Psychotherapy in Peptic Ulcer Disease

Abstract

Psychotherapy in Peptic Ulcer Disease. A controlled outcome study. By Ingemar Sjödin, Department o f Psychiatry, Sahlgren's Hospital, Göteborg, Sweden. Thesis defended 20th May 1983. Problem. Although the peptic ulcer disease (PUD) has long had the post on of a psychosomatic disorder, the approach to treatment has been principally somatic. Many PUD‐patients are not helped sufficiently by medical treatment alone. The purpose was to study the significance of a psychosomatic mode of treatment in respect of effect, mechanisms of therapeutic action and prognostic variables. Methods. Short‐term psychotherapy administrated in one‐hour weekly sessions with a limit of ten added to medical treatment was compared to medical treatment only by randomizing PUD‐outpatients into two treatment groups consisting of 50 and 53 patients respectively. Assessments were made by independent raters and self‐ratings before intake, after the three months treatment course and at follow up after 15 months. Changes in the severity of symptoms, social dysfunction and the mode of handling of problems focused in the therapy were the main criteria of outcome. Results. There were only two droup‐outs. The patients in both groups improved somatically and mentally during treatment to a similar extent, except for pain, dyspepsia and self‐rated social maladjustment where the psychotherapy group was superior. At follow up there was a significant difference in favour of the psychotherapy group in most symptoms, coping ability, self‐confidence and belief in own capacity to resolve the problems. Globally rated, 42 per cent had improved in the psychotherapy group vs 28 per cent in the control group. The ability to cope with problems was improved in 58 per cent vs 28 per cent. Confounding factors such as use of drugs, smoking and drinking habits, treatment outside the programme and exposure to life events could not account for the different outcome. Due to alexithymic personality traits, in more than half of the patients the psychotherapy had to develop through phases of symptom‐orientation and support before conflicts could be focused, but in about one third the psychotherapy could be conflict‐oriented from the start. Conclusions. The findings are in agreement with a psychosomatic approach according to which treatment is more effective if it covers both somatic and psychological aspects of a disorder. Psychsomatic treatment of PUD, of the type described in this study, may be given in primary care and be supervised by psychiatrists.

Short-Term Psychodynamic Psychotherapy for Somatic Disorders

“…Despite known bacteriological causes of ulcer, Sjodin [23] found that STPP brought sustained gains compared to medical treatment as usual in ulcer patients.…”

“…Two trials reported trends toward reduced surgical procedures in ulcer disease [23] (p = 0.07) and in Crohn’s disease [33], where 15% of the STPP patients vs. 26% of the controls required surgery (p = 0.27).…”

“…We did not include data from a 15th study [23] as this was a report on peptic ulcer from 1983, i.e. before the introduction of triple therapy for the eradication of Helicobacter pylori .…”

A meta-analysis of psychodynamic psychotherapy outcomes: Evaluating the effects of research-specific procedures.

“…Twenty-three studies were excluded because the criterion of randomized design was not fulfilled. Seven studies were excluded because the necessary data to enable effect size calculation were not available (Baldoni et al, 1995;Creed et al, 2003;Guthrie, Creed, Dawson, & Tomenson, 1993;Morris, 1975;Piper, Azim, McCallum, & Joyce, 1990;Sjodin, 1983;Svedlund, Sjodin, Ottosson, & Dotevall, 1983). Hardy et al (1995) was excluded because data were reported on a subsample of Shapiro et al (1994).…”

Psychodrama Group Therapy for Patients with Functional Gastrointestinal Disorders – a Controlled Long-Term Follow-Up Study

“…Therefore, psychotherapy ought to be a logi cal component of therapy in many cases of functional gastrointestinal disorder. Individ ual short-term goal-oriented psychotherapy has been performed in such cases, and a con trolled evaluation with follow-up of symp tom development after a year showed that this therapy was more successful than medi cal routine therapy [2,3], A question that has not been explored previously is whether group therapy could be valuable in these cases. The group setting has certain advan-tages in comparison to individual therapy.…”