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Cox K, Deiderich J. A primer on investigating treatment effect heterogeneity and causal moderation in psychotherapy research. Psychother Res 2023; 33:1031-1042. [PMID: 37231703 DOI: 10.1080/10503307.2023.2215396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 05/12/2023] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVE Experimental designs provide strong evidence for causal claims involving the main effects of a treatment but analyzes that solely focus on the main effects are inherently limited. Considerations for effect heterogeneity allow psychotherapy researchers to investigate for whom and under what conditions a treatment is likely to be effective. Evidence of causal moderation requires more stringent assumptions but is an important extension of treatment effect heterogeneity when interventions on the moderator are possible. METHOD This primer clarifies and differentiates treatment effect heterogeneity and causal moderation in the context of psychotherapy research. RESULTS Particular attention is given to the causal framework, assumptions, estimation, and interpretation of causal moderation. An illustrative example is included to ensure an approachable format with colloquial and intuitive language with R syntax provided to encourage and ease future implementation. CONCLUSIONS This primer encourages proper consideration and interpretation of treatment effect heterogeneity and, when conditions are met, causal moderation. This knowledge improves the understanding of treatment efficacy across participant characteristics and study contexts and, relatedly, the generalizability of treatment effects.
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Affiliation(s)
- Kyle Cox
- Educational Leadership, University of North Carolina at Charlotte, Charlotte, USA
| | - Jada Deiderich
- Educational Leadership, University of North Carolina at Charlotte, Charlotte, USA
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Weigel A, Hüsing P, Junge M, Löwe B. Helpful explanatory models for persistent somatic symptoms (HERMES): Results of a three-arm randomized-controlled pilot trial. J Psychosom Res 2023; 172:111419. [PMID: 37352693 DOI: 10.1016/j.jpsychores.2023.111419] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVE This three-arm randomized controlled trial aimed to test the efficacy of an etiological model for persistent somatic symptoms (PSS) translated into video-animated explanatory models in comparison to a control group, and to examine additional value of personalization of the explanatory models (i.e. possibility to choose information based on mechanisms of symptom persistence). METHODS Outpatients with PSS were shown one of three 15-min video animations: a) explanatory model without personalization, b) explanatory model with personalization, c) no explanatory model control group. Changes in somatic symptom severity (PHQ-15) and psychological burden related to somatic symptoms or associated health concerns (SSD-12) from baseline to one-month follow-up were the primary outcome. Health-related quality of life (SF-12) and perceived usefulness (USE) were also assessed. RESULTS Seventy-five patients with PSS were allocated to the study arms (Mage = 44.2 ± 13.3 years, 56% female). The study arms did not differ significantly on the primary outcomes. However, no explanatory model participants reported significantly greater mental quality of life improvements than explanatory model without personalization participants (Mdiff = 7.50 [0.43; 14.56]). Further, explanatory model with personalization participants rated the individual fit of the intervention significantly higher than no explanatory model participants (Mdiff = 2.05 [0.17; 3.93]). All groups rated credibility of the intervention as very high. CONCLUSION The HERMES materials seemed to have been too brief to improve symptom related outcomes. However, all three interventions were positively evaluated regarding their usefulness, particularly in case of additional personalization. Future studies should investigate potential effects of an increased intervention dose. TRIAL REGISTRATION DRKS00018803.
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Affiliation(s)
- Angelika Weigel
- University Medical Center Hamburg-Eppendorf, Department of Psychosomatic Medicine and Psychotherapy, Hamburg, Germany.
| | - Paul Hüsing
- University Medical Center Hamburg-Eppendorf, Department of Psychosomatic Medicine and Psychotherapy, Hamburg, Germany.
| | - Magdalena Junge
- University Medical Center Hamburg-Eppendorf, Department of Psychosomatic Medicine and Psychotherapy, Hamburg, Germany.
| | - Bernd Löwe
- University Medical Center Hamburg-Eppendorf, Department of Psychosomatic Medicine and Psychotherapy, Hamburg, Germany.
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Wortman MSH, van der Wouden JC, Twisk JWR, Visser B, Assendelft WJJ, van der Horst HE, Olde Hartman TC. Effectiveness of psychosomatic therapy for patients with persistent somatic symptoms: Results from the CORPUS randomised controlled trial in primary care. J Psychosom Res 2023; 167:111178. [PMID: 36753944 DOI: 10.1016/j.jpsychores.2023.111178] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 01/18/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of psychosomatic therapy versus care as usual in primary care for patients with persistent somatic symptoms (PSS). METHODS We conducted a pragmatic, two-armed, randomised controlled trial among primary care patients with PSS in the Netherlands that included 39 general practices and 34 psychosomatic therapists. The intervention, psychosomatic therapy, consisted of 6-12 sessions delivered by specialised exercise- and physiotherapists. PRIMARY OUTCOME MEASURE patient's level of functioning. SECONDARY OUTCOMES severity of physical and psychosocial symptoms, health-related quality of life, health-related anxiety, illness behaviour and number of GP contacts. RESULTS Compared to usual care (n = 85), the intervention group (n = 84) showed no improvement in patient's level of functioning (mean difference - 0.50 [95% CI -1.10 to 0.10]; p = .10), and improvement in health-related anxiety (mean difference - 1.93 [95% CI -3.81 to -0.04]; p = .045), over 12 months. At 5-month follow-up, we found improvement in physical functioning, somatisation, and health-related anxiety. The 12-month follow-up revealed no therapy effects. Subgroup analyses showed an overall effect in patient's level of functioning for the group with moderate PSS (mean difference - 0.91 [95% CI -1.78 to -0.03]; p = .042). In the year after the end of therapy, the number of GP contacts did not differ significantly between the two groups. CONCLUSION We only found effects on some secondary outcome measures, and on our primary outcome measure especially in patients with moderate PSS, the psychosomatic therapy appears promising for further study. TRIAL REGISTRATION the trial is registered in the Netherlands Trial Registry, https://trialsearch.who.int/Trial2.aspx?TrialID=NTR7356 under ID NTR7356.
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Affiliation(s)
- Margreet S H Wortman
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan, 1117 Amsterdam, the Netherlands.
| | - Johannes C van der Wouden
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan, 1117 Amsterdam, the Netherlands.
| | - Jos W R Twisk
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
| | - Bart Visser
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands.
| | - Willem J J Assendelft
- Department of Primary and Community Care, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Henriëtte E van der Horst
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan, 1117 Amsterdam, the Netherlands.
| | - Tim C Olde Hartman
- Department of Primary and Community Care, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
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Frechman E, Buck HG, Dietrich MS, Maxwell CA. Development of a Planning for Aging and Frailty Questionnaire. Res Gerontol Nurs 2022; 15:239-244. [PMID: 36113008 DOI: 10.3928/19404921-20220830-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
There is a gap in understanding adults' readiness to plan for adaptions across the aging trajectory. The purpose of the current psychometric project was to develop and test the Planning for Aging and Frailty Questionnaire. Clinical experience and extant literature formed the basis for creating items measuring planning for aging. Content validity was established with gerontology and health service research experts. Face validity testing was conducted through two cognitive interviewing and debriefing sessions at a senior center. All survey questions resulted in a content validity index ≥0.80 from experts. Face validity testing involved successful completion of the survey by 12 adults followed by cognitive interviewing/debriefing, resulting in minor changes. The 21-item Planning for Aging and Frailty Questionnaire demonstrates good initial validity and can be used to measure readiness in planning for aging and personal experiences and experiences with others. Further testing with additional usage is warranted. [Research in Gerontological Nursing, 15(5), 239-244.].
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Hijne K, van Eck van der Sluijs JF, van Broeckhuysen-Kloth SAM, Lucassen PLBJ, Reinders M, Tak LM, Gerritsen L, Geenen R. Individual treatment goals and factors influencing goal attainment in patients with somatic symptom disorder from the perspective of clinicians: A concept mapping study. J Psychosom Res 2022; 154:110712. [PMID: 34999524 DOI: 10.1016/j.jpsychores.2021.110712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 12/01/2021] [Accepted: 12/19/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Overviews of treatment goals and influencing factors may support shared decision making and optimize customized treatment to the patient with somatic symptom disorder (SSD). The aim of this study was to identify and structure comprehensive sets of treatment goals and factors influencing goal attainment in patients with SSD from the perspective of clinicians. METHODS Using a concept mapping procedure, clinicians participated in interviews (N = 17) and card sorting tasks comprising 55 treatment goals and 55 factors influencing goal attainment (N = 38). RESULTS We identified four overarching categories (A to D) of nine clusters (1 to 9) of treatment goals: A. empowerment (A1. personal values, A2. committed action, A3. self-esteem), B. skill improvement (B4. interpersonal skills, B5. emotion and stress regulation), C. symptom reduction (C6. dysfunctional beliefs, C7. somatic symptoms, C8. psychological symptoms), and D9. active and structured lifestyle. Also, we identified four overarching categories (A to D) of nine clusters (1 to 9) of factors influencing goal attainment: A1. therapeutic alliance, B. social and everyday context (B2. [family] system, B3. meaningful daily schedule, B4. social and economic circumstances), C. ability to change (C5. externalizing tendency, C6. reflective and psychological skills, C7. perspective and motivation), and D. psychological vulnerability (D8. vulnerable personality, D9. [psychiatric] comorbidity). CONCLUSION The overviews of treatment goals and factors influencing goal attainment reflect different paradigmatic backgrounds of clinicians. The results can be used, in combination with the perspective of the patient, to define treatment goals, and to monitor and evaluate change in outcomes.
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Affiliation(s)
- Kim Hijne
- Altrecht Psychosomatic Medicine Eikenboom, Zeist, the Netherlands; Department of Psychology, Utrecht University, Utrecht, the Netherlands.
| | | | | | - Peter L B J Lucassen
- Radboud University Nijmegen, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, the Netherlands
| | - Michel Reinders
- GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands
| | | | - Lotte Gerritsen
- Department of Psychology, Utrecht University, Utrecht, the Netherlands
| | - Rinie Geenen
- Altrecht Psychosomatic Medicine Eikenboom, Zeist, the Netherlands; Department of Psychology, Utrecht University, Utrecht, the Netherlands
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Senger K, Rubel JA, Kleinstäuber M, Schröder A, Köck K, Lambert MJ, Lutz W, Heider J. Symptom change trajectories in patients with persistent somatic symptoms and their association to long-term treatment outcome. Psychother Res 2021; 32:624-639. [PMID: 34711141 DOI: 10.1080/10503307.2021.1993376] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE This study investigated symptom change trajectory for patients with persistent somatic symptoms (PSS) during psychotherapy and the association of these patterns with pre-treatment characteristics and long-term outcome. METHODS Growth mixture modeling was used to identify trajectory curves in a sample of N = 210 outpatients diagnosed with PSS and treated either with conventional cognitive behavioral therapy (CBT) or CBT enriched with emotion regulation training (ENCERT). RESULTS We identified three subgroups of patients with similar symptom change patterns over the course of treatment (a "no change," "strong response," and "slow change" subgroup). Higher initial anxiety symptoms were significantly associated with the no change and strong response subgroups; symptom-related disability in daily routine with no changes. Patients with a strong response had the highest proportion of reliable improvement at termination and at six-month-follow-up. CONCLUSION Our results indicate that, instead of one common change pattern, patients with PSS respond differently to treatment. Due to the high association of symptom curves with long-term outcome, the identification and prediction of an individual's trajectory could provide important information for clinicians to identify non-responding patients that are at risk for failure. Selecting personalized treatment interventions could increase the effectiveness of psychotherapy.Trial registration: ClinicalTrials.gov identifier: NCT01908855..
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Affiliation(s)
- Katharina Senger
- Department of Psychology, University of Koblenz-Landau, Landau, Germany
| | - Julian A Rubel
- Department of Psychology, University of Giessen, Giessen, Germany
| | - Maria Kleinstäuber
- Department of Psychology, Emma Eccles Jones College of Education and Health Services, Utah State University, Logan, UT, USA
| | - Annette Schröder
- Department of Psychology, University of Koblenz-Landau, Landau, Germany
| | - Katharina Köck
- Department of Psychology, University of Koblenz-Landau, Landau, Germany
| | | | - Wolfgang Lutz
- Department of Psychology, University of Trier, Trier, Germany
| | - Jens Heider
- Department of Psychology, University of Koblenz-Landau, Landau, Germany
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Weigel A, Maehder K, Witt M, Löwe B. Psychotherapists' perspective on the treatment of patients with somatic symptom disorders. J Psychosom Res 2020; 138:110228. [PMID: 32896756 DOI: 10.1016/j.jpsychores.2020.110228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/30/2020] [Accepted: 08/25/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Guidelines recommend psychotherapy in addition to primary care for patients with moderate to severe somatic symptom disorders. While general practitioners' experiences have been well studied, psychotherapists' experiences with this patient group and the explanatory models psychotherapists use in psychotherapy are unknown. METHODS Semi-structured qualitative interviews were conducted between April and July 2018 with 20 German licensed outpatient psychotherapists with either a medical or a psychological background, using the label "somatoform disorders". Interviews were analyzed applying thematic analysis. RESULTS Psychotherapists experienced management of affected patients as challenging and partly frustrating, mainly due to the difficult diagnostic process and the "somatic fixation" of some patients. Diagnostic labelling was considered a delicate issue, with some psychotherapists using the term "somatoform", while others preferred either "functional" or vague descriptions like "psychosomatic". The explanatory process was deemed essential for treatment, as was the adaptation of explanations to both a patient's biography and language. As main explanatory factors, psychotherapists referred to generic vulnerability factors, previous somatic illness and health care system influences. CONCLUSIONS Explanatory models used in psychotherapy are patient-centred, processual and constitute a major component of the psychotherapeutic process. However, this process might be impeded if patients are confronted with different diagnostic labels and explanatory models during their pathways through care.
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Affiliation(s)
- Angelika Weigel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Germany.
| | - Kerstin Maehder
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Germany.
| | - Marie Witt
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Germany.
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9
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Managing fibromyalgia syndrome in pregnancy no bridges between USA and EU. Arch Womens Ment Health 2019; 22:711-721. [PMID: 30607517 DOI: 10.1007/s00737-018-0933-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 11/26/2018] [Indexed: 10/27/2022]
Abstract
The first aim of this article is to analyze the risk/benefit ratio of using psychotropic drugs approved in some countries for treating fibromyalgia syndrome (FMS) during pregnancy. Assessing the effectiveness of non-pharmacological interventions is the second scope of this article, in order to help clinicians to manage FMS in pregnancy in those countries were no drugs are approved for treating the disease. Following the PRISMA guidelines for systematic reviews, a literature search was conducted on PubMed and Google Scholar. Separate literature searches were performed for the three psychotropic drugs approved in the USA for treating FMS, psychotherapy, and transcranial magnetic stimulation (TMS). Perinatal duloxetine exposure is associated with increased risk of gestational and perinatal complications. With regards pregabalin, available information suggests that the drug is not devoid of structural teratogenicity potential. No data are available for milnacipran. Duloxetine and pregabalin should be only given to pregnant women diagnosed with severe forms of FMS after carefully weighing the benefits and risks for the mother-fetus dyad. On the other hand, we have to consider that the proportion of women who discontinue psychotropic drugs during pregnancy is as high as 85.4%. This figure raises further questions about adequate alternative treatment of FMS during the perinatal period. Moreover, neither duloxetine nor milnacipran or pregabalin have been approved by the EMEA for the treatment of FMS. Unfortunately, psychological treatment of FMS in perinatal women are not yet tested and data on TMS are conflicting.
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Letzen JE, Seminowicz DA, Campbell CM, Finan PH. Exploring the potential role of mesocorticolimbic circuitry in motivation for and adherence to chronic pain self-management interventions. Neurosci Biobehav Rev 2019; 98:10-17. [PMID: 30543904 PMCID: PMC6401294 DOI: 10.1016/j.neubiorev.2018.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 12/04/2018] [Accepted: 12/08/2018] [Indexed: 12/28/2022]
Abstract
Adherence to pain self-management strategies is associated with favorable psychobehavioral outcomes among individuals with chronic pain. Substantive adherence to treatments teaching these adaptive skills often proves challenging, resulting in poor individual and societal outcomes. Evidence demonstrates motivation for behavior change as a key predictor of treatment adherence. Despite behavioral techniques that target motivation, however, nonadherence persists as a barrier to positive clinical outcomes in chronic pain. Understanding the neurobiological mechanisms underlying treatment motivation might highlight novel avenues for augmentative therapies. The purpose of this review is to present theory and evidence that the mesocorticolimbic system (i.e., brain circuitry associated with reward processing and motivation) contributes to treatment motivation among chronic pain patients, ultimately influencing adherence. We review evidence for motivation as a key adherence determinant, detail neuroimaging findings relating mesocorticolimbic circuitry and motivation, and discuss data supporting mesocorticolimbic dysfunction among chronic pain patients. We propose a neurobehavioral model for adherence to pain self-management interventions, listing testable hypotheses. Finally, we discuss potential research and intervention implications from the proposed model.
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Affiliation(s)
- Janelle E Letzen
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, 5510 Nathan Shock Drive, Suite 101, Baltimore, MD, USA.
| | - David A Seminowicz
- Department of Neural and Pain Sciences, School of Dentistry, and Center to Advance Chronic Pain Research, University of Maryland, 650 W. Baltimore St., Baltimore, MD, USA
| | - Claudia M Campbell
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, 5510 Nathan Shock Drive, Suite 101, Baltimore, MD, USA
| | - Patrick H Finan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, 5510 Nathan Shock Drive, Suite 101, Baltimore, MD, USA
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Lüdtke T, Pult LK, Schröder J, Moritz S, Bücker L. A randomized controlled trial on a smartphone self-help application (Be Good to Yourself) to reduce depressive symptoms. Psychiatry Res 2018; 269:753-762. [PMID: 30273901 DOI: 10.1016/j.psychres.2018.08.113] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 07/10/2018] [Accepted: 08/28/2018] [Indexed: 02/01/2023]
Abstract
Depressive symptoms are common, yet only a subgroup of individuals receive adequate treatment. To reduce the treatment gap, several online self-help programs have been developed, yielding small to moderate effects. We developed a smartphone self-help application addressing depressive symptoms. We sought to evaluate its feasibility and efficacy in participants reporting a subjective need for help (a diagnosis of depression was not mandatory). We conducted a randomized controlled trial (N = 90). The primary outcome was a reduction of depressive symptoms measured with the Patient Health Questionnaire-9 (PHQ-9). Secondary outcomes included improved self-esteem (Rosenberg Self-Esteem Scale) and quality of life (WHOQOL-BREF). The intervention group obtained access to the application for four weeks, the wait-list group received access after the post assessment. No group differences emerged in either outcome in intention-to-treat analyses. Per protocol analyses with frequent users (i.e., several times a week or more) yielded a small effect size (η2p = 0.049) at trend level on the reduction of depressive symptoms in favor of the treatment group. However, 39% of the participants did not use the application frequently. Mobile self-help applications represent a promising addition to existing treatments, but it is important to increase patients' motivation to use them.
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Affiliation(s)
- Thies Lüdtke
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Psychology, UiT - The Arctic University of Norway, Hansine Hansens veg 18, 9019, Tromsø, Norway.
| | - Lilian Klara Pult
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johanna Schröder
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lara Bücker
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Mander J, Schaller G, Bents H, Dinger U, Zipfel S, Junne F. Increasing the treatment motivation of patients with somatic symptom disorder: applying the URICA-S scale. BMC Psychiatry 2017; 17:240. [PMID: 28673262 PMCID: PMC5496251 DOI: 10.1186/s12888-017-1400-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 06/26/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Therapeutic intervention programs for somatic symptom disorder (SSD) show only small-to-moderate effect sizes. These effects are partly explained by the motivational problems of SSD patients. Hence, fostering treatment motivation could increase treatment success. One central aspect in SSD patients might be damage to motivation because of symptomatic relapses. Consequently, the aim of the present study was to investigate associations between motivational relapse struggle and therapeutic outcome in SSD patients. METHODS We assessed 84 inpatients diagnosed with SSD in the early, middle and late stages of their inpatient treatment. The maintenance subscale of the University of Rhode Island Change Assessment-Short (URICA-S) was applied as a measure to assess motivational relapse struggle. Additionally, patients completed measures of treatment outcome that focus on clinical symptoms, stress levels and interpersonal functioning. RESULTS The results from multiple regression analyses indicate that higher URICA-S maintenance scores assessed in early stages of inpatient treatment were related to more negative treatment outcomes in SSD patients. CONCLUSIONS SSD patients with ambivalent treatment motivation may fail in their struggle against relapse over the course of therapy. The URICA-S maintenance score assessed at therapy admission facilitated early identification of SSD patients who are at greater risk of relapse. Future studies should incorporate randomized controlled trials to investigate whether this subgroup could benefit from motivational interventions that address relapse.
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Affiliation(s)
- Johannes Mander
- Center for Psychological Psychotherapy, University of Heidelberg, Heidelberg, Germany. .,Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital of Tübingen, Tübingen, Germany. .,, Bergheimer Str. 58a, 69115, Heidelberg, Germany.
| | - Georg Schaller
- 0000 0001 2190 4373grid.7700.0Center for Psychological Psychotherapy, University of Heidelberg, Heidelberg, Germany
| | - Hinrich Bents
- 0000 0001 2190 4373grid.7700.0Center for Psychological Psychotherapy, University of Heidelberg, Heidelberg, Germany
| | - Ulrike Dinger
- 0000 0001 0328 4908grid.5253.1Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital of Heidelberg, Heidelberg, Germany
| | - Stephan Zipfel
- 0000 0001 0196 8249grid.411544.1Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital of Tübingen, Tübingen, Germany
| | - Florian Junne
- 0000 0001 0196 8249grid.411544.1Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital of Tübingen, Tübingen, Germany
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