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Kleinstäuber M, Allwang C, Bailer J, Berking M, Brünahl C, Erkic M, Gitzen H, Gollwitzer M, Gottschalk JM, Heider J, Hermann A, Lahmann C, Löwe B, Martin A, Rau J, Schröder A, Schwabe J, Schwarz J, Stark R, Weiss FD, Rief W. Cognitive Behaviour Therapy Complemented with Emotion Regulation Training for Patients with Persistent Physical Symptoms: A Randomised Clinical Trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2020; 88:287-299. [PMID: 31430755 DOI: 10.1159/000501621] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 06/20/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Persistent medically unexplained symptoms (MUS) are a major burden for health care. Cognitive behaviour therapy (CBT) is efficacious for patients with MUS, with small to medium effects. The current study investigates whether therapy outcomes of a CBT for MUS patients can be improved by complementing it with emotion regulation training. METHODS In a multicentre trial 255 patients with at least three persisting MUS were randomised to 20 sessions of either conventional CBT (n = 128) or CBT complemented with emotion regulation training (ENCERT; n = 127). Somatic symptom severity and secondary outcomes were assessed at pre-treatment, therapy session 8, end of therapy, and 6-month follow-up. RESULTS Linear mixed-effect models revealed medium to large effects in both study arms for almost all outcomes at the end of therapy and 6-month follow-up. ENCERT and CBT did not differ in their effect on the primary outcome (d = 0.20, 95% CI: -0.04 to 0.44). Significant time × group cross-level interactions suggested ENCERT to be of more benefit than conventional CBT for a few secondary outcomes. Moderator analyses revealed higher effects of ENCERT in patients with co-morbid mental disorders. DISCUSSION/CONCLUSIONS Current findings are based on a representative sample. Results demonstrate that both CBT and ENCERT can achieve strong effects on primary and secondary outcomes in MUS patients. Our results do not indicate that adding a training in emotion regulation skills generally improves the effect of CBT across all patients with MUS. Large effect sizes of both treatments and potential specific benefits of ENCERT for patients with co-morbid mental disorders are discussed.
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Affiliation(s)
- Maria Kleinstäuber
- Department of Clinical Psychology and Psychotherapy, Philipps University, Marburg, Germany,
| | - Christine Allwang
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Josef Bailer
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Friedrich Alexander University, Erlangen, Germany
| | - Christian Brünahl
- Institute and Outpatients Clinic for Psychosomatic Medicine and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Maja Erkic
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Harald Gitzen
- School of Human and Social Sciences, University of Wuppertal, Wuppertal, Germany
| | - Mario Gollwitzer
- Department of Social Psychology, Ludwig Maximilian University, Munich, Germany
| | | | - Jens Heider
- Outpatient Clinic for Psychotherapy, University of Koblenz-Landau, Landau, Germany
| | - Andrea Hermann
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University of Giessen, Giessen, Germany
| | - Claas Lahmann
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bernd Löwe
- Institute and Outpatients Clinic for Psychosomatic Medicine and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Alexandra Martin
- School of Human and Social Sciences, University of Wuppertal, Wuppertal, Germany
| | - Jörn Rau
- Coordinating Centre for Clinical Trials, Philipps University, Marburg, Germany
| | - Annette Schröder
- Department of Clinical Psychology and Psychotherapy, University of Koblenz-Landau, Landau, Germany
| | - Johannes Schwabe
- Department of Social Psychology, Ludwig Maximilian University, Munich, Germany
| | - Jeanine Schwarz
- Department of Clinical Psychology and Psychotherapy, Philipps University, Marburg, Germany
| | - Rudolf Stark
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University of Giessen, Giessen, Germany
| | - Frauke Dorothee Weiss
- Department of Clinical Psychology and Psychotherapy, Philipps University, Marburg, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps University, Marburg, Germany
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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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Cooper D, Yap K, Batalha L. Mindfulness-based interventions and their effects on emotional clarity: A systematic review and meta-analysis. J Affect Disord 2018; 235:265-276. [PMID: 29660642 DOI: 10.1016/j.jad.2018.04.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 02/13/2018] [Accepted: 04/02/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND An inability to identify or describe internal emotional experience has been linked to a range of affective disorders. Despite burgeoning research on mindfulness-based interventions and their possible effects on emotion regulation, the effects of such interventions on emotional clarity is unclear. This review examines the evidence for the effect of mindfulness-based interventions on self-reported emotional clarity. METHOD Published studies indexed by PsycINFO, PubMed and Scopus, as available in April 2017, were systematically reviewed. Interventions that included mindfulness practice or philosophy, and reported a suitable measure of emotional clarity at pre- and post-intervention were selected. A random-effects meta-analysis was performed. Subgroup comparisons were also conducted to test for differences between clinical and non-clinical samples, between specific and approximate measures of emotional clarity, and between controlled and uncontrolled trials. RESULTS Seventeen studies met the criteria for inclusion. The overall estimated effect size for pre- to post-intervention was small to moderate, Hedges' g = 0.42, 95% CI [0.25, 0.59] and for between groups results was small to large, Hedges' g = 0.52, 95% CI [0.15, 0.90]. LIMITATIONS Studies varied substantially in design quality and study characteristics. Furthermore, while interventions in the reviewed studies all had mindfulness components, many had other components in addition to mindfulness. Consequently, this review is limited by the heterogeneity of studies and results should be interpreted with caution. CONCLUSIONS There is preliminary evidence to suggest that mindfulness-based interventions may increase emotional clarity. However, more homogenous and targeted experiments are required to confirm these initial findings.
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Affiliation(s)
- David Cooper
- School of Psychology, Australian Catholic University, Strathfield Campus, 25A Barker Road, Strathfield, NSW 2135, Australia
| | - Keong Yap
- School of Psychology, Australian Catholic University, Strathfield Campus, 25A Barker Road, Strathfield, NSW 2135, Australia.
| | - Luisa Batalha
- School of Psychology, Australian Catholic University, Strathfield Campus, 25A Barker Road, Strathfield, NSW 2135, Australia
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Volkaert B, Wante L, Vervoort L, Braet C. 'Boost Camp', a universal school-based transdiagnostic prevention program targeting adolescent emotion regulation; evaluating the effectiveness by a clustered RCT: a protocol paper. BMC Public Health 2018; 18:904. [PMID: 30031383 PMCID: PMC6054752 DOI: 10.1186/s12889-018-5754-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 06/26/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The transition from childhood into adolescence can be considered as a critical developmental period. Moreover, adolescence is associated with a decreased use of adaptive emotion regulation strategies and an increased use of maladaptive emotion regulation strategies increasing the risk of emotional problems. Targeting emotion regulation is therefore seen as an innovative prevention approach. The present study aims to evaluate the effectiveness of Boost camp, an innovative school-based prevention program targeting ER, on adolescents' emotion regulation skills and emotional wellbeing. Also secondary outcomes and possible moderators will be included. METHODS The aim is to reach 300 adolescents (16 class groups, 6 schools) in their first year of high school. A clustered Randomized Controlled Trial (RCT) with two conditions, intervention (n = 150) and control (n = 150), will be set up. Adolescents in the intervention condition will receive 14 lessons over the course of 2 days, followed by Booster sessions, and will be compared with adolescents in a non-intervention control group. The outcomes will be measured by self-report questionnaires at baseline, immediately after Boost camp, and at three and 6 months follow-up. DISCUSSION Data-collection is planned to be completed in May 2018. Data-analyses will be finished the end of 2018. The presented paper describes the Boost camp program and the clustered RCT design to evaluate its effectiveness. It is expected that Boost camp will have beneficial effects. If found effective, Boost camp will have the potential to increase adolescent's ER and well-being, and reduce the risk to become adults in need. The trials is registered on the 13th of June 2017 in ISRCTN registry [ISRCTN68235634].
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Affiliation(s)
- Brenda Volkaert
- Department of Developmental, Personality and Social Psychology, Ghent University, Henri Dunantlaan 2, Ghent, Belgium
| | - Laura Wante
- Department of Developmental, Personality and Social Psychology, Ghent University, Henri Dunantlaan 2, Ghent, Belgium
| | - Leentje Vervoort
- Department of Developmental, Personality and Social Psychology, Ghent University, Henri Dunantlaan 2, Ghent, Belgium
| | - Caroline Braet
- Department of Developmental, Personality and Social Psychology, Ghent University, Henri Dunantlaan 2, Ghent, Belgium
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Koechlin H, Coakley R, Schechter N, Werner C, Kossowsky J. The role of emotion regulation in chronic pain: A systematic literature review. J Psychosom Res 2018; 107:38-45. [PMID: 29502762 DOI: 10.1016/j.jpsychores.2018.02.002] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 01/31/2018] [Accepted: 02/01/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Emotion regulation (ER) includes a set of cognitive and attentional processes used to change or maintain emotional state. A small but growing body of research suggests that maladaptive ER might be a risk factor for the development of chronic pain. This review aims to summarize existing literature on the association between ER and chronic pain, and to determine whether the construct of ER may further enhance our understanding of the risk and protective factors that may contribute to the onset and maintenance of chronic pain. METHODS A systematic search was conducted using the search terms "chronic pain" and "emotion regulation." Studies that measured both constructs across all age groups were included. RESULTS We found 15 studies that met our inclusion criteria. Nine studies were completed within the last five years, suggesting that the evaluation of ER as it relates to pain is a new line of research. Studies that measured "response-focused" ER found associations between maladaptive ER and pain. Studies that measured "antecedent-focused" ER strategies were less likely to show a direct association with pain. CONCLUSION Maladaptive response-focused ER may be an important risk factor in the development and maintenance of chronic pain, as it is associated with pain and psychological comorbidities. Adding ER to chronic pain investigations may help to further explain individual differences in the risk and protective mechanisms that are known to influence chronic pain. Importantly, this line of research has potential to directly inform future interventions for patients with chronic pain.
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Affiliation(s)
- Helen Koechlin
- Department of Clinical Psychology & Psychotherapy, University of Basel, Switzerland; Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, USA.
| | - Rachael Coakley
- Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, USA
| | - Neil Schechter
- Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, USA
| | | | - Joe Kossowsky
- Department of Clinical Psychology & Psychotherapy, University of Basel, Switzerland; Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, USA
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Erkic M, Bailer J, Fenske SC, Schmidt SNL, Trojan J, Schröder A, Kirsch P, Mier D. Impaired emotion processing and a reduction in trust in patients with somatic symptom disorder. Clin Psychol Psychother 2017; 25:163-172. [PMID: 29044807 DOI: 10.1002/cpp.2151] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 08/18/2017] [Accepted: 09/13/2017] [Indexed: 01/10/2023]
Abstract
There is accumulating evidence for deficits in the perception and regulation of one's own emotions, as well as the recognition of others' emotions in somatic symptom disorder (SSD). However, investigations of SSD focusing on specific aspects of emotion processing and how these might interact are missing. We included 35 patients with SSD and 35 healthy controls who completed questionnaires on the perception and regulation of their own emotions, as well as experimental investigations of emotion recognition and trust. In line with previous studies, our results show that SSD patients in comparison to healthy controls have difficulties in the identification and description of own feelings (ηp2 = .381 and ηp2 = .315). Furthermore, we found that patients apply less cognitive reappraisal (ηp2 = .185) but tend to use more expressive suppression (ηp2 = .047). In contrast to previous studies, we found SSD patients to perform superior in emotion recognition, in particular for anger (d = 0.40). In addition, patients with SSD invested less in a trust game (d = 0.73). These results point to a higher sensitivity for negative emotions and less trust in others. Further, these findings suggest a dissociation between the ability to recognize one's own emotions versus others' emotions in SSD. Future interventions targeting emotion processing in SSD might focus on the identification of one's own emotions, prior to the training of emotion regulation.
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Affiliation(s)
- Maja Erkic
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany
| | - Josef Bailer
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany
| | - Sabrina C Fenske
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany
| | - Stephanie N L Schmidt
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany
| | - Jörg Trojan
- Department of Psychology, University of Koblenz-Landau, Landau, Germany
| | - Annette Schröder
- Department of Clinical Psychology and Psychotherapy, University of Koblenz-Landau, Landau, Germany
| | - Peter Kirsch
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany
| | - Daniela Mier
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany
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Mander J, Schaller G, Bents H, Dinger U, Zipfel S, Junne F. Increasing the treatment motivation of patients with somatic symptom disorder: applying the URICA-S scale. BMC Psychiatry 2017; 17:240. [PMID: 28673262 PMCID: PMC5496251 DOI: 10.1186/s12888-017-1400-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 06/26/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Therapeutic intervention programs for somatic symptom disorder (SSD) show only small-to-moderate effect sizes. These effects are partly explained by the motivational problems of SSD patients. Hence, fostering treatment motivation could increase treatment success. One central aspect in SSD patients might be damage to motivation because of symptomatic relapses. Consequently, the aim of the present study was to investigate associations between motivational relapse struggle and therapeutic outcome in SSD patients. METHODS We assessed 84 inpatients diagnosed with SSD in the early, middle and late stages of their inpatient treatment. The maintenance subscale of the University of Rhode Island Change Assessment-Short (URICA-S) was applied as a measure to assess motivational relapse struggle. Additionally, patients completed measures of treatment outcome that focus on clinical symptoms, stress levels and interpersonal functioning. RESULTS The results from multiple regression analyses indicate that higher URICA-S maintenance scores assessed in early stages of inpatient treatment were related to more negative treatment outcomes in SSD patients. CONCLUSIONS SSD patients with ambivalent treatment motivation may fail in their struggle against relapse over the course of therapy. The URICA-S maintenance score assessed at therapy admission facilitated early identification of SSD patients who are at greater risk of relapse. Future studies should incorporate randomized controlled trials to investigate whether this subgroup could benefit from motivational interventions that address relapse.
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Affiliation(s)
- Johannes Mander
- Center for Psychological Psychotherapy, University of Heidelberg, Heidelberg, Germany. .,Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital of Tübingen, Tübingen, Germany. .,, Bergheimer Str. 58a, 69115, Heidelberg, Germany.
| | - Georg Schaller
- 0000 0001 2190 4373grid.7700.0Center for Psychological Psychotherapy, University of Heidelberg, Heidelberg, Germany
| | - Hinrich Bents
- 0000 0001 2190 4373grid.7700.0Center for Psychological Psychotherapy, University of Heidelberg, Heidelberg, Germany
| | - Ulrike Dinger
- 0000 0001 0328 4908grid.5253.1Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital of Heidelberg, Heidelberg, Germany
| | - Stephan Zipfel
- 0000 0001 0196 8249grid.411544.1Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital of Tübingen, Tübingen, Germany
| | - Florian Junne
- 0000 0001 0196 8249grid.411544.1Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital of Tübingen, Tübingen, Germany
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Kleinstäuber M, Gottschalk J, Berking M, Rau J, Rief W. Enriching Cognitive Behavior Therapy with Emotion Regulation Training for Patients with Multiple Medically Unexplained Symptoms (ENCERT): Design and implementation of a multicenter, randomized, active-controlled trial. Contemp Clin Trials 2016; 47:54-63. [DOI: 10.1016/j.cct.2015.12.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 11/23/2015] [Accepted: 12/03/2015] [Indexed: 11/27/2022]
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Berking M, Lukas CA. The Affect Regulation Training (ART): a transdiagnostic approach to the prevention and treatment of mental disorders. Curr Opin Psychol 2015. [DOI: 10.1016/j.copsyc.2015.02.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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