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Sahm AHJ, Witthöft M, Bailer J, Mier D. Putting the Vicious Cycle to the Test: Evidence for the Cognitive Behavioral Model of Persistent Somatic Symptoms From an Online Study. Psychosom Med 2024; 86:569-575. [PMID: 38666664 DOI: 10.1097/psy.0000000000001313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
OBJECTIVE In clinical practice, persistent somatic symptoms are regularly explained using a cognitive-behavioral model (CBM). In the CBM, predisposing, perpetuating, and precipitating factors are assumed to interact and to cause the onset and endurance of somatic symptoms. However, these models are rarely investigated in their entirety. METHODS We conducted an online survey during the COVID-19 pandemic. A total of 2114 participants from the general German population completed questionnaires that measured different factors of the CBM. We used state negative affectivity and neuroticism as predisposing factors, fear of a COVID-19 infection as the precipitating factor, and somatic symptoms, misinterpretation of bodily symptoms, attention allocation to bodily symptoms, and health anxiety as perpetuating factors. Moreover, we added safety and avoidance behavior as end points to the model. We conducted a psychological network analysis to exploratively study the relationships between the model's different factors and tested the assumptions of the CBM by evaluating a structural equation model (SEM) that incorporated all factors of the model. RESULTS Network analyses revealed clustering in our data: Health anxiety and different cognitive factors are closely related, whereas somatic symptoms and state negative affectivity are strongly associated. Our SEM showed adequate fit. CONCLUSIONS Our findings from an exploratory and a confirmatory approach give empirical support for the CBM, suggesting it as a suitable model to explain bodily symptoms in the general population and to possibly guide clinical practice. The network model additionally indicates the necessity to apply an individualized CBM for patients, depending on a preponderance of either persistent somatic symptoms or health concerns.
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Affiliation(s)
- Alexander H J Sahm
- From the Department of Psychology (Sahm, Mier), University of Konstanz, Konstanz; Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology (Witthöft), Johannes Gutenberg-University Mainz, Mainz; and Department of Clinical Psychology, Central Institute of Mental Health (Bailer), University of Heidelberg/Medical Faculty Mannheim, Mannheim, Germany
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Huth D, Bräscher AK, Tholl S, Fiess J, Birke G, Herrmann C, Jöbges M, Mier D, Witthöft M. Cognitive-behavioral therapy for patients with post-COVID-19 condition (CBT-PCC): a feasibility trial. Psychol Med 2024; 54:1122-1132. [PMID: 37842765 DOI: 10.1017/s0033291723002921] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
BACKGROUND The post-COVID-19 condition describes the persistence or onset of somatic symptoms (e.g. fatigue) after acute COVID-19. Based on an existing cognitive-behavioral treatment protocol, we developed a specialized group intervention for individuals with post-COVID-19 condition. The present study examines the feasibility, acceptance, and effectiveness of the program for inpatients in a neurological rehabilitation setting. METHODS The treatment program comprises eight sessions and includes psychoeducational and experience-based interventions on common psychophysiological mechanisms of persistent somatic symptoms. A feasibility trial was conducted using a one-group design in a naturalistic setting. N = 64 inpatients with a history of mild COVID-19 that fulfilled WHO criteria for post-COVID-19 condition were enrolled. After each session, evaluation forms were completed and psychometric questionnaires on somatic and psychopathological symptom burden were collected pre- and post-intervention. RESULTS The treatment program was well received by participants and therapists. Each session was rated as comprehensible and overall satisfaction with the sessions was high. Pre-post effect sizes (of standard rehabilitation incl. new treatment program; intention-to-treat) showed significantly reduced subjective fatigue (p < 0.05, dav = 0.33) and improved disease coping (ps < 0.05, dav = 0.33-0.49). CONCLUSIONS Our results support the feasibility and acceptance of the newly developed cognitive-behavioral group intervention for individuals with post-COVID-19 condition. Yet, findings have to be interpreted cautiously due to the lack of a control group and follow-up measurement, the small sample size, and a relatively high drop-out rate.
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Affiliation(s)
- Daniel Huth
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Anne-Kathrin Bräscher
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sarah Tholl
- Department of Clinical Psychology and Psychotherapy, University of Konstanz, Konstanz, Germany
| | - Johanna Fiess
- Department of Clinical Psychology and Psychotherapy, University of Konstanz, Konstanz, Germany
| | - Gunnar Birke
- Kliniken Schmieder Gailingen, Gailingen, Germany
| | | | | | - Daniela Mier
- Department of Clinical Psychology and Psychotherapy, University of Konstanz, Konstanz, Germany
| | - Michael Witthöft
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg University Mainz, Mainz, Germany
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Kleinstäuber M, Schröder A, Daehler S, Pallesen KJ, Rask CU, Sanyer M, Van den Bergh O, Weinreich Petersen M, Rosmalen JGM. Aetiological Understanding of Fibromyalgia, Irritable Bowel Syndrome, Chronic Fatigue Syndrome and Classificatory Analogues: A Systematic Umbrella Review. CLINICAL PSYCHOLOGY IN EUROPE 2023; 5:e11179. [PMID: 38356902 PMCID: PMC10863637 DOI: 10.32872/cpe.11179] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 08/27/2023] [Indexed: 02/16/2024] Open
Abstract
Background This umbrella review systematically assesses the variety and relative dominance of current aetiological views within the scientific literature for the three most investigated symptom-defined functional somatic syndromes (FSS) and their classificatory analogues within psychiatry and psychology. Method An umbrella review of narrative and systematic reviews with and without meta-analyses based on a search of electronic databases (PubMed, Web of Science, Embase, PsychINFO) was conducted. Eligible reviews were published in English, focused on research of any kind of aetiological factors in adults diagnosed with fibromyalgia syndrome (FMS), irritable bowel syndrome (IBS), chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), and somatic symptom disorder (SSD)/somatoform disorder (SFD). Results We included 452 reviews (132 systematic reviews including meta-analyses, 133 systematic reviews, 197 narrative reviews), of which 132 (29%) focused on two or more of the investigated health conditions simultaneously. Across diagnoses, biological factors were addressed in 90% (k = 405), psychological in 33% (k = 150), social in 12% (k = 54), and healthcare factors in 5% (k = 23) of the reviews. The methodological quality of the included systematic reviews (k = 255) was low (low/critically low: 41% [k = 104]; moderate: 49% [k = 126]; high quality: 10% [k = 25]). The high-quality systematic reviews suggest that deficient conditioned pain modulation, genetic factors, changes in the immune, endocrinological, gastrointestinal, cardiovascular, and nervous system, and psychosocial factors such as sexual abuse and pain catastrophizing increase the risk for FSS. Conclusion Only very few systematic reviews have used comprehensive, biopsychosocial disease models to guide the selection of aetiological factors in FSS research. Future research should strive for higher scientific standards and broaden its perspective on these health conditions.
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Affiliation(s)
- Maria Kleinstäuber
- Department of Psychology, Emma Eccles Jones College of Education and Human Services, Utah State University, Logan, UT, USA
| | - Andreas Schröder
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Sarah Daehler
- Department of Psychology, Emma Eccles Jones College of Education and Human Services, Utah State University, Logan, UT, USA
| | | | - Charlotte U. Rask
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
- Department of Child and Adolescent Psychiatry, Psychiatry, Aarhus University Hospital, Aarhus, Denmark
| | - Mathias Sanyer
- Department of Psychology, Emma Eccles Jones College of Education and Human Services, Utah State University, Logan, UT, USA
| | | | - Marie Weinreich Petersen
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Judith G. M. Rosmalen
- University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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Liu Y, Peng W, Cao M, Zhang S, Peng J, Zhou Z. Cyberchondria and Chinese Adolescent Mental Health in the Age of COVID-19 Pandemic. CYBERPSYCHOLOGY, BEHAVIOR AND SOCIAL NETWORKING 2023. [PMID: 37406285 DOI: 10.1089/cyber.2022.0319] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
One of the far-reaching impacts of the COVID-19 pandemic is that it has become the fertile soil of cyberchondria. Adolescents' mental health was severely hit by this by-product of the COVID-19 pandemic both due to the direct effects and its indirect effects on security. This study investigated whether and how cyberchondria was associated with Chinese adolescents' mental health (i.e., well-being and depressive symptoms). Based on a large Internet sample (N = 1,108, 67.5 percent female, Mage = 16.78 years), cyberchondria, psychological insecurity, mental health, and a series of covariates were assessed. Preliminary analyses were conducted in SPSS Statistics software and main analyses were conducted in Mplus. Path analyses indicated that (a) cyberchondria was negatively associated with well-being (b = -0.12, p = 0.001) and positively associated with depressive symptoms (b = 0.17, p < 0.001); (b) psychological insecurity could fully mediate the association between cyberchondria and mental health (indirect effect well-being = -0.15, 95% confidence interval [CI -0.19 to -0.12] and indirect effect depressive symptoms = 0.15, 95% CI [0.12 to 0.19]); (c) the two dimensions (social insecurity and uncertainty) of psychological insecurity could play the mediating role in the associations between cyberchondria and mental health, uniquely and parallelly; and (d) these results did not vary by gender. This study suggests that cyberchondria may arouse individuals' psychological insecurity about interpersonal interaction and the development of events, which ultimately decreases their well-being and increases the risk of depressive symptoms. These findings facilitate the establishment and implementation of relevant prevention and intervention programs.
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Affiliation(s)
- Yuxiao Liu
- Key Laboratory of Adolescent Cyberpsychology and Behavior (CCNU), Ministry of Education, Wuhan, China
- School of Psychology, Central China Normal University, Wuhan, China
| | - Wenya Peng
- Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Min Cao
- Key Laboratory of Adolescent Cyberpsychology and Behavior (CCNU), Ministry of Education, Wuhan, China
- School of Psychology, Central China Normal University, Wuhan, China
| | - Shujing Zhang
- Key Laboratory of Adolescent Cyberpsychology and Behavior (CCNU), Ministry of Education, Wuhan, China
- School of Psychology, Central China Normal University, Wuhan, China
| | - Ji Peng
- Key Laboratory of Adolescent Cyberpsychology and Behavior (CCNU), Ministry of Education, Wuhan, China
- School of Psychology, Central China Normal University, Wuhan, China
| | - Zongkui Zhou
- Key Laboratory of Adolescent Cyberpsychology and Behavior (CCNU), Ministry of Education, Wuhan, China
- School of Psychology, Central China Normal University, Wuhan, China
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Wu H, Manglike A, Chen Y, Liu Z, Fritzsche K, Lu Z. Scoping review update on somatic symptom disorder that includes additional Chinese data. Gen Psychiatr 2023; 36:e100942. [PMID: 37337547 PMCID: PMC10277133 DOI: 10.1136/gpsych-2022-100942] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 04/23/2023] [Indexed: 06/21/2023] Open
Abstract
Somatic symptom disorder (SSD) is a new diagnosis introduced into the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which is expected to solve the diagnostic difficulties of patients with medically unexplained symptoms. Based on the previous work, this review aims to comprehensively synthesise updated evidence related to SSD from recent years in English publications and, more extensively, from data published in Chinese language journals. The scoping review update was based on an earlier scoping review and included Chinese language publication data from China National Knowledge Internet (CNKI), WANFANG and WEIPU between January 2013 and May 2022 and data from PubMed, PsycINFO, and Cochrane Library between June 2020 and May 2022. Initially, 2 984 articles were identified, of which 63 full texts were included for analysis. In China, SSD is mainly applied in scientific research, but it also shows good predictive validity and clinical application potential. The mean frequency of SSD was 4.5% in the general population, 25.2% in the primary care population and 33.5% in diverse specialised care settings. Biological factors, such as brain region changes and heart rate variability, are associated with the onset of SSD. Psychological impairment related to somatic symptoms is the best predictor of prognosis. While adolescent SSD was significantly associated with family function, SSD overall is associated with an increased dysfunction of cognition and emotion, decreased quality of life, and high comorbidity with anxiety and depressive disorders. Further research is needed on suicide risk and cultural and gender-related issues. Updating the data of Chinese language studies, our research enriches the evidence-based findings related to the topics addressed in the text sections of the SSD chapter of DSM-5. However, research gaps remain about SSD reliability, population-based prevalence, suicide risk, and cultural and gender-related issues.
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Affiliation(s)
- Heng Wu
- Department of Psychosomatic Medicine, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ayinuer Manglike
- Department of Psychosomatic Medicine, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yixiao Chen
- Department of Psychosomatic Medicine, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ziming Liu
- Department of Psychosomatic Medicine, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Kurt Fritzsche
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center, University of Freiburg, Freiburg, Germany
| | - Zheng Lu
- Department of Psychosomatic Medicine, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Dagnall N, Denovan A, Drinkwater KG. Longitudinal assessment of the temporal stability and predictive validity of the Revised Paranormal Belief Scale. Front Psychol 2023; 13:1094701. [PMID: 36778162 PMCID: PMC9911539 DOI: 10.3389/fpsyg.2022.1094701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/30/2022] [Indexed: 01/28/2023] Open
Abstract
The Revised Paranormal Belief Scale (RPBS) is the prevailing measure of supernatural credence. However, there exists only limited evidence to support the temporal stability and predictive validity of the instrument over time. Acknowledging this, the present study assessed the test-retest reliability of the RPBS using a large, heterogeneous sample across multiple trials. In addition, predictive validity was tested using a longitudinal statistical model, which focused on allied health outcomes (Perceived Stress and Somatic Complaints). A sample of 1,665 (M age = 54.40, 853 females, 804 males, five non-binary and three not disclosing of gender) completed study measures at three time points separated by 2 month intervals. Prior to assessing temporal stability, assessment of structural validity and longitudinal invariance occurred. Test-retest reliability of the RPBS was in the moderate to high range across time intervals, and good internal consistency was observed. Furthermore, satisfactory stability coefficients existed for RPBS subfactors. Data-model fit for the predictive model was acceptable. Belief in the paranormal explained low variance over time in Perceived Stress and Somatic Complaints (between 2.4 and 4.2%). Findings supported the stability and reliability of the RPBS. In addition, they aligned with the notion that paranormal belief in the absence of high scores on cognitive-perceptual factors (e.g. transliminality and schizotypy), has a benign influence on perceived health.
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Affiliation(s)
- Neil Dagnall
- Department of Psychology, Manchester Metropolitan University, Manchester, United Kingdom,*Correspondence: Neil Dagnall, ✉
| | - Andrew Denovan
- Department of Psychology, University of Huddersfield, Huddersfield, United Kingdom
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Sperling EL, Hulett JM, Sherwin LB, Thompson S, Bettencourt BA. Prevalence, characteristics and measurement of somatic symptoms related to mental health in medical students: a scoping review. Ann Med 2023; 55:2242781. [PMID: 37552776 PMCID: PMC10411307 DOI: 10.1080/07853890.2023.2242781] [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: 03/14/2023] [Revised: 07/22/2023] [Accepted: 07/27/2023] [Indexed: 08/10/2023] Open
Abstract
INTRODUCTION Somatic symptoms related to mental health in medical students are under-researched, with nothing on the topic being published in the United States in over three decades. This scoping review is the first of its kind to explore the prevalence, type and severity of somatic symptoms induced by stress, anxiety, depression and burnout amongst medical students, with the objective of describing the significance and breadth of this issue. METHODS PRISMA-ScR guidelines were used to guide this review. A comprehensive search was performed of 22 databases, followed by bibliographic and hand searching. Inclusion criteria were published, peer-reviewed articles with a sample of medical students and at least one measure of somatic symptoms related to mental health, in English or with an English-language translation. Excluded were review, companion and editorial articles. Coding was done by an experienced coder trained in systematic review techniques. Two authors reviewed each article. RESULTS Twenty-nine articles met inclusion criteria, representing 16 countries, 31 schools/teaching hospitals and 9,887 medical students. The prevalence of somatic symptoms ranged from 5.7 to 80.1%, and somatic symptoms were overwhelmingly found to be significantly correlated with mental ill-health. Somatic symptoms included back pain, neck pain, headaches, sleep disturbances and functional gastrointestinal disorders. Eleven different outcome measures were used, with varying degrees of validity and reliability, which were compared and assessed. CONCLUSIONS Somatic symptoms appear strongly correlated with mental ill-health in medical students, and are likely highly prevalent. This review highlights the need for further research on somatic symptoms of mental ill-health in medical students, particularly in the United States, and the addition of larger, multi-institutional cohorts to expand our understanding of prevalence, incidence and inciting factors of somatic symptoms. Longitudinal studies tracking somatic symptoms' effect on career trajectory and professional burnout levels are also needed. Finally, future research should explore interventions for reducing physical symptom burden in medical students.
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Affiliation(s)
- Edie L. Sperling
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
- College of Osteopathic Medicine of the Pacific-Northwest, Western University of Health Sciences, Lebanon, OR, USA
| | - Jennifer M. Hulett
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
- Ellis Fischel Cancer Center, University of Missouri, Columbia, MO, USA
| | | | - Sarah Thompson
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
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Yang Y, Ta N, Li Z. Investigating the Obsessive and Compulsive Features of Cyberchondria: A Holistic Review. Front Psychol 2022; 13:897426. [PMID: 35859839 PMCID: PMC9289532 DOI: 10.3389/fpsyg.2022.897426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/13/2022] [Indexed: 11/24/2022] Open
Abstract
Background Cyberchondria has been brought into sharp focus during the COVID-19 health emergency; it refers to individuals who obsessively and compulsively search for health information online, resulting in excessive health concerns. Recent scholarship focuses on its obsessive and compulsive aspect, following a biopsychosocial approach as opposed to a pathology of health anxiety. It lacks interpretation of the socio-psychological dynamics between the dimensions. Objective This review aims to propose a holistic view toward understanding cyberchondria as an obsessive–compulsive syndrome and considers possible interventions. It specifically seeks to explain cyberchondria from diversified mediator variables and to pinpoint connections between each perspective. Methodology Comprehensive searches of databases such as PubMed and Springer were conducted to identify English articles relating to cyberchondria from 2001 to 2022. Based on a systematic filtering process, 27 articles were finally reviewed. Findings The authors compare and confirm three forecasts to predict cyberchondria, associating it with individual metacognition, uncertainty of unverified information, and algorithm-driven, biased information environments. Value Theoretically, a holistic framework is proposed to explain the obsessive and compulsive features of cyberchondria. Clinically, the research calls for more professional psychoeducation and chain screening of cyberchondria and other psychological disorders. Socially, it promotes support for risk-sensitive, information-deficient groups during pandemics like COVID-19. It also stresses more careful use of algorithm-driven search engine technology for platforms delivering medical information. Future research may explore areas such as the association between cyberchondria and other social-related disorders, as well as correlations among cyberchondria, obsessive and compulsive disorders, medical trust, and algorithm-driven search results.
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Affiliation(s)
- Yi Yang
- School of Chinese Culture and Communication, Beijing International Studies University, Beijing, China
| | - Na Ta
- School of Journalism and Communication, Renmin University of China, Beijing, China
- *Correspondence: Na Ta,
| | - Zhanghao Li
- Computational Communication Research Center, Beijing Normal University, Zhuhai, China
- School of Journalism and Communication, Beijing Normal University, Beijing, China
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Woodling C, Wygant DB, Umlauf RL, Marek RJ. Somatoform's placement and validity in the hierarchical taxonomy of psychopathology (HiTOP). Psychiatry Res 2022; 313:114593. [PMID: 35533473 DOI: 10.1016/j.psychres.2022.114593] [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: 10/01/2021] [Revised: 04/04/2022] [Accepted: 04/30/2022] [Indexed: 11/24/2022]
Abstract
Limitations of a polythetic-categorical classification system has sparked ongoing quantitative efforts to establish a valid and reliable method for diagnosing mental illness. Dimensional methods of classification, such as the Hierarchical Taxonomy of Psychopathology (HiTOP), have been found to ameliorate the limitations of a categorical approach - despite the provisional placement of a Somatoform spectrum. The current investigation sought to elucidate the placement of the Somatoform spectrum within the HiTOP model, and to further corroborate discriminant and convergent validity of the Somatoform spectrum. Using a sample of patients seeking chronic low-back pain treatment (n = 200), superior model fit suggested Somatoform fits better as a separate spectrum from Internalizing and placing Somatoform as a subfactor of Internalizing did not improve model fit. Discriminant and convergent validity with an external criteria demonstrated distinctiveness of the Somatoform spectrum from the Internalizing spectrum in the HiTOP model.
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Affiliation(s)
- Chloe Woodling
- Department of Psychological Sciences, Ball State University, Indiana
| | - Dustin B Wygant
- Department of Psychology, Eastern Kentucky University, Kentucky
| | | | - Ryan J Marek
- Department of Primary Care and Clinical Medicine, Sam Houston State University, Texas.
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Ciułkowicz M, Misiak B, Szcześniak D, Grzebieluch J, Maciaszek J, Rymaszewska J. The Portrait of Cyberchondria-A Cross-Sectional Online Study on Factors Related to Health Anxiety and Cyberchondria in Polish Population during SARS-CoV-2 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074347. [PMID: 35410027 PMCID: PMC8998772 DOI: 10.3390/ijerph19074347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/30/2022] [Accepted: 04/01/2022] [Indexed: 01/22/2023]
Abstract
The SARS-CoV-2 pandemic has served as a magnifying glass for cyberchondria, while the internet emerged as one of the main sources of medical information and support. The core ambition of this study was to estimate the level of cyberchondria and describe the socio-demographic, clinical and pandemic-related factors affecting its severity amid the SARS-CoV-2 pandemic. A cross-sectional study was performed between 16 May 2020 and 29 December 2020 in Poland within a sample of 538 adult internet users. The online survey tool included a Polish adaptation of the Cyberchondria Severity Scale (CSS-PL) and the Short Health Anxiety Inventory (SHAI), complemented with a set of questions covering sociodemographic, clinical and pandemic-related factors. Participants were clustered according to severity of health anxiety and cyberchondria symptoms. The performed binary logistic regression indicated professional inactivity, having a chronic mental disorder and subjectively limited access to healthcare due to COVID-19 to be key determinants of severe health anxiety and cyberchondria. Cyberchondria might be a remarkable public health issue as large proportion of respondents from the analyzed sample population of internet users met the criteria for severe symptoms. Key determinants of intense cyberchondria corresponded with employment stability, mental resilience and accessibility of healthcare services, which could be greatly challenged amid the pandemic.
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Affiliation(s)
- Marta Ciułkowicz
- Department of Psychiatry, Wroclaw Medical University, 50-367 Wroclaw, Poland; (B.M.); (D.S.); (J.M.); (J.R.)
- Correspondence:
| | - Błażej Misiak
- Department of Psychiatry, Wroclaw Medical University, 50-367 Wroclaw, Poland; (B.M.); (D.S.); (J.M.); (J.R.)
| | - Dorota Szcześniak
- Department of Psychiatry, Wroclaw Medical University, 50-367 Wroclaw, Poland; (B.M.); (D.S.); (J.M.); (J.R.)
| | - Jolanta Grzebieluch
- Department of Population Health, Wroclaw Medical University, 50-367 Wroclaw, Poland;
| | - Julian Maciaszek
- Department of Psychiatry, Wroclaw Medical University, 50-367 Wroclaw, Poland; (B.M.); (D.S.); (J.M.); (J.R.)
| | - Joanna Rymaszewska
- Department of Psychiatry, Wroclaw Medical University, 50-367 Wroclaw, Poland; (B.M.); (D.S.); (J.M.); (J.R.)
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Watson D, Levin-Aspenson HF, Waszczuk MA, Conway CC, Dalgleish T, Dretsch MN, Eaton NR, Forbes MK, Forbush KT, Hobbs KA, Michelini G, Nelson BD, Sellbom M, Slade T, South SC, Sunderland M, Waldman I, Witthöft M, Wright AGC, Kotov R, Krueger RF. Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): III. Emotional dysfunction superspectrum. World Psychiatry 2022; 21:26-54. [PMID: 35015357 PMCID: PMC8751579 DOI: 10.1002/wps.20943] [Citation(s) in RCA: 72] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The Hierarchical Taxonomy of Psychopathology (HiTOP) is a quantitative nosological system that addresses shortcomings of traditional mental disorder diagnoses, including arbitrary boundaries between psychopathology and normality, frequent disorder co-occurrence, substantial heterogeneity within disorders, and diagnostic unreliability over time and across clinicians. This paper reviews evidence on the validity and utility of the internalizing and somatoform spectra of HiTOP, which together provide support for an emotional dysfunction superspectrum. These spectra are composed of homogeneous symptom and maladaptive trait dimensions currently subsumed within multiple diagnostic classes, including depressive, anxiety, trauma-related, eating, bipolar, and somatic symptom disorders, as well as sexual dysfunction and aspects of personality disorders. Dimensions falling within the emotional dysfunction superspectrum are broadly linked to individual differences in negative affect/neuroticism. Extensive evidence establishes that dimensions falling within the superspectrum share genetic diatheses, environmental risk factors, cognitive and affective difficulties, neural substrates and biomarkers, childhood temperamental antecedents, and treatment response. The structure of these validators mirrors the quantitative structure of the superspectrum, with some correlates more specific to internalizing or somatoform conditions, and others common to both, thereby underlining the hierarchical structure of the domain. Compared to traditional diagnoses, the internalizing and somatoform spectra demonstrated substantially improved utility: greater reliability, larger explanatory and predictive power, and greater clinical applicability. Validated measures are currently available to implement the HiTOP system in practice, which can make diagnostic classification more useful, both in research and in the clinic.
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Affiliation(s)
- David Watson
- Department of Psychology, University of Notre Dame, South Bend, IN, USA
| | | | - Monika A Waszczuk
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | | | - Tim Dalgleish
- Medical Research Council, Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Michael N Dretsch
- US Army Medical Research Directorate - West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, WA, USA
| | - Nicholas R Eaton
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Miriam K Forbes
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Kelsie T Forbush
- Department of Psychology, University of Kansas, Lawrence, KS, USA
| | - Kelsey A Hobbs
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Giorgia Michelini
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | - Brady D Nelson
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Martin Sellbom
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Tim Slade
- Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, NSW, Australia
| | - Susan C South
- Department of Psychological Sciences, Purdue University, West Lafayette, IN, USA
| | - Matthew Sunderland
- Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, NSW, Australia
| | - Irwin Waldman
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Michael Witthöft
- Department for Clinical Psychology, Psychotherapy, and Experimental Psychopathology, University of Mainz, Mainz, Germany
| | - Aidan G C Wright
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Roman Kotov
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - Robert F Krueger
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
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12
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Okur Güney ZE, Cardone D, Sattel H, Ariens S, Witthöft M, Merla A, Kuppens P, Henningsen P. Interpersonal Emotion Dynamics in Couples With Somatic Symptom Disorder: Dyadic Coherence in Facial Temperature During Emotional Interactions. Psychosom Med 2022; 84:188-198. [PMID: 34654022 DOI: 10.1097/psy.0000000000001032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Disturbances in emotional processes are commonly reported in patients with a somatic symptom disorder (SSD). Although emotions usually occur in social interactions, little is known about interpersonal emotion dynamics of SSD patients during their actual emotional encounters. This study examined physiological coherence (linkage) between SSD patients and their partners, and in healthy couples during their emotional interactions. Secondarily, we explored group-level relationships between participants' and their partners' subjective affect. METHODS Twenty-nine romantic couples (16 healthy and 13 SSD patient-couples) underwent a dyadic conversation task with neutral and anger-eliciting topics followed by a guided relaxation. Partners' cutaneous facial temperature was recorded simultaneously by functional infrared thermal imaging. Immediately after each condition, participants reported on their pain intensity, self-affect, and perceived partner-affect. RESULTS Emotional conditions and having a partner with an SSD significantly affected coherence amplitude on the forehead (F(2,54) = 4.95, p = .011) and nose tip temperature (F(2,54) = 3.75, p = .030). From baseline to anger condition, coherence amplitude significantly increased in the patient-couples, whereas it decreased in the healthy couples. Correlation changes between partners' subjective affect comparably accompanied the changes in physiological coherence in healthy and patient-couples. CONCLUSIONS Inability to reduce emotional interdependence in sympathetic activity and subjective affect during a mutual conflict observed in SSD patient-couples seems to capture emotion co-dysregulation. Interventions should frame patients' emotional experiences as embodied and social. Functional infrared thermal imaging confirms to be an ecological and reliable method for examining autonomic changes in interpersonal contexts.Registration Page: https://osf.io/8eyjr.
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Affiliation(s)
- Zeynep Emine Okur Güney
- From the Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology (Okur Güney, Witthöft), Johannes Gutenberg University of Mainz, Mainz; Department of Psychosomatic Medicine and Psychotherapy (Okur Güney, Sattel, Henningsen), Technical University of Munich, Munich, Germany; Department of Neurosciences, Imaging and Clinical Sciences (Cardone, Merla), University G. d'Annunzio of Chieti-Pescara, Pescara, Italy; and Faculty of Psychology and Educational Sciences, Quantitative Psychology and Individual Differences (Ariens, Kuppens), KU Leuven, Leuven, Belgium
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13
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Akariya O, Anholt GE, Shahar G. Is Self-Criticism Uniquely Associated with Health Anxiety among Jewish and Arab Israeli Young Adults? Int J Cogn Ther 2021. [DOI: 10.1007/s41811-021-00121-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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Sica C, Caudek C, Cerea S, Colpizzi I, Caruso M, Giulini P, Bottesi G. Health Anxiety Predicts the Perceived Dangerousness of COVID-19 over and above Intrusive Illness-Related Thoughts, Contamination Symptoms, and State and Trait Negative Affect. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1933. [PMID: 33671223 PMCID: PMC7922316 DOI: 10.3390/ijerph18041933] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/03/2021] [Accepted: 02/12/2021] [Indexed: 02/07/2023]
Abstract
This study sought to evaluate the specificity of health anxiety, relative to other forms of psychopathology, in perceptions of COVID-19 as dangerous. Measures of health anxiety, COVID-19 perceived dangerousness, negative affect, anxiety, depression, stress, contamination-related obsessions and compulsions, and intrusive illness-related thoughts were administered online to 742 community individuals during the Italian national lockdown. Results showed that, after controlling for demographic variables and other internalizing problems, health anxiety was the single most important factor associated with the perceived dangerousness of COVID-19. Moreover, a comparison between the current sample's scores on various symptom measures and scores from prepandemic Italian samples revealed that, whereas other internalizing symptoms increased by a large or very large magnitude during the pandemic, levels of health anxiety and negative affect increased by a medium amount. This result may indicate that health anxiety is relatively trait-like, increasing the likelihood that our correlational data support the model of health anxiety as a vulnerability rather than an outcome. Together, these results indicate that health anxiety may be a specific risk factor for COVID-related maladjustment and support the distinction of health anxiety from other psychological problems.
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Affiliation(s)
- Claudio Sica
- Department of Health Sciences, Psychology Section, University of Firenze, Via San Salvi, 12, 50135 Firenze, Italy; (C.S.); (I.C.); (M.C.); (P.G.)
| | - Corrado Caudek
- Department of Neurosciences, Psychology, Drug Research, and Child Health, University of Firenze, Via San Salvi, 12, 50135 Firenze, Italy;
| | - Silvia Cerea
- Department of General Psychology, University of Padova, Via Venezia, 8, 35131 Padova, Italy;
| | - Ilaria Colpizzi
- Department of Health Sciences, Psychology Section, University of Firenze, Via San Salvi, 12, 50135 Firenze, Italy; (C.S.); (I.C.); (M.C.); (P.G.)
| | - Maria Caruso
- Department of Health Sciences, Psychology Section, University of Firenze, Via San Salvi, 12, 50135 Firenze, Italy; (C.S.); (I.C.); (M.C.); (P.G.)
| | - Paolo Giulini
- Department of Health Sciences, Psychology Section, University of Firenze, Via San Salvi, 12, 50135 Firenze, Italy; (C.S.); (I.C.); (M.C.); (P.G.)
| | - Gioia Bottesi
- Department of General Psychology, University of Padova, Via Venezia, 8, 35131 Padova, Italy;
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15
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Van den Bergh O, Brosschot J, Critchley H, Thayer JF, Ottaviani C. Better Safe Than Sorry: A Common Signature of General Vulnerability for Psychopathology. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2020; 16:225-246. [DOI: 10.1177/1745691620950690] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Several labels, such as neuroticism, negative emotionality, and dispositional negativity, indicate a broad dimension of psychopathology. However, largely separate, often disorder-specific research lines have developed that focus on different cognitive and affective characteristics that are associated with this dimension, such as perseverative cognition (worry, rumination), reduced autobiographical memory specificity, compromised fear learning, and enhanced somatic-symptom reporting. In this article, we present a theoretical perspective within a predictive-processing framework in which we trace these phenotypically different characteristics back to a common underlying “better-safe-than-sorry” processing strategy. This implies information processing that tends to be low in sensory-perceptual detail, which allows threat-related categorical priors to dominate conscious experience and for chronic uncertainty/surprise because of a stagnated error-reduction process. This common information-processing strategy has beneficial effects in the short term but important costs in the long term. From this perspective, we suggest that the phenomenally distinct cognitive and affective psychopathological characteristics mentioned above represent the same basic processing heuristic of the brain and are only different in relation to the particular type of information involved (e.g., in working memory, in autobiographical memory, in the external and internal world). Clinical implications of this view are discussed.
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Affiliation(s)
| | - Jos Brosschot
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University
| | - Hugo Critchley
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex
| | - Julian F. Thayer
- Department of Psychological Science, University of California, Irvine
| | - Cristina Ottaviani
- Department of Psychology, Sapienza University of Rome
- Laboratorio di Neuroimmagini Funzionali, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Fondazione Santa Lucia, Rome, Italy
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16
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Medically unexplained symptoms in children and adolescents: Illness-related self-concept and parental symptom evaluations. J Behav Ther Exp Psychiatry 2020; 68:101565. [PMID: 32171996 DOI: 10.1016/j.jbtep.2020.101565] [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: 09/05/2019] [Revised: 01/15/2020] [Accepted: 02/29/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND OBJECTIVES According to cognitive-behavioral models, illness-related symptom evaluations and self-concepts play a pivotal role in the development and maintenance of medically unexplained somatic symptoms (MUS). However, illness-related cognitions related to MUS have rarely been studied in children/adolescents and their parents. METHODS Seventy-eight children and adolescents (M = 14.2 years; 59% female) performed two versions of the Implicit Association Test (IAT) to measure the implicit illness-related and the implicit anxiety-related self-concept. Illness-related evaluations of unspecific symptoms were assessed via the Health Norms Sorting Task (HNST), and MUS as well as characteristics of somatic symptom disorder (SSD) via questionnaires. RESULTS MUS were significantly positively associated with the explicit (r = 0.30, p < .01) and implicit illness-related self-concept (r = 0.24, p = .04), but not with the anxiety-related self-concept (r = 0.15, p = .18). The implicit illness-related self-concept explained incremental variance in MUS (ΔR2 = 0.05, p = .04) beyond the explicit illness-related self-concept. Regarding health anxiety, parental illness-related symptom evaluations moderated the relationship between child-reported severity of MUS and health anxiety (B = 0.12, p < .01). LIMITATIONS Some measures have been adapted for childhood and adolescence, but validations on larger samples are still pending. CONCLUSIONS A disorder-specific self-concept of being ill, as well as parental symptom evaluations, seem to play an essential role in MUS and health anxiety in childhood and adolescence. Due to the importance of the top-down processes found here, the findings are in line with current predictive coding models of somatic symptom perception.
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17
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Leaviss J, Davis S, Ren S, Hamilton J, Scope A, Booth A, Sutton A, Parry G, Buszewicz M, Moss-Morris R, White P. Behavioural modification interventions for medically unexplained symptoms in primary care: systematic reviews and economic evaluation. Health Technol Assess 2020; 24:1-490. [PMID: 32975190 PMCID: PMC7548871 DOI: 10.3310/hta24460] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The term 'medically unexplained symptoms' is used to cover a wide range of persistent bodily complaints for which adequate examination and appropriate investigations do not reveal sufficiently explanatory structural or other specified pathologies. A wide range of interventions may be delivered to patients presenting with medically unexplained symptoms in primary care. Many of these therapies aim to change the behaviours of the individual who may have worsening symptoms. OBJECTIVES An evidence synthesis to determine the clinical effectiveness and cost-effectiveness of behavioural modification interventions for medically unexplained symptoms delivered in primary care settings was undertaken. Barriers to and facilitators of the effectiveness and acceptability of these interventions from the perspective of patients and service providers were evaluated through qualitative review and realist synthesis. DATA SOURCES Full search strategies were developed to identify relevant literature. Eleven electronic sources were searched. Eligibility criteria - for the review of clinical effectiveness, randomised controlled trials were sought. For the qualitative review, UK studies of any design were included. For the cost-effectiveness review, papers were restricted to UK studies reporting outcomes as quality-adjusted life-year gains. Clinical searches were conducted in November 2015 and December 2015, qualitative searches were conducted in July 2016 and economic searches were conducted in August 2016. The databases searched included MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO and EMBASE. Updated searches were conducted in February 2019 and March 2019. PARTICIPANTS Adult participants meeting the criteria for medically unexplained symptoms, including somatoform disorders, chronic unexplained pain and functional somatic syndromes. INTERVENTIONS Behavioural interventions were categorised into types. These included psychotherapies, exercise-based interventions, multimodal therapies (consisting of more than one intervention type), relaxation/stretching/social support/emotional support, guided self-help and general practitioner interventions, such as reattribution. Evidence synthesis: a network meta-analysis was conducted to allow a simultaneous comparison of all evaluated interventions in a single coherent analysis. Separate network meta-analyses were performed at three time points: end of treatment, short-term follow-up (< 6 months since the end of treatment) and long-term follow-up (≥ 6 months after the end of treatment). Outcomes included physical and psychological symptoms, physical functioning and impact of the illness on daily activities. Economic evaluation: within-trial estimates of cost-effectiveness were generated for the subset of studies where utility values (or quality-adjusted life-years) were reported or where these could be estimated by mapping from Short Form questionnaire-36 items or Short Form questionnaire-12 items outcomes. RESULTS Fifty-nine studies involving 9077 patients were included in the clinical effectiveness review. There was a large degree of heterogeneity both between and within intervention types, and the networks were sparse across all outcomes. At the end of treatment, behavioural interventions showed some beneficial effects when compared with usual care, in particular for improvement of specific physical symptoms [(1) pain: high-intensity cognitive-behavioural therapy (CBTHI) standardised mean difference (SMD) 0.54 [95% credible interval (CrI) 0.28 to 0.84], multimodal SMD 0.52 (95% CrI 0.19 to 0.89); and (2) fatigue: low-intensity cognitive-behavioural therapy (CBTLI) SMD 0.72 (95% CrI 0.27 to 1.21), relaxation/stretching/social support/emotional support SMD 0.87 (95% CrI 0.20 to 1.55), graded activity SMD 0.51 (95% CrI 0.14 to 0.93), multimodal SMD 0.52 (95% CrI 0.14 to 0.92)] and psychological outcomes [(1) anxiety CBTHI SMD 0.52 (95% CrI 0.06 to 0.96); (2) depression CBTHI SMD 0.80 (95% CrI 0.26 to 1.38); and (3) emotional distress other psychotherapy SMD 0.58 (95% CrI 0.05 to 1.13), relaxation/stretching/social support/emotional support SMD 0.66 (95% CrI 0.18 to 1.28) and sport/exercise SMD 0.49 (95% CrI 0.03 to 1.01)]. At short-term follow-up, behavioural interventions showed some beneficial effects for specific physical symptoms [(1) pain: CBTHI SMD 0.73 (95% CrI 0.10 to 1.39); (2) fatigue: CBTLI SMD 0.62 (95% CrI 0.11 to 1.14), relaxation/stretching/social support/emotional support SMD 0.51 (95% CrI 0.06 to 1.00)] and psychological outcomes [(1) anxiety: CBTHI SMD 0.74 (95% CrI 0.14 to 1.34); (2) depression: CBTHI SMD 0.93 (95% CrI 0.37 to 1.52); and (3) emotional distress: relaxation/stretching/social support/emotional support SMD 0.82 (95% CrI 0.02 to 1.65), multimodal SMD 0.43 (95% CrI 0.04 to 0.91)]. For physical functioning, only multimodal therapy showed beneficial effects: end-of-treatment SMD 0.33 (95% CrI 0.09 to 0.59); and short-term follow-up SMD 0.78 (95% CrI 0.23 to 1.40). For impact on daily activities, CBTHI was the only behavioural intervention to show beneficial effects [end-of-treatment SMD 1.30 (95% CrI 0.59 to 2.00); and short-term follow-up SMD 2.25 (95% CrI 1.34 to 3.16)]. Few effects remained at long-term follow-up. General practitioner interventions showed no significant beneficial effects for any outcome. No intervention group showed conclusive beneficial effects for measures of symptom load (somatisation). A large degree of heterogeneity was found across individual studies in the assessment of cost-effectiveness. Several studies suggested that the interventions produce fewer quality-adjusted life-years than usual care. For those interventions that generated quality-adjusted life-year gains, the mid-point incremental cost-effectiveness ratios (ICERs) ranged from £1397 to £129,267, but, where the mid-point ICER fell below £30,000, the exploratory assessment of uncertainty suggested that it may be above £30,000. LIMITATIONS Sparse networks meant that it was not possible to conduct a metaregression to explain between-study differences in effects. Results were not consistent within intervention type, and there were considerable differences in characteristics between studies of the same type. There were moderate to high levels of statistical heterogeneity. Separate analyses were conducted for three time points and, therefore, analyses are not repeated-measures analyses and do not account for correlations between time points. CONCLUSIONS Behavioural interventions showed some beneficial effects for specific medically unexplained symptoms, but no one behavioural intervention was effective across all medically unexplained symptoms. There was little evidence that these interventions are effective for measures of symptom load (somatisation). General practitioner-led interventions were not shown to be effective. Considerable heterogeneity in interventions, populations and sparse networks mean that results should be interpreted with caution. The relationship between patient and service provider is perceived to play a key role in facilitating a successful intervention. Future research should focus on testing the therapeutic effects of the general practitioner-patient relationship within trials of behavioural interventions, and explaining the observed between-study differences in effects within the same intervention type (e.g. with more detailed reporting of defined mechanisms of the interventions under study). STUDY REGISTRATION This study is registered as PROSPERO CRD42015025520. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 46. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Joanna Leaviss
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Sarah Davis
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Shijie Ren
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Jean Hamilton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Alison Scope
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anthea Sutton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Glenys Parry
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Marta Buszewicz
- Department of Primary Care and Population Health, University College London Medical School, London, UK
| | | | - Peter White
- Barts and The London School of Medicine and Dentistry, London, UK
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18
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Zhang T, Bai T, Xie W, Wei Q, Lv H, Wang A, Guan J, Tian Y, Wang K. Abnormal connectivity of anterior-insular subdivisions and relationship with somatic symptom in depressive patients. Brain Imaging Behav 2020; 15:1760-1768. [PMID: 32748317 DOI: 10.1007/s11682-020-00371-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Depressive patients frequently present with somatic complaints such as pain and fatigue. The anterior insula (AI) is a crucial region for somatic processing, but reported contributions of AI dysfunction to somatic symptoms have varied across studies. We speculated that functional heterogeneity among AI subdivisions may contribute to this inconsistency. To reveal the correlation between each subdivision and somatic symptoms, we investigated resting-state functional connectivity (RSFC) based on seeds within distinct AI subdivisions in 45 depressive patients and 35 matched healthy controls (HCs). Depressive and somatic symptoms were assessed using the Hamilton Depression Rating Scale (HDRS) and the 15-item somatic symptom severity scale of the Patient Health Questionnaire (PHQ-15), respectively. The contributions of AI subregion-specific pathways to depression were further validated by examining changes in symptom severity and RSFC following electroconvulsive therapy (ECT). At baseline, depressive patients exhibited weaker RSFC between ventral AI (vAI) and right orbitofrontal cortex (rOFC) than HCs. Moreover, vAI-rOFC RSFC strength was negatively correlated with PHQ-15 and HDRS scores, indicating that weaker RSFC predicted greater symptom severity. ECT reduced depressive and somatic symptoms, and symptom mitigation was correlated with enhanced vAI-rOFC RSFC. The findings suggest that reduced vAI-rOFC RSFC underlies the somatic symptoms of depression and that enhancing vAI-rOFC RSFC can contribute to amelioration of somatic symptoms.
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Affiliation(s)
- Ting Zhang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Anhui Province, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, China
| | - Tongjian Bai
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Anhui Province, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, China
| | - Wen Xie
- Anhui Mental Health Center, Hefei, Anhui Province, China
| | - Qiang Wei
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Anhui Province, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, China
| | - Huaming Lv
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Anhui Province, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, China
| | - Anzhen Wang
- Anhui Mental Health Center, Hefei, Anhui Province, China
| | - Jianjun Guan
- Anhui Mental Health Center, Hefei, Anhui Province, China
| | - Yanghua Tian
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Anhui Province, Hefei, China. .,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China. .,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, China. .,National Clinical Research Center for Mental Disorders, Hefei, China. .,Department of Medical Psychology, Anhui Medical University, Anhui Province, Hefei, China.
| | - Kai Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Anhui Province, Hefei, China. .,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China. .,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, China. .,Department of Medical Psychology, Anhui Medical University, Anhui Province, Hefei, China.
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19
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Jungmann SM, Witthöft M. Health anxiety, cyberchondria, and coping in the current COVID-19 pandemic: Which factors are related to coronavirus anxiety? J Anxiety Disord 2020; 73:102239. [PMID: 32502806 PMCID: PMC7239023 DOI: 10.1016/j.janxdis.2020.102239] [Citation(s) in RCA: 295] [Impact Index Per Article: 73.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/13/2020] [Accepted: 05/13/2020] [Indexed: 12/21/2022]
Abstract
According to cognitive-behavioral models, traits, triggering events, cognitions, and adverse behaviors play a pivotal role in the development and maintenance of health anxiety. During virus outbreaks, anxiety is widespread. However, the role of trait health anxiety, cyberchondria, and coping in the context of virus anxiety during the current COVID-19 pandemic has not yet been studied. An online survey was conducted in the German general population (N = 1615, 79.8 % female, Mage = 33.36 years, SD = 13.18) in mid-March 2020, which included questionnaires on anxiety associated with SARS-CoV-2, trait health anxiety, cyberchondriaPandemic (i.e. excessive online information search), and emotion regulation. The participants reported a significantly increasing virus anxiety in recent months (previous months recorded retrospectively), especially among individuals with heightened trait health anxiety. CyberchondriaPandemic showed positive correlations with current virus anxiety (r = .09-.48), and this relationship was additionally moderated by trait health anxiety. A negative correlation was found between the perception of being informed about the pandemic and the current virus anxiety (r=-.18), with adaptive emotion regulation being a significant moderator for this relationship. The findings suggest that trait health anxiety and cyberchondria serve as risk factors, whereas information about the pandemic and adaptive emotion regulation might represent buffering factors for anxiety during a virus pandemic.
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Affiliation(s)
- Stefanie M Jungmann
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg-University Mainz, Mainz, Germany.
| | - Michael Witthöft
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg-University Mainz, Mainz, Germany
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20
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Balabanovic J, Hayton P. Engaging patients with "medically unexplained symptoms" in psychological therapy: An integrative and transdiagnostic approach. Psychol Psychother 2020; 93:347-366. [PMID: 30618182 DOI: 10.1111/papt.12213] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 11/26/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Patients with "medically unexplained symptoms" or "MUS" experience subjectively compelling and distressing somatic symptoms that are not fully explained by underlying physical pathology. Effective treatment of these patients has been impeded by multiple barriers. Problems with patient engagement have been highlighted in the clinical and research literature, yet few exploratory studies have been conducted in this area. This research explores how experienced psychological therapists in a specialist MUS service work to engage these patients. DESIGN An in-depth qualitative study was conducted to explore the process of engaging patients with MUS in psychological therapy. METHOD Semi-structured depth interviews were conducted with psychological therapists who work with complex patients with MUS. The therapists interviewed were recruited from an NHS primary care psychological therapy service that specializes in working with this patient group. Data were analysed using grounded theory to develop a model of this process. RESULTS The analysis identified how multiple interacting layers of systemic, interpersonal, and intrapsychic disconnections impede engagement. The research introduces a new theoretical framework 'Negotiating disconnection' that conceptualizes the process of engagement in terms of a series of stages, namely 'Drawing in' (negotiating systemic disconnection), 'Meeting' (connecting in the disconnection), and 'Nudging Forward' (cultivating new connections), and illustrates how these are negotiated by therapists. CONCLUSIONS The model shows that it is critical for therapists to collaborate closely with GPs to engage these patients while also highlighting barriers to doing this, reflecting the complexities of organizational and cultural change. Clinically, the model illustrates the importance of adopting a flexible, pluralistic, and integrative approach that is person-centred and process-led. Doctors and therapists should embrace a holistic, biopsychosocial stance towards MUS and be sensitively attuned to its complex phenomenology. PRACTITIONER POINTS To engage patients with MUS psychological therapists should be person-centred and process-led rather than theory- or protocol-led. A pluralistic and integrative mindset facilitates this by enhancing clinicians' flexibility. A multidisciplinary approach is essential. Clinicians should embrace a biopsychosocial stance towards MUS and work closely with medical colleagues to help them do the same. Structural and cultural change is needed to tackle this issue effectively.
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21
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Witthöft M, Bräscher AK, Jungmann SM, Köteles F. Somatic Symptom Perception and Interoception. ZEITSCHRIFT FUR PSYCHOLOGIE-JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1027/2151-2604/a000403] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Abstract. Models of chronic somatic symptoms assume that abnormalities in interoception are related to the development and maintenance of symptom distress. Different models, however, disagree on the exact nature of the assumed abnormality: cognitive-behavioral models stress a hypervigilant cognitive style (predicting higher interoceptive accuracy) whereas predictive processing models assume a less detailed sensory processing (predicting lower interoceptive accuracy). This study aimed at testing the relationship between interoception and symptom perception. Using structural equation modeling, associations between cardiac interoception and symptom perception were tested in a sample of students ( n = 316) and a second heterogeneous sample ( n = 340, including 63 patients with either pathological health anxiety or a somatoform disorder according to DSM-IV). Stronger sensory symptom perceptions in the cardiorespiratory system were associated with lower interoceptive accuracy in sample 2. The findings are more in line with the predictive processing approach, suggesting less detailed and more biased interoception being associated with chronic somatic symptom distress.
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Affiliation(s)
- Michael Witthöft
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg-University of Mainz, Germany
| | - Anne-Kathrin Bräscher
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg-University of Mainz, Germany
| | - Stefanie M. Jungmann
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg-University of Mainz, Germany
| | - Ferenc Köteles
- Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Budapest, Hungary
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Řiháček T, Čevelíček M. Common therapeutic strategies in psychological treatments for medically unexplained somatic symptoms. Psychother Res 2019; 30:532-545. [PMID: 31345126 DOI: 10.1080/10503307.2019.1645370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objective: Medically unexplained somatic symptoms (MUSS) represent a frequent complaint in health care services. While psychological treatments have demonstrated some effect in patients with MUSS, further progress may be achieved by a synthesis of clinical strategies used in diverse treatment models. The aim of this study was to identify clinical strategies shared across multiple psychological treatments intended for the treatment of adult patients with MUSS. Method: Descriptions of psychological treatments for patients with MUSS were searched in the PsycINFO, PsycARTICLES, and Medline databases and manually. N = 135 resources met inclusion criteria and were subjected to qualitative analysis. Results: Similarities across treatments were captured in 8 broad categories and 18 subcategories that covered aspects of the therapeutic relationship, specific skills (bodily, emotional, and relational) for patients to develop, search for the meaning of symptoms, and the orientation on life beyond symptoms. Conclusions: Despite the differences in technique, it was possible to identify common therapeutic strategies in psychological treatments for patients with MUSS. These overarching treatment strategies, many of which have already obtained empirical support, may inspire further research and the development of comprehensive treatments with enhanced efficacy. Limitations of the present study include the lack of focus on specific syndromes.
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Affiliation(s)
- Tomáš Řiháček
- Department of Psychology, Faculty of Social Studies, Masaryk University, Brno, Czech Republic
| | - Michal Čevelíček
- Department of Psychology, Faculty of Social Studies, Masaryk University, Brno, Czech Republic
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Okur Güney ZE, Sattel H, Witthöft M, Henningsen P. Emotion regulation in patients with somatic symptom and related disorders: A systematic review. PLoS One 2019; 14:e0217277. [PMID: 31173599 PMCID: PMC6555516 DOI: 10.1371/journal.pone.0217277] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/08/2019] [Indexed: 12/28/2022] Open
Abstract
Background Somatic symptoms and related disorders (SSD) are prevalent phenomena in the health-care system. Disturbances in emotion regulation (ER) are commonly observed in patients suffering from SSD. Objectives This review aimed to examine ER processes that characterize SSD by a systematic analysis of the available empirical studies. Data sources PsycINFO and PubMed databases for the articles published between January 1985 and June 2018. Search terms “emotion/al regulation” or “affect regulation” and various forms of SSD. Study eligibility criteria Empirical studies that a) assigned adolescent or adult patients suffering from SSD based on a clinical diagnosis, and b) examined the relationship between ER and SSD, were included. Study synthesis methods A tabular summary of the articles was generated according to study characteristics, study quality, variables, and findings. The findings were organized based on ER variables used in the articles and diagnoses of SSD, which were then re-organized under the main constituents of ER (attention, body, and knowledge). Results The findings of the 64 articles largely supported the association between SSD and disturbances in ER, which are usually shared by different diagnoses of SSD. The results indicate that patients show a reduced engagement with cognitive content of emotions. On the other hand, bodily constituents of ER seem to depict an over-reactive pattern. Similarly, the patients tend to encounter difficulties in flexibly disengaging their (spontaneous) attention from emotional material. Limitations There is a scarcity of longitudinal designs, randomized controlled trials, experiments, and diary studies suited to investigate the short- and long-term causal relationship between ER and SSD. Symptoms of SSD and measures to assess emotion regulation are heterogeneous. Conclusions and implications Assessment of ER processes is potentially useful to understand SSD and for treatment planning. Furthermore, a concurrent investigation of the dynamic interaction of the ER modalities promises insights for better understanding of the role of ER in development, course, and maintenance of SSD.
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Affiliation(s)
- Zeynep Emine Okur Güney
- Klinikum rechts der Isar, Department of Psychosomatic Medicine and Psychotherapy Technical University of Munich, Munich, Germany
- Johannes Gutenberg University of Mainz, Department of Clinical Psychology, Psychotherapy and Experimental Psychology, Mainz, Germany
- * E-mail:
| | - Heribert Sattel
- Klinikum rechts der Isar, Department of Psychosomatic Medicine and Psychotherapy Technical University of Munich, Munich, Germany
| | - Michael Witthöft
- Johannes Gutenberg University of Mainz, Department of Clinical Psychology, Psychotherapy and Experimental Psychology, Mainz, Germany
| | - Peter Henningsen
- Klinikum rechts der Isar, Department of Psychosomatic Medicine and Psychotherapy Technical University of Munich, Munich, Germany
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Guo D, Kleinstäuber M, Johnson MH, Sundram F. Evaluating Commonalities Across Medically Unexplained Symptoms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050818. [PMID: 30845721 PMCID: PMC6427368 DOI: 10.3390/ijerph16050818] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 02/28/2019] [Accepted: 03/05/2019] [Indexed: 12/19/2022]
Abstract
This commentary presents commonalities in medically unexplained symptoms (MUS) across multiple organ systems, including symptoms, aetiological mechanisms, comorbidity with mental health disorders, symptom burden and impact on quality of life. Further, treatment outcomes and barriers in the clinician–patient relationship, and cross-cultural experiences are highlighted. This discussion is necessary in aiding an improved understanding and management of MUS due to the interconnectedness underlying MUS presentations across the spectrum of medical specialties.
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Affiliation(s)
- Dan Guo
- Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria 3010, Australia.
| | - Maria Kleinstäuber
- Department of Psychological Medicine, Dunedin Medical School, University of Otago, Dunedin 9016, New Zealand.
| | - Malcolm Henry Johnson
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1142, New Zealand.
| | - Frederick Sundram
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1142, New Zealand.
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Chapman A, Poliakoff E, Chew-Graham CA, Brown RJ. Attending away from the body predicts increased physical symptom reports at six months in primary care patients. J Psychosom Res 2018; 113:81-88. [PMID: 30190054 DOI: 10.1016/j.jpsychores.2018.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/01/2018] [Accepted: 08/02/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE High symptom reporting (HSR) and medically unexplained symptoms (MUS) are associated with considerable distress, disability, healthcare utilization and costs, but are poorly understood, and current treatments are of limited benefit. Most models of HSR and MUS implicate cognitive-perceptual factors, such as increased body-focused attention, reduced perceptual thresholds and a tendency to experience somatic misperception, but little is known about the causal role of these variables. We investigated this issue by studying whether there is a longitudinal relationship between perceptual-attentional variables and later clinical outcomes in primary care patients. METHOD Primary care patients (N = 102) completed clinical (physical symptom reporting, health anxiety and healthcare utilization) and perceptual-attentional (body-focused attention, perceptual threshold, somatic misperception) measures at baseline and then again six months later (N = 72). Hierarchical regression was used to examine cross-lagged relationships between baseline and follow-up scores. RESULTS Contrary to expectation, attending away from the body at baseline predicted increased not decreased symptom reporting six months later. Neither perceptual threshold nor somatic misperception predicted clinical outcomes at six months. CONCLUSIONS These findings suggest that body avoidance, rather than increased body focus, contribute to the development of HSR. Future studies should consider the potential clinical benefits of reducing bodily avoidance, via techniques that promote adaptive engagement with bodily sensations.
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Affiliation(s)
- Anna Chapman
- Northumberland, Tyne and Wear NHS Foundation Trust, United Kingdom
| | | | | | - Richard J Brown
- University of Manchester, United Kingdom; University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, United Kingdom.
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26
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Davoodi E, Wen A, Dobson KS, Noorbala AA, Mohammadi A, Farahmand Z. Early maladaptive schemas in depression and somatization disorder. J Affect Disord 2018; 235:82-89. [PMID: 29655079 DOI: 10.1016/j.jad.2018.04.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 02/23/2018] [Accepted: 04/02/2018] [Indexed: 10/17/2022]
Abstract
Cognitive theories of depression posit that early maladaptive schemas (EMSs) are key vulnerability factors for psychological disorders. In this study, we investigated specific EMSs as shared or distinct cognitive vulnerability factors for depression and somatization disorder. The sample consisted of patients with Major depressive disorder (N = 30) and Somatization disorder (N = 30) from a community hospital or a psychiatric clinic. Participants completed the Structured Clinical Interview for DSM-IV (SCID), the Beck Depression Inventory-II (BDI-II), and the short form of the Young Schema Questionnaire (YSQ-SF). Depressed patients exhibited significantly higher levels of all five schema domains and specific maladaptive schemas, including emotional deprivation, mistrust and abuse, social isolation and alienation, defectiveness and shame, failure, subjugation, emotional inhibition, and insufficient self-control or self-discipline. Moreover, depressed patients exhibited significantly higher levels of social isolation, emotional inhibition, as well as the overvigilance and inhibition domain when depressive symptom severity was controlled. Our results provide preliminary evidence that specific EMSs distinguish patients with depression and somatization. Suggestions for future research include the need to have a non-psychiatric control group, to evaluate the absolute role of EMSs in Somatization Disorder.
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Affiliation(s)
- Elham Davoodi
- Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Iran
| | | | | | - Ahmad Ali Noorbala
- Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Iran
| | - Abolfazl Mohammadi
- Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Iran
| | - Zahra Farahmand
- Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Iran
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Heimann P, Herpertz-Dahlmann B, Buning J, Wagner N, Stollbrink-Peschgens C, Dempfle A, von Polier GG. Somatic symptom and related disorders in children and adolescents: evaluation of a naturalistic inpatient multidisciplinary treatment. Child Adolesc Psychiatry Ment Health 2018; 12:34. [PMID: 29988308 PMCID: PMC6022439 DOI: 10.1186/s13034-018-0239-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 05/23/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND This naturalistic study assesses the effectiveness of inpatient multidisciplinary treatment of children and adolescents with somatic symptom disorders (SSD) and investigates the role of pain coping strategies and psychiatric comorbidity (anxiety, depression). METHODS Sixty children and adolescents (mean age 14.4 years) with SSD who underwent inpatient multidisciplinary treatment were assessed regarding their school attendance, levels of discomfort, coping strategies and psychiatric comorbidity (depression, anxiety) at pretreatment, discharge and 6 months following treatment. RESULTS At discharge, the children and adolescents reported improvements in their level of discomfort, psychiatric comorbidities (anxiety, depression) and pain coping strategies, with medium to large effect sizes. Six months following treatment, the improvements remained stable, including significantly higher school attendance rates (d = 1.6; p < 0.01). Improvement in pain coping was associated with increased school attendance. CONCLUSION Inpatient multidisciplinary treatment is effective in reducing levels of discomfort, psychiatric comorbidity (anxiety, depression), and school absence and in improving coping strategies.
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Affiliation(s)
- Pola Heimann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany
| | - Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany
| | - Jonas Buning
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany
| | - Norbert Wagner
- Department of Pediatrics, RWTH Aachen University, Aachen, Germany
| | | | - Astrid Dempfle
- Department of Medical Informatics and Statistic, University Schleswig-Holstein, Kiel, Germany
| | - Georg G. von Polier
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany
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Schmaling KB, Fales JL. The association between borderline personality disorder and somatoform disorders: A systematic review and meta-analysis. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2018. [DOI: 10.1111/cpsp.12244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Karen B. Schmaling
- Department of Psychology; Washington State University; Vancouver Washington
| | - Jessica L. Fales
- Department of Psychology; Washington State University; Vancouver Washington
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29
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Dewsaran-van der Ven C, van Broeckhuysen-Kloth S, Thorsell S, Scholten R, De Gucht V, Geenen R. Self-compassion in somatoform disorder. Psychiatry Res 2018; 262:34-39. [PMID: 29407566 DOI: 10.1016/j.psychres.2017.12.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 11/06/2017] [Accepted: 12/07/2017] [Indexed: 12/22/2022]
Abstract
'Third wave' cognitive-behavioral therapies have given a boost to the study of resilience factors, such as self-compassion. To get an indication of the potential clinical relevance of self-compassion for somatoform disorder, this study examined whether self-compassion in patients with somatoform disorder is lower than in the general population, and whether self-compassion is associated with number of symptoms and health-related quality of life. Two-hundred-and-thirty-six participants with somatoform disorder and 236 subjects from the general population, matched on sex and age, filled out questionnaires regarding self-compassion (SCS), number of symptoms (PSC) and health-related quality of life (EQ-5D). The difference in self-compassion between the patient group (Mean 3.53, SD .96) and the general population (Mean 4.16, SD .98) was significant with a medium effect size (d = -.65). Multiple regression analyses showed that having a somatoform disorder and low self-compassion were independently associated with number of symptoms and reduced health-related quality of life. The lower level of self-compassion in somatoform disorder and its association with more physical symptoms and lower health-related quality of life, indicate that self-compassion is a potential clinically relevant factor that may influence therapy outcome and that can be a therapeutic target in patients with somatoform disorder.
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Affiliation(s)
- Charlotte Dewsaran-van der Ven
- Altrecht Psychosomatic Medicine Eikenboom, Vrijbaan 2, 3705 WC Zeist, The Netherlands; Department of Psychology, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, The Netherlands.
| | | | - Shiva Thorsell
- Altrecht Psychosomatic Medicine Eikenboom, Vrijbaan 2, 3705 WC Zeist, The Netherlands
| | - Ron Scholten
- Altrecht Psychosomatic Medicine Eikenboom, Vrijbaan 2, 3705 WC Zeist, The Netherlands
| | - Véronique De Gucht
- Altrecht Psychosomatic Medicine Eikenboom, Vrijbaan 2, 3705 WC Zeist, The Netherlands; Health, Medical and Neuropsychology Unit, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands
| | - Rinie Geenen
- Altrecht Psychosomatic Medicine Eikenboom, Vrijbaan 2, 3705 WC Zeist, The Netherlands; Department of Psychology, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, The Netherlands.
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Menon V, Shanmuganathan B, Thamizh JS, Arun AB, Sarkar S. Efficacy of Adjunctive Single Session Counseling for Medically Unexplained Symptoms: A Randomized Controlled Trial. Indian J Psychol Med 2017; 39:641-647. [PMID: 29200561 PMCID: PMC5688892 DOI: 10.4103/ijpsym.ijpsym_73_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
CONTEXT Medically unexplained symptoms (MUS) are often poorly responsive to standard treatments. AIM The aim of the study is to assess short-term efficacy of adjunctive single session cognitive behavior therapy (CBT)-based counseling for patients with MUS. SETTING AND DESIGN Randomized controlled trial at a psychosomatic clinic of a tertiary care hospital. MATERIALS AND METHODS Patients with MUS were randomized to receive either the single session counseling (intervention group) (n = 41) or control group which received treatment as usual (n = 35). The counseling intervention focused on three areas - cognitive reattribution, shifting focus, and guided muscular relaxation and lasted around 30 min. The two groups were assessed at baseline and after 1 month for change in outcome measures. STATISTICAL ANALYSIS USED Repeated measures analysis of variance. P value was adjusted for multiple comparisons using Bonferroni correction and set at <0.01 for significance. RESULTS Both groups did not differ on change in the primary outcome measure: Patient Health Questionnaire - 15 scores (P = 0.055). However, at follow-up, the intervention group showed statistically greater reduction in the number of workdays lost (P = 0.005). Trend level changes were noted for depressive symptom reduction only in the intervention group (P = 0.022). CONCLUSIONS One session CBT-based therapy demonstrates potentially important benefits over standard care among Indian patients with MUS. Further testing in larger samples with longer follow-up periods is therefore recommended.
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Affiliation(s)
- Vikas Menon
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | | | | | - Anand Babu Arun
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Siddharth Sarkar
- Department of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
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Herr RM, Li J, Loerbroks A, Angerer P, Siegrist J, Fischer JE. Effects and mediators of psychosocial work characteristics on somatic symptoms six years later: Prospective findings from the Mannheim Industrial Cohort Studies (MICS). J Psychosom Res 2017; 98:27-33. [PMID: 28554369 DOI: 10.1016/j.jpsychores.2017.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 03/29/2017] [Accepted: 05/03/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Ample evidence documented the adverse health effects of work stressors, and recent research has increasingly focused on somatic symptoms which are very common and costly. Prospective evidence is however sparse and yielded mixed findings. Furthermore, there is reason to assume that depression and anxiety might mediate the effects of adverse psychosocial work conditions on somatic symptoms. This study aimed to investigate longitudinal effects of work stressors on somatic symptoms and the potential mediation by anxiety and/or depression. METHODS Six year follow-up data from 352 individuals - free of potentially stress-related chronic disease - were utilized. Somatic symptoms were assessed by 19 items of an established list of complaints at baseline and follow-up. The effort-reward-imbalance (ERI) model measured adverse psychosocial work conditions and over-commitment (OC). Linear regressions adjusted for socio-demographics, social status, lifestyle, and baseline symptoms estimated the effects of the ERI ratio, effort, reward, OC, and the ERI ratio×OC interaction on somatic symptoms six years later. Furthermore, single and multiple mediation by anxiety and/or depression was investigated. RESULTS There was a strong longitudinal effect of the ERI ratio, as well as of its subcomponents, and OC on somatic symptoms (all Bs≥|0.49|; p-values ≤0.004). Moreover, the ERI ratio×OC interaction was significant (p-value=0.047). Multiple mediation analyses revealed especially anxiety to mediate the effect of work stressors on somatic symptoms (Sobel test=0.007). CONCLUSION Adverse psychosocial work conditions seem to longitudinally affect somatic symptoms, potentially moderated by OC, and mediated by anxiety.
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Affiliation(s)
- Raphael M Herr
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Germany; Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University of Düsseldorf, Germany.
| | - Jian Li
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University of Düsseldorf, Germany.
| | - Adrian Loerbroks
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University of Düsseldorf, Germany.
| | - Peter Angerer
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University of Düsseldorf, Germany.
| | - Johannes Siegrist
- Senior Professorships on Work Stress Research, Life Science Center, Faculty of Medicine, Heinrich-Heine-University of Düsseldorf, Germany.
| | - Joachim E Fischer
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Germany.
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Mier D, Bailer J, Ofer J, Kerstner T, Zamoscik V, Rist F, Witthöft M, Diener C. Neural correlates of an attentional bias to health-threatening stimuli in individuals with pathological health anxiety. J Psychiatry Neurosci 2017; 42:200-209. [PMID: 28234209 PMCID: PMC5403665 DOI: 10.1503/jpn.160081] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND An attentional bias to health-threat stimuli is assumed to represent the primary pathogenetic factor for the development and maintenance of pathological health anxiety (PHA; formerly termed "hypochondriasis"). However, little is known about the neural basis of this attentional bias in individuals with PHA. METHODS A group of patients with PHA, a group of depressed patients and a healthy control group completed an emotional Stroop task with health-threat (body symptom and illness) words and neutral control words while undergoing functional MRI. RESULTS We included 33 patients with PHA, 28 depressed patients and 31 controls in our analyses. As reflected in reaction times, patients with PHA showed a significantly stronger attentional bias to health-threat words than both control groups. In addition, patients with PHA showed increased amygdala and rostral anterior cingulate cortex activation for body symptom, but not for illness words. Moreover, only in patients with PHA amygdala activation in response to symptom words was positively associated with higher arousal and more negative valence ratings of the body symptom word material. LIMITATIONS A control group of patients with an anxiety disorder but without PHA would have helped to define the specificity of the results for PHA. CONCLUSION The attentional bias observed in patients with PHA is associated with hyperactivation in response to body symptom words in brain regions that are crucial for an arousal-related fear response (e.g., the amygdala) and for resolving emotional interference (e.g., the rostral anterior cingulate cortex). The findings have important implications for the nosological classification of PHA and suggest the application of innovative exposure-based interventions for the treatment of PHA.
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Affiliation(s)
- Daniela Mier
- Correspondence to: D. Mier, Department of Clinical Psychology, Central Institute of Mental Health, J5, 68159 Mannheim, Germany;
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Hypochondriasis Differs From Panic Disorder and Social Phobia: Specific Processes Identified Within Patient Groups. J Nerv Ment Dis 2017; 205:227-233. [PMID: 27805984 DOI: 10.1097/nmd.0000000000000613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Studies of the comorbidity of hypochondriasis have indicated high rates of cooccurrence with other anxiety disorders. In this study, the contrast among hypochondriasis, panic disorder, and social phobia was investigated using specific processes drawing on cognitive-perceptual models of hypochondriasis. Affective, behavioral, cognitive, and perceptual processes specific to hypochondriasis were assessed with 130 diagnosed participants based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria (66 with hypochondriasis, 32 with panic disorder, and 32 with social phobia). All processes specific to hypochondriasis were more intense for patients with hypochondriasis in contrast to those with panic disorder or social phobia (0.61 < d < 2.67). No differences were found between those with hypochondriasis with comorbid disorders and those without comorbid disorders. Perceptual processes were shown to best discriminate between patients with hypochondriasis and those with panic disorder.
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Porcelli P, De Carne M, Leandro G. The role of alexithymia and gastrointestinal-specific anxiety as predictors of treatment outcome in irritable bowel syndrome. Compr Psychiatry 2017; 73:127-135. [PMID: 27940317 DOI: 10.1016/j.comppsych.2016.11.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 11/24/2016] [Accepted: 11/25/2016] [Indexed: 02/08/2023] Open
Abstract
In a previous investigation irritable bowel syndrome (IBS) was associated more to alexithymia than gastrointestinal-specific anxiety (GSA). In this study their independent contribution in predicting treatment outcome was longitudinally investigated. Consecutive 150 IBS patients were evaluated for IBS symptoms, alexithymia, GSA, and psychological distress with validated scales after as-usual treatment for 6-12months. The primary treatment outcome was improvement measured with the IBS-Severity Scoring System that showed 111 patients who improved and 39 who did not improve. Improvement was associated to both alexithymia (d=1.27) and GSA (d=4.63) but only alexithymia showed overtime stability by hierarchical regression, controlled for co-variables. A series of logistic and linear regressions showed that baseline alexithymia, but not GSA, independently predicted both post-treatment improvement status (Cox & Snell R2=0.15; overall classification rate=74%) and symptom change (23% of explained variance). Although alexithymia and GSA were closely related IBS symptoms, only alexithymia was found to be a stable trait and a stronger predictor of treatment outcome than GSA. Since no treatment was established to be definitely effective for IBS, clinicians might improve treatment outcome by identifying patients with high alexithymia, attempting to improve their coping skills, emotional regulation, and affective awareness.
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Affiliation(s)
- Piero Porcelli
- Psychosomatic Unit, Scientific Institute for Digestive Disease "Saverio de Bellis" Hospital, Castellana Grotte, Italy.
| | - Massimo De Carne
- Department of Gastroenterology 2, Scientific Institute for Digestive Disease "Saverio de Bellis" Hospital, Castellana Grotte, Italy.
| | - Gioacchino Leandro
- Department of Gastroenterology 1, Scientific Institute for Digestive Disease "Saverio de Bellis" Hospital, Castellana Grotte, Italy; Department of Liver and Digestive Health, University College of London, UK.
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Symptoms and the body: Taking the inferential leap. Neurosci Biobehav Rev 2017; 74:185-203. [PMID: 28108416 DOI: 10.1016/j.neubiorev.2017.01.015] [Citation(s) in RCA: 285] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 12/01/2016] [Accepted: 01/11/2017] [Indexed: 12/19/2022]
Abstract
The relationship between the conscious experience of physical symptoms and indicators of objective physiological dysfunction is highly variable and depends on characteristics of the person, the context and their interaction. This relationship often breaks down entirely in the case of "medically unexplained" or functional somatic symptoms, violating the basic assumption in medicine that physical symptoms have physiological causes. In this paper, we describe the prevailing theoretical approach to this problem and review the evidence pertaining to it. We then use the framework of predictive coding to propose a new and more comprehensive model of the body-symptom relationship that integrates existing concepts within a unifying framework that addresses many of the shortcomings of current theory. We describe the conditions under which a close correspondence between the experience of symptoms and objective physiology might be expected, and when they are likely to diverge. We conclude by exploring some theoretical and clinical implications of this new account.
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What makes sense in our body? Personality and sensory correlates of body awareness and somatosensory amplification. PERSONALITY AND INDIVIDUAL DIFFERENCES 2017. [DOI: 10.1016/j.paid.2016.07.034] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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The association of work stress with somatic symptoms in Chinese working women: a large cross-sectional survey. J Psychosom Res 2016; 89:7-10. [PMID: 27663103 DOI: 10.1016/j.jpsychores.2016.08.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 07/29/2016] [Accepted: 08/02/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE It has been suggested that the relationship between work stress and somatic symptoms (e.g., cardiopulmonary, gastrointestinal complaints, general pain, and fatigue) is particularly pronounced in women. As evidence from China is sparse, we used a large sample of Chinese working women to test those potential associations. METHODS Data were obtained from a cross-sectional study of 6826 working women in five urban areas in China who were free from major clinical disease. The sample was drawn from five occupations (physicians, nurses, school teachers, bank employees, and industrial workers). The Effort-Reward Imbalance Questionnaire and Patient Health Questionnaire-15 were used to measure work stress and somatic symptoms, respectively. Multivariate ordinal logistic regression was performed to analyze the associations. RESULTS 52.6% participants reported high work stress in terms of concurrent high effort and low reward. The distribution of severity of somatic symptoms covered the full range from minimal (37.3%) and low (30.6%), to medium (19.7%) and high (12.4%). The adjusted odds ratio of somatic symptoms by high work stress was 2.45 (95% confidence interval=2.24-2.68), and all single psychosocial work factors (effort, reward, and over-commitment) exerted substantial effects on somatic symptoms (odds ratios>2.00). CONCLUSIONS Work stress is strongly associated with somatic symptoms in Chinese working women. Future longitudinal studies and intervention studies are needed to understand and improve women's psychosocial work environment and their psychosomatic health in China and elsewhere.
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Rodic D, Meyer AH, Lieb R, Meinlschmidt G. The Association of Sensory Responsiveness with Somatic Symptoms and Illness Anxiety. Int J Behav Med 2016; 23:39-48. [PMID: 25896875 DOI: 10.1007/s12529-015-9483-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Somatoform Disorders or Somatic Symptom and Related Disorders are a major public health problem.The pathophysiology underlying these disorders is not yet understood. PURPOSE The aim of this study was to explore if sensory responsiveness could contribute to a better understanding of pathophysiological mechanisms underlying two key symptoms of Somatoform Disorders, namely somatic symptoms and illness anxiety. METHODS We measured vibrotactile perception thresholds with the HVLab Perception Meter and examined their association with somatic symptoms, illness anxiety and trait anxiety. A sample of 205 volunteers participated in the study. RESULTS Sensory responsiveness was neither associated with somatic symptoms (β = -0.01; 95% confidence interval (CI), -0.37, 0.39) nor trait anxiety (β = -0.07; 95% CI, -0.30, 0.07). However, lower vibrotactile perception thresholds were associated with increased scores of the overall illness anxiety scale (β = -0.65; 95% CI, -1.21, -0.14) and its constituent subscale disease conviction (β = -2.07; 95% CI, -3.94, -0.43). CONCLUSIONS Our results suggest that increased sensory responsiveness is associated with illness anxiety and hence should be examined further as potential target within the etiopathology of somatoform disorders.
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Affiliation(s)
- Donja Rodic
- Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland.
| | - Andrea Hans Meyer
- Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland.
| | - Roselind Lieb
- Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland.
| | - Gunther Meinlschmidt
- Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland. .,Faculty of Medicine, Ruhr-University Bochum, Bochum, Germany. .,Department of Psychology, University of Basel, Missionsstrasse 60/62, 4055, Basel, Switzerland.
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Berryman C, Wise V, Stanton TR, McFarlane A, Moseley GL. A case-matched study of neurophysiological correlates to attention/working memory in people with somatic hypervigilance. J Clin Exp Neuropsychol 2016; 39:84-99. [DOI: 10.1080/13803395.2016.1203869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Schreiber F, Witthöft M, Neng JMB, Weck F. Changes in negative implicit evaluations in patients of hypochondriasis after treatment with cognitive therapy or exposure therapy. J Behav Ther Exp Psychiatry 2016. [PMID: 26204567 DOI: 10.1016/j.jbtep.2015.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND OBJECTIVES Previous studies using modified versions of the Affect Misattribution Procedure (AMP; Payne, Cheng, Govorun, & Stewart, 2005) have revealed that there is an implicit negative evaluation bias of illness-related information in patients with hypochondriasis (HYP), which might be a maintaining feature of HYP. However, there is no evidence on whether this bias might be targeted successfully by effective treatments, such as exposure therapy (ET) or cognitive therapy (CT). This is the first study to examine the change in negative implicit evaluations in a randomized controlled trial, including individual CT and ET, compared to a wait-list control group for HYP. METHODS An AMP with illness, symptom and neutral primes was used in 70 patients with HYP before and after treatment (wait-list respectively). RESULTS There was no significant change in negative implicit affective evaluations in both CT and ET, compared to wait-list. However, comparisons between the two active treatments revealed an interaction effect, that only for CT were the affective reactions on illness-as well as symptom-related prime trials (but not neutral primes) significantly more positive at post-compared to pre-treatment. In CT but not in ET, the reduction of implicit negative evaluation bias regarding symptom-related primes was significantly related to the reduction of self-reported health anxiety. LIMITATIONS The small subsample sizes for CT and ET, in comparison to wait-list, prohibit the detection of smaller effects. CONCLUSIONS Formal cognitive restructuring is necessary for reducing implicit negative evaluation bias in HYP, but the latter is not a prerequisite for reducing health anxiety. Thus, the importance of the negative implicit evaluation bias for the maintenance of HYP remains questionable.
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Affiliation(s)
- Franziska Schreiber
- Department of Clinical Psychology and Psychotherapy, Goethe-University, Frankfurt am Main, Germany.
| | - Michael Witthöft
- Clinical Psychology, Psychotherapy and Experimental Psychopathology, Johannes Gutenberg University, Mainz, Germany.
| | - Julia M B Neng
- Department of Clinical Psychology and Psychotherapy, Goethe-University, Frankfurt am Main, Germany.
| | - Florian Weck
- Clinical Psychology, Psychotherapy and Experimental Psychopathology, Johannes Gutenberg University, Mainz, Germany.
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Dömötör Z, Doering BK, Köteles F. Dispositional aspects of body focus and idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF). Scand J Psychol 2016; 57:136-43. [DOI: 10.1111/sjop.12271] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 11/02/2015] [Indexed: 11/29/2022]
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Teufel M, Zipfel S. Somatoforme Körperbeschwerden und umweltbezogene Gesundheitsstörung. ALLERGOLOGIE 2016. [DOI: 10.1007/978-3-642-37203-2_41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Shedden-Mora MC, Gross B, Lau K, Gumz A, Wegscheider K, Löwe B. Collaborative stepped care for somatoform disorders: A pre-post-intervention study in primary care. J Psychosom Res 2016; 80:23-30. [PMID: 26721544 DOI: 10.1016/j.jpsychores.2015.11.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 10/20/2015] [Accepted: 11/16/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The successful management of somatoform disorders in primary care is often limited due to low diagnostic accuracy, delayed referral to psychotherapy, and unstructured overuse of health care. This study aimed to investigate the feasibility of establishing a collaborative stepped health care network for somatoform disorders, and its impact on the diagnostic process and treatment recommendations in primary care. METHOD The Network for Somatoform and Functional Disorders (Sofu-Net) was established to connect 41 primary care physicians (PCP), 35 psychotherapists, and 8 mental health clinics. To evaluate Sofu-Net, primary care patients at high risk of having a somatoform disorder were identified using the Patient Health Questionnaire, and were assessed in detail at the patient and PCP level. Discussion of psychosocial distress in the consultations, diagnostic detection rates and treatment recommendations were compared before and 12 months after establishing the network. RESULTS Out of the pre- (n=1645) and 12-months-post Sofu-Net patient samples (n=1756), 267 (16.2%) and 269 (15.3%) high-risk patients were identified. From these, 156 and 123 patients were interviewed and information was assessed from their PCP. Twelve months after Sofu-Net establishment, high-risk patients more frequently discussed psychosocial distress with their PCP (63.3% vs. 79.2%, p<.001). PCPs prescribed more antidepressants (3.8% vs. 25.2%, p<.001) and less benzodiazepines (21.8% vs. 6.5%, p<.001). Sofu-Net did not affect PCP's diagnostic detection rates or recommendation to initiate psychotherapy. CONCLUSION The study results indicate feasibility of an interdisciplinary network for somatoform disorders. Collaborative care networks for somatoform disorders have the potential to improve doctor-patient-communication and prescription behavior.
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Affiliation(s)
- M C Shedden-Mora
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Clinic Hamburg-Eilbek, Martinistr. 52, 20246 Hamburg, Germany.
| | - B Gross
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Clinic Hamburg-Eilbek, Martinistr. 52, 20246 Hamburg, Germany
| | - K Lau
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Clinic Hamburg-Eilbek, Martinistr. 52, 20246 Hamburg, Germany; Department of Medical Psychology, University of Greifswald, Walther-Rathenau-Straße 48, 17475 Greifswald, Germany
| | - A Gumz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Clinic Hamburg-Eilbek, Martinistr. 52, 20246 Hamburg, Germany
| | - K Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - B Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Clinic Hamburg-Eilbek, Martinistr. 52, 20246 Hamburg, Germany
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Associations of psychosocial working conditions and working time characteristics with somatic complaints in German resident physicians. Int Arch Occup Environ Health 2015; 89:583-92. [PMID: 26542379 DOI: 10.1007/s00420-015-1096-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 09/28/2015] [Indexed: 12/21/2022]
Abstract
PURPOSE Somatic complaints (SC) are highly prevalent in working populations and cause suffering and extensive health-care utilization. Adverse psychosocial working conditions as conceptualized in the Job Demand-Control-Support Model (JDC-S) and adverse working time characteristics (WTC) are potential risk factors. This combination is particularly common in hospital physicians. This study examines associations of JDC-S and WTC with SC in resident physicians from Germany. METHODS A cross-sectional study was conducted among 405 physicians at the end of residency training. SC were measured using the Giessen Subjective Complaints List (GBB-24) containing the sub-categories exhaustion, gastrointestinal, musculoskeletal, and cardiovascular complaints. Data on working conditions were collected by a self-report method for work analysis in hospitals (TAA-KH-S) and by questions on WTC (i.e., working hours). Multivariable stepwise regression analyses were applied. RESULTS Workload showed the most pronounced relationship with all sub-categories of SC except gastrointestinal complaints. Job autonomy was not significantly related to any SC sub-category. Social support at work was inversely associated with all SC sub-categories except for cardiovascular complaints. Free weekends were associated with reduced SC except for exhaustion. Shift work was related to an increased SC total score and musculoskeletal complaints. Working hours showed no association with SC. CONCLUSION In resident physicians, high workload and shift work are associated with increased SC, while social support at work and free weekends are associated with decreased SC. These insights may inform the development of preventive measures to improve the health of this professional group. Prospective studies are needed though to corroborate our findings.
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Riebel K, Egloff B, Witthöft M. Modifying the implicit illness-related self-concept in patients with somatoform disorders may reduce somatic symptoms. Int J Behav Med 2015; 21:861-8. [PMID: 25356457 DOI: 10.1007/s12529-013-9362-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND According to dual process theories, not only do explicit but also implicit cognitive processes play a major role in the development and maintenance of somatoform disorders(SFDs). Recent evidence [1] suggests that patients with SFD shave a stronger implicit illness-related self-concept, which is related to the experience of medically unexplained symptoms. PURPOSE The current study was designed to investigate a possible causal link between biased implicit associations and symptoms in SFD patients by experimentally modifying the implicit illness-related self-concept. METHODS Twenty-nine patients with SFDs (according to the DSM-IV) initially completed an Implicit Association Test(IAT) for assessing the implicit illness-related self-concept.Two weeks later, they underwent an evaluative conditioning task to modify the implicit self-concept. RESULTS After this procedure, a change toward a healthier implicit self-concept was apparent in the follow-up IAT. A reduction in symptom severity and changes in health- and body-related cognitions were observed 13 days after the training in the follow-up questionnaires. CONCLUSIONS The findings suggest that a biased implicit self-concept may be causally relevant for symptom experiences inpatients with SFDs. Existing cognitive behavioral treatments for SFDs might benefit from targeting implicit cognitive processes more directly.
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Klemenc-Ketiš Z, Kersnik J. Focus points in prevention actions against legal substances' abuse. Wien Klin Wochenschr 2015; 127 Suppl 5:S241-6. [PMID: 25787211 DOI: 10.1007/s00508-015-0706-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 01/16/2015] [Indexed: 12/28/2022]
Abstract
AIM To determine the factors associated with alcohol and tobacco abuse in Slovenian general population. MATERIAL AND METHODS We performed an observational cross-sectional study in a representative sample of 1002 Slovenian inhabitants in June 2011. It was performed using a method of computer-assisted telephone interview. The telephone interview consisted of questions about the prevalence and duration of preselected health-related symptoms in the past month, questions about the presence of chronic diseases, question about the presence of current smoking, EQ-5D questionnaire and AUDIT-C questionnaire. RESULTS Risky drinking was found in 103 (14.3 %) of the sample and smoking was found in 226 (22.6 %) of the sample. Men reported risky drinking more often when compared with women (17.7 vs. 10.5 %, P = 0.007). Multivariate analysis showed that male sex, current tobacco smoking, lower education level, self-reported presence of anxiety/depression and self-reported presence of muscle pain and excessive fatigue in the past month were independently associated with risky drinking and that male sex, lower education and income, the presence of chronic disease, self-reported problems in daily activities, risky drinking, self-reported troubles in sleeping and restless leg syndrome were independently associated with current tobacco smoking. CONCLUSION Risky alcohol drinking and smoking are still major public health problems in Slovenia and are associated with known demographic risk factors but also with some symptoms of somatoform disorders. These findings should be incorporated into the guidelines for family physicians as the important focus points for screening and intervening against legal substances' abuse in their patients.
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Affiliation(s)
- Zalika Klemenc-Ketiš
- Department of Family Medicine, Medical School, University of Maribor, Maribor, Slovenia. .,Department of Family Medicine, Medical School, University of Ljubljana, Ljubljana, Slovenia. .,, Kersnikova 1, 3320, Velenje, Slovenia.
| | - Janko Kersnik
- Department of Family Medicine, Medical School, University of Maribor, Maribor, Slovenia.,Department of Family Medicine, Medical School, University of Ljubljana, Ljubljana, Slovenia
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Hiller W, Rief W. Die Abschaffung der somatoformen Störungen durch DSM-5 – ein akademischer Schildbürgerstreich? PSYCHOTHERAPEUT 2014. [DOI: 10.1007/s00278-014-1081-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Kleinstäuber M, Witthöft M, Steffanowski A, van Marwijk H, Hiller W, Lambert MJ. Pharmacological interventions for somatoform disorders in adults. Cochrane Database Syst Rev 2014; 2014:CD010628. [PMID: 25379990 PMCID: PMC11023023 DOI: 10.1002/14651858.cd010628.pub2] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Somatoform disorders are characterised by chronic, medically unexplained physical symptoms (MUPS). Although different medications are part of treatment routines for people with somatoform disorders in clinics and private practices, there exists no systematic review or meta-analysis on the efficacy and tolerability of these medications. We aimed to synthesise to improve optimal treatment decisions. OBJECTIVES To assess the effects of pharmacological interventions for somatoform disorders (specifically somatisation disorder, undifferentiated somatoform disorder, somatoform autonomic dysfunction, and pain disorder) in adults. SEARCH METHODS We searched the Cochrane Depression, Anxiety and Neurosis Review Group's Specialised Register (CCDANCTR) (to 17 January 2014). This register includes relevant randomised controlled trials (RCTs) from The Cochrane Library (all years), MEDLINE (1950 to date), EMBASE (1974 to date), and PsycINFO (1967 to date). To identify ongoing trials, we searched ClinicalTrials.gov, Current Controlled Trials metaRegister, the World Health Organization International Clinical Trials Registry Platform, and the Chinese Clinical Trials Registry. For grey literature, we searched ProQuest Dissertation & Theses Database, OpenGrey, and BIOSIS Previews. We handsearched conference proceedings and reference lists of potentially relevant papers and systematic reviews and contacted experts in the field. SELECTION CRITERIA We selected RCTs or cluster RCTs of pharmacological interventions versus placebo, treatment as usual, another medication, or a combination of different medications for somatoform disorders in adults. We included people fulfilling standardised diagnostic criteria for somatisation disorder, undifferentiated somatoform disorder, somatoform autonomic dysfunction, or somatoform pain disorder. DATA COLLECTION AND ANALYSIS One review author and one research assistant independently extracted data and assessed risk of bias. Primary outcomes included the severity of MUPS on a continuous measure, and acceptability of treatment. MAIN RESULTS We included 26 RCTs (33 reports), with 2159 participants, in the review. They examined the efficacy of different types of antidepressants, the combination of an antidepressant and an antipsychotic, antipsychotics alone, or natural products (NPs). The duration of the studies ranged between two and 12 weeks.One meta-analysis of placebo-controlled studies showed no clear evidence of a significant difference between tricyclic antidepressants (TCAs) and placebo for the outcome severity of MUPS (SMD -0.13; 95% CI -0.39 to 0.13; 2 studies, 239 participants; I(2) = 2%; low-quality evidence). For new-generation antidepressants (NGAs), there was very low-quality evidence showing they were effective in reducing the severity of MUPS (SMD -0.91; 95% CI -1.36 to -0.46; 3 studies, 243 participants; I(2) = 63%). For NPs there was low-quality evidence that they were effective in reducing the severity of MUPS (SMD -0.74; 95% CI -0.97 to -0.51; 2 studies, 322 participants; I(2) = 0%).One meta-analysis showed no clear evidence of a difference between TCAs and NGAs for severity of MUPS (SMD -0.16; 95% CI -0.55 to 0.23; 3 studies, 177 participants; I(2) = 42%; low-quality evidence). There was also no difference between NGAs and other NGAs for severity of MUPS (SMD -0.16; 95% CI -0.45 to 0.14; 4 studies, 182 participants; I(2) = 0%).Finally, one meta-analysis comparing selective serotonin reuptake inhibitors (SSRIs) with a combination of SSRIs and antipsychotics showed low-quality evidence in favour of combined treatment for severity of MUPS (SMD 0.77; 95% CI 0.32 to 1.22; 2 studies, 107 participants; I(2) = 23%).Differences regarding the acceptability of the treatment (rate of all-cause drop-outs) were neither found between NGAs and placebo (RR 1.01, 95% CI 0.64 to 1.61; 2 studies, 163 participants; I(2) = 0%; low-quality evidence) or NPs and placebo (RR 0.85, 95% CI 0.40 to 1.78; 3 studies, 506 participants; I(2) = 0%; low-quality evidence); nor between TCAs and other medication (RR 1.48, 95% CI 0.59 to 3.72; 8 studies, 556 participants; I(2) =14%; low-quality evidence); nor between antidepressants and the combination of an antidepressant and an antipsychotic (RR 0.80, 95% CI 0.25 to 2.52; 2 studies, 118 participants; I(2) = 0%; low-quality evidence). Percental attrition rates due to adverse effects were high in all antidepressant treatments (0% to 32%), but low for NPs (0% to 1.7%).The risk of bias was high in many domains across studies. Seventeen trials (65.4%) gave no information about random sequence generation and only two (7.7%) provided information about allocation concealment. Eighteen studies (69.2%) revealed a high or unclear risk in blinding participants and study personnel; 23 studies had high risk of bias relating to blinding assessors. For the comparison NGA versus placebo, there was relatively high imprecision and heterogeneity due to one outlier study. Although we identified 26 studies, each comparison only contained a few studies and small numbers of participants so the results were imprecise. AUTHORS' CONCLUSIONS The current review found very low-quality evidence for NGAs and low-quality evidence for NPs being effective in treating somatoform symptoms in adults when compared with placebo. There was some evidence that different classes of antidepressants did not differ in efficacy; however, this was limited and of low to very low quality. These results had serious shortcomings such as the high risk of bias, strong heterogeneity in the data, and small sample sizes. Furthermore, the significant effects of antidepressant treatment have to be balanced against the relatively high rates of adverse effects. Adverse effects produced by medication can have amplifying effects on symptom perceptions, particularly in people focusing on somatic symptoms without medical causes. We can only draw conclusions about short-term efficacy of the pharmacological interventions because no trial included follow-up assessments. For each of the comparisons where there were available data on acceptability rates (NGAs versus placebo, NPs versus placebo, TCAs versus other medication, and antidepressants versus a combination of an antidepressant and an antipsychotic), no clear differences between the intervention and comparator were found.Future high-quality research should be carried out to determine the effectiveness of medications other than antidepressants, to compare antidepressants more thoroughly, and to follow-up participants over longer periods (the longest follow up was just 12 weeks). Another idea for future research would be to include other outcomes such as functional impairment or dysfunctional behaviours and cognitions as well as the classical outcomes such as symptom severity, depression, or anxiety.
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Affiliation(s)
- Maria Kleinstäuber
- Philipps‐University MarburgDepartment of Clinical Psychology and PsychotherapyGutenbergstr. 18MarburgHessenGermanyD‐35032
| | - Michael Witthöft
- Johannes Gutenberg‐University MainzDepartment of Clinical Psychology and PsychotherapyWallstr. 3MainzRheinland‐PfalzGermanyD‐55122
| | - Andrés Steffanowski
- University of MannheimDepartment of PsychologySchloss Ehrenhof Ost (2.OG)MannheimBaden‐WürttembergGermanyD‐68131
| | - Harm van Marwijk
- VU University Medical CenterDepartment of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care ResearchPO Box 7057AmsterdamNetherlands1007 MB
| | - Wolfgang Hiller
- Johannes Gutenberg‐University MainzDepartment of Clinical Psychology and PsychotherapyWallstr. 3MainzRheinland‐PfalzGermanyD‐55122
| | - Michael J Lambert
- Brigham Young UniversityDepartment of PsychologyOffice TLRB 2721001 Kimball TowerProvoUtahUSAUT 84602‐5543
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Schaefer M, Egloff B, Gerlach AL, Witthöft M. Improving heartbeat perception in patients with medically unexplained symptoms reduces symptom distress. Biol Psychol 2014; 101:69-76. [DOI: 10.1016/j.biopsycho.2014.05.012] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 05/14/2014] [Accepted: 05/17/2014] [Indexed: 11/25/2022]
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Zhang Y, Fritzsche K, Leonhart R, Zhao X, Zhang L, Wei J, Yang J, Wirsching M, Nater-Mewes R, Larisch A, Schaefert R. Dysfunctional illness perception and illness behaviour associated with high somatic symptom severity and low quality of life in general hospital outpatients in China. J Psychosom Res 2014; 77:187-95. [PMID: 25149028 DOI: 10.1016/j.jpsychores.2014.06.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 05/13/2014] [Accepted: 06/15/2014] [Indexed: 02/05/2023]
Abstract
OBJECTIVE In primary care populations in Western countries, high somatic symptom severity (SSS) and low quality of life (QoL) are associated with adverse psychobehavioural characteristics. This study assessed the relationship between SSS, QoL and psychobehavioural characteristics in Chinese general hospital outpatients. METHODS This multicentre cross-sectional study enrolled 404 patients from 10 outpatient departments, including Neurology, Gastroenterology, Traditional Chinese Medicine [TCM] and Psychosomatic Medicine departments, in Beijing, Shanghai, Chengdu and Kunming. A structured interview was used to assess the cognitive, affective and behavioural features associated with somatic complaints, independent of their origin. Several standard instruments were used to assess SSS, emotional distress and health-related QoL. Patients who reported low SSS (PHQ-15<10, n=203, SOM-) were compared to patients who reported high SSS (PHQ-15≥10, n=201, SOM+). RESULTS As compared to SOM- patients, SOM+ patients showed significantly more frequently adverse psychobehavioural characteristics in all questions of the interview. In hierarchical linear regression analyses adjusted for anxiety, depression, gender and medical conditions (SSS additionally for doctor visits), high SSS was significantly associated with "catastrophising" and "illness vulnerability"; low physical QoL was associated with "avoidance of physical activities" and "disuse of body parts"; low mental QoL was associated with "need for immediate medical help." CONCLUSION In accordance with the results from Western countries, high SSS was associated with negative illness and self-perception, low physical QoL with avoidance behaviour, and low mental QoL with reassurance seeking in Chinese general hospital outpatients.
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Affiliation(s)
- Yaoyin Zhang
- Mental Health Centre, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Kurt Fritzsche
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Freiburg, Germany.
| | | | - Xudong Zhao
- Department of Psychosomatic Medicine, Dongfang Hospital, School of Medicine, Tongji University, Shanghai, P.R. China
| | - Lan Zhang
- Mental Health Centre, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Jing Wei
- Department of Psychosomatic Medicine, Peking Union Hospital, P.R. China
| | - Jianzhong Yang
- Department of Psychosomatic Medicine, Red Cross Hospital, Kunming, P.R. China
| | - Michael Wirsching
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Freiburg, Germany
| | | | - Astrid Larisch
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University, Giessen, Germany
| | - Rainer Schaefert
- Department of General Internal Medicine and Psychosomatics, University Medical Centre Heidelberg, Germany
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