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.

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.

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

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.

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 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.

Using the Patient Health Questionnaire to estimate prevalence and gender differences of somatic symptoms and psychological co-morbidity in a secondary inpatient population with abdominal pain

2021 ◽  
pp. 000486742110446
Author(s):  
Melissa Stieler ◽  
Peter Pockney ◽  
Cassidy Campbell ◽  
Vaisnavi Thirugnanasundralingam ◽  
Lachlan Gan ◽  
...  
Keyword(s):  
Gender Differences ◽  
Abdominal Pain ◽  
Somatic Symptom ◽  
Somatic Symptoms ◽  
Patient Health Questionnaire ◽  
Health Questionnaire ◽  
Cut Points ◽  
Co Morbidity ◽  
Female Predominance ◽  
Patient Health

Background: Somatic disorders and somatic symptoms are common in primary care populations; however, little is known about the prevalence in surgical populations. Identification of inpatients with high somatic symptom burden and psychological co-morbidity could improve access to effective psychological therapies. Methods: Cross-sectional analysis ( n = 465) from a prospective longitudinal cohort study of consecutive adult admissions with non-traumatic abdominal pain, at a tertiary hospital in New South Wales, Australia. We estimated somatic symptom prevalence with the Patient Health Questionnaire-15 at three cut-points: moderate (⩾10), severe (⩾15) and ‘bothered a lot’ on ⩾3 symptoms; and psychological co-morbidity with the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 at standard (⩾10) cut-points. We also examined gender differences for somatic symptoms and psychological co-morbidity. Results: Prevalence was moderate (52%), female predominance (odds ratio = 1.71; 95% confidence interval = [1.18, 2.48]), severe (20%), no gender difference (1.32; [0.83, 2.10]) and ‘bothered a lot’ on ⩾3 symptoms (53%), female predominance (2.07; [1.42, 3.03]). Co-morbidity of depressive, anxiety and somatic symptoms ranged from 8.2% to 15.9% with no gender differences. Conclusion: Somatic symptoms were common and psychological triple co-morbidity occurred in one-sixth of a clinical population admitted for abdominal pain. Co-ordinated surgical and psychological clinical intervention and changes in clinical service organisation may be warranted to provide optimal care.

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.

A comprehensive study of oxidative stress in patients with somatic symptom disorder

2018 ◽  
Vol 31 (2) ◽  
pp. 100-105
Author(s):  
Esra Kabadayi Sahin ◽  
Ali Caykoylu ◽  
Almila Senat ◽  
Ozcan Erel
Keyword(s):  
Oxidative Stress ◽  
Somatic Symptom ◽  
Total Antioxidant Status ◽  
Stress Index ◽  
Control Group ◽  
Somatic Symptom Disorder ◽  
Oxidative Balance ◽  
Significant Difference ◽  
Patient Health ◽  
Total Antioxidant

AbstractObjectiveTo investigate oxidative stress parameters [total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI), paraoxonase (PON), arylesterase (ARE) and thiol-disulphide homeostasis] in patients who were diagnosed as having somatic symptom disorder in accordance with Diagnostic and Statistical Manual of Mental Disorders-5.MethodsThe study included 41 medication-free patients with somatic symptom disorder and 47 age, sex, and sociodemographic-matched healthy individuals. The patients were administered the Patient Health Questionnaire-15, Somatic Symptom Amplification Scale, Beck Depression Inventory, and Beck Anxiety Inventory. TOS, TAS, OSI, PON, ARE thiol, disulphide levels, and routine biochemical parameters were compared between the two groups.ResultsTOS, OSI, disulphide levels, disulphide/native thiol, and disulphide/total thiol ratios were found significantly higher in the patient group compared with the control group (p < 0.001). There was no significant difference in PON, ARE, and TAS parameters between the two groups (p > 0.05).ConclusionThis study showed that the level of oxidants increased and oxidative balance was impaired in somatic symptom disorder. Oxidative stress may play a role in the aetiopathogenesis of this disorder. This is the first study to report an association between oxidative stress and somatic symptom disorder.

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