Cognitive Behaviour Therapy Complemented with Emotion Regulation Training for Patients with Persistent Physical Symptoms: A Randomised Clinical Trial

Abstract

<b><i>Introduction:</i></b> Persistent medically unexplained symptoms (MUS) are a major burden for health care. Cognitive behaviour therapy (CBT) is efficacious for patients with MUS, with small to medium effects. The current study investigates whether therapy outcomes of a CBT for MUS patients can be improved by complementing it with emotion regulation training. <b><i>Methods:</i></b> In a multicentre trial 255 patients with at least three persisting MUS were randomised to 20 sessions of either conventional CBT (<i>n</i> = 128) or CBT complemented with emotion regulation training (ENCERT; <i>n</i> = 127). Somatic symptom severity and secondary outcomes were assessed at pre-treatment, therapy session 8, end of therapy, and 6-month follow-up. <b><i>Results:</i></b> Linear mixed-effect models revealed medium to large effects in both study arms for almost all outcomes at the end of therapy and 6-month follow-up. ENCERT and CBT did not differ in their effect on the primary outcome (<i>d</i> = 0.20, 95% CI: –0.04 to 0.44). Significant time × group cross-level interactions suggested ENCERT to be of more benefit than conventional CBT for a few secondary outcomes. Moderator analyses revealed higher effects of ENCERT in patients with co-morbid mental disorders. <b><i>Discussion/Conclusions:</i></b> Current findings are based on a representative sample. Results demonstrate that both CBT and ENCERT can achieve strong effects on primary and secondary outcomes in MUS patients. Our results do not indicate that adding a training in emotion regulation skills generally improves the effect of CBT across all patients with MUS. Large effect sizes of both treatments and potential specific benefits of ENCERT for patients with co-morbid mental disorders are discussed.

Internet-based CBT for somatic symptom distress (iSOMA) in emerging adults: A randomized controlled trial.

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Efficacy of a Psychological Single-Session Intervention in Non-Cardiac Chest Pain

“…There is evidence that CBT-based interventions of fixed or flexible 3–10 sessions are effective, though outcome results are mixed (Jonsbu, Dammen, Morken, Moum, & Martinsen, 2011; Mulder et al, 2019; Tyrer et al, 2017). With regard to content, more intense CBT enriched with emotion regulation strategies (Kleinstäuber et al, 2019) seems promising as NCCP is strongly associated with unpleasant emotions such as anxiety (Smeijers et al., 2014).…”

Network Analysis of Persistent Somatic Symptoms in Two Clinical Patient Samples

“…Comorbid diagnoses were not an exclusion criterion if SSD was the primary diagnosis (for detailed inclusion and exclusion criteria, see Refs. (51,53). Mood (n = 99; 38.98%) and anxiety disorder (n = 46; 18.11%) were the two most prevalent mental disorders.…”