Predicting the outcome of a cognitive-behavioral group training for patients with unexplained physical symptoms: a one-year follow-up study

BMC Public Health

Jan JV Busschbach²  Adriaan van ’t Spijker²  Reinier Timman²  Cornelis G Kooiman¹  Yanda R van Rood³  Lyonne NL Zonneveld⁴ 

[1] Riagg Rijnmond, Stationsplein 2, Schiedam, 3112 HJ, the Netherlands;Department of Medical Psychology and Psychotherapy, Erasmus Medical Center, PO Box 2040, Rotterdam, 3000 CA, the Netherlands;Department of Psychiatry, Leiden University Medical Centre, PO Box 9600, Leiden, 2300 RC, the Netherlands;Department of Anesthesiology, Academic Medical Center, PO Box 22660, Amsterdam, 1100 DD, the Netherlands

关键词: Assessment;    Cognitive behavioral therapy;    Unexplained physical symptoms;    Somatoform disorders;    Treatment outcome;    Predictors;   

Others  :  1163014
DOI  :  10.1186/1471-2458-12-848

 received in 2012-02-07, accepted in 2012-10-02,  发布年份 2012

【 摘 要 】

Background

Although Cognitive-Behavioral Therapy (CBT) is effective for Unexplained Physical Symptoms (UPS), some therapists in clinical practice seem to believe that CBT outcome will diminish if psychiatric comorbidity is present. The result is that patients with a psychiatric comorbidity are redirected from treatment for UPS into treatment for mental health problems. To explore whether this selection and allocation are appropriate, we explored whether CBT outcomes in UPS could be predicted by variables assessed at baseline and used in routine-practice assessments.

Methods

Patients (n=162) with UPS classified as undifferentiated somatoform disorder or chronic pain disorder were followed up until one year after they had attended a CBT group training. The time-points of the follow-up were at the end of CBT (immediate outcome), three months after CBT (short-term outcome), and one year after CBT (long-term outcome).

CBT outcome was measured using the Physical Component Summary of the SF-36, which was the primary outcome measure in the randomized controlled trial that studied effectiveness of the CBT group training. Predictors were: 1.) psychological symptoms (global severity score of SCL-90), 2.) personality-disorder characteristics (sum of DSM-IV axis II criteria confirmed), 3.) psychiatric history (past presence of DSM-IV axis I disorders), and 4.) health-related quality of life in the mental domain (mental component summary of SF-36). The effect of this predictor set was explored using hierarchical multiple regression analyses into which these predictors had been entered simultaneously, after control for: a.) pretreatment primary outcome scores, b.) age, c.) gender, d.) marital status, and e.) employment.

Results

The predictor set was significant only for short-term CBT outcome, where it explained 15% of the variance. A better outcome was predicted by more psychological symptoms, fewer personality-disorder characteristics, the presence of a psychiatric history, and a better quality of life in the mental domain.

Conclusions

As the predictors do not seem to predict CBT outcome consistently over time, the need for selection and allocation of patients for CBT is doubtful. It seems that this would unnecessarily deprive patients of effective treatment.

Trial registration

Nederlands Trial Register, NTR1609

【 授权许可】

   
2012 Zonneveld et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Kroenke K: Efficacy of treatment for somatoform disorders: a review of randomized controlled trials. Psychosom Med 2007, 69(9):881-888.
• [2]Nezu AM, Nezu CM, Lombardo ER: Cognitive-behavior therapy for medically unexplained symptoms: a critical review of the treatment literature. Behav Ther 2001, 32(3):537-583.
• [3]Sumathipala A: What is the evidence for the efficacy of treatments for somatoform disorders? A critical review of previous intervention studies. Psychosom Med 2007, 69(9):889-900.
• [4]Allen LA, Woolfolk RL, Escobar JI, Gara MA, Hamer RM: Cognitive-behavioral therapy for somatization disorder: a randomized controlled trial. Arch Intern Med 2006, 166:1512-1518.
• [5]Allen LA, Woolfolk RL: Cognitive behavioral therapy for somatoform disorders. Psychiatr Clin North Am 2010, 33:579-593.
• [6]Escobar JI, Gara MA, Diaz-Martinez AM, Interian A, Warman M, Allen LA, Woolfolk RL, Jahn E, Rodgers D: Effectiveness of a time-limited cognitive behavior therapy–type intervention among primary care patients with medically unexplained symptoms. Ann Fam Med 2007, 5(4):328-335.
• [7]Greeven A, Van Balkom AJ, Van der Leeden R, Merkelbach JW, Van den Heuvel OA, Spinhoven P: Cognitive behavioral therapy versus paroxetine in the treatment of hypochondriasis: an 18-month naturalistic follow-up. J Behav Ther Exp Psychiatry 2009, 40(3):487-496.
• [8]Leibbrand R, Hiller W, Fichter MM: Effect of comorbid anxiety, depressive, and personality disorders on treatment outcome of somatoform disorders. Compr Psychiatry 1999, 40(3):203-209.
• [9]Rief W, Hiller W, Geissner E, Fichter MM: A two-year follow-up study of patients with somatoform disorders. Psychosomatics 1995, 36(4):376-386.
• [10]Buwalda FM, Bouman TK: Predicting the effect of psychoeducational group treatment for hypochondriasis. Clin Psychol Psychother 2008, 15:396-403.
• [11]Kellner R: Prognosis of treated hypochondriasis. Acta Psychiatr Scand 1983, 67:69-79.
• [12]Blanchard EB, Lackner JM, Gusmano R, Gudleski GD, Sanders K, Keefer L, Krasner S: Prediction of treatment outcome among patients with irritable bowel syndrome treated with group cognitive therapy. Behav Pharmacol 2006, 44:317-337.
• [13]Shorter E, Abbey SE, Gillies LA, Singh M, Lipowski ZJ: Inpatient treatment of persistent somatization. Psychosomatics 1992, 33(3):295-301.
• [14]Nakao M, Fricchione G, Myers P, Zuttermeister PC, Baim M, Mandle CL, Medich C, Wells-Federman CL, Arcari PM, Ennis M, et al.: Anxiety is a good indicator for somatic symptom reduction through behavioral medicine intervention in a mind/body medicine clinic. Psychother Psychosom 2001, 70:50-57.
• [15]Bleichhardt G, Timmer B, Rief W: Prädiktoren für den direkten und längerfristigen therapieerfolg bei patienten mit somatoformen störungen nach verhaltenstherapeutischer behandlung. Z Klin Psychol Psychiatr Psychother 2005, 53(1):40-58.
• [16]Leibbrand R, Hiller W, Fichter MM: Influence of personality disorders on therapy outcome in somatoform disorders at 2-year follow-up. J Nerv Ment Dis 1999, 187(8):509-512.
• [17]Hiller W, Leibbrand R, Rief W, Fichter MM: Predictors of course and outcome in hypochondriasis after cognitive-behavioural treatment. Psychother Psychosom 2002, 71:318-325.
• [18]Prins J, Bleijenberg G, Rouweler EK, Van der Meer J: Effect of psychiatric disorders on outcome of cognitive-behavioural therapy for chronic fatigue syndrome. Br J Psychiatry 2005, 187:184-185.
• [19]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.
• [20]Michaelson P, Sjölander P, Johansson H: Factors predicting pain reduction in chronic back and neck pain after multimodal treatment. Clin J Pain 2004, 20(6):447-454.
• [21]Bonner D, Ron M, Chalder T, Butler S, Wessely S: Chronic fatigue syndrome: a follow up study. J Neurol Neurosurg Psychiatry 1994, 57:617-621.
• [22]Zonneveld LNL, Van Rood YR, Timman R, Kooiman CG, Vant Spijker A, Busschbach JJV: Effective group training for patients with unexplained physical symptoms: a randomized controlled trial with a non-randomized one-year follow-up. PLoS One 2012, 7(8):e42629.
• [23]Group training for patients with unexplained physical symptoms. http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1609 webcite
• [24]Zonneveld LNL, Van’t Spijker A, Passchier J, Van Busschbach JJ, Duivenvoorden HJ: he effectiveness of a training for patients with unexplained physical symptoms: protocol of a cognitive behavioral group training and randomized controlled trial. BMC Publ Health 2009, 9:251. BioMed Central Full Text
• [25]De Waal MWM, Arnold IA, Eekhof JAH, Van Hemert AM: Somatoform disorders in general practice: prevalence, functional impairment and comorbidity with anxiety and depressive disorders. Br J Psychiatry 2004, 184(6):470-476.
• [26]First MB, Spitzer RL, Gibbon M, Williams JBW: Structured clinical interview for DSM-IV axis I disorders. Amsterdam: Harcourt Test Publishers; 1999.
• [27]Zonneveld LNL: Draaiboek ‘Omgaan met de gevolgen van onverklaarde lichamelijke klachten’. Vlaardingen/Rotterdam: Riagg Rijnmond/Erasmus MC Department of Medical Psychology and Psychotherapy; 2005.
• [28]Zonneveld LNL, Duivenvoorden HJ, Passchier J, Van’t Spijker A: Tailoring a cognitive behavioural model for unexplained physical symptoms to patientcs perspective: a bottom-up approach. Clin Psychol Psychother 2010, 17(6):528-535.
• [29]Ware JE, Snow KK, Kosinski M, Gandek B: SF-36 health survey: manual and interpretation guide. Boston, MA: New England Medical Center, The Health Institute; 1993.
• [30]Zonneveld LNL, Van Rood YR, Timman R, Kooiman CG, Vant Spijker A, Busschbach JJV: Effective group training for patients with unexplained physical symptoms: a randomized controlled trial with a non-randomized one-year follow-up. PLoS One 2012, e42629:7-8.
• [31]Arrindell WA, Ettema JHM: SCL-90/symptom checklist: handleiding bij een multidimensionele psychopathologie-indicator. Lisse: Swets Test Publishers; 2003.
• [32]Duijsens IJ, Haringsma R, Eurelings-Bontekoe EHM: V.K.P. handleiding. Leiderdorp: Datec; 2002.
• [33]Field A: Regression. 3rd edition. London: Sage; 2009:197-263. [Discovering statistics using SPSS]
• [34]Miles JNV, Shevlin M: Issues in regression analysis. London: Sage; 2001:119-121. [Applying regression and correlation: a guide for students and researchers]
• [35]Cohen J: Statistical power analysis for the behavioral sciences. Hillsdale, New Jersey: Lawrence Erlbaum; 1988.
• [36]Heins MJ, Knoop H, Prins JB, Stulemeijer M, Van der Meer JWM, Bleijenberg G: Possible detrimental effects of cognitive behaviour therapy for chronic fatique syndrome. Psychother Psychosom 2010, 79:249-256.
• [37]A-priori sample size calculator for multiple regression: online software. http://www.danielsoper.com/statcalc3 webcite
• [38]Green SB: How many subjects does it take to do a regression-analysis. Multivar Behav Res 1991, 26(3):499-510.
• [39]Pallant J: SPSS survival manual: a step by step guide to data analysis using SPSS for Windows (Version 12). 2nd edition. Maidenhead Berkshire: Open University Press; 2005.
• [40]Lambert MJ, Barley DE: Research summary on the therapeutic relationship and psychotherapy outcome. Psychotherapy: theory, research, practice training 2001, 38(4):357-361.
• [41]Nater UM, Jones JF, Lin J-MS, Maloney E, Reeves WC, Heim C: Personality features and personality disorders in chronic fatigue syndrome: a population-based study. Psychother Psychosom 2010, 79:312-318.
• [42]Henningsen P, Zimmermann T, Sattel H: Medically unexplained physical symptoms, anxiety, and depression: a meta-analytic review. Psychosom Med 2003, 65:528-533.
• [43]Peters S, Rogers A, Salmon P, Gask L, Dowrick C, Towey M, Clifford R, Morriss R: What do patients choose to tell their doctors? Qualitative analysis of potential barriers to reattributing medically unexplained symptoms. J Gen Intern Med 2008, 24(4):443-449.
• [44]Raine R, Haines A, Sensky T, Hutchings A, Larkin K, Black N: Systematic review of mental health interventions for patients with common somatic symptoms: can research evidence from secondary care be extrapolated to primary care? Br Med J 2002, 325:1082-1092.