Self-help interventions for young people with persistent physical symptoms: A systematic review.

OBJECTIVE: Persistent physical symptoms are frequent among young people causing considerable social, psychological, and economic consequences. Easily accessible interventions adapted to non-specialized settings are needed. We aimed to systematically review randomized controlled trials on self-help interventions for young people with persistent physical symptoms compared to active or passive control groups. Our purpose was to 1) describe applied therapeutic approaches and content and 2) examine potential effects on symptom burden and psychosocial outcomes. METHODS: We included randomized controlled trials on minimal contact self-help interventions for young people with persistent physical symptoms. Systematic literature searches in PubMed, Cochrane Central, Embase, and PsycINFO were conducted. Study selection, data extraction and quality assessment were performed independently by two reviewers. A narrative synthesis of the effects was performed. RESULTS: We identified 11 studies on self-help interventions for young people. The methodological quality of the studies was generally low. Participants suffered from impairing fatigue, headache, abdominal pain, and musculoskeletal or multi-site pain. Applied therapeutic approaches were cognitive behavioral therapy, relaxation training, hypnotherapy, and written self-disclosure. Outcomes were diverse and mainly related to symptom burden, whereas psychosocial outcomes were only sporadically examined. Overall, evidence of effectiveness of self-help interventions in alleviating symptom burden was weak, and potential effects could not be linked to one specific theoretical approach. CONCLUSION: Few self-help interventions of diverse content exist for young people with persistent physical symptoms. Rigorously designed studies that include recommended outcome domains assessed by aligned measures are needed to determine and compare the clinical value of such interventions.

"Understand your illness and your needs": Assessment-informed patient education for people with multiple functional somatic syndromes.

OBJECTIVES: Patients suffering from multiple functional somatic syndromes (FSS) such as fibromyalgia, chronic fatigue syndrome, or irritable bowel syndrome, often lack both a clear diagnosis and tangible illness explanations, which is a barrier for treatment engagement. We tested a short-term intervention taking the unifying concept of Bodily Distress Syndrome (BDS) as a point of departure. The intervention consisted of a clinical assessment, group-based patient education, and one follow-up consultation. METHODS: 174 patients were included and received questionnaires at baseline, after clinical assessment, after patient education, and median 19 weeks after baseline. Data were analyzed using random effects models and simple t-tests. Qualitative data were thematically analyzed. RESULTS: We found small reductions in symptom levels, considerable reductions in illness worry, and improvement of illness perceptions and illness-related behaviors. Overall, patients evaluated the intervention positively and expressed high expectations for further treatment. Qualitative results mainly supported these findings. CONCLUSION: Targeting illness perceptions through patient education is crucial to obtain patient engagement in self-help management or further treatment. This may lead to improved outcomes. PRACTICAL IMPLICATIONS: Physicians in primary and secondary care should strive to give patients with multiple FSS a clear understanding that their various FSS diagnoses are related and provide tangible illness explanations.

Is psychotherapy for functional somatic syndromes harmful? A mixed methods study on negative effects.

INTRODUCTION: Concern for negative effects of psychotherapy for functional somatic syndromes (FSS) has been expressed by clinicians and some patient associations, which may prevent patients from seeking treatment. Therefore, we sought to explore the occurrence and characteristics of negative effects from group-based psychotherapy as experienced by patients with severe or multiple FSS. METHODS: An adapted version of the explanatory sequential mixed methods design was applied. We used data from an on-going pilot study on Acceptance and Commitment Therapy and Mindfulness-Based Stress Reduction. Negative effects were measured by Inventory for the assessment of Negative Effects of Psychotherapy (INEP). In addition, telephone interviews were conducted with randomly chosen patients and patients who reported negative effects. The latter were asked to elaborate on their INEP response. Quantitative data were analysed descriptively while interview transcripts were explored by thematic analysis. RESULTS: Eighty patients responded to the questionnaire (89%). Negative effects to different extent (from 'slightly agree' to 'fully agree') were reported by 25 (31%). The most frequent negative effects were dependence on the therapist (12%), feeling down after therapy (6%) and insurance problems (7%). By exploring 27 participants' experiences of negative effects 3 main themes were identified: relations in therapy, outcome and transition from therapy to everyday life. CONCLUSION: Patients with FSS reported a few specific negative effects, all with low frequency. Generally, therapy was well-received. Some patients did however express negative effects both within and outside the therapeutic context. It is important to inform patients about potential negative effects prior to psychotherapy.