Skip to main content
×
×
Home

Cognitive–behavioural group treatment for a range of functional somatic syndromes: Randomised trial

  • Andreas Schröder (a1), Emma Rehfeld (a1), Eva Ørnbøl (a1), Michael Sharpe (a2), Rasmus W. Licht (a3) and Per Fink (a1)...
Abstract
Background

Many specialty-specific functional somatic syndrome diagnoses exist to describe people who are experiencing so-called medically unexplained symptoms. Although cognitive–behavioural therapy can be effective in the management of such syndromes, it is rarely available. A cognitive–behavioural therapy suitable for group treatment of people with different functional somatic syndromes could address this problem.

Aims

To test the efficacy of a cognitive–behavioural therapy (Specialised Treatment for Severe Bodily Distress Syndromes, STreSS) designed for patients with a range of severe functional somatic syndromes.

Method

A randomised controlled trial (clinicaltrials.gov, NCT00132197) compared STreSS (nine 3.5 h sessions over 4 months, n = 54) with enhanced usual care (management by primary care physician or medical specialist, n = 66). The primary outcome was improvement in aggregate score on subscales of the 36-item Short Form Health Survey (physical functioning, bodily pain and vitality) at 16 months.

Results

Participants receiving STreSS had a greater improvement on the primary outcome (adjusted mean difference 4.0, 95% CI 1.4–6.6, P = 0.002) and on most secondary outcomes.

Conclusions

In the management of functional somatic syndromes, a cognitive–behavioural group treatment was more effective than enhanced usual care.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Cognitive–behavioural group treatment for a range of functional somatic syndromes: Randomised trial
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Cognitive–behavioural group treatment for a range of functional somatic syndromes: Randomised trial
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Cognitive–behavioural group treatment for a range of functional somatic syndromes: Randomised trial
      Available formats
      ×
Copyright
Corresponding author
Dr Andreas Schröder, Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, DK-8000 Aarhus C, Denmark. E-mail: andreas.schroeder@aarhus.rm.dk
Footnotes
Hide All

See editorial, pp. 444–445, this issue.

Declaration of interest

None.

Footnotes
References
Hide All
1 Simon, G, Gater, R, Kisely, S, Piccinelli, M. Somatic symptoms of distress: an international primary care study. Psychosom Med 1996; 58: 481–8.
2 Wessely, S, Nimnuan, C, Sharpe, M. Functional somatic syndromes: one or many? Lancet 1999; 354: 936–9.
3 Whitehead, LC. Quest, chaos and restitution: living with chronic fatigue syndrome/myalgic encephalomyelitis. Soc Sci Med 2005; 62: 2236–45.
4 Barsky, AJ, Orav, EJ, Bates, DW. Somatization increases medical utilization and costs independent of psychiatric and medical comorbidity. Arch Gen Psychiatry 2005; 62: 903–10.
5 Bass, C, Peveler, R, House, A. Somatoform disorders: severe psychiatric illnesses neglected by psychiatrists. Br J Psychiatry 2001; 179: 11–4.
6 Creed, F. Should general psychiatry ignore somatization and hypochondriasis? World Psychiatry 2006; 5: 146–50.
7 Sharpe, M, Carson, A. ‘Unexplained’ somatic symptoms, functional syndromes, and somatization: do we need a paradigm shift? Ann Intern Med 2001; 134: 926–30.
8 Henningsen, P, Zipfel, S, Herzog, W. Management of functional somatic syndromes. Lancet 2007; 369: 946–55.
9 Fink, P. Surgery and medical treatment in persistent somatizing patients. J Psychosom Res 1992; 36: 439–47.
10 Glombiewski, JA, Rief, W, Bosner, S, Keller, H, Martin, A, Donner-Banzhoff, N. The course of nonspecific chest pain in primary care: symptom persistence and health care usage. Arch Intern Med 2010; 170: 251–5.
11 Fink, P. The use of hospitalizations by persistent somatizing patients. Psychol Med 1992; 22: 173–80.
12 Zijdenbos, IL, de Wit, NJ, van der Heijden, GJ, Rubin, G, Quartero, AO. Psychological treatments for the management of irritable bowel syndrome. Cochrane Database Syst Rev 2009; CD006442.
13 Price, JR, Mitchell, E, Tidy, E, Hunot, V. Cognitive behaviour therapy for chronic fatigue syndrome in adults. Cochrane Database Syst Rev 2008; CD001027.
14 Kroenke, K. Efficacy of treatment for somatoform disorders: a review of randomized controlled trials. Psychosom Med 2007; 69: 881–8.
15 Glombiewski, JA, Sawyer, AT, Gutermann, J, Koenig, K, Rief, W, Hofmann, SG. Psychological treatments for fibromyalgia: a meta-analysis. Pain 2010; 151: 280–95.
16 White, PD, Goldsmith, KA, Johnson, AL, Potts, L, Walwyn, R, DeCesare, JC, et al. Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. Lancet 2011; 377: 823–36.
17 Shir, Y, Fitzcharles, MA. Should rheumatologists retain ownership of fibromyalgia? J Rheumatol 2009; 36: 667–70.
18 Fink, P, Toft, T, Hansen, MS, Ornbol, E, Olesen, F. Symptoms and syndromes of bodily distress: an exploratory study of 978 internal medical, neurological, and primary care patients. Psychosom Med 2007; 69: 30–9.
19 Fink, P, Schröder, A. One single diagnosis, bodily distress syndrome, succeeded to capture ten diagnostic categories of functional somatic syndromes and somatoform disorders. J Psychosom Res 2010; 68: 415–26.
20 Perera, R, Heneghan, C, Yudkin, P. Graphical method for depicting randomised trials of complex interventions. BMJ 2007; 334: 127–9.
21 World Health Organization. SCAN: Schedules for Clinical Assessment in Neuropsychiatry, Version 2.1. WHO Division of Mental Health, 1998.
22 Nielsen, JM, Vedsted, P, Olesen, F. The postgraduate psychiatric training of general practitioners: a questionnaire survey in Aarhus County. Ugeskr Laeger 2002; 164: 895–9.
23 Ware, J, Kosinski, M, Gandek, B. SF-36 Health Survey: Manual and Interpretation Guide. Quality Metric, 2005.
24 Mease, P, Arnold, LM, Bennett, R, Boonen, A, Buskila, D, Carville, S, et al. Fibromyalgia syndrome. J Rheumatol 2007; 34: 1415–25.
25 Ware, JE, Kosinski, M. SF-36 Physical and Mental Health Summary Scales: A Manual for Users of Version 1, Second Edition. Quality Metric, 2001.
26 Norman, GR, Sloan, JA, Wyrwich, KW. Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care 2003; 41: 582–92.
27 Ware, JE, Bayliss, MS, Rogers, WH, Kosinski, M, Tarlov, AR. Differences in 4-year health outcomes for elderly and poor, chronically ill patients treated in HMO and fee-for-service systems. Results from the Medical Outcomes Study. JAMA 1996; 276: 1039–47.
28 Fink, P, Ewald, H, Jensen, J, Sørensen, L, Engberg, M, Holm, M, et al. Screening for somatization and hypochondriasis in primary care and neurological in-patients: a seven-item scale for hypochondriasis and somatization. J Psychosom Res 1999; 46: 261–73.
29 Derogatis, LR, Cleary, PA. Confirmation of the dimensional structure of the SCL-90: A study in construct validation. J Clin Psychol 1977; 33: 981–9.
30 Fink, P, Ørnbøl, E, Huyse, FJ, De Jonge, P, Lobo, A, Herzog, T, et al. A brief diagnostic screening instrument for mental disturbances in general medical wards – the SCL-8 Scale. A European multi-centre study. J Psychosom Res 2004; 57: 1724.
31 Schröder, A, Ørnbøl, E, Licht, RW, Sharpe, M, Fink, P. Outcome measurement in functional somatic syndromes: SF-36 summary scores and some scales were not valid. J Clin Epidemiol 2012; ∗.65: 3041.
32 Hann, M, Reeves, D. The SF-36 scales are not accurately summarised by independent physical and mental component scores. Qual Life Res 2008; 17: 413–23.
33 Walwyn, R, Roberts, C. Therapist variation within randomised trials of psychotherapy: implications for precision, internal and external validity. Stat Methods Med Res 2010; 19: 291315.
34 Allen, LA, Woolfolk, RL, Escobar, JI, Gara, MA, Hamer, RM. Cognitive–behavioral therapy for somatization disorder: a randomized controlled trial. Arch Intern Med 2006; 166: 1512–8.
35 Donta, ST, Clauw, DJ, Engel, CC, Guarino, P, Peduzzi, P, Williams, DA, et al. Cognitive behavioral therapy and aerobic exercise for Gulf War veterans' illnesses: a randomized controlled trial. JAMA 2003; 289: 1396–404.
36 Kleinstauber, M, Witthoft, M, Hiller, W. Efficacy of short-term psychotherapy for multiple medically unexplained physical symptoms: a meta-analysis. Clin Psychol Rev 2011; 31: 146–60.
37 Schröder, A, Fink, P. The proposed diagnosis of somatic symptom disorders in DSM-V: two steps forward and one step backward? J Psychosom Res 2010; 68: 95–6.
38 Feinstein, AR. The Blame-X syndrome: problems and lessons in nosology, spectrum, and etiology. J Clin Epidemiol 2001; 54: 433–9.
39 Deary, V, Chalder, T, Sharpe, M. The cognitive behavioural model of medically unexplained symptoms: a theoretical and empirical review. Clin Psychol Rev 2007; 27: 781–97.
40 Bradley, LA. Pathophysiologic mechanisms of fibromyalgia and its related disorders. J Clin Psych 2008; 69 (suppl 2): 613.
41 Clauw, DJ. Potential mechanisms in chemical intolerance and related conditions. Ann NY Acad Sci 2001; 933: 235–53.
42 Wood, PB. Neuroimaging in functional somatic syndromes. Int Rev Neurobiol 2005; 67: 119–63.
43 Rief, W, Broadbent, E. Explaining medically unexplained symptoms – models and mechanisms. Clin Psychol Rev 2007; 27: 821–41.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×
Type Description Title
PDF
Supplementary materials

Schröder et al. supplementary material
Supplementary Material

 PDF (39 KB)
39 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Cognitive–behavioural group treatment for a range of functional somatic syndromes: Randomised trial

  • Andreas Schröder (a1), Emma Rehfeld (a1), Eva Ørnbøl (a1), Michael Sharpe (a2), Rasmus W. Licht (a3) and Per Fink (a1)...
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *