Perceived working mechanisms of psychosomatic therapy in patients with persistent somatic symptoms in primary care.., 2022, Wortman et al

Abstract

Objectives
To explore the perceived working mechanisms of psychosomatic therapy according to patients with persistent somatic symptoms (PSS) and their psychosomatic therapists.

Design
Qualitative study using semistructured face-to-face interviews and focus groups. All interviews were audiorecorded, transcribed verbatim and analysed, by two researchers independently, based on the thematic analysis.

Setting
Alongside a randomised controlled trial to establish the (cost-)effectiveness of psychosomatic therapy in patients with PSS in primary care, we conducted a process evaluation with a qualitative study. Patients were recruited in general practice in three regions in the Netherlands.

Participants
Interviews were conducted with twenty patients with PSS who received psychosomatic therapy and 25 psychosomatic therapists. In addition, two focus groups were conducted with six and seven psychosomatic therapists, respectively.

Intervention
Psychosomatic therapy, delivered by specialised exercise and physical therapists, is a multimodal and tailored treatment based on the biopsychosocial model.

Outcome measures
Experiences, opinions and views from patients’ and therapists’ perspective on psychosomatic therapy were identified.

Results
A total of 37 interviews with patients, 25 interviews and two focus groups with therapists were analysed. Three main themes emerged from the data of the patients: (1) continuous alternation of psychosocial conversations and body-oriented exercises; (2) awareness of body–mind connection and (3) good relationship with therapist. Four main themes emerged from the data of the therapists (1) building rapport; (2) continuously searching for common ground; (3) making patients aware of the interaction between body and mind; and (4) continuous alternation between exploration and treatment.

Conclusion
According to patients as well as therapists, the continuous alternation of psychosocial conversations and body-oriented exercises to provide awareness of the interaction between body and mind are the perceived working mechanism of psychosomatic therapy. Therapeutic alliance and finding common ground between patient and therapist are prerequisites for the success of psychosomatic therapy.

Open access, https://bmjopen.bmj.com/content/12/1/e057145#DC1

 

I don’t know what the guidelines currently are in the Netherlands, but is there any value in making representations to the ethics committees which permit this sort of research?

This sort of statement, for instance, would presumably have informed the original proposals:

Persistent somatic symptoms (PSS), such as headache, dizziness, fibromyalgia and chronic fatigue syndrome, are symptoms that persist longer than usual and, either by their character or following the negative results of clinical examination, cannot be attributed to a disease

 

So maybe this answers the complaint from Newcastle or whoever about not being able to separate the 'therapeutic alliance' from the specific treatment. The therapeutic alliance is all there is. There ain't no specific treatment that works. It is just that:

The better you manage to persuade the patient to pretend they are happy the more they will pretend they are happy. Easy.

It's actually non-pharmacological homeopathy.

 

When you absolutely, positively, have absolutely nothing to work with and are just making stuff to justify your employment. What a bunch of mindless drivel.

By controlling a discussion around the therapists' pet ideas, they made patients talk about those pet ideas. Groundbreaking stuff.

Although basically this is all of it:

In a nutshell: psychosomatic therapists need patients willing to entertain psychosomatic ideology and mindset. Which is the exact same idea behind alternative medicine: the providers need clients who are willing to believe in their ideas.

About 1/3 of the population believes in astrology and other superstitions. It's not hard to find people willing to go for any bit of nonsense, it's the business model of both alternative medicine and, clearly now, the biopsychosocial model of illness.

So basically they admit that they must select their patients, then cherry-pick what is reported, otherwise it doesn't "work". So they need people with prior beliefs about this, to manipulate those beliefs, then use those beliefs, which have to be prior to, as evidence.

I have no problem with alternative medicine, but it can't be coercive, it must be a free choice made without repercussions. This is alternative medicine, full stop. If they enjoy wasting their careers on this, fine, but to coercively impose this nonsense onto millions is criminal and is entirely anti-scientific.

 

Strangely, in all the time I've been ill, I've never been able to observe this mysterious psychosomatic interaction between mind and body. To me the illness appears to be completely uninterested in my thoughts, wishes and opinions. Emotional relief brings nothing more than emotional relief. A positive attitude is good for morale but does nothing to restore my functioning. My mind is not able to control the symptoms at all.

Perhaps I need therapy sessions so that I can learn to interpret ambiguous observations in the right psychosomatic way. Or is therapy more about believing in it so that I don't have to admit I'm powerless? It seems to be too late for that.

 

And I suspect much of homeopathy revolves around all the blarney the homeopaths bamboozle their clients with.

 

I have come across lots of Hoovers that don't work but have a working mechanism.

 

Ah, but the study is in to the "perceived" working mechanisms. Perceptions may be misleading.

 

Sorry I meant non-non-pharmacological, as opposed to non-pharmacological.

 

Indeed. The working mechanism of Jonathan's hoovers may be to make enough noise to dissuade the cat from sleeping in an armchair, thereby removing the need to vacuum hair off the seat.

But only if he has a cat.

 

I think this is where the fairies come into play. Magical fairies solve all sorts of problems.

 

you mean like Herbert Hoover?

 

It is just me or am I seeing the word "perceived" cropping up more and more in the titles of recent studies? Maybe it's just my perception.

 

Presumably if you use an unblinded study and subjective outcome criteria then you can get a positive result ---
"Outcome measures
Experiences, opinions and views from patients’ and therapists’ perspective on psychosomatic therapy were identified."

Results
"(1) building rapport; (2) continuously searching for common ground; (3) making patients aware of the interaction between body and mind; and (4) continuous alternation between exploration and treatment."

So you get rid of the patients who you cannot "(1) building rapport; (2) continuously searching for common ground;---". AKA the ones who tell you it's not working ---- gaslighting seems a fair description.

Makes you wonder who should be in the psychiatrists chair ---- the folks who are delivering this "treatment" --- or the vulnerable ill? I was laughing at times when I read this, but on reflection it really isn't funny.