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Psychotherapy and Psychosomatics Vol. 69, No. 4, On Looking Inward and Being Scientific: A Tribute to G.L. Engel, MD (2000) , pp. 205-215 (11 pages) Published By: S. Karger AG https://www.jstor.org/stable/48510595 Read and download Log in through your school or library Read Online (Free) relies on page scans, which are not currently available to screen readers. To access this article, please contact JSTOR User Support. We'll provide a PDF copy for your screen reader.With a personal account, you can read up to 100 articles each month for free. Get StartedAlready have an account? Log in Monthly Plan
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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. Journal Information As the volume of literature in the fields of psychotherapy and psychosomatics continues to grow, it becomes increasingly difficult to keep abreast of new and important developments, and to have independent, critical views on key clinical issues concerned with assessment and treatment of mental disorders. Psychotherapy and Psychosomatics has progressively increased its reputation for independence, originality and methodological rigor. It has anticipated and developed new lines of research concerned with psychosomatic medicine, psychotherapy research and psychopharmacology. The journal features editorials and reviews on current and controversial issues; innovations in assessment and treatment; original investigations; literature updates; and a lively correspondence section. It has become a unique and vital reference to current research and practice, the home of innovative thinking at the interface between medical and behavioral sciences. Publisher Information Karger Publishers is a worldwide publisher of scientific and medical content based in Basel, Switzerland. It is independent and family-led in the fourth generation by Chairwoman and Publisher Gabriella Karger. Karger has been continuously evolving, keeping pace with the current developments and shifts in research and publishing. The publishing house is dedicated to serving the information needs of the scientific community, clinicians and patients with publications of high-quality content and services in health sciences. Rights & Usage This item is part of a JSTOR Collection. OverviewWhat is somatic symptom disorder?Somatic symptom disorder (SSD) is a mental health condition in which a person feels significantly distressed about physical symptoms and has abnormal thoughts, feelings and behaviors in response to them. The disorder disrupts their daily functioning and quality of life. Although a person with somatic symptom disorder reports symptoms, the symptoms may have no medical explanation or be normal body sensations or discomfort. Even when there’s a medical cause, the person’s worry is out of proportion to the symptom. People with somatic symptom disorder are often unaware of their underlying mental health condition and believe that they have serious physical ailments. The distress often causes them to visit multiple healthcare providers and to have many medical tests and unnecessary procedures. What’s the difference between somatic symptom disorder and illness anxiety disorder?Illness anxiety disorder is a mental health condition in which a person is preoccupied and excessively worried about having an illness or getting an illness. Unlike somatic symptom disorder, a person with illness anxiety disorder usually doesn’t experience physical symptoms. What’s the difference between conversion disorder and somatic symptom disorder?Conversion disorder (functional neurological symptom disorder) is a condition involving the function of your nervous system with no evidence of physical or neurological causes. This can cause symptoms that affect your perception, sensation or mobility. While people with conversion disorder frequently experience depression or anxiety, excessive worrying and distress about the physical symptoms aren’t part of the diagnosis for conversion disorder. In contrast, excessive concern about physical symptoms is the main part of the diagnosis of somatic symptom disorder. Who does somatic symptom disorder affect?Somatic symptom disorder can occur in children, adolescents and adults, and it usually begins by age 30. People assigned female at birth (AFAB) are 10 times more likely to have somatic symptom disorder than people assigned male at birth (AMAB). How common is somatic symptom disorder?Somatic symptom disorder is somewhat common and occurs in about 5% to 7% of the adult population. Symptoms and CausesWhat are the signs and symptoms of somatic symptom disorder?Physical symptoms that people with SSD may have include:
The physical symptoms may be mild to severe, and there may be one or multiple symptoms. They may be due to a medical condition or have no clear cause. How people think, feel and behave in response to these physical symptoms are the main signs of somatic symptom disorder. People with SSD may:
Approximately 30% to 60% of people with somatic symptom disorder also have anxiety and/or depression. What causes somatic symptom disorder?Researchers believe there are many biological, environmental and psychological factors that can contribute to the development of SSD, including:
Diagnosis and TestsHow is somatic symptom disorder diagnosed?Your healthcare provider will perform a physical exam and probably order some laboratory tests to rule out conditions that may be causing your physical symptoms. They’ll also ask you about your health history. If test results show that you don’t have a medical condition or illness or that your medical condition doesn’t match the severity of your symptoms, your healthcare provider may refer you to a mental health provider for assessment. A mental health provider, such as a psychologist or psychiatrist, confirms a diagnosis of somatic symptom disorder using specific criteria. To be diagnosed, a person must have one or more symptoms that cause distress or disrupt daily life for at least six months. They must also have excessive thoughts, feelings or behaviors in response to the symptoms that meet at least one of the following criteria:
People with somatic symptom disorder may have a difficult time accepting that their concerns are excessive. Management and TreatmentHow is somatic symptom disorder treated?The goal of treating somatic symptom disorder is to manage physical symptoms, as well as psychological symptoms using psychotherapy (talk therapy) and sometimes medications that treat underlying anxiety and depression. Cognitive behavioral therapy (CBT) is a type of psychotherapy that helps people learn ways to change their patterns of thinking or behavior in order to change the way they feel. Under the guidance of a psychologist or psychiatrist, CBT helps people better cope with anxiety and stress and respond to situations more effectively. If you have somatic symptom disorder, CBT can help you:
Your healthcare provider may prescribe medication, such as an antidepressant. In addition to helping mood, antidepressants have been reported to help ease such symptoms as pain, fatigue, pain in joints and sleep problems. PreventionWhat are the risk factors for developing somatic symptom disorder?Studies have found certain risk factors associated with somatic symptom disorder. These risk factors include a history of:
Therapy may help people who are prone to SSD learn other ways of dealing with stress and triggers. This may help reduce the intensity of their symptoms. Outlook / PrognosisWhat is the prognosis (outlook) for somatic symptom disorder?The course of somatic symptom disorder is likely chronic (long-term), with episodes that come and go from several months to years. Left untreated, somatic syndrome disorder can lead to:
The good news is that with treatment, most people can experience an improvement or remission in their symptoms. Living WithHow do I take care of myself if I have somatic symptom disorder?If you’ve been diagnosed with somatic symptom disorder, taking the following steps will likely aid in your treatment:
When should I see my healthcare provider about somatic syndrome disorder?It’s important to see your primary healthcare provider and/or mental health provider if you:
A note from Cleveland Clinic It’s important to remember that somatic symptom disorder (SSD) is a mental health condition. As with all mental health conditions, seeking help as soon as symptoms appear can help decrease the disruptions to your life. Mental health professionals can offer treatment plans that can help you manage your thoughts and behaviors. What is the aim of cognitive behavioral therapy?CBT aims to help you deal with overwhelming problems in a more positive way by breaking them down into smaller parts. You're shown how to change these negative patterns to improve the way you feel. Unlike some other talking treatments, CBT deals with your current problems, rather than focusing on issues from your past.
What are three of the goals of cognitive behavioral therapy?Goals of Cognitive Therapy Include:
the promotion of self-awareness and emotional intelligence by teaching clients to “read” their emotions and distinguish healthy from unhealthy feelings. helping clients understand how distorted perceptions and thoughts contribute to painful feelings.
What is the treatment for somatic symptom disorder?Cognitive behavior therapy and mindfulness-based therapy are effective for the treatment of somatic symptom disorder. Amitriptyline, selective serotonin reuptake inhibitors, and St. John's wort are effective pharmacologic treatments for somatic symptom disorder.
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What is the aim of cognitive behavioral therapy CBT when treating somatic symptom and related disorders?
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