A cognitive behavioural group treatment for somatic symptom disorder: a pilot study 2023 Jongsma et al

[Andy]

NB: All authors are from McMaster Uni, Canada.

Background
Somatic symptom disorder (SSD) presents challenges to the healthcare system, including frequent medical visits, lack of symptom relief experienced by individuals with this condition, high associated medical costs, and patient dissatisfaction. This study examined the utility of a novel, low-barrier, brief cognitive behavioural therapy (CBT) group intervention for individuals with SSD.

Methods
Participants were referred by their mental health providers or self-referral. Each participant underwent a telephone screen and in-person psychological and neuropsychological screen. Two cycles of the CBT-based group (n = 30), each consisting of six weekly two-hour sessions, were facilitated at a large outpatient mental healthcare facility in Ontario, Canada. The final sample consisted of 13 individuals of whom 11 completed the treatment. Clinical outcome measures were administered pre-, mid- and post-group, including the Generalized Anxiety Disorder–7, Perceived Stress Scale–4, Pain Self-Efficacy Questionnaire, Pain Disability Index, Revised Illness Perception Questionnaire, and sections of the Patient Health Questionnaire. Six healthcare utilization metrics were collected from electronic medical records at six months pre- and post-group. Paired samples t-tests were used to examine pre- to post-group differences in participants’ somatic symptoms, psychological functioning, health, and degree of healthcare utilization.

Results
When comparing pre- and post- group, we observed reductions in the mean scores for somatic symptom severity, depressive symptomatology, anxiety, perceived stress, and perceived disability related to pain. The change in depressive symptomatology yielded a small effect size (d = 0.30). Further, we observed downward trends across participants’ pre- to post-group healthcare utilization, with small effect sizes observed for hospital admission (d = 0.36), days admitted to hospital (d = 0.47), and inpatient consults (d = 0.42). Differences between pre- and post-group measures of somatic symptom severity, psychological functioning, health, or healthcare utilization did not reach significance.

Conclusions
Current findings provide support for the potential effectiveness of an abbreviated CBT group for individuals with SSD in reducing psychiatric symptomatology. Further research is recommended, including randomized control trials, cost-benefit analyses, and comparisons between abbreviated versus longer-duration treatment programs for SSD.

Open access, https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-023-05141-9

 

[Trish]

So basically they cherry picked a few results with small effect sizes and most of their questionnaires didn't given significant results.
The conclusion should clearly be to scrap this treatment as a bad idea and move on. Instead the oh so predictable conclusion of 'potential effectiveness' and more research needed.

 

[rvallee]

A pilot study of a pragmatic trial for a pseudoscientific treatment model that has been tried hundreds of times before, including in large scale trial, and is, in fact, the current treatment model. A pilot study, which means trying something new for feasibility. The current treatment paradigm.

But they call it "novel" and somehow a journal will publish it. And they even screened the participants, no doubt selecting for probability of reporting good outcomes regardless of actual outcome. Good grief, they are making a mockery of what it even means to be an expert.

downward trends across participants’ pre- to post-group healthcare utilization, with small effect sizes observed for hospital admission (d = 0.36), days admitted to hospital (d = 0.47), and inpatient consults (d = 0.42). Differences between pre- and post-group measures of somatic symptom severity, psychological functioning, health, or healthcare utilization did not reach significance.

So the patients are just as ill, but have slightly given up on healthcare. Slightly, not significantly. And they report it a success anyway by talking about "support for the potential for effectiveness". About the current treatment paradigm, applied to millions of people for several decades.

This is antiscience regression.

 

[Hutan]

Cherry-picked participants; cherry-picked outcomes. Another study in a long line of studies, this one with a hopelessly small sample size. And still there is no convincing case made for the treatment.

Katherine Jongsma,
Bri Susanna Darboh,
Sasha Davis &
Emily MacKillop

It's worth recording the names of people who are willing to put their names to this prejudiced nonsense.

It is well-documented that the ongoing distress about physical symptoms experienced in SSD promotes a self-perpetuating feedback loop between increased somatic and exacerbated psychological symptoms.

Just because something is well-documented, doesn't make it true.

Western biomedical perspectives propose that the development of SSD is facilitated by an individual’s heightened awareness of bodily sensations and a concurrent propensity for interpreting these sensations as secondary to medical illness

I suppose the psychosomatic hypothesis is one western biomedical perspective, which again does not make it true. Highlighting it as such presumably is meant to make it more credible than describing it as 'vague hand-waving, patient-blaming pseudoscience', which it also is.

Ontario has a diverse and multicultural population; thus, it is imperative to consider multicultural perspectives of somatic symptoms. The current study was conducted in the City of Hamilton, which is situated on the traditional and ancestral territories of the Erie, Neutral, Huron-Wendat, Haudenosaunee, and Mississaugas. Many Indigenous cultures emphasize the notion of balance across the mental, physical, spiritual, and emotional aspects of one’s life, within the social and community context [3,4,5,6,7]. This holistic model of health and wellbeing is often represented through the concept of the medicine wheel. With respect to cultural idioms of distress, many cultures (including as Asian and Indigenous cultures) are more likely to express their distress through physical symptoms instead of psychological complaints, and some cultures have specific presentations of mental disorders with somatic components such as ‘hwabyung’ in Korea, ‘shenjing shuairuo’ in China, and ‘brain fag’ in Nigeria [8]. Applying Western diagnostic criteria for somatic disorders to those in different cultures runs significant risk of lower diagnostic validity and over-pathologizing.

This paragraph is notable.

We've seen the psychosomatic hypothesis portrayed as something modern, a turning away from a narrow biological approach to considering the whole person and their environment - holistic, bio-psycho-social. We've seen objections to the wide application of SSD and functional disorder labels being framed as a prejudice against mental illness. We've seen SSD promoted as a feminist issue - that is, the stigma that people diagnosed with SSD experience has been described as a result of prejudice against women and their health conditions. Now it seems that any rejection of SSD is going to be painted as a lack of openness to the way that other cultures interpret emotional distress. These are all clever approaches that make clear arguments against the concept so much harder to make.

 

[Sean]

This is antiscience regression.

Par excellence.

We've seen the psychosomatic hypothesis portrayed as something modern, a turning away from a narrow biological approach to considering the whole person and their environment - holistic, bio-psycho-social. We've seen objections to the wide application of SSD and functional disorder labels being framed as a prejudice against mental illness. We've seen SSD promoted as a feminist issue - that is, the stigma that people diagnosed with SSD experience has been described as a result of prejudice against women and their health conditions. Now it seems that any rejection of SSD is going to be painted as a lack of openness to the way that other cultures interpret emotional distress. These are all clever approaches that make clear arguments against the concept so much harder to make.

They are just throwing everything and anything they can think of against the wall, hoping something, anything, will stick.

 

[Midnattsol]

We've seen the psychosomatic hypothesis portrayed as something modern, a turning away from a narrow biological approach to considering the whole person and their environment - holistic, bio-psycho-social. We've seen objections to the wide application of SSD and functional disorder labels being framed as a prejudice against mental illness. We've seen SSD promoted as a feminist issue - that is, the stigma that people diagnosed with SSD experience has been described as a result of prejudice against women and their health conditions. Now it seems that any rejection of SSD is going to be painted as a lack of openness to the way that other cultures interpret emotional distress. These are all clever approaches that make clear arguments against the concept so much harder to make.

And as we know, there has never been cases of misattributions of "distress" as cause for illness.

I remember and old acquaintance of mine. He became psychotic due to the consequences of undiagnosed celiac disease. When he cut gluten from his diet and treated the nutrient deficiencies his psychological symptoms disappeared.

 

[bobbler]

I have no idea whether the two questionnaires are related (the one in this link is 15), however having read the following paper which includes Sharpe, Stone, Carson saying that the PHQ 15 doesn't identify people with unexplained symptoms better than chance I thought I'd do a quick google in case there were papers for which this reference might be relevant:

Somatic symptom count scores do not identify patients with symptoms unexplained by disease: a prospective cohort study of neurology outpatients - PubMed (nih.gov)

Conclusions: Self-rated symptom count scores should not be used to identify patients with symptoms unexplained by disease."

To discuss this paper, go to this thread:
Somatic symptom count scores do not identify patients with symptoms unexplained by disease: a ... study of neurology outpatients, 2015, Carson, Sharpe