Cognitive behavioural therapy for patients with electric sensitivity - a multidisciplinary approach in a controlled study

An IoMT-Based Approach for Real-Time Monitoring Using Wearable Neuro-Sensors

The Internet of Things (IoT) has demonstrated over the past few decades to be a powerful tool for connecting various medical equipment with in-built sensors and healthcare professionals to deliver superior health services that also reach remote areas. In addition to reducing healthcare costs, increasing access to clinical services, and enhancing operational effectiveness in the healthcare industry, it has also enhanced patient health safety. Recent research has focused on using EEG to assist and comprehend brain changes in rehabilitation facilities. These technologies can spot fluctuations in EEG constraints during treatment, which could result in more effective therapy and better functional outcomes. As a result, we have tried to use an IoT-based system for real-time monitoring of the constraints. Another unknown patient who is suffering from acute ischemic stroke may experience stroke-in-evolution or an early worsening of neurological symptoms, which is frequently associated with poor clinical outcomes. Because of this, managing an acute stroke requires early detection of these indications. The present investigation work will act as a standard reference for academic researchers, medical professionals, and everyone else involved in the use of IoMT. This study aims to anticipate strokes sooner and prevent their consequences by early intervention using an Internet of Things (IoT)-based system. Also, this study proposes usage of wearable equipment that can monitor and analyze brain signals for improved treatment and the prevention of stroke-related complications.

An idiographic approach to idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF) part I. Environmental, psychosocial and clinical assessment of three individuals with severe IEI-EMF

IEI-EMF refers to an environmental illness whose primary feature is the occurrence of symptoms that are attributed to exposure to weak electromagnetic fields (EMFs). There is a growing evidence that this condition is characterized by marked individual differences thus a within-subject approach might add important information beyond the widely used nomothetic method. A mixed qualitative/quantitative idiographic protocol with a threefold diagnostic approach was tested with the participation of three individuals with severe IEI-EMF. In this qualitative paper, the environmental, psychosocial, and clinical aspects are presented and discussed (results of ecological momentary assessment are discussed in Part II of this study). For two participants, psychopathological factors appeared to be strongly related to the condition. Psychological assessment indicated a severe pre-psychotic state with paranoid tendencies, supplemented with a strong attentional focus on bodily sensations and health status. The psychological profile of the third individual showed no obvious pathology. Overall, the findings suggest that the condition might have uniformly been triggered by serious psychosocial stress for all participants. Substantial aetiological differences among participants with severe IEI-EMF were revealed. The substantial heterogeneity in the psychological and psychopathological profiles associated with IEI-EMF warrants the use of idiographic multimodal assessments in order to better understand the different ways of aetiology and to facilitate person-taylored treatments.

Modern health worries and idiopathic environmental intolerance attributed to electromagnetic fields are associated with paranoid ideation

OBJECTIVE

Paranoid ideation is assumed to characterize worries about possible harmful effects of modern technologies (MHWs) and idiopathic environmental intolerances (IEIs), such as IEI attributed to electromagnetic fields (IEI-EMF). Empirical evidence on these associations is scarce.

METHODS

In a cross-sectional on-line survey, participants of a community sample (n = 700; mean age: 28.4 ± 12.0; 434 females) completed the Somatosensory Amplification Scale, the Modern Health Worries Scale, and the Paranoid Ideation scale of the Symptom Checklist 90 Revised. They were considered IEI-EMF if (1) they categorized themselves so, (2) they had experienced symptoms that they attributed to the exposure to electromagnetic fields, and (3) the condition impacted their everyday functioning.

RESULTS

Paranoid ideation was significantly positively associated with MHWs (standardized β = 0.150, p < .001) even after controlling for socio-demographic variables and somatosensory amplification tendency, an indicator of somatic symptom distress. Also, paranoid ideation explained significant variability in IEI-EMF (OR = 1.090, 95% CI: 1.006-1.180, p = .035) even after statistically controlling for socio-demographic variables and somatosensory amplification.

CONCLUSIONS

Paranoid ideation was found to be associated with MHWs and IEI-EMF. This association appears independent of general somatic symptom distress in both cases. This might partly explain the temporal stability of these constructs.

Comparing non-specific physical symptoms in environmentally sensitive patients: prevalence, duration, functional status and illness behavior

OBJECTIVE

Little is known about the potential clinical relevance of non-specific physical symptoms (NSPS) reported by patients with self-reported environmental sensitivities. This study aimed to assess NSPS in people with general environmental sensitivity (GES) and idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF) and to determine differences in functional status and illness behavior.

METHODS

An epidemiological study was conducted in the Netherlands, combining self-administered questionnaires with the electronic medical records of the respondents as registered by general practitioners. Analyses included n=5789 registered adult (≥18 years) patients, comprising 5073 non-sensitive (NS) individuals, 514 in the GES group and 202 in the IEI-EMF group.

RESULTS

Participants with GES were about twice as likely to consult alternative therapy compared to non-sensitive individuals; those with IEI-EMF were more than three times as likely. Moreover, there was a higher prevalence of symptoms and medication prescriptions and longer symptom duration among people with sensitivities. Increasing number and duration of self-reported NSPS were associated with functional impairment, illness behavior, negative symptom perceptions and prevalence of GP-registered NSPS in the examined groups.

CONCLUSION

Even after adjustment for medical and psychiatric morbidity, environmentally sensitive individuals experience poorer health, increased illness behavior and more severe NSPS. The number and duration of self-reported NSPS are important components of symptom severity and are associated with characteristics similar to those of NSPS in primary care. The substantial overlap between the sensitive groups strengthens the notion that different types of sensitivities might be part of one, broader environmental illness.

Idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF): a systematic review of identifying criteria

BACKGROUND

Idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF) remains a complex and unclear phenomenon, often characterized by the report of various, non-specific physical symptoms (NSPS) when an EMF source is present or perceived by the individual. The lack of validated criteria for defining and assessing IEI-EMF affects the quality of the relevant research, hindering not only the comparison or integration of study findings, but also the identification and management of patients by health care providers. The objective of this review was to evaluate and summarize the criteria that previous studies employed to identify IEI-EMF participants.

METHODS

An extensive literature search was performed for studies published up to June 2011. We searched EMBASE, Medline, Psychinfo, Scopus and Web of Science. Additionally, citation analyses were performed for key papers, reference sections of relevant papers were searched, conference proceedings were examined and a literature database held by the Mobile Phones Research Unit of King's College London was reviewed.

RESULTS

Sixty-three studies were included. "Hypersensitivity to EMF" was the most frequently used descriptive term. Despite heterogeneity, the criteria predominantly used to identify IEI-EMF individuals were: 1. Self-report of being (hyper)sensitive to EMF. 2. Attribution of NSPS to at least one EMF source. 3. Absence of medical or psychiatric/psychological disorder capable of accounting for these symptoms 4. Symptoms should occur soon (up to 24 hours) after the individual perceives an exposure source or exposed area. (Hyper)sensitivity to EMF was either generalized (attribution to various EMF sources) or source-specific. Experimental studies used a larger number of criteria than those of observational design and performed more frequently a medical examination or interview as prerequisite for inclusion.

CONCLUSIONS

Considerable heterogeneity exists in the criteria used by the researchers to identify IEI-EMF, due to explicit differences in their conceptual frameworks. Further work is required to produce consensus criteria not only for research purposes but also for use in clinical practice. This could be achieved by the development of an international protocol enabling a clearly defined case definition for IEI-EMF and a validated screening tool, with active involvement of medical practitioners.

Electromagnetic hypersensitivity: fact or fiction?

As the prevalence of wireless telecommunication escalates throughout the world, health professionals are faced with the challenge of patients who report symptoms they claim are connected with exposure to some frequencies of electromagnetic radiation (EMR). Some scientists and clinicians acknowledge the phenomenon of hypersensitivity to EMR resulting from common exposures such as wireless systems and electrical devices in the home or workplace; others suggest that electromagnetic hypersensitivity (EHS) is psychosomatic or fictitious. Various organizations including the World Health Organization as well as some nation states are carefully exploring this clinical phenomenon in order to better explain the rising prevalence of non-specific, multi-system, often debilitating symptoms associated with non-ionizing EMR exposure. As well as an assortment of physiological complaints, patients diagnosed with EHS also report profound social and personal challenges, impairing their ability to function normally in society. This paper offers a review of the sparse literature on this perplexing condition and a discussion of the controversy surrounding the legitimacy of the EHS diagnosis. Recommendations are provided to assist health professionals in caring for individuals complaining of EHS.

Symptoms, personality traits, and stress in people with mobile phone-related symptoms and electromagnetic hypersensitivity

OBJECTIVE

Some people report symptoms that they associate with electromagnetic field (EMF) exposure. These symptoms may be related to specific EMF sources or to electrical equipment in general (perceived electromagnetic hypersensitivity, EHS). Research and clinical observations suggest a difference between mobile phone (MP)-related symptoms and EHS with respect to symptom prevalence, psychological factors, and health prognosis. This study assessed prevalence of EMF-related and EMF-nonrelated symptoms, anxiety, depression, somatization, exhaustion, and stress in people with MP-related symptoms or EHS versus a population-based sample and a control sample without EMF-related symptoms.

METHODS

Forty-five participants with MP-related symptoms and 71 with EHS were compared with a population-based sample (n=106) and a control group (n=63) using self-report questionnaires.

RESULTS

The EHS group reported more symptoms than the MP group, both EMF-related and EMF-nonrelated. The MP group reported a high prevalence of somatosensory symptoms, whereas the EHS group reported more neurasthenic symptoms. As to self-reported personality traits and stress, the case groups differed only on somatization and listlessness in a direct comparison. In comparison with the reference groups, the MP group showed increased levels of exhaustion and depression but not of anxiety, somatization, and stress; the EHS group showed increased levels for all of the conditions except for stress.

CONCLUSION

The findings support the idea of a difference between people with symptoms related to specific EMF sources and people with general EHS with respect to symptoms and anxiety, depression, somatization, exhaustion, and stress. The differences are likely to be important in the management of patients.

Association of tinnitus and electromagnetic hypersensitivity: hints for a shared pathophysiology?

Background

Tinnitus is a frequent condition with high morbidity and impairment in quality of life. The pathophysiology is still incompletely understood. Electromagnetic fields are discussed to be involved in the multi-factorial pathogenesis of tinnitus, but data proofing this relationship are very limited. Potential health hazards of electromagnetic fields (EMF) have been under discussion for long. Especially, individuals claiming themselves to be electromagnetic hypersensitive suffer from a variety of unspecific symptoms, which they attribute to EMF-exposure. The aim of the study was to elucidate the relationship between EMF-exposure, electromagnetic hypersensitivity and tinnitus using a case-control design.

Methodology

Tinnitus occurrence and tinnitus severity were assessed by questionnaires in 89 electromagnetic hypersensitive patients and 107 controls matched for age-, gender, living surroundings and workplace. Using a logistic regression approach, potential risk factors for the development of tinnitus were evaluated.

Findings

Tinnitus was significantly more frequent in the electromagnetic hypersensitive group (50.72% vs. 17.5%) whereas tinnitus duration and severity did not differ between groups. Electromagnetic hypersensitivity and tinnitus were independent risk factors for sleep disturbances. However, measures of individual EMF-exposure like e.g. cell phone use did not show any association with tinnitus.

Conclusions

Our data indicate that tinnitus is associated with subjective electromagnetic hypersensitivity. An individual vulnerability probably due to an over activated cortical distress network seems to be responsible for, both, electromagnetic hypersensitivity and tinnitus. Hence, therapeutic efforts should focus on treatment strategies (e.g. cognitive behavioral therapy) aiming at normalizing this dysfunctional distress network.

Cognitive and neurobiological alterations in electromagnetic hypersensitive patients: results of a case-control study

BACKGROUND

Hypersensitivity to electromagnetic fields (EMF) is frequently claimed to be linked to a variety of non-specific somatic and neuropsychological complaints. Whereas provocation studies often failed to demonstrate a causal relationship between EMF exposure and symptom formation, recent studies point to a complex interplay of neurophysiological and cognitive alterations contributing to symptom manifestation in electromagnetic hypersensitive patients (EHS). However, these studies have examined only small sample sizes or have focused on selected aspects. Therefore this study examined in the largest sample of EHS EMF-specific cognitive correlates, discrimination ability and neurobiological parameters in order to get further insight into the pathophysiology of electromagnetic hypersensitivity.

METHOD

In a case-control design 89 EHS and 107 age- and gender-matched controls were included in the study. Health status and EMF-specific cognitions were evaluated using standardized questionnaires. Perception thresholds following single transcranial magnetic stimulation (TMS) pulses to the dorsolateral prefrontal cortex were determined using a standardized blinded measurement protocol. Cortical excitability parameters were measured by TMS.

RESULTS

Discrimination ability was significantly reduced in EHS (only 40% of the EHS but 60% of the controls felt no sensation under sham stimulation during the complete series), whereas the perception thresholds for real magnetic pulses were comparable in both groups (median 21% versus 24% of maximum pulse intensity). Intra-cortical facilitation was decreased in younger and increased in older EHS. In addition, typical EMF-related cognitions (aspects of rumination, symptom intolerance, vulnerability and stabilizing self-esteem) specifically differentiated EHS from their controls.

CONCLUSIONS

These results demonstrate significant cognitive and neurobiological alterations pointing to a higher genuine individual vulnerability of electromagnetic hypersensitive patients.

Psychological factors associated with self-reported sensitivity to mobile phones

OBJECTIVE

Some people report symptoms associated with mobile phone use. A minority also report "electrosensitivity," experiencing symptoms following exposure to other electrical devices. Research suggests that electromagnetic fields do not trigger these symptoms. In this study, we examined the differences between these two "sensitive" groups and healthy controls.

METHODS

Fifty-two people who reported sensitivity to mobile phones, 19 people who reported sensitivity to mobile phones and "electrosensitivity," and 60 nonsensitive controls completed a questionnaire assessing the following: primary reason for using a mobile phone, psychological health, symptoms of depression, modern health worries (MHW), general health status, symptom severity, and the presence of other medically unexplained syndromes.

RESULTS

Perceived sensitivity was associated with an increased likelihood of using a mobile phone predominantly for work (3% of controls, 13% of those sensitive to mobile phones, and 21% of those reporting "electrosensitivity") and greater MHW concerning radiation [mean (S.D.) on a scale of 1-5: 2.0 (1.0), 2.7 (0.9), and 4.0 (0.8), respectively]. Participants who reported "electrosensitivity" also experienced greater depression, greater worries about tainted food and toxic interventions, worse general health on almost every measure, and a greater number of other medically unexplained syndromes compared to participants from the other two groups. No group differences were observed with regards to psychiatric cases.

CONCLUSIONS

The data illustrate that patients reporting "electrosensitivity" experience substantially worse health than either healthy individuals or people who report sensitivity to mobile phones but who do not adopt the label "electrosensitivity." Clinicians and researchers would be wise to pay greater attention to this subdivision.

Altered cortical excitability in subjectively electrosensitive patients: results of a pilot study

OBJECTIVE

Hypersensitivity to electromagnetic fields is frequently claimed to be linked to a variety of unspecific somatic and/or neuropsychological complaints. Whereas provocation studies often failed to demonstrate a causal relationship between electromagnetic field exposure and symptom formation, neurophysiological examinations highlight baseline deviations in people claiming to be electrosensitive.

METHODS

To elucidate a potential role of dysfunctional cortical regulations in mediating hypersensitivity to electromagnetic fields, cortical excitability parameters were measured by transcranial magnetic stimulation in subjectively electrosensitive patients (n=23) and two control groups (n=49) differing in their level of unspecific health complaints.

RESULTS

Electrosensitive patients showed reduced intracortical facilitation as compared to both control groups, while motor thresholds and intracortical inhibition were unaffected.

CONCLUSIONS

This pilot study gives additional evidence that altered central nervous system function may account for symptom manifestation in subjectively electrosensitive patients as has been postulated for several chronic multisymptom illnesses sharing a similar clustering of symptoms.

A systematic review of treatments for electromagnetic hypersensitivity

BACKGROUND

Electromagnetic hypersensitivity (EHS) is a poorly understood condition in which patients report symptoms following perceived exposure to weak electromagnetic fields (EMFs) such as those produced by mobile phones or visual display units. Little is known about the aetiology of the condition although experimental data suggest that EMFs are an unlikely causal agent. In this systematic review we assessed the efficacy of any treatment for people reporting EHS.

METHODS

Twelve literature databases were examined to identify relevant studies. We also hand-searched conference proceedings and examined the reference sections of reviews and other papers. Only clinical trials that compared the efficacy of a potential treatment for EHS against a control condition were included in the review.

RESULTS

Nine controlled clinical trials were identified, examining the effects of cognitive behavioural therapy (4 studies), visual display unit screen filters (2 studies), 'shielding' EMF emitters (1 study), supplementary antioxidant therapy (1 study) and acupuncture (1 study). The quality of these studies was limited. Nevertheless, their results suggest that cognitive behavioural therapy is more effective than providing no treatment. None of the other therapies have had their efficacy adequately demonstrated.

CONCLUSIONS

The evidence base concerning treatment options for EHS is limited and more research is needed before any definitive clinical recommendations can be made. However, the best evidence currently available suggests that cognitive behavioural therapy is effective for patients who report being hypersensitive to weak EMFs.

Microwaves from GSM mobile telephones affect 53BP1 and gamma-H2AX foci in human lymphocytes from hypersensitive and healthy persons

The data on biologic effects of nonthermal microwaves (MWs) from mobile telephones are diverse, and these effects are presently ignored by safety standards of the International Commission for Non-Ionizing Radiation Protection (ICNIRP). In the present study, we investigated effects of MWs of Global System for Mobile Communication (GSM) at different carrier frequencies on human lymphocytes from healthy persons and from persons reporting hypersensitivity to electromagnetic fields (EMFs). We measured the changes in chromatin conformation, which are indicative of stress response and genotoxic effects, by the method of anomalous viscosity time dependence, and we analyzed tumor suppressor p53-binding protein 1 (53BP1) and phosphorylated histone H2AX (gamma-H2AX), which have been shown to colocalize in distinct foci with DNA double-strand breaks (DSBs), using immunofluorescence confocal laser microscopy. We found that MWs from GSM mobile telephones affect chromatin conformation and 53BP1/gamma-H2AX foci similar to heat shock. For the first time, we report here that effects of MWs from mobile telephones on human lymphocytes are dependent on carrier frequency. On average, the same response was observed in lymphocytes from hypersensitive and healthy subjects.

Comparison perception of singular transcranial magnetic stimuli by subjectively electrosensitive subjects and general population controls

Transcranial magnetic stimulation of the dorsolateral prefrontal cortex by single pulses of varying field intensities was used to measure thresholds of individual perception and motor response in three groups of subjects: subjectively electrosensitive people, general population controls with a high burden of complaints related to electromagnetic field (EMF) exposure in the literature (highest decile in complaint burden), and general population controls with a low burden of complaints (lowest decile in complaint burden). The major study endpoint was the ability of the subjects to differentiate between real magnetic stimulation and a sham condition. There were no significant differences between groups in the thresholds, neither of detecting the real magnetic stimulus nor in motor response. But the three groups differed significantly in differentiating between stimulation and sham condition, with the subjectively electrosensitive people having the lowest ability to differentiate and the control group with high level of EMF-related complaints having the best ability to differentiate. Differences between groups were mostly due to false alarm reactions in the sham condition reported by subjectively electrosensitives (SES). We found no objective correlate of the self perception of being "electrosensitive." Overall, our experiment does not support the hypothesis that subjectively electrosensitive patients suffer from a physiological hypersensitivity to EMFs or stimuli. Further research should focus on disposing factors explaining the unspecific sensory hyperresponsiveness of subjectively electrosensitive subjects.

Idiopathic Environmental Intolerance

Toxicogenic and psychogenic theories have been proposed to explain idiopathic environmental intolerance (IEI). Part 2 of this article is an evidence-based causality analysis of the psychogenic theory using an extended version of Bradford Hill's criteria. The psychogenic theory meets all of the criteria directly or indirectly and is characterised by a progressive research programme including double-blind, placebo-controlled provocation challenge studies. We conclude that IEI is a belief characterised by an overvalued idea of toxic attribution of symptoms and disability, fulfilling criteria for a somatoform disorder and a functional somatic syndrome. A neurobiological diathesis similar to anxiety, specifically panic disorder, is a neurobiologically plausible mechanism to explain triggered reactions to ambient doses of environmental agents, real or perceived. In addition, there is a cognitively mediated fear response mechanism characterised by vigilance for perceived exposures and bodily sensations that are subsequently amplified in the process of learned sensitivity. Implications for the assessment and treatment of patients are presented.

Environmental illness--effectiveness of a salutogenic group-intervention programme

AIMS

Hypersensitivity to electricity (HE) is a common form of reported environmental illness in Sweden. Functional somatic symptoms has been attributed to exposure to activated electrical equipment, but no causal relationship to electromagnetic fields has been proved. In many cases, traumatic life events and psychosocial stress can be identified, but patients often reject psychological explanations. This study evaluates the effectiveness of a new short-term group-intervention programme.

METHODS

A multidisciplinary team developed a short-term group-intervention programme, with a salutogenic approach that focuses on somatic and psychological reactions. Twenty-two patients (14 women and 8 men) who reported HE participated in eight weekly sessions of group meetings and physiotherapy. The effect of the programme was evaluated with regard to changes in work capacity, subjective well-being, coping ability, body awareness and physical fitness.

RESULTS

Contrary to our hypothesis physical fitness was not remarkably low. Muscular tension was reduced and body awareness increased but no significant change in symptoms was observed. Individual differences in progress were observed. Fourteen patients chose to continue with psychotherapy or physiotherapy.

CONCLUSIONS

Participants accepted the programme very well. One important result was identification of underlying contributing factors and motivation for further therapy. A multidisciplinary group-intervention programme with a salutogenic approach might be a useful approach to patients with medically unexplained symptoms in primary healthcare.

Idiopathic environmental intolerances (formerly multiple chemical sensitivity) psychiatric perspectives

Idiopathic environmental intolerances (IEI)/multiple chemical sensitivity (MCS) is characterized by various somatic symptoms which cannot be explained organically, but are attributed to the influences of toxic environmental chemicals in low, usually harmless doses. In the absence of a widely accepted definition of IEI, contradictory aetiological hypotheses and therapeutic suggestions are discussed. Some authors doubt the existence of IEI/MCS as a disease entity of its own. The label IEI does not implicate neither a diagnosis of somatic disease nor that it is caused by an avoidable exposure. Many IEI patients suffer from psychiatric diseases. A majority of them can be diagnosed as somatoform disorders. Consequently, psychiatric therapies could be effective. This review describes the current knowledge about IEI/MCS, outlines a diagnostic algorithm and a psychotherapeutic concept for variants of IEI understood as a somatoform disorder.

Environmental illness: fatigue and cholinesterase activity in patients reporting hypersensitivity to electricity

The lack of a pathophysiological marker hinders studies on environmental illnesses of unknown origin. Hence, research focused on the identification of such a marker is a priority. This study investigated the nature and a possible etiology of fatigue in hypersensitivity to electricity (the most commonly reported environmental illness in Sweden). The aim was to test the hypothesis that perceived fatigue was due to alterations in cholinesterase activity. The study group consisted of 14 people who reported a hypersensitivity to electricity, including disabling fatigue. We assessed cholinesterase activity three times: twice based on current symptoms reported by the subjects (severe fatigue attributed to electromagnetic fields and absence of this symptom) and once at a randomly selected time. No significant reduction in acetylcholinesterase was identified in any subject. Examined on a group level, no significant reduction in activity was identified at the time of severe fatigue, and no correlation between reported degree of fatigue and cholinesterase activity was observed. Fatigue attributed to electromagnetic fields was nonphysical and showed a significant correlation to difficulties in concentrating. The results do not support the hypothesis that a change in cholinesterase activity mediates fatigue in people reporting hypersensitivity to electricity.

Cognitive-behavioral therapy for somatization and symptom syndromes: a critical review of controlled clinical trials

OBJECTIVE

Few treatments for somatization have been proven effective. In the past decade, however, clinical trials of cognitive-behavioral therapy (CBT) have been promising. Our aim was to critically review and synthesize the evidence from these trials.

METHODS

A search of the Medline database from 1966 through July 1999 was conducted to identify controlled trials designed to evaluate the efficacy of CBT in patients with somatization or symptom syndromes.

RESULTS

A total of 31 controlled trials (29 randomized and 2 nonrandomized) were identified. Twenty-five studies targeted a specific syndrome (e.g. chronic fatigue, irritable bowel, pain) while 6 focused on more general somatization or hypochondriasis. Primary outcome assessment included physical symptoms, psychological distress and functional status in 28, 26 and 19 studies, respectively. Physical symptoms appeared the most responsive: CBT-treated patients improved more than control subjects in 71% of the studies and showed possibly greater improvement (i.e., a trend) in another 11% of the studies. A definite or possible advantage of CBT for reducing psychological distress was demonstrated in only 38 and 8% of studies, and for improving functional status in 47 and 26%. Group therapy and interventions as brief as 5 sessions proved efficacious. Benefits were sustained for up to 12 months.

CONCLUSION

CBT can be an effective treatment for patients with somatization or symptom syndromes. Benefits can occur whether or not psychological distress is ameliorated. Since chronic symptoms are exceptionally common and most studies were conducted in referral populations, the optimal sequencing of CBT in treating primary care patients and the identification of those most likely to accept and respond to therapy should be further evaluated.

Hypersensitivity to electricity: working definition and additional characterization of the syndrome

Those who believe that electric appliances trigger adverse symptoms have coined the label hypersensitivity to electricity. Scientific research has not been able to identify a direct link between electromagnetic fields and symptoms, and no diagnostic criteria exist. Groups with reported hypersensitivity are very heterogeneous. A need exists for an operational working definition and improved characterization of groups. We report an investigation of symptoms and risk indicators associated with reported hypersensitivity to electricity-based on a survey at a high-technology, multinational telecommunications corporation. Comparisons are also made with patients referred to a university department of occupational and environmental health. No association was found between specific psychosocial work characteristics nor personal traits and hypersensitivity to electricity. We present skin and neurovegetative symptom indices. Results indicate that skin, and not neurovegetative symptoms, characterize the syndrome, at least during the first years of illness. For characterization, we propose a set of dimensions, including triggering factors, behavior, and duration of symptoms.