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.

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.

Psychological Interventions for Health Anxiety and Somatic Symptoms

2020 ◽  
Vol 228 (2) ◽  
pp. 68-80 ◽  
Author(s):  
Ulrike Maass ◽  
Franziska Kühne ◽  
Jana Maas ◽  
Maria Unverdross ◽  
Florian Weck
Keyword(s):  
Somatic Symptom ◽  
Health Anxiety ◽  
Somatic Symptoms ◽  
Risk Of Bias ◽  
Post Treatment ◽  
Psychological Interventions ◽  
Treatment As Usual ◽  
Illness Anxiety Disorder ◽  
Illness Anxiety

Abstract. This study examined the effectiveness of psychological interventions for severe health anxiety (SHA) regarding somatic symptoms (SS) and health anxiety (HA). The databases Web of Science, EBSCO, and CENTRAL were searched on May 15, 2019, May 16, 2019, and August 5, 2019, respectively. Eighteen randomized controlled trials ( N = 2,050) met the inclusion criteria (i.e., hypochondriasis, illness anxiety disorder or somatic symptom disorder with elevated HA being assessed with validated interviews; use of standardized outcome measures). Two reviewers independently evaluated the studies’ risk of bias using the Revised Cochrane Risk-of-Bias Tool for randomized trials (RoB-2) tool. Overall, psychological interventions were significantly more effective than waitlist, treatment-as-usual, or placebo post-treatment ( gSS = 0.70, gHA = 1.11) and at follow-up ( gSS = 0.33, gHA = 0.70). CBT outperformed other psychological interventions or pharmacotherapy for HA post-treatment (Hedge’s  gHA = 0.81). The number of sessions did not significantly predict the effect sizes. In sum, psychological interventions were effective for SHA, but the generalizability of the results for SS is limited, because only two high-quality trials contributed to the comparisons.

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.

Emotional Awareness and Expression Therapy Achieves Greater Pain Reduction than Cognitive Behavioral Therapy in Older Adults with Chronic Musculoskeletal Pain: A Preliminary Randomized Comparison Trial

Pain Medicine ◽  
2020 ◽  
Vol 21 (11) ◽  
pp. 2811-2822
Author(s):  
Brandon C Yarns ◽  
Mark A Lumley ◽  
Justina T Cassidy ◽  
W Neil Steers ◽  
Sheryl Osato ◽  
...  
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Musculoskeletal Pain ◽  
Behavioral Therapy ◽  
Emotional Awareness ◽  
Pain Reduction ◽  
Post Treatment ◽  
Chronic Musculoskeletal Pain ◽  
Comparison Trial ◽  
Secondary Outcomes

Abstract Objective Emotional awareness and expression therapy (EAET) emphasizes the importance of the central nervous system and emotional processing in the etiology and treatment of chronic pain. Prior trials suggest EAET can substantially reduce pain; however, only one has compared EAET with an established alternative, demonstrating some small advantages over cognitive behavioral therapy (CBT) for fibromyalgia. The current trial compared EAET with CBT in older, predominately male, ethnically diverse veterans with chronic musculoskeletal pain. Design Randomized comparison trial. Setting Outpatient clinics at the West Los Angeles VA Medical Center. Subjects Fifty-three veterans (mean age = 73.5 years, 92.4% male) with chronic musculoskeletal pain. Methods Patients were randomized to EAET or CBT, each delivered as one 90-minute individual session and eight 90-minute group sessions. Pain severity (primary outcome), pain interference, anxiety, and other secondary outcomes were assessed at baseline, post-treatment, and three-month follow-up. Results EAET produced significantly lower pain severity than CBT at post-treatment and follow-up; differences were large (partial η2 = 0.129 and 0.157, respectively). At post-treatment, 41.7% of EAET patients had >30% pain reduction, one-third had >50%, and 12.5% had >70%. Only one CBT patient achieved at least 30% pain reduction. Secondary outcomes demonstrated small to medium effect size advantages of EAET over CBT, although only post-treatment anxiety reached statistical significance. Conclusions This trial, although preliminary, supports prior research suggesting that EAET may be a treatment of choice for many patients with chronic musculoskeletal pain. Psychotherapy may achieve substantial pain reduction if pain neuroscience principles are emphasized and avoided emotions are processed.

scholarly journals Adolescents’ Pain Coping Profiles: Expectations for Treatment, Functional Outcomes and Adherence to Psychological Treatment Recommendations

2011 ◽  
Vol 16 (3) ◽  
pp. 192-196 ◽  
Author(s):  
Robyn Lewis Claar ◽  
Laura E Simons
Keyword(s):  
Functional Disability ◽  
Psychological Treatment ◽  
Somatic Symptoms ◽  
Treatment Recommendations ◽  
Pain Clinic ◽  
Pain Coping ◽  
Significant Group ◽  
Pain Clinics ◽  
School Absences

OBJECTIVES: To explore how adolescents’ pain coping profiles relate to their expectations regarding psychological treatment recommendations, and to examine patients’ functioning and engagement in psychological treatment three months following a multidisciplinary pain clinic evaluation.METHODS: Adolescents and their parents completed measures of pain coping strategies, treatment expectations, pain ratings, somatic symptoms, school absences and functional disability. Parents also reported whether patients followed through with psychological treatment recommendations.RESULTS: Adaptive copers and their parents were more likely to expect psychological treatments to be helpful; however, at follow-up, there were no significant group differences in patients’ participation in psychological treatment. Patients in both groups experienced significantly lower levels of somatic symptoms and functional disability, and had fewer school absences from the initial evaluation to the follow-up.DISCUSSION: The results of the present study identify preliminary clinical implications for the way in which practitioners in multidisciplinary pain clinics present recommendations for psychological treatment to patients and their families.

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 0532 Cognitive Behavioral Therapy Delivered Via Telemedicine vs. Face-to-Face: Results from a Randomized Controlled Non-Inferiority Trial

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A203-A204
Author(s):  
J Arnedt ◽  
D Conroy ◽  
A Mooney ◽  
K DuBuc ◽  
S Balstad ◽  
...  
Keyword(s):  
Behavioral Therapy ◽  
Severity Index ◽  
Healthcare Services ◽  
Post Treatment ◽  
Self Report ◽  
Daytime Functioning ◽  
Face To Face ◽  
Randomized Controlled ◽  
Pre Treatment

Abstract Introduction Telemedicine is increasingly an option for delivery of healthcare services, but its efficacy and acceptability for delivering CBT for insomnia has not been adequately tested. In a randomized controlled non-inferiority trial, we compared face-to-face and telemedicine delivery (via the AASM SleepTM platform) of CBT for insomnia for improving sleep and daytime functioning at post-treatment and 12-week follow-up. Methods Sixty-five adults with chronic insomnia (46 women, mean age 47.2 ± 16.3 years) were recruited primarily from insomnia clinics and screened for disqualifying sleep, medical, and mental health disorders. Eligible participants were randomized to 6 sessions of CBT for insomnia delivered face-to-face (n=32) or via AASM SleepTM (n=33). Participants completed self-report measures of insomnia (Insomnia Severity Index, ISI) and daytime functioning (fatigue, depression, anxiety, and overall functioning) at pre-treatment, post-treatment, and 12-week follow-up. The ISI was the primary non-inferiority outcome. Results Telemedicine was non-inferior to face-to-face delivery of CBT for insomnia, based on a non-inferiority margin of 4 points on the ISI (β = -0.07, 95% CI -2.28 to 2.14). Compared to pre-treatment, ISI scores improved significantly at post-treatment (β = -9.02, 95% CI -10.56 to -7.47) and at 12-week follow-up (β = -9.34, 95% CI -10.89 to -7.79). Similarly, daytime functioning measures improved from pre- to post-treatment, with sustained improvements at 12-week follow-up. Scores on the fatigue scale were lower in the telemedicine group at both post-treatment (F=4.64, df=1,119, p<.03) and follow-up (F=5.79, df=1,119, p<.02). Conclusion Insomnia and daytime functioning improve similarly whether CBT for insomnia is delivered via telemedicine or face-to-face. Telemedicine delivery of CBT for insomnia should be implemented more systematically to improve access to this evidence-based treatment. Support American Sleep Medicine Foundation Grant # 168-SR-17 (JT Arnedt, PhD)

scholarly journals Common mental disorders, subthreshold symptoms and disability: longitudinal study

2010 ◽  
Vol 197 (5) ◽  
pp. 411-412 ◽  
Author(s):  
Dheeraj Rai ◽  
Petros Skapinakis ◽  
Nicola Wiles ◽  
Glyn Lewis ◽  
Ricardo Araya
Keyword(s):  
Mental Disorders ◽  
Functional Disability ◽  
Psychiatric Symptoms ◽  
Common Mental Disorders ◽  
Psychiatric Morbidity ◽  
Diagnostic Categories ◽  
Icd 10 ◽  
The Uk ◽  
Aggregate Burden

SummaryIn a representative sample of the UK population we found that common mental disorders (as a group and in ICD–10 diagnostic categories) and subthreshold psychiatric symptoms at baseline were both independently associated with new-onset functional disability and significant days lost from work at 18-month follow-up. Subthreshold symptoms contributed to almost half the aggregate burden of functional disability and over 32 million days lost from work in the year preceding the study. Leaving these symptoms unaccounted for in surveys may lead to gross underestimation of disability related to psychiatric morbidity.

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