Effectiveness of psychosomatic therapy for patients with persistent somatic symptoms: Results from the CORPUS... 2023 Wortman et al

Full title: Effectiveness of psychosomatic therapy for patients with persistent somatic symptoms: Results from the CORPUS randomised controlled trial in primary care

Highlights

• We investigated the effectiveness of psychosomatic therapy for PSS.
  
  
• No improvement was established in patient's level of functioning.
  
  
• We only found effects on some secondary outcome measures.
  
  
• Especially patients with moderate PSS benefited from the psychosomatic therapy.
  
  
• Psychosomatic therapy could be an important treatment to improve PSS management.

Abstract

Objective
To evaluate the effectiveness of psychosomatic therapy versus care as usual in primary care for patients with persistent somatic symptoms (PSS).

Methods
We conducted a pragmatic, two-armed, randomised controlled trial among primary care patients with PSS in the Netherlands that included 39 general practices and 34 psychosomatic therapists. The intervention, psychosomatic therapy, consisted of 6–12 sessions delivered by specialised exercise- and physiotherapists. Primary outcome measure: patient's level of functioning. Secondary outcomes: severity of physical and psychosocial symptoms, health-related quality of life, health-related anxiety, illness behaviour and number of GP contacts.

Results
Compared to usual care (n = 85), the intervention group (n = 84) showed no improvement in patient's level of functioning (mean difference − 0.50 [95% CI -1.10 to 0.10]; p = .10), and improvement in health-related anxiety (mean difference − 1.93 [95% CI -3.81 to −0.04]; p = .045), over 12 months. At 5-month follow-up, we found improvement in physical functioning, somatisation, and health-related anxiety. The 12-month follow-up revealed no therapy effects. Subgroup analyses showed an overall effect in patient's level of functioning for the group with moderate PSS (mean difference − 0.91 [95% CI -1.78 to −0.03]; p = .042). In the year after the end of therapy, the number of GP contacts did not differ significantly between the two groups.

Conclusion
We only found effects on some secondary outcome measures, and on our primary outcome measure especially in patients with moderate PSS, the psychosomatic therapy appears promising for further study.

Open access, https://www.sciencedirect.com/science/article/pii/S0022399923000338

 

"The term Persistent Somatic Symptoms (PSS) refers to a heterogeneous group of physical symptoms such as chronic widespread pain, headache, dizziness, fibromyalgia, chronic fatigue and irritable bowel syndrome that cannot be directly attributed to detectable underlying diseases or an organic pathology"

 

What does psychosomatic therapy consist of? Is it GET and CBT?

 

From the Discussion section.

"Due to our selection procedure we may have included patients who did not always expect a psychosomatic approach. Some patients may need more explicit attention to a shared biopsychosocial disease model, more focus on understanding and acceptance of the symptoms as well as on their personal possibilities, which might reduce patients focussing on pain or complaints [55]. In addition, psychosomatic therapy aims at behavioural change and readiness to change might influence a positive outcome [57]. Some patients may lack this readiness to change. Furthermore, for the 30% of patients who were older than 66 years it might be more difficult to obtain a real change in symptoms and functioning. This needs to be verified in future studies."

 

"The psychosomatic therapy was administered by psychosomatic therapists with special interest in PSS, registered with the Dutch Association of Exercise Therapists [14] and the Dutch Association for Psychosomatics in Physical Therapy [13], respectively. It includes the following elements: psychoeducation, relaxation therapy and mindfulness, cognitive-behavioural approaches and activating therapy. During the psychosomatic therapy sessions, the therapist explores somatic symptoms and integrates the physical, cognitive, emotional, behavioural and social dimensions of the symptoms together with the patient. The overall aim of the treatment is to improve patients' functioning by stimulating self-regulation and empowerment to regain control over own health [22]. The intervention consisted of 6 to 12 sessions of 30–45 min over a period of 4 to 5 months, depending on the number and severity of the patient's symptoms."

So, in far less words, yes, pretty much GET and CBT.

 

This is just wall-to-wall neglect and torture (edit : I'm referring to the suggested treatment, not the results)

 

It's like they're playing roulette but with an additional option where either red or black gives them back all their money, and if they fall on 0/green the casino gives them a win, even if they didn't bet on it. This literally disproves the model, and they market it as a win anyway, and will get away with it.

And they have the utter shamelessness of taking such a null result, making it about being "promising", about something that has been used onto millions of people for decades.

This is madness. Nothing matters here. Not reality, not the patients, not the outcomes. They just make stuff up on and on, for decades, always talking about the thing they sell as fully effective being "promising" and also irrefutably effective, even though the evidence is complete garbage.

All of this taken at face value, taught at medical schools as being just as valid as the number of bones in the human body. Completely absurd.

 

Excellent point about ethics @Hutan.

We have all heard of psych studies that mispresented what they were really about. I don't know if this was the case here, but participants should be completely informed.

 

But more honest in its title and more appropriate in its description as far as informed consent due to calling it psychosomatic therapy.

shsme about the methods testing whether it helps instead of whether their chosen ‘measures’ are just ‘coached into people’ gif said effects

 

I'm trying to write a post about this paper but am very confused by Table 3. The right side of it (under "Difference") seems to show the difference between all the moderates and all the severes, whether or not they got the intervention. The left side splits them up into the intervention and non-intervention people. But the data cited in the abstract for the claim of an effect on the more moderate people seems to be reporting a change regardless of whether or not they received the intervention. In other words, the data seem to suggest that the moderates were more likely to do marginally better than the severes but it seems to have nothing to do with the intervention.

Can anyone clarify if I seem to be reading this table correctly? (This is apart from Hutan's concerns as well.)

 

I was just about to post to highlight the ridiculousness of these two statements, when you beat me to it.

Unethical to continue. It does not work. Give it a rest. The END.

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From the discussion section:
"Due to our selection procedure we may have included patients who did not always expect a psychosomatic approach."
OK so how was that managed ethically?

"Some patients may need more explicit attention to a shared biopsychosocial disease model, more focus on understanding and acceptance of the symptoms as well as on their personal possibilities, which might reduce patients focussing on pain or complaints [55]." Symptoms are a signal to help the human to identify that there might be an issue, and that they need to attend to something, and it it can't be fixed to take care and look after themselves. How might reducing focusing on this help - as in ignore / avoid it - all that does is increase anxiety.....

"In addition, psychosomatic therapy aims at behavioural change and readiness to change might influence a positive outcome [57]." Ahhhhh, so if the so-called changes do not occur: it is therefore all the patients fault for not being ready... or something like that..... Big emphasis on the "might". Alternatively, it might be 'cos the therapy is twaddle and it's unlikely, as they have shown in this very study, to not improve patient functioning. Which is surely, kinda the point of doing anything really. (sarcasm off)

"Some patients may lack this readiness to change." Some therapists and doctors might lack the readiness to admit what they are doing and thinking is whoooooooooo.

"Furthermore, for the 30% of patients who were older than 66 years it might be more difficult to obtain a real change in symptoms and functioning. This needs to be verified in future studies." OK, so the oldies are not in to changing - so ageist as well as twaddle. Lovely.

What a total pile of junk. Please no more "future studies" Just stop.