Internet-based Emotional Awareness and Expression Therapy for Somatic Symptom Disorder

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.

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

10.31234/osf.io/4wx5b ◽

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.

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

Frontiers in Psychology ◽

10.3389/fpsyg.2021.712518 ◽

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.

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Historische Entwicklung, Diagnostik und Klassifikation der Somatoformen Störungen – Vergleich von ICD-10, DSM-IV-TR und DSM-5

Die Psychiatrie ◽

10.1055/s-0038-1670759 ◽

2014 ◽

Vol 11 (03) ◽

pp. 149-155

Author(s):

M. Zaudig

Keyword(s):

Anxiety Disorder ◽

Somatic Symptom ◽

Somatic Symptom Disorder ◽

Historische Entwicklung ◽

Dsm 5 ◽

Illness Anxiety Disorder ◽

Icd 10 ◽

Dsm Iv ◽

Illness Anxiety

ZusammenfassungDer vorliegende Artikel beschreibt die aktuellen diagnostischen Entwicklungen im Bereich der Somatoformen Störung unter Zugrundelegung der aktuellen S3-Leitlinien für „Nichtspezifische funktionelle und somatoforme Körperbeschwerden“ und der historischen Entwicklung der Somatoformen Störungen (einschließlich der Hypochondrie). Neben einem Vergleich von ICD-10 mit DSM-IV-TR und DSM-5 werden die neuen Kriterien für Somatic Symptom Disorder und Illness Anxiety Disorder (vormals Hypochondrie) nach DSM-5 vorgestellt und diskutiert.

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Patients who complain of autonomic dysregulation: A cross-sectional study of patients with somatic symptom disorder

International Journal of Social Psychiatry ◽

10.1177/00207640211025549 ◽

2021 ◽

pp. 002076402110255

Author(s):

Chao-Ying Tu ◽

Wei-Shih Liu ◽

Yen-Fu Chen ◽

Wei-Lieh Huang

Keyword(s):

Help Seeking ◽

Somatic Symptom ◽

Health Anxiety ◽

Cross Sectional Study ◽

Psychiatric Diagnoses ◽

Somatic Symptom Disorder ◽

Autonomic Dysregulation ◽

Cross Sectional ◽

Significant Difference ◽

Patient Health

Background: Somatic symptom disorder (SSD) is common in medical settings but has been underdiagnosed. Stigma related to psychiatric illness was one of the barriers to making the diagnosis. More and more SSD patients who visited psychiatric clinics with physical complaints identify themselves as having ‘autonomic dysregulation’ in Taiwan. Aims: This study aimed to investigate the characteristics of patients with a subjective diagnosis of ‘autonomic dysregulation’. Method: We assessed the sociodemographic profile, medical/psychiatric diagnoses, subjective psychiatric diagnoses, perceived psychiatric stigma, help-seeking attitude, and healthcare utilization of 122 participants with SSD. Participants who identified themselves as having ‘autonomic dysregulation’ ( n = 84) were compared to those who did not (n=38). Results: Participants with a subjective diagnosis of ‘autonomic dysregulation’ were younger and had a higher education level than those who did not have such a subjective diagnosis. They also had higher scores on the Patient Health Questionnaire-15 (PHQ-15) and Health Anxiety Questionnaire (HAQ), whereas comorbid psychiatric diagnoses were similar in the two groups. Participants with and without a subjective diagnosis of ‘autonomic dysregulation’ did not have a significant difference in perceived psychiatric stigma and help-seeking attitude/behaviors. In a multiple logistic regression model, only age was associated with having a subjective diagnosis of ‘autonomic dysregulation’. Conclusion: Among SSD patients, those who identify themselves as having ‘autonomic dysregulation’ tend to have higher somatic distress and health anxiety than those who do not. ‘Autonomic dysregulation’ is not associated with perceived psychiatric stigma.

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Association between Stroop tasks and heart rate variability features in patients with somatic symptom disorder

Journal of Psychiatric Research ◽

10.1016/j.jpsychires.2021.02.002 ◽

2021 ◽

Vol 136 ◽

pp. 246-255

Author(s):

Wei-Lieh Huang ◽

Shih-Cheng Liao ◽

Susan Shur-Fen Gau

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Somatic Symptom ◽

Somatic Symptom Disorder ◽

Stroop Tasks

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Impact of childhood trauma on multidimensional frailty in older patients with a unipolar depressive-, anxiety- or somatic symptom disorder

Archives of Gerontology and Geriatrics ◽

10.1016/j.archger.2021.104452 ◽

2021 ◽

pp. 104452

Author(s):

O.C. Schmahl ◽

H.W. Jeuring ◽

I. Aprahamian ◽

P. Naarding ◽

R.M. Marijnissen ◽

...

Keyword(s):

Childhood Trauma ◽

Older Patients ◽

Somatic Symptom ◽

Somatic Symptom Disorder

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Tendency of mass people to misunderstand (intentionally or not) the agony of the psychiatric patient and tormenting them as a subject of mockery with an emphasize on somatic-symptom disorder

10.31234/osf.io/t72qu ◽

2021 ◽

Author(s):

Deep Bhattacharjee

Keyword(s):

Somatic Symptom ◽

Psychiatric Treatment ◽

Somatic Symptom Disorder ◽

Physical Pain ◽

The People ◽

Pain And Suffering ◽

The Subject ◽

The Right ◽

The Mind ◽

Affected Subject

Psychiatric disorders’ or as emphasized in the paper in the form of somatic-symptom disorder, a sub-category of Schizophrenia has been from the ancient of the human civilization, when the medicinal approach and treatment of the subject hasn’t been developed yet, the notion of the affected subject to be under some spiritual subjugation has automatically been implied on the minds of the people which leads to immense torture and torment of the subject by the society. However, in the modern medical scenario, the situation has shifted from spiritual/evilness to the extreme derision where it has been already implied on the healthy societies brain that, the subject is intentionally acting like a patient or it’s a ‘disease of the mind’ with no associated physical pain which being attributed to the tendency of late diagnosis and recovery, makes the subject a sheer block of ‘sarcasm’ among the healthy society where they tries their best to make ‘the fun out of him’ as regards to his continuous pain and suffering. This generally amplified by the delay in the starting of the treatment for the difficulty of the doctors to diagnose the disease, as not so developed instruments are still in their infancy to detect and derelict the mental disorders, where in most of the time, the golden period of diagnosis is either over or even if psychiatric treatment is initiated can lead to a more defocused effects as doctors itself finds it difficult to approach the right medicine to the disordered person, where, in case, they have to go from one doctor to another in the risk of a trial and error effect.

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