Which advantage does cognitive behavioral therapy CBT have for patients with somatization disorders?

Psychotherapy and Psychosomatics

Special Article

Psychother Psychosom 2000;69:205–215

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Article / Publication Details

First-Page Preview

Published online: June 13, 2000
Issue release date: July – August

Number of Print Pages: 11
Number of Figures: 0
Number of Tables: 3

ISSN: 0033-3190 (Print)
eISSN: 1423-0348 (Online)

For additional information: https://www.karger.com/PPS

Abstract

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.

© 2000 S. Karger AG, Basel

References

1. Kroenke K: Symptoms and science: The frontiers of primary care research. J Gen Intern Med 1997;12:509–510.
2. Kroenke K, Spitzer RL, Williams JBW, Linzer M, Hahn SR, deGruy FV, Brody D: Physical symptoms in primary care: Predictors of psychiatric disorders and functional impairment. Arch Fam Med 1994;3:774–779.
3. Simon G, Gater R, Kisely S, Piccinelli M: Somatic symptoms of distress: An international primary care study. Psychosom Med 1996;58:481–488.
4. Smith GR, Monson RA, Ray DC: Psychiatric consultation in somatization disorder: A randomized, controlled study. N Engl J Med 1986;314:1407–1413.
5. Smith GR, Rost K, Kashner TM: A trial of the effect of a standardized psychiatric consultation on health outcomes and costs in somatizing patients. Arch Gen Psychiatry 1995;52:238–243.
6. Buchwald D, Garrity D: Comparison of patients with chronic fatigue syndrome, fibromyalgia, and multiple chemical sensitivites. Arch Intern Med 1994;154:2049–2053.
7. Yunus MB, Masi AT, Aldag JC: A controlled study of primary fibromyalgia syndrome: Clinical features and association with other functional syndromes. J Rheumatol 1989;16(suppl 19):62–71.
8. Hudson JI, Goldenberg DL, Pope HG, Keck PE, Schlesinger L: Comorbidity of fibromyalgia with medical and psychiatric disorders. Am J Med 1992;92:363–367.
9. Compas BE, Haaga DAF, Keefe FJ, Leitenberg H, Williams DA: Sampling of empirically supported psychological treatments from health psychology: Smoking, chronic pain, cancer, and bulimia nervosa. J Consult Clin Psychol 1998;66:89–112.
10. Keefe FJ, Dunsmore J, Burnett R: Behavioral and cognitive-behavioral approaches to chronic pain: Recent advances and future directions. J Consult Clin Psychol 1992; 60:528–536.
11. Enright SJ: Fortnightly review: Cognitive behaviour therapy – Clinical applications. Br Med J 1997;314:1811–1816.
12. Hawton K, Salkovskis PM, Kirk J, Clark DM (eds): Cognitive Behaviour Therapy for Psychiatric Problems. Oxford, Oxford University Press, 1989.
13. Mayou R, Bass C, Sharpe M (eds): Treatment of Functional Somatic Symptoms. Oxford, Oxford University Press, 1995.
14. Lloyd AR, Brockman A, Hickie C, Wilson A, Dwyer J, Wakefield D: Immunologic and psychologic therapy for patients with chronic fatigue syndrome: A double-blind, placebo-controlled trial. Am J Med 1993;94:197–203.
15. Sharpe M, Hawton K, Simkin S, Surawy C, Hackmann A, Klimes I, Peto T, Warrell D, Seagroatt V: Cognitive behaviour therapy for the chronic fatigue syndrome: A randomized controlled trial. Br Med J 1996;312:22–26.
16. Deale A, Chalder T, Marks I, Wessely S: Cognitive behavior therapy for chronic fatigue syndrome: A randomized controlled trial. Am J Psychiatry 1997;154:408–414.
17. Greene B, Blanchard EB: Cognitive therapy for irritable bowel syndrome. J Consult Clin Psychol 1994;62:576–582.
18. Payne A, Blanchard EB: A controlled comparison of cognitive therapy and self-help support groups in the treatment of irritable bowel syndrome. J Clin Consult Psychol 1995;63:779–786.
19. Sanders MR, Shepherd RW, Cleghorn G, Woolford H: The treatment of recurrent abdominal pain in children: A controlled comparison of cognitive-behavioral family intervention and standard pediatric care. J Consult Clin Psychol 1994;62:306–314.
20. Turner JA: Comparison of group progressive-relaxation training and cognitive-behavioral group therapy for chronic low back pain. J Consult Clin Psychol 1982;50:757–765.
21. Turner JA, Clancy S: Comparison of operant behavioral and cognitive-behavorial group treatment for chronic low back pain. Only treatment that had immediate posttreatment effect (compared to controls) was operant therapy. CBT had no effect (vs. wait list) on any measure, including pain, but had some delayed effect (vs. operant) on SIP function. J Consult Clin Psychol 1988;56:262–266.
22. Nicholas MK, Wilson PH, Goyen J: Operant-behavioural and cognitive-behavioural treatment for chronic low back pain. Behav Res Ther 1991;29:225–238.
23. Nicholas MK, Wilson PH, Goyen J: Comparison of cognitive-behavioral group treatment and an alternative non-psychological treatment for chronic low back pain. Pain 1992;48:339–347.
24. Turner JA, Jensen MC: Efficacy of cognitive therapy for chronic low back pain. Pain 1993;52:169–177.
25. Klimes I, Mayou RA, Pearce MJ, Coles L, Fagg JR: Psychological treatment for atypical non-cardiac chest pain: A controlled evaluation. Psychol Med 1990;20:605–611.
26. Mayou RA, Bryant BM, Sanders D, Bass C, Klimes I, Forfar C: A controlled trial of cognitive behavioural therapy for non-cardiac chest pain. Psychol Med 1997;27:1021–1031.
27. van Peski-Oosterbaan AS, Spinhoven P, van Rood Y, van der Does JW, Bruschke AV, Rooijmans HG: Cognitive-behavioral therapy for noncardiac chest pain: A randomized trial. Am J Med 1999;106:424–429.
28. Blanchard EB, Appelbaum KA, Radnitz CL, Michultka D, Morrill B, Kirsch C, Hillhouse J, Evans DD, Guarnieri P, Attanasio V, Andrasik F, Jaccard J, Dentinger MP: Placebo-controlled evaluation of abbreviated progressive muscle relaxation and of relaxation combined with cognitive therapy in the treatment of tension headache. J Consult Clin Psychol 1990;58:210–215.
29. Dworkin SF, Turner JA, Wilson L, Massoth D, Whitney C, Huggins KH, et al: Brief group cognitive-behavioral intervention for temporomandibular disorders. Pain 1994;59:175–187.
30. Jakes SC, Hallam RS, McKenna L,Hinchcliffe R: Group cognitive therapy for medical patients: An application to tinnitus. Cogn Ther Res 1992;16:67–82.
31. Kroner-Herwig B, Hebing G, van Rijn-Kalmann U, Frenzel A, Schilkowsky G, Esser G: The management of chronic tinnitus – Comparison of a cognitive-behavioural group training with yoga. J Psychosom Res 1995;39:153–165.
32. Morin CM, Colecchi C, Stone J, Sood R, Brink D: Behavioral and pharmacological therapies for late-life insomnia: A randomized controlled trial. JAMA 1999;281:991–999.
33. Bergdahl J, Anneroth G, Perris H: Cognitive therapy in the treatment of patients with resistant burning mouth syndrome: A controlled study. J Oral Pathol Med 1995;24:213–215.
34. Kerns RD, Turk DC, Holzman AD, Rudy TE: Comparison of cognitive-behavioral and behavioral approaches to the outpatient treatment of chronic pain. Clin J Pain 1986;1:195–203.
35. Hillert L, Hedman BG, Dolling BF, Arnetz BB: Cognitive behavioural therapy for patients with electric sensitivity – A multidisciplinary approach in a controlled study. Psychother Psychosom 1998;67:302–310.
36. Vlaeyen JWS, Teeken-Bruben NJG, Goossens MEJB, Rutten-van Molken MPMH, Pelt RAGB, van Eek H, Heuts PHTG: Cognitive-educational treatment of fibromyalgia: A randomized clinical trial. I. Clinical effects. J Rheumatol 1996;23:1237–1245.
37. van Dulmen AM, Fennis JFM, Bleijenberg G: Cognitive-behavioral group therapy for irritable bowel syndrome: Effects and long-term follow-up. Psychosom Med 1996;58:508–514.
38. Goldenberg DL, Kaplan KH, Nadeau MG, Brodeur C, Smith S, Schmid CH: A controlled study of a stress-reduction, cognitive-behavioral treatment program in fibromyalgia. J Musculoskeletal Pain 1994;2:53–66.
39. Speckens AEM, van Hemert AM, Spinhoven P, Hawton KE, Bolk JH, Rooijmans GM: Cognitive behavioural therapy for medically unexplained physical symptoms: A randomized controlled trial. Br Med J 1995;311:1328–1332.
40. Lidbeck J: Group therapy for somatization disorders in general practice: Effectiveness of a short cognitive-behavioural treatment model. Acta Psychiatr Scand 1997;96:14–24.
41. Hellman CJC, Budd M, Borysenko J, McClelland DC, Benson H: A study of the effectiveness of two group behavioral medicine interventions for patients with psychosomatic complaints. Behav Med 1990;16:165–173.
42. Warwick MCH, Clark DM, Cobb AM, Salkovskis PM: A controlled trial of cognitive-behavioural treatment of hypochondriasis. Br J Psychiatry 1996;169:189–195.
43. Clark DM, Salkovskis PM, Hackman A, Wells A, Fennell M, Ludgate J, Ahmad S, Richards HC, Gelder M: Two psychological treatments for hypochondriasis. A randomised controlled trial. Br J Psychiatry 1998;173:218–225.
44. Bouman TK, Visser S: Cognitive and behavioural treatment of hypochondriasis. Psychother Psychosom 1998;67:214–221.
45. Miranda J, Munoz R: Intervention for minor depression in primary care patients. Psychosom Med 1994;56:136–142.
46. Marks I: Is a paradigm shift occurring in brief psychological treatments? Psychother Psychosom 1999;68:169–170.
47. Smith GR: The course of somatization and its effects on utilization of health care resources. Psychosomatics 1994;35:263–267.
48. Hahn SR, Kroenke K, Spitzer RL, Williams JBW, Brody D, Linzer M, deGruy FV: The difficult patient in primary care: Prevalence, psychopathology and impairment. J Gen Intern Med 1996;11:1–8.
49. Jackson JL, Kroenke K: Difficult patient encounters in the ambulatory clinic: Clinical predictors and outcomes. Arch Intern Med 1999;159:1069–1075.
50. Lin EHB, Katon W, Von Korff M, Bush T, Lipscomb P, Russo J, Wagner E: Frustrating patients: Physician and patient perspectives among distressed high users of medical services. J Gen Intern Med 1991;6:241–246.
51. Smith RC, Lyles JS, Mettler J, Stoffelmayr BE, Van Egeren LF, Marshall AA, Gardiner JC, Maduschke KM, Stanley JM, Osborn GG, Shebroe V, Greenbaum RB: The effectiveness of intensive training for residents in interviewing: A randomized, controlled study. Ann Intern Med 1998;128:118–126.
52. Fava GA: Sequential treatment: A new way of integrating pharmacotherapy and psychotherapy. Psychother Psychosom 199;68:227–229.
53. O’Malley PG, Jackson JL, Kroenke K, Tomkins G, Santoro J, Balden E: Efficacy of antidepressants for physical symptoms: A critical review of the literature. J Fam Pract 1999;48:980–990.
54. Kellner R: Psychosomatic Syndromes and Somatic Symptoms. Washington, American Psychiatric Press, 1991.
55. Wilkinson P, Mynors-Wallis L: Problem-solving therapy in the treatment of unexplained physical symptoms in primary care: A preliminary study. J Psychosom Res 1994;38:591–598.
56. Wise K, Rief W, Goebel G: Meeting the expectations of chronic tinnitus patients: Comparison of a structured group therapy program for tinnitus management with a problem-solving group. J Psychosom Res 1998;44:681–685.
57. Katon W, Von Korff M, Lin E, Walker E, Simon GE, Bush T, Robinson P, Russo J: Collaborative management to achieve treatment guidelines: Impact on depression in primary care. JAMA 1995;273:1026–1031.

Article / Publication Details

First-Page Preview

Published online: June 13, 2000
Issue release date: July – August

Number of Print Pages: 11
Number of Figures: 0
Number of Tables: 3

ISSN: 0033-3190 (Print)
eISSN: 1423-0348 (Online)

For additional information: https://www.karger.com/PPS

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