Internet-based Emotional Awareness and Expression Therapy for Somatic Symptom Disorder - A Preliminary Efficacy Trial

2020 ◽  
Author(s):  
Daniel Maroti ◽  
Josefine Ek ◽  
Rose-Marie Widlund ◽  
Howard Schubiner ◽  
Mark Lumley ◽  
...  
Keyword(s):  
Emotional Processing ◽  
Somatic Symptom ◽  
Controlled Trial ◽  
Treatment Protocol ◽  
Somatic Symptoms ◽  
Emotional Awareness ◽  
The Internet ◽  
Somatic Symptom Disorder ◽  
Efficacy Trial ◽  
Group Reduction

Background and Aims: This study investigated the feasibility of an Internet-delivered Emotional Awareness and Expression Therapy (I-EAET) for adult patients with somatic symptom disorder (SSD). Although EAET for SSD has been shown to be effective in both individual and group format using RCTs, no trial of an internet-delivered EAET exists. Therefore a preliminary, uncontrolled feasibility and efficacy trial of I-EAET for SSD was conducted. Methods: 124 patients registered to participate, and a structured psychiatric assessment to judge suitability for the treatment was conducted for all patients. A total of 52 patients (50 women, 2 men) were included and initiated treatment. Mean age was 49.6 (SD 11.9). The internet-based treatment protocol consisted of nine modules, which were adapted and translated from the self-help book, Unlearn your Pain by Schubiner. Seven therapists (primarily psychology students) communicated with patients over the internet. Every therapist spent approximately 20 minutes per patient per week to answer question and giving feedback on home-work assignments. Treatment lasted nine weeks. Patients completed measures of somatic symptoms, depression, anxiety, trauma related symptoms, and emotional processing before treatment and again at post-treatment.Results: A large within-group reduction in somatic symptoms (PHQ-15) was observed (d = 1.12; 95% CI: 0.77-1.46). Small to moderate magnitude reductions in anxiety (GAD-7), depression (PHQ-9), trauma related symptoms (PCL-5), and dysfunctional emotional processing (EPS-25) occurred. Almost one-quarter of the sample (23.1 %) achieved a 50 % or greater reduction in somatic symptoms. The treatment also significantly increased patient’s ability to take part in social and family life (Sheehan Disability Scale).Conclusions: I-EAET appears to be a feasible treatment for adults with SSD. Results seems similar or even larger than those obtained in RCTs of EAET delivered face-to-face. A controlled trial is needed determine the effects of I-EAET specifically, and whether this approach might be superior to other internet-delivered treatments. Research should also identify treatment responders and mechanisms of change in EAET.

scholarly journals Internet-Administered Emotional Awareness and Expression Therapy for Somatic Symptom Disorder With Centralized Symptoms: A Preliminary Efficacy Trial

2021 ◽  
Vol 12 ◽  
Author(s):  
Daniel Maroti ◽  
Josefine Ek ◽  
Rose-Marie Widlund ◽  
Howard Schubiner ◽  
Mark A. Lumley ◽  
...  
Keyword(s):  
Somatic Symptom ◽  
Functional Disability ◽  
Psychiatric Symptoms ◽  
Somatic Symptoms ◽  
Emotional Awareness ◽  
Post Treatment ◽  
Somatic Symptom Disorder ◽  
Efficacy Trial ◽  
Face To Face

Background: There is growing evidence that trauma, psychosocial conflict, and difficulties with emotional processing contribute to centralized somatic symptoms. Emotional Awareness and Expression Therapy (EAET) was developed to address these factors and reduce symptoms, and EAET has shown efficacy in face-to-face formats. No trial of an internet-delivered EAET (I-EAET) exists, however, so we developed such an intervention and conducted an uncontrolled feasibility and potential efficacy trial of I-EAET for patients with Somatic Symptom Disorder (SSD) with centralized symptoms (SSD-CS).Method: After screening potential participants, a sample of 52 patients (50 women, two men; age M = 49.6, SD = 11.9) diagnosed with SSD-CS initiated treatment. I-EAET consisted of nine weekly modules focused on psychoeducation, emotional awareness and exposure, and anxiety regulation with self-compassion. Therapists communicated with each patient by email for about 20 min per week during treatment, answering questions and giving feedback on homework assignments. Patients completed measures of somatic symptoms, depression, anxiety, trauma-related symptoms, and functional disability before treatment and again at post-treatment and 4-month follow-up.Results: A large reduction in somatic symptoms (PHQ-15) occurred pre-to post-treatment (d = 1.13; 95% CI: 0.84–1.47) which was fully maintained at 4-month follow-up (d = 1.19; 95% CI: 0.88–1.56). Twenty-three percent of the patients at post-treatment and 27% at follow-up achieved a 50% or greater reduction in somatic symptoms, and about 70% achieved a minimally important clinical difference. In addition, at post-treatment, there were small to medium reductions (d's from 0.33 to 0.72) in anxiety (GAD-7), depression (PHQ-9), trauma-related symptoms (PCL-5), and functional disability (Sheehan Disability Scale). For all of these secondary outcomes, improvements were slightly to substantially larger at follow-up than at post-treatment (d's from 0.46 to 0.80).Conclusion: I-EAET appears to be a feasible treatment for adults with SSD and centralized symptoms, resulting in substantial and durable improvement not only in somatic symptoms but in other psychiatric symptoms and functioning. Controlled trials are needed determine the effects of I-EAET specifically and how this approach compares to face-to-face EAET and to other internet-delivered treatments, such as cognitive-behavioral interventions. Research should also identify treatment responders and mechanisms of change in EAET.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT04122846.

scholarly journals Emotional Processing and Its Association to Somatic Symptom Change in Emotional Awareness and Expression Therapy for Somatic Symptom Disorder: A Preliminary Mediation Investigation

2021 ◽  
Vol 12 ◽  
Author(s):  
Daniel Maroti ◽  
Brjánn Ljótsson ◽  
Mark A. Lumley ◽  
Howard Schubiner ◽  
Henrik Hallberg ◽  
...  
Keyword(s):  
Emotional Processing ◽  
Somatic Symptom ◽  
Emotional Experience ◽  
Somatic Symptoms ◽  
Emotional Awareness ◽  
Symptom Change ◽  
Somatic Symptom Disorder ◽  
Mediation Analyses ◽  
Patient Health ◽  
Using Data

Objective: The aim of this study was to investigate emotional processing as a potential mediator in therapist-guided, internet-based Emotional Awareness and Expression Therapy (I-EAET) for somatic symptom disorder, using data from a previously published pilot study.Methods: Participants (N = 52) engaged in a 9-week I-EAET treatment. Before treatment and each week during treatment (i.e., 10 weekly measurements), emotional processing was assessed with the Emotional Processing Scale-25 (EPS-25), which contains five subscales, and somatic symptoms were assessed with the Patient Health Questionnaire-15 (PHQ-15).Results: Mediation analyses using linear mixed models showed that two EPS-25 subscales—Signs of Unprocessed Emotions and Impoverished Emotional Experience—were uniquely associated with somatic symptom reduction. The proportion of the mediated effect was 0.49, indicating that about half of the total association of the PHQ-15 with symptoms was accounted for by the two EPS-25 subscales.Conclusion: This preliminary mediation analysis suggests that improved emotional processing is associated with change in somatic symptoms in I-EAET. However, randomized controlled and comparison trials are needed to establish that I-EAET creates the change in emotional processing and that such changes are specific to I-EAET.

scholarly journals Exposure-based cognitive–behavioural therapy via the internet and as bibliotherapy for somatic symptom disorder and illness anxiety disorder: randomised controlled trial

2016 ◽  
Vol 209 (5) ◽  
pp. 407-413 ◽  
Author(s):  
Erik Hedman ◽  
Erland Axelsson ◽  
Erik Andersson ◽  
Mats Lekander ◽  
Brjánn Ljótsson
Keyword(s):  
Somatic Symptom ◽  
Controlled Trial ◽  
Behavioural Therapy ◽  
Somatic Symptom Disorder ◽  
Dsm 5 ◽  
Internet Treatment ◽  
Cognitive Behavioural ◽  
Illness Anxiety Disorder ◽  
Illness Anxiety ◽  
Randomised Controlled

BackgroundIn DSM-5 two new diagnoses, somatic symptom disorder (SSD) and illness anxiety disorder (IAD), have replaced DSM-IV hypochondriasis. There are no previous treatment studies for these disorders. Cognitive–behavioural therapy (CBT) delivered as therapist-guided or unguided internet treatment or as unguided bibliotherapy could be used to increase treatment accessibility.AimsTo investigate the effect of CBT delivered as guided internet treatment (ICBT), unguided internet treatment (U-ICBT) and as unguided bibliotherapy.MethodA randomised controlled trial (RCT) where participants (n= 132) with a diagnosis of SSD or IAD were randomised to ICBT, U-ICBT, bibliotherapy or to a control condition on a waiting list (trial registration: Clinicaltrials.gov identifier NCT01966705).ResultsCompared with the control condition, all three treatment groups made large and significant improvements on the primary outcome Health Anxiety Inventory (between-groupdat post-treatment was 0.80–1.27).ConclusionsICBT, U-ICBT and bibliotherapy can be highly effective in the treatment of SSD and IAD. This is the first study showing that these new DSM-5 disorders can be effectively treated.

scholarly journals Loneliness and Mental Health: The Mediating Effect of Perceived Social Support

2021 ◽  
Vol 18 (22) ◽  
pp. 11963
Author(s):  
Elody Hutten ◽  
Ellen M. M. Jongen ◽  
Anique E. C. C. Vos ◽  
Anja J. H. C. van den Hout ◽  
Jacques J. D. M. van Lankveld
Keyword(s):  
Mental Health ◽  
Social Support ◽  
Social Connectedness ◽  
Somatic Symptom ◽  
Somatic Symptoms ◽  
Mediating Effect ◽  
Somatic Symptom Disorder ◽  
Physical And Mental Health ◽  
Anxiety Depression ◽  
The Relationship

Social connectedness is a fundamental human need. The Evolutionary Theory of Loneliness (ETL) predicts that a lack of social connectedness has long-term mental and physical health consequences. Social support is a potential mechanism through which loneliness influences health. The present cross-sectional study examined the relationship between loneliness and mental health, and the mediating effects of social support in a Dutch adult sample (N = 187, age 20 to 70). The health variables included in the study are anxiety, depression, somatic symptoms as measured by the SCL-90, and the DSM-5 diagnosis somatic symptom disorder. The results indicated that social support partially mediated the relationship between loneliness and anxiety, depression, and somatic symptoms. These results indicate that social support partially explains the relationship between loneliness and physical and mental health issues. The relationship between loneliness and being diagnosed with somatic symptom disorder was not mediated by social support. This suggests that the mechanisms through which loneliness relates to either somatic symptoms or somatic symptom disorder are different.

Somatic symptom and related disorders

2015 ◽  
pp. 226-232
Author(s):  
Martin Brüne
Keyword(s):  
Somatic Symptom ◽  
Somatic Symptoms ◽  
Somatic Complaints ◽  
Conscious Awareness ◽  
Factitious Disorder ◽  
Somatic Symptom Disorder ◽  
Illness Anxiety Disorder ◽  
Somatic Illness ◽  
Illness Anxiety ◽  
Somatic Symptom Disorders

Somatic symptom disorders are characterized by the presentation of somatic complaints (somatization), often, but not necessarily, in the absence of a medical explanation of these sensations. The level of concern is generally disproportionate in relation to the severity of the somatic illness. Behaviourally, somatic symptom disorder entails signals that call for help and attention from others. Evolutionary considerations of why people present with somatic symptoms in the absence of a medical cause suggest that this behaviour could reflect a strategy to manipulate others in order to evoke care. Signals that aim at eliciting care from others are more persuasive if the ‘real’ intention is hidden from conscious awareness. Thus, self-deception may be involved in the presentation of somatic symptoms. Within the spectrum of somatic symptom and related disorders, the degree of self-deception may vary from high, as in illness anxiety disorder, to relatively low, as in factitious disorder.

scholarly journals Efficacy of a guided internet-based intervention (iSOMA) for somatic symptoms and related distress in university students: study protocol of a randomised controlled trial

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e024929 ◽  
Author(s):  
Severin Hennemann ◽  
Katja Böhme ◽  
Harald Baumeister ◽  
Eileen Bendig ◽  
Maria Kleinstäuber ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
University Students ◽  
Somatic Symptom ◽  
Controlled Trial ◽  
Somatic Symptoms ◽  
Symptom Burden ◽  
Control Group ◽  
Age Cohorts ◽  
Randomised Controlled ◽  
Internet Based Intervention

IntroductionPersistent and distressing somatic symptoms are common in younger age cohorts such as university students. However, the majority does not receive adequate psychosocial care. Internet-based and mobile-based interventions may represent low threshold and effective extensions to reduce somatic and associated mental symptom severity. The planned study aims to investigate the feasibility and efficacy of an internet-based intervention in reducing somatic and psychological symptoms in an international population of university students with somatic symptom burden.Methods and analysisThis parallel two-armed randomised controlled trial evaluates an 8-week guided intervention, including web-based consecutive modules based on cognitive behavioural therapy (CBT) principles against a waitlist control group. Guidance will be provided by trained psychologists with weekly written supportive feedback. As part of the ‘Studicare’ project, the present study aims to recruit n=154 university students indicating somatic symptom burden at baseline in German-speaking universities. Self-report assessments will take place at baseline and after intervention completion (8, 16 weeks after randomisation). The primary outcome will be the severity of somatic symptoms and associated mental distress. Secondary outcomes include depression, (health) anxiety, disability, intervention satisfaction and adherence.Ethics and disseminationEthics approval has been granted. Results from this study will be published in peer-reviewed journals and presented at international conferences.Trial registration numberDRKS00014375; Pre-results.

scholarly journals Case Report: Somatic Symptoms Veiling Gender Dysphoria in an Adolescent

2021 ◽  
Vol 9 ◽  
Author(s):  
Giuliana Morabito ◽  
Dora Cosentini ◽  
Gianluca Tornese ◽  
Giulia Gortani ◽  
Serena Pastore ◽  
...  
Keyword(s):  
Mental Health ◽  
Diagnostic Tests ◽  
Gender Dysphoria ◽  
Somatic Symptom ◽  
Somatic Symptoms ◽  
Hospital Services ◽  
Somatic Symptom Disorder ◽  
Case Presentation ◽  
Psychosocial Impairment ◽  
History Of

Background: Somatic symptom disorder is common in children and adolescents; usually, it is an expression of a mental health problem or other conditions that lead to psychosocial impairment and suffering. Among these, in pubertal age, gender dysphoria should be considered.Case Presentation: We present the case of a 15-year-old girl admitted to the hospital because of a 2-month history of scattered arthralgia and myalgia, headache, and fatigue, with repeated visits to the emergency room. The physical exam was unremarkable, except for step walking and pain. Repeated diagnostic tests were normal, and consecutive psychological interviews disclosed intense suffering due to a gender incongruence. Referral to the hospital gender service was offered and refused by the parents.Conclusions: In pubertal age, gender dysphoria may be expressed through somatoform symptoms. Diagnosis is challenging to accept for the parents even in the presence of adequate multi-disciplinary hospital services.

Présent et avenir des troubles somatoformes

2015 ◽  
Vol 30 (S2) ◽  
pp. S40-S41
Author(s):  
C. Lemogne
Keyword(s):  
Somatic Symptom ◽  
Somatic Symptoms ◽  
Prise En Charge ◽  
Somatic Symptom Disorder ◽  
Dsm V ◽  
Dsm Iv ◽  
Troubles Somatoformes

Dans le DSM-IV, les « troubles somatoformes » étaient définis négativement par la présence de symptômes somatiques « médicalement inexpliqués ». Cette appellation a disparu du DSM-V au profit des somatic symptoms and related disorders. Les troubles somatisation, douloureux, somatoforme indifférencié et l’hypocondrie, lorsqu’elle est associée à des symptômes somatiques, sont regroupés sous l’appellation unique de somatic symptom disorder. Ce trouble est désormais défini positivement par la présence de pensées, émotions ou comportements « excessifs ou inappropriés », à l’origine d’un retentissement fonctionnel ou d’une souffrance subjective et accompagnant des symptômes somatiques ayant, ou non, une cause somatique identifiée. Les raisons de ce changement sont le recouvrement diagnostique des anciennes catégories, leur non-utilisation par les somaticiens, le risque de stigmatisation et le caractère intenable d’une conception dualiste des rapports corps-esprit. La notion de symptômes « médicalement inexpliqués » demeure néanmoins centrale dans la conversion, renommée « trouble neurologique fonctionnel ». Plusieurs études d’imagerie cérébrales fonctionnelles portant sur un petit nombre de patients présentant un déficit moteur unilatéral ont tenté d’élucider la physiopathologie de ce trouble. Certains résultats semblent reproductibles : hyperactivation et hypo-activation controlatérales respectivement des cortex cingulaire antérieur et moteur primaire. Ces résultats ont servi de rationnel à l’utilisation thérapeutique de la stimulation magnétique transcrânienne. L’hypocondrie sans symptômes somatiques devient dans le DSM-V « l’anxiété pour la santé », caractérisée par la crainte excessive d’avoir ou de développer une maladie. La prise en charge est souvent difficile et peut renforcer les symptômes si elle est inappropriée. Plusieurs études ont montré l’efficacité des thérapies cognitives et comportementales, basées sur la restructuration cognitive et l’extinction des comportements d’évitement, ainsi que des thérapies basées sur la pleine conscience. Compte tenu du lien fréquent entre pensées intrusives et souvenirs douloureux, la valeur ajoutée d’une thérapie des schémas est vraisemblable.

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