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

Hennemann, Severin; Böhme, Katja; Kleinstäuber, Maria; Baumeister, Harald; Küchler, Ann-Marie; Ebert, David Daniel; Witthöft, Michael

doi:10.1037/ccp0000707

Cited by 17 publications

(5 citation statements)

References 89 publications

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Section: Discussionsupporting

confidence: 86%

“…The finding that physical disorders were associated with optimality of guided i-CBT is consistent with the suggestion in previous i-CBT trials that a human coach is useful in addressing interference related to psychosomatic distress. [31][32][33] The associations of psychiatric comorbidities with HTE expand on prior studies finding mixed evidence for psychiatric comorbidities predicting i-CBT response. [34][35][36] The important associations of bullying with HTE highlight the importance of institutionally embedded antibullying policies and the value of guided i-CBT in facilitating stress management efforts related to this salient student stressor.…”

Section: Discussionmentioning

confidence: 99%

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A Precision Treatment Model for Internet-Delivered Cognitive Behavioral Therapy for Anxiety and Depression Among University Students

et al. 2023

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ImportanceGuided internet-delivered cognitive behavioral therapy (i-CBT) is a low-cost way to address high unmet need for anxiety and depression treatment. Scalability could be increased if some patients were helped as much by self-guided i-CBT as guided i-CBT.ObjectiveTo develop an individualized treatment rule using machine learning methods for guided i-CBT vs self-guided i-CBT based on a rich set of baseline predictors.Design, Setting, and ParticipantsThis prespecified secondary analysis of an assessor-blinded, multisite randomized clinical trial of guided i-CBT, self-guided i-CBT, and treatment as usual included students in Colombia and Mexico who were seeking treatment for anxiety (defined as a 7-item Generalized Anxiety Disorder [GAD-7] score of ≥10) and/or depression (defined as a 9-item Patient Health Questionnaire [PHQ-9] score of ≥10). Study recruitment was from March 1 to October 26, 2021. Initial data analysis was conducted from May 23 to October 26, 2022.InterventionsParticipants were randomized to a culturally adapted transdiagnostic i-CBT that was guided (n = 445), self-guided (n = 439), or treatment as usual (n = 435).Main Outcomes and MeasuresRemission of anxiety (GAD-7 scores of ≤4) and depression (PHQ-9 scores of ≤4) 3 months after baseline.ResultsThe study included 1319 participants (mean [SD] age, 21.4 [3.2] years; 1038 women [78.7%]; 725 participants [55.0%] came from Mexico). A total of 1210 participants (91.7%) had significantly higher mean (SE) probabilities of joint remission of anxiety and depression with guided i-CBT (51.8% [3.0%]) than with self-guided i-CBT (37.8% [3.0%]; P = .003) or treatment as usual (40.0% [2.7%]; P = .001). The remaining 109 participants (8.3%) had low mean (SE) probabilities of joint remission of anxiety and depression across all groups (guided i-CBT: 24.5% [9.1%]; P = .007; self-guided i-CBT: 25.4% [8.8%]; P = .004; treatment as usual: 31.0% [9.4%]; P = .001). All participants with baseline anxiety had nonsignificantly higher mean (SE) probabilities of anxiety remission with guided i-CBT (62.7% [5.9%]) than the other 2 groups (self-guided i-CBT: 50.2% [6.2%]; P = .14; treatment as usual: 53.0% [6.0%]; P = .25). A total of 841 of 1177 participants (71.5%) with baseline depression had significantly higher mean (SE) probabilities of depression remission with guided i-CBT (61.5% [3.6%]) than the other 2 groups (self-guided i-CBT: 44.3% [3.7%]; P = .001; treatment as usual: 41.8% [3.2%]; P &lt; .001). The other 336 participants (28.5%) with baseline depression had nonsignificantly higher mean (SE) probabilities of depression remission with self-guided i-CBT (54.4% [6.0%]) than guided i-CBT (39.8% [5.4%]; P = .07).Conclusions and RelevanceGuided i-CBT yielded the highest probabilities of remission of anxiety and depression for most participants; however, these differences were nonsignificant for anxiety. Some participants had the highest probabilities of remission of depression with self-guided i-CBT. Information about this variation could be used to optimize allocation of guided and self-guided i-CBT in resource-constrained settings.Trial RegistrationClinicalTrials.gov Identifier: NCT04780542

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

A Precision Treatment Model for Internet-Delivered Cognitive Behavioral Therapy for Anxiety and Depression Among University Students

et al. 2023

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“…Effects were also relatively similar to other interventions which have a similar target group but do not focus as heavily on conventional exposure exercises, notable examples being acceptance and commitment therapy [ 64 , 65 ], multicomponent strains of cognitive behaviour therapy [ 66 , 67 ] and emotional awareness and expression therapy [ 68 ]. In the next few years, knowledge about treatment approaches suitable for a wide spectrum of patients who experience distress related to somatic symptoms is likely to improve, considering that several other such protocols appear to be in development [ 69 – 71 ]. We also note that in this field, there are interesting differences in the sampling method used in different trials.…”

Section: Discussionmentioning

confidence: 99%

A unified Internet-delivered exposure treatment for undifferentiated somatic symptom disorder: single-group prospective feasibility trial

Hybelius

Gustavsson

Hammarberg

et al. 2022

Pilot Feasibility Stud

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Background Exposure-based psychological treatment appears to have beneficial effects for several patient groups that commonly report distress related to persistent somatic symptoms. Yet exposure-based treatment is rarely offered in routine care. This may be because existing treatment protocols have been developed for specific symptom clusters or specific unwanted responses to somatic symptoms, and many clinics do not have the resources to offer all these specialised treatments in parallel. In preparation for a randomised controlled trial, we investigated the feasibility of a new and unified Internet-delivered exposure treatment (OSF.io: cnbwj) for somatic symptom disorder regardless of somatic symptom domain (e.g. cardiopulmonary, fatigue, gastrointestinal, pain), combination of unwanted emotions (e.g. anger, anxiety, fear, shame) and whether somatic symptoms are medically explained or not. We hypothesised that a wide spectrum of subgroups would show interest, that the treatment would be rated as credible, that adherence would be adequate, that the measurement strategy would be acceptable and that there would be no serious adverse events. Methods Single-group prospective cohort study where 33 self-referred adults with undifferentiated DSM-5 somatic symptom disorder took part in 8 weeks of unified Internet-delivered exposure treatment delivered via a web platform hosted by a medical university. Self-report questionnaires were administered online before treatment, each week during treatment, post treatment and 3 months after treatment. Results Participants reported a broad spectrum of symptoms. The Credibility/Expectancy mean score was 34.5 (SD = 7.0, range: 18–47). Participants completed 91% (150/165) of all modules and 97% of the participants (32/33) completed at least two exposure exercises. The average participant rated the adequacy of the rationale as 8.4 (SD = 1.5) on a scale from 0 to 10. The post-treatment assessment was completed by 97% (32/33), and 84% (27/32) rated the measurement strategy as acceptable. The Client Satisfaction Questionnaire mean score was 25.3 (SD = 4.7, range: 17–32) and no serious adverse events were reported. Reductions in subjective somatic symptom burden (the Patient Health Questionnaire 15; d = 0.90) and symptom preoccupation (the somatic symptom disorder 12; d = 1.17) were large and sustained. Conclusions Delivering a unified Internet-delivered exposure-based treatment protocol for individuals with undifferentiated somatic symptom disorder appears to be feasible. Trial registration ClinicalTrials.gov, NCT04511286. Registered on August 13, 2020.

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“…medical consultation, physiotherapy, medical training therapy, occupational therapy, cognitive training, individual psychotherapeutic sessions). The treatment protocol was based on an established CBT manual for SSD (Kleinstäuber, Thomas, Witthöft, & Hiller, 2018), which has been shown to effectively reduce somatic symptom distress in recent trials (Hennemann et al, 2022;Kleinstäuber et al, 2019). The suggested interventions of the treatment protocol were reviewed in advance by practitioners from PCC rehabilitation and transcribed in a study manual that was provided to the study therapists.…”

Section: Treatmentmentioning

confidence: 99%

Cognitive-behavioral therapy for patients with post-COVID-19 condition (CBT-PCC): a feasibility trial

Huth,

Bräscher,

Tholl

et al. 2023

Psychol. Med.

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Background The post-COVID-19 condition describes the persistence or onset of somatic symptoms (e.g. fatigue) after acute COVID-19. Based on an existing cognitive-behavioral treatment protocol, we developed a specialized group intervention for individuals with post-COVID-19 condition. The present study examines the feasibility, acceptance, and effectiveness of the program for inpatients in a neurological rehabilitation setting. Methods The treatment program comprises eight sessions and includes psychoeducational and experience-based interventions on common psychophysiological mechanisms of persistent somatic symptoms. A feasibility trial was conducted using a one-group design in a naturalistic setting. N = 64 inpatients with a history of mild COVID-19 that fulfilled WHO criteria for post-COVID-19 condition were enrolled. After each session, evaluation forms were completed and psychometric questionnaires on somatic and psychopathological symptom burden were collected pre- and post-intervention. Results The treatment program was well received by participants and therapists. Each session was rated as comprehensible and overall satisfaction with the sessions was high. Pre-post effect sizes (of standard rehabilitation incl. new treatment program; intention-to-treat) showed significantly reduced subjective fatigue (p < 0.05, dav = 0.33) and improved disease coping (ps < 0.05, dav = 0.33–0.49). Conclusions Our results support the feasibility and acceptance of the newly developed cognitive-behavioral group intervention for individuals with post-COVID-19 condition. Yet, findings have to be interpreted cautiously due to the lack of a control group and follow-up measurement, the small sample size, and a relatively high drop-out rate.

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

Cited by 17 publications

References 89 publications

A Precision Treatment Model for Internet-Delivered Cognitive Behavioral Therapy for Anxiety and Depression Among University Students

A Precision Treatment Model for Internet-Delivered Cognitive Behavioral Therapy for Anxiety and Depression Among University Students

A unified Internet-delivered exposure treatment for undifferentiated somatic symptom disorder: single-group prospective feasibility trial

Cognitive-behavioral therapy for patients with post-COVID-19 condition (CBT-PCC): a feasibility trial

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