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

Abstract

BackgroundAlthough 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.MethodsPatients (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.ResultsThe 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.ConclusionsAs 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 registrationNederlands Trial Register, NTR1609

Treatment course and its predictors in patients with somatoform disorders: A routine outcome monitoring study in secondary psychiatric care

“…Our modest treatment results for somatoform disorders are in line with studies in primary care (e.g., Steinbrecher & Hiller, ) and secondary care (e.g., Deary, Chalder, & Sharpe, ; Zonneveld et al, ) but in contrast to those who found somewhat better treatment results (e.g., Kroenke, ). Possible reasons for our modest treatment results are, for instance, the limited follow‐up period of 6 months and/or the negative influence of characteristics that might have hampered successful treatment outcome (e.g., maladaptive personality traits, and dysfunctional therapeutic alliance; Reuter, Bengel, & Scheidt, ).…”

“…The course of functioning was determined by the difference score of the SF‐36 physical (SF‐36 physical at 6 months–SF‐36 physical at baseline; Zonneveld et al, ). Predictors were based on the relevant literature (e.g., Zonneveld et al, ) and their availability in our ROM database. The following control variables were taken into account for the course of symptoms in Table (e.g., Grant et al, ; Iezzoni, ; Karlsen et al, ; Ware et al, ; Zonneveld et al, ): pretreatment BSI total, age, gender, marital status, and employment status.…”

“…The following control variables were taken into account for the course of symptoms in Table (e.g., Grant et al, ; Iezzoni, ; Karlsen et al, ; Ware et al, ; Zonneveld et al, ): pretreatment BSI total, age, gender, marital status, and employment status. In addition, the predictors that were taken into account for the course of symptoms included (e.g., Pedersen Frølund et al, ; Schröder et al, ; Wortman et al, ; Zonneveld et al, ): education, anxiety disorder, mood disorder, combination of anxiety and mood disorders, total diagnoses, PSC total, BAS, MADRS, SF‐36 physical functioning, SF‐36 social functioning, SF‐36 general health, and the four somatoform disorder groups (undifferentiated somatoform disorder, pain disorder, body dysmorphic disorder, and hypochondriasis). The following control variables were taken into account for the course of functioning (Zonneveld et al, ): pretreatment SF‐36 physical functioning, age, gender, marital status, and employment status.…”

“…In addition, the predictors that were taken into account for the course of symptoms included (e.g., Pedersen Frølund et al, ; Schröder et al, ; Wortman et al, ; Zonneveld et al, ): education, anxiety disorder, mood disorder, combination of anxiety and mood disorders, total diagnoses, PSC total, BAS, MADRS, SF‐36 physical functioning, SF‐36 social functioning, SF‐36 general health, and the four somatoform disorder groups (undifferentiated somatoform disorder, pain disorder, body dysmorphic disorder, and hypochondriasis). The following control variables were taken into account for the course of functioning (Zonneveld et al, ): pretreatment SF‐36 physical functioning, age, gender, marital status, and employment status. In addition, the predictors that were taken into account for the course of functioning included education, anxiety disorder, mood disorder, combination of anxiety and mood disorders, total diagnoses, PSC total, BAS, MADRS, BSI total, and the four somatoform disorder groups (undifferentiated somatoform disorder, pain disorder, body dysmorphic disorder, and hypochondriasis).…”

“…The following control variables were taken into account for the course of symptoms in Table 5 (e.g., Grant et al, 2014;Iezzoni, 2013;Karlsen et al, 2011;Ware et al, 1993;Zonneveld et al, 2012) Significant p values (p < .01) are printed in bold.…”