Short-Term Psychotherapeutic Interventions for Somatizing Patients in the General Hospital: A Randomized Controlled Study

Abstract

Background: Treatment acceptance and motivation for psychotherapy of somatizing patients in the general hospital is low. Methods: Patients (n = 91) fulfilling the criteria for somatization were randomized into an intervention group (n = 49) and a control group (n = 42). The patients in the intervention group attended 5 psychotherapeutic sessions based on the modified reattribution model. The patients in the control group received psychoeducational reading material. The primary outcomes were motivation for psychotherapy and contacting a psychotherapist after discharge. The secondary outcomes consisted of changes regarding somatoform symptoms, emotional distress and quality of life. Results: Patients from the intervention group were significantly more motivated for psychotherapy (p = 0.001) than patients from the control group. At the 3-month follow-up, 42% of the patients from the intervention group had contacted a psychotherapist, compared to 20% of the patients from the control group (p = 0.045). At the 6-month follow-up, however, the ratio of patients having contacted a psychotherapist had changed to 44 and 29%, respectively, and was no longer significant. The intensity of somatoform symptoms and the anxiety symptoms decreased and mental functioning improved significantly over time for patients from both groups. Conclusions: Short-term psychotherapeutic interventions for somatizing patients in general hospitals have a moderately better effect on motivation for psychotherapy and contacting a psychotherapist than psychoeducational reading material alone. Future studies should attempt to prove the effectiveness of short-term psychoeducational interventions for somatizing patients in the general hospital.

Training General Practitioners in the Treatment of Functional Somatic Symptoms: Effects on Patient Health in a Cluster-Randomised Controlled Trial (the Functional Illness in Primary Care Study)

“…Patients with FSS may be treated effectively with psychotherapy provided by specialists [13,14,15,16]. However, for capacity reasons and because early intervention could be more cost-effective and prevent chronification of the condition, pragmatic primary care trials with GPs as therapists are needed [17].…”

Developmental Influences on Medically Unexplained Symptoms

“…If some of the MUS turn out to have developmental origins, these drugs may be appropriate to consider for their therapeutic potential in these patients. This hypothesis also may explain the effectiveness of such ‘central’ approaches to therapy as tricyclic antidepressants (which among other actions attenuate catecholaminergic output) [75,76,77,78], hypnosis [79, 80], effective doctor–patient communication [81], use of psychiatrists as consultants in the general practice setting [82], and various other psychological approaches to treatment [2,83,84,85,86,87,88] that might reduce the perception of threat in amenable patients. We also have successfully used an ‘environmental’ approach to therapy for cats with FIC [89]; EMGEX is one candidate mechanism for the effects of environmental enrichment [90].…”

Cognitive-Behavioral Therapy, Psychotherapy and Psychosocial Interventions in the Medically Ill

“…Psychotherapy may not be accepted well among these patients, either. As Schweickhardt et al [1] reminded us recently, patients with somatizing behavior ‘by definition have no psychological attribution to the symptoms’, and thus treatment acceptance and motivation for psychotherapy is low. Another factor complicating the use of psychotherapy and its outcome in this population is alexithymia.…”

“…Some of the interventions – e.g. the short-term psychotherapeutic intervention for somatizing patients in general hospitals prior to referral for outpatient psychosocial intervention suggested by Schweickhardt et al [1] – could probably be used uniformly.…”

“…Maybe a similar sequential paradigm – the short-term preparatory psychotherapeutic intervention proposed by Schweickhardt et al [1] and/or motivational interviewing, followed by psychotherapy (CBT), behavioral conditioning for medication and finally medication itself – could be tested for treatment of some medical diseases, so-called psychosomatic disorders and/or psychological symptoms of medical illness. Interestingly, motivational interviewing has been used, in addition to the management of alcohol and other substance abuses, in the management of eating and weight disorders either alone [21] or in combination with CBT [22], chronic heart failure [23] and in health coaching [24].…”