that the research designs have a high risk of bias and the study populations were exclusively from tertiary care settings. Thus, they conclude that non-invasive psychosocial interventions are supported by only weak evidence. However, they also note that although weak, this still constitutes a stronger evidence base than is available for the usual and more invasive procedures. Markus Themessl-Huber

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Cognitive-Behavioral Therapy for Somatization Disorder

Abstract: For patients diagnosed as having SD, CBT may produce clinical benefits beyond those that result from the current state-of-the-art treatment.

Cited by 200 publications

References 20 publications

Guided self-help for functional (psychogenic) symptoms

Guided self-help for functional (psychogenic) symptoms

Effectiveness of a Time-Limited Cognitive Behavior Therapy Type Intervention Among Primary Care Patients With Medically Unexplained Symptoms

Weak evidence supports the use of psychosocial interventions for chronic orofacial pain

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