Patient experiences with internet-based cognitive behavioral therapy for multi-system functional somatic disorder: A qualitative study 2026 Lamm et al

Andy

Andy

Senior Member (Voting rights)

Highlights​

  • Users found the intervention relevant, acceptable, and helpful
  • The internet format did not compromise treatment delivery
  • Therapist support and the internet format facilitated engagement and accessibility
  • Treatment engagement required discipline and effort and outcome was heterogenous
  • User-centered design approach may lead to more usable internet-based interventions

Abstract​

Background​

Cognitive behavioral therapy (CBT) is an effective treatment for functional somatic disorder (FSD), but access to treatment remains limited in many countries. Studies indicate that internet-based CBT (iCBT) for FSD might improve accessibility and scalability without compromising effectiveness. However, most research on iCBT for FSD has relied on quantitative designs, providing limited insight into participants' subjective experiences with this digital approach.

Objective​

This study aimed to explore the experience of receiving iCBT for FSD, with a focus on how participants experienced the therapeutic process, the online format, the role of the therapist, and the outcome of the treatment.

Methods​

In total, 15 semi-structured qualitative interviews were conducted following a three-month post-treatment assessment in the context of a larger randomized controlled trial testing the efficacy of therapist-assisted iCBT for multi-system FSD. The interviews were transcribed and analyzed by two researchers using reflexive thematic analysis.

Results​

Three themes were identified: 1) “Helpful - but not Enough” explored the participants' descriptions of the changes they observed following treatment, 2) “Reversing a History of Overexertion” described how participants had engaged with the treatment content, and what they had found helpful in their therapeutic process, 3) “Psychotherapy is Hard” addressed the factors that facilitated or hindered engagement with the digital treatment.

Conclusion​

Findings from this study indicate that participants with FSD found iCBT to be relevant, acceptable, and helpful. Furthermore, future iCBT development should adopt an iterative, user-centered design approach to continually identify and mitigate barriers to engagement while strengthening key facilitators.

Open access
 
"Randomized controlled trials indicate that iCBT is an efficacious treatment for a range of FSD presentations, including irritable bowel syndrome, fibromyalgia, chronic fatigue syndrome, and somatic symptom distress..."

"To our knowledge, only a few qualitative studies have explored user experiences of engaging with CBT for FSD. The available studies, primarily conducted in chronic fatigue syndrome, suggest that CBT is generally perceived as a helpful albeit rarely curative treatment..."
 
Turtle said:
@Andy wrote
iCBT is an efficacious treatment for chronic fatigue syndrome albeit rarely curative??????????
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No, I didn't, I quoted the paper. My actual opinion is that CBT as a treatment for anything is useless and that any 'evidence' for it is just smoke and mirrors, relying on convincing patients to change how they answer questionnaires without affecting the underlying symptoms and the few who might improve naturally over time.
 
Brainwashing in action. Patients feed back to investigators what they have been told on the course:

Participants generally described FSD as a bio-psycho-social condition shaped by stress and overexertion with symptoms that could be influenced by changes in behavior, emotion, and cognition, which closely mirrored the treatment focus on Patient Education (domain 1). The focus on regulating overexertion and stress, which was framed by participants as the primary vehicle of therapeutic change, was also well aligned with the treatment focus on stabilization (Domain 2). Participants' descriptions of working with challenging anxiety and avoidance were also observed, consistent with the treatment focus on Exposure (Domain 3), although this appeared less consistently. While it is unclear to what extent participant's conceptualization of FSD originated from the treatment itself, it seems likely that the intervention contributed to shaping participants' understanding of FSD.
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One thing that strikes me about all these CBT for physical symptoms programs is the structure is the same.

First give patients a pseudo scientific BPS explanation for their symptoms,
second, get them to do some version of cutting back exertion/stressors to find a baseline,
third get them to 'challenge', pace up, overcome fear of activity etc.
 
Trish said:
One thing that strikes me about all these CBT for physical symptoms programs is the structure is the same.

First give patients a pseudo scientific BPS explanation for their symptoms,
second, get them to do some version of cutting back exertion/stressors to find a baseline,
third get them to 'challenge', pace up, overcome fear of activity etc.
Click to expand...
And around a third of all the participants realise its all nonsense or harming them and walk out mid study and the researchers don't even consider asking the question why that happened. The longer the study is the more that drop out, likely due to pacing up causing them crashes that remove their ability to participate.
 
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