Cognitive Behavioral Therapy for Somatoform Disorders

Allen, Lesley A.; Woolfolk, Robert L.

doi:10.1016/j.psc.2010.04.014

Cited by 61 publications

(40 citation statements)

References 97 publications

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“…As the prevalence of comorbid mood, anxiety [42], and personality disorders [41] is high in this patient group, patients are often redirected from treatment for UPS to treatment for mental health problems, which is usually provided by the mental health services. However, these predictors did not consistently predict CBT outcome, neither in our study nor in our review of other studies, and as a substantial number of patients communicates in physical and not mental terms [43] and refuses to be referred to the mental health services [5,44], this practice does not seem to be appropriate.…”

Section: Discussioncontrasting

confidence: 79%

Predicting the outcome of a cognitive-behavioral group training for patients with unexplained physical symptoms: a one-year follow-up study

Zonneveld

Rood

Kooiman³

et al. 2012

BMC Public Health

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BackgroundAlthough Cognitive-Behavioral Therapy (CBT) is effective for Unexplained Physical Symptoms (UPS), some therapists in clinical practice seem to believe that CBT outcome will diminish if psychiatric comorbidity is present. The result is that patients with a psychiatric comorbidity are redirected from treatment for UPS into treatment for mental health problems. To explore whether this selection and allocation are appropriate, we explored whether CBT outcomes in UPS could be predicted by variables assessed at baseline and used in routine-practice assessments.MethodsPatients (n=162) with UPS classified as undifferentiated somatoform disorder or chronic pain disorder were followed up until one year after they had attended a CBT group training. The time-points of the follow-up were at the end of CBT (immediate outcome), three months after CBT (short-term outcome), and one year after CBT (long-term outcome).CBT outcome was measured using the Physical Component Summary of the SF-36, which was the primary outcome measure in the randomized controlled trial that studied effectiveness of the CBT group training. Predictors were: 1.) psychological symptoms (global severity score of SCL-90), 2.) personality-disorder characteristics (sum of DSM-IV axis II criteria confirmed), 3.) psychiatric history (past presence of DSM-IV axis I disorders), and 4.) health-related quality of life in the mental domain (mental component summary of SF-36). The effect of this predictor set was explored using hierarchical multiple regression analyses into which these predictors had been entered simultaneously, after control for: a.) pretreatment primary outcome scores, b.) age, c.) gender, d.) marital status, and e.) employment.ResultsThe predictor set was significant only for short-term CBT outcome, where it explained 15% of the variance. A better outcome was predicted by more psychological symptoms, fewer personality-disorder characteristics, the presence of a psychiatric history, and a better quality of life in the mental domain.ConclusionsAs the predictors do not seem to predict CBT outcome consistently over time, the need for selection and allocation of patients for CBT is doubtful. It seems that this would unnecessarily deprive patients of effective treatment.Trial registrationNederlands Trial Register, NTR1609

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Section: Discussioncontrasting

confidence: 79%

Predicting the outcome of a cognitive-behavioral group training for patients with unexplained physical symptoms: a one-year follow-up study

Zonneveld

Rood

Kooiman³

et al. 2012

BMC Public Health

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“…It was only after doing so that we discovered that, due to low acceptance [74], and no effectiveness [27], two previous attempts to use the original consequences model in primary care had failed. Although most patients in our study had been referred by medical services, especially by general practitioners, ‘only’ 78 of the 269 (29%) patients did not attend the first appointments (so-called ‘no shows’); this no-show figure was substantially lower than the estimated 50%–80% of patients who refuse to be referred to mental-health services [20]. Patients also seemed to accept the training itself: 65 of the 84 who were randomized to it (77%), and 52 of the 72 who waited for it (72%) really attended the training.…”

Section: Discussionmentioning

confidence: 65%

“…It reduces UPS and concomitant psychological symptoms, improves daily functioning, and reduces financial expenses [13], [14], [15] without causing harmful effects [16]. However, the effect of this treatment has been studied mainly in medical subspecialty clinics or mental health centers [13], [17], [18] – resources that are not easily accessible to patients [19], either because their capacity is limited, or because patients refuse to be referred to the mental-health services [17], [20].…”

Section: Introductionmentioning

confidence: 99%

Effective Group Training for Patients with Unexplained Physical Symptoms: A Randomized Controlled Trial with a Non-Randomized One-Year Follow-Up

et al. 2012

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BackgroundAlthough cognitive-behavioral therapy for Unexplained Physical Symptoms (UPS) is effective in secondary care, studies done in primary care produced implementation problems and conflicting results. We evaluated the effectiveness of a cognitive-behavioral group training tailored to primary care patients and provided by a secondary community mental-health service reaching out into primary care.Methodology/Principal FindingsThe effectiveness of this training was explored in a randomized controlled trial. In this trial, 162 patients with UPS classified as undifferentiated somatoform disorder or as chronic pain disorder were randomized either to the training or a waiting list. Both lasted 13 weeks. The preservation of the training's effect was analyzed in non-randomized follow-ups, for which the waiting group started the training after the waiting period. All patients attended the training were followed-up after three months and again after one year. The primary outcomes were the physical and the mental summary scales of the SF-36. Secondary outcomes were the other SF-36-scales and the SCL-90-R. The courses of the training's effects in the randomized controlled trial and the follow-ups were analyzed with linear mixed modeling. In the randomized controlled trial, the training had a significantly positive effect on the quality of life in the physical domain (Cohen's d = 0.38;p = .002), but this overall effect was not found in the mental domain. Regarding the secondary outcomes, the training resulted in reporting an improved physical (Cohen's d = 0.43;p = 0.01), emotional (Cohen's d = 0.44;p = .0.01), and social (Cohen's d = 0.36;p = 0.01) functioning, less pain and better functioning despite pain (Cohen's d = 0.51;p = <0.001), less physical symptoms (Cohen's d = −.23;p = 0.05) and less sleep difficulties (Cohen's d = −0.25;p = 0.04) than time in the waiting group. During the non-randomized follow-ups, there were no relapses.Conclusions/SignificanceThe cognitive-behavioral group training tailored for UPS in primary care and provided by an outreaching secondary mental-health service appears to be effective and to broaden the accessibility of treatment for UPS.Trial RegistrationTrialRegister.nl NTR1609

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“…Olatunji et al (2010) found that cognitive behavior therapy has also been shown to be effective in the treatment of anxiety (e.g., specific phobia, PTSD). Allen and Woolfolk (2010) have shown that cognitive behavior therapy has been found effective for somatoform disorder. However, to date, there have been no controlled trials examining its efficacy for pain disorders.…”

Section: Treatmentmentioning

confidence: 99%

Trends in Psychological/Psychiatric Injury and Law: Continuing Education, Practice Comments, Recommendations

Young

2010

Psychol. Inj. and Law

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This literature review of the major topics in the field of psychological/psychiatric injury and law is aimed at developing commentary for practice in the area. The field is a fast-developing one, with over ten major topics that it needs to integrate. In particular, the present review focuses current work on: law (evidence, tort); forensic psychology; assessment and testing; psychological injuries (posttraumatic stress disorder, chronic pain, traumatic brain injury, other); the APA DSM-5 draft (Diagnostic and statistical manual of mental disorders; American Psychiatric Association 2010); malingering; causality; multicultural considerations; disability; the American Medical Association (AMA) Guides to the evaluation of permanent impairment (Rondinelli et al. 2008); models; and treatment. At the end of each section of the article, practice comments introduce critical issues in applying the research to psychological work in the area. Whether undertaking tort evaluations, disability, and treatment plan assessments or treating individuals with psychological injuries, the professional needs state-of-the-art information in all the areas listed in order to remain scientifically informed, comprehensive, and impartial. The article concludes with recommendations for an integrated field in psychological/psychiatric injury and law, study in the field, research in its major areas, best practice policies, for example in assessment and treatment, and model building.

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Cognitive Behavioral Therapy for Somatoform Disorders

Cited by 61 publications

References 97 publications

Predicting the outcome of a cognitive-behavioral group training for patients with unexplained physical symptoms: a one-year follow-up study

Predicting the outcome of a cognitive-behavioral group training for patients with unexplained physical symptoms: a one-year follow-up study

Effective Group Training for Patients with Unexplained Physical Symptoms: A Randomized Controlled Trial with a Non-Randomized One-Year Follow-Up

Trends in Psychological/Psychiatric Injury and Law: Continuing Education, Practice Comments, Recommendations

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