Cognitive–behavioural group treatment for a range of functional somatic syndromes: Randomised trial

Schröder, Andreas; Rehfeld, Emma; Ørnbøl, Eva; Sharpe, Michael; Licht, Rasmus W; Fink, Per

doi:10.1192/bjp.bp.111.098681

Cited by 81 publications

(99 citation statements)

References 37 publications

(68 reference statements)

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“…Moreover, a current study [34] showed that the PCS in particular should be interpreted with caution in patients with severe MUS, as the PCS and MCS turned out to be negatively correlated in these patients. Finally, the improvements of patients’ physical QoL may not have been completely captured; a principal component analysis of the mentioned study showed that the SF-36 domain of vitality, which covers a key aspect of physical health [4] and was significantly improved in our trial, was more strongly associated with the PCS than with the MCS [34]. …”

Section: Discussionmentioning

confidence: 99%

“…Following a stepped care approach [1,27], the group intervention could be intended for patients with a higher degree of impairment. Two tertiary care trials (Brief Psychodynamic Interpersonal Therapy for Patients with Multisomatoform Disorder (PISO) [19] and Specialized Treatment for Severe Bodily Distress Syndromes (STreSS) [4]) targeting more severe syndromes achieved stronger intervention effects.…”

Section: Discussionmentioning

confidence: 99%

“…To date, most studies have evaluated the effect of interventions delivered in secondary and tertiary care. As an economic and effective treatment strategy, group interventions have shown promising effects in MUS [4,16,18,21,22,23,24,25,26]. Only 4 studies have investigated group interventions for primary care patients with MUS; each has found promising and beneficial outcomes [18,24,25,26].…”

Section: Introductionmentioning

confidence: 99%

“…In primary care, a broad and heterogeneous spectrum of MUS patients with a variety of bodily complaints has to be managed. To meet this need, our study follows the ‘overlap hypothesis’, adopting a unifying approach to MUS across single functional syndromes [1,2,3,4]. MUS are present in approximately 20% of primary care patients [5,6] and cause substantial patient impairment.…”

Section: Introductionmentioning

confidence: 99%

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Specific Collaborative Group Intervention for Patients with Medically Unexplained Symptoms in General Practice: A Cluster Randomized Controlled Trial

Schaefert¹,

Kaufmann²,

Wild³

et al. 2012

Psychother Psychosom

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Background: Patients with medically unexplained symptoms (MUS) are frequent in primary care and substantially impaired in their quality of life (QoL). Specific training of general practitioners (GPs) alone did not demonstrate sustained improvement at later follow-up in current reviews. We evaluated a collaborative group intervention. Methods: We conducted a cluster randomized controlled trial. Thirty-five GPs recruited 304 MUS patients (intervention group: 170; control group: 134). All GPs were trained in diagnosis and management of MUS (control condition). Eighteen randomly selected intervention GPs participated in training for a specific collaborative group intervention. They conducted 10 weekly group sessions and 2 booster meetings in their practices, together with a psychosomatic specialist. Six and 12 months after baseline, QoL was assessed with the Short-Form 36. The primary outcome was the physical composite score (PCS), and the secondary outcome was the mental composite score (MCS). Results: At 12 months, intention-to-treat analyses showed a significant between-group effect for the MCS (p = 0.023) but not for the PCS (p = 0.674). This effect was preceded by a significant reduction of somatic symptom severity (15-item somatic symptom severity scale of the Patient Health Questionnaire, PHQ-15) at 6 months (p = 0.008) that lacked significance at 12 months (p = 0.078). As additional between-group effects at 12 months, per-protocol analyses showed less health anxiety (Whiteley-7; p = 0.038) and less psychosocial distress (PHQ; p = 0.024); GP visits were significantly (p = 0.042) reduced in the intervention group. Conclusions: Compared to pure GP training, collaborative group intervention achieved a progressive, clinically meaningful improvement in mental but not physical QoL. It could bridge gaps between general practice and mental health care.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Specific Collaborative Group Intervention for Patients with Medically Unexplained Symptoms in General Practice: A Cluster Randomized Controlled Trial

Schaefert¹,

Kaufmann²,

Wild³

et al. 2012

Psychother Psychosom

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“…Given that no single treatment has proven outperform another treatment for a single subtype of somatic symptom disorders, it has been suggested that the selection and intensity of the intervention should be drawn from the severity and complexity of the disorder (Schroder et al, 2012). Three groups of antidepressants are particularly considered in pharmacological interventions relevant to somatic disorders.…”

Section: Murat Boysanmentioning

confidence: 99%

Comparison of Eye Movement Desensitization and Reprocessing (EMDR) and Duloxetine Treatment Outcomes in Women Patients with Somatic Symptom Disorder

Demirci¹,

Sağaltıcı²,

Yıldırım³

et al. 2017

Sleep Hypn

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Somatic symptom disorder (SSD) is a debilitating disorder that significantly diminishes quality of life and causes psychological distress such as anxiety and depression. The paper explored the efficiency of the eye movement desensitization and reprocessing (EMDR) therapy in SSD. The current investigation is a clinical trial investigating the effectiveness of eye movement desensitization (EMDR) therapy in the treatment of 31 first-diagnosed SSD patients in comparison to age, education and marital status matched 31-first-diagnosed SSD patients who received duloxetine over a 6-week course of treatment. Somatization subscale of the Symptom Checklist-Revised 90 (SCL-90), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Short Form Health Survey (SF-36) were administered to the participants. EMDR group showed enhanced improvement relative to baseline after 6 weeks of treatment compared to duloxetine group. We concluded that EMDR appears to be a highly promising therapy and should be considered among the first-line interventions in the treatment of SSD.

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Non-pharmacological interventions for somatoform disorders and medically unexplained physical symptoms (MUPS) in adults

Dessel

Boeft

Wouden

et al. 2014

Cochrane Database of Systematic Reviews

149

115

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When all psychological therapies included this review were combined they were superior to usual care or waiting list in terms of reduction of symptom severity, but effect sizes were small. As a single treatment, only CBT has been adequately studied to allow tentative conclusions for practice to be drawn. Compared with usual care or waiting list conditions, CBT reduced somatic symptoms, with a small effect and substantial differences in effects between CBT studies. The effects were durable within and after one year of follow-up. Compared with enhanced or structured care, psychological therapies generally were not more effective for most of the outcomes. Compared with enhanced care, CBT was not more effective. The overall quality of evidence contributing to this review was rated low to moderate.The intervention groups reported no major harms. However, as most studies did not describe adverse events as an explicit outcome measure, this result has to be interpreted with caution.An important issue was that all studies in this review included participants who were willing to receive psychological treatment. In daily practice, there is also a substantial proportion of participants not willing to accept psychological treatments for somatoform disorders or MUPS. It is unclear how large this group is and how this influences the relevance of CBT in clinical practice.The number of studies investigating various treatment modalities (other than CBT) needs to be increased; this is especially relevant for studies concerning physical therapies. Future studies should include participants from a variety of age groups; they should also make efforts to blind outcome assessors and to conduct follow-up assessments until at least one year after the end of treatment.

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Cognitive–behavioural group treatment for a range of functional somatic syndromes: Randomised trial

Abstract: In the management of functional somatic syndromes, a cognitive-behavioural group treatment was more effective than enhanced usual care.

Cited by 81 publications

References 37 publications

Specific Collaborative Group Intervention for Patients with Medically Unexplained Symptoms in General Practice: A Cluster Randomized Controlled Trial

Specific Collaborative Group Intervention for Patients with Medically Unexplained Symptoms in General Practice: A Cluster Randomized Controlled Trial

Comparison of Eye Movement Desensitization and Reprocessing (EMDR) and Duloxetine Treatment Outcomes in Women Patients with Somatic Symptom Disorder

Non-pharmacological interventions for somatoform disorders and medically unexplained physical symptoms (MUPS) in adults

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