Comparing group-based acceptance and commitment therapy (ACT) with enhanced usual care for adolescents with functional somatic syndromes: a study protocol for a randomised trial (original) (raw)
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BMC Psychiatry, 2020
Background Recurrent and impairing functional somatic syndromes (FSS) are common in adolescents. Despite a high need for care, empirically supported treatments are lacking for youth. The aim of this uncontrolled pilot study was to assess feasibility and treatment potential of a new intervention with group-based Acceptance and Commitment Therapy (ACT) in a generic treatment approach for adolescents with multiple FSS. Methods Twenty-one patients received ‘ACT for Health in Adolescents’ (AHEAD) (30 h), specifically developed for adolescents (aged 15–19 years) with moderate to severe FSS. Close relatives attended an information meeting to facilitate support of the patients throughout treatment. Treatment satisfaction was evaluated by means of self-report and relatives’ impressions. Self-reported physical health at 3 months follow-up (FU) after end of treatment was the primary outcome whereas secondary outcomes included symptom burden, limitation due to symptoms, illness worry, emotional...
Child and Adolescent Mental Health, 2006
Functional or unexplained medical symptoms (physical symptoms that are not adequately explained by organic factors and where a major role for psychological factors is assumed) are common amongst children in the general population but can also be an expression of somatisation and somatoform disorders. Co-morbid psychopathology is common. We describe measures mostly used in research into problems related to somatisation in children and adolescents that may be helpful to clinical researchers. Some address the nature and severity of physical symptoms, others document illness attitudes, beliefs and functional impairment, and a third group assesses emotional symptoms. Questionnaires can be helpful for clinicians in quantifying (i) the nature and severity of somatic symptoms and associated functional impairment, (ii) contributory health attitudes and illness beliefs and (iii) co-morbid or primary anxiety and depressive disorders. Together with pain and activity diaries and careful documentation of school attendance, these measures may also be helpful in monitoring treatment response.
Research Square (Research Square), 2024
Background: Functional somatic symptoms and bodily distress disorders are highly prevalent across all medical settings. Services for these patients are dispersed across the health care system with minimal conceptual and operational integration and patients do not currently access therapeutic offers in signi cant numbers due to a mismatch between their and professionals' understanding of the nature of the symptoms. New service models are urgently required to address patients' needs and to align with advances in aetiological evidence and diagnostic classi cation systems to overcome the body-mind dichotomy. Method: A panel of clinical experts from different clinical services involved in providing aspects of health care for patients with functional symptoms reviewed the current care provision. This review and the results from a focus group exploration of patients with lived experience of functional symptoms were explored by the expert advisory group and conclusions summarised as recommendations for best practice. Conclusion: We propose a novel, integrated care pathway for patients with 'functional somatic disorder', which delivers care according to and working with patients' explanatory beliefs. The therapeutic model should operate based upon an understanding of the embodied nature of patient's complaints and provide exible access points to the care pathway.
Psychotherapy and Psychosomatics
Introduction: Central sensitization is one of the major conditions that constitutes chronic pain, and is influenced by various kinds of biopsychosocial factors. Pain intensity and anxiety will increase hypersensitivity to experimental pain stimuli, while depression will decrease it. Although it is well known that there is high comorbidity between chronic pain and major depressive disorder, it is still difficult to evaluate the pathological condition of chronic pain because of its heterogeneity. In this research, we investigated the relationship between pain intensity and depression which caused the change of pain threshold. Methods: We studied 76 patients with chronic non-malignant pain. Pain intensity and depression were assessed by Short-form McGill Pain Questionnaire (SF-MPQ) and Beck Depression Inventory (BDI). Electrical pain tolerance thresholds (PTT) were measured at asymptomatic regions, and subjects were divided into low PTT group and the others group by 10th percentile values for PTT in controls. Results: The low PTT group accounted for 22% of the subjects. Within the demographic and psychological data, there were no significant differences when compared between two subgroups. Pain intensity significantly showed positive correlation with depression in both all subjects and the others group, but not in the low PTT group. Conclusions: In this study, the decrease of PTT reflected less correlation between pain intensity and depression. Thus, PTT at asymptomatic regions can be a good indicator of the central sensitization formed by the effects of depression in chronic pain.
Cognitive and Behavioral Practice, 2005
This case example illustrates how Acceptance and Commitment Therapy (ACT) within a behavior medicine approach was used in the rehabilitation of an adolescent with debilitating chronic pain. For chronic pain with unclear etiology (idiopathic pain), pharmacological therapy alone is often insufficient. Psychological treatment strategies have been developed and evaluated for adults with chronic pain. However, few such studies have been conducted with youths. To date, there is limited empirical evidence regarding the effectiveness of psychological treatment for generalized musculoskeletal pain syndromes in children and adolescents. This patient was a 14-year-old girl severely disabled by idiopathic generalized pain. It was hypothesized that avoidance of pain and pain-related stimuli was central to the subject's disability. ACT, a development of cognitive behavior therapy, was used as the treatment model in this study, focusing on building the behavior repertoire in valued life directions rather than emphasizing reductions in pain and distress. As the subject moved in valued directions, exposure to avoided pain stimuli took place naturally. Following treatment, improvements in valued life activities and functional ability was seen, as evidenced by increased school attendance, lower pain ratings, and individual goal achievement. The outcome of this treatment indicates that ACT and a behavioral medicine approach can be useful in the rehabilitation of young people with chronic disabling pain. Empirical studies are needed to investigate the clinical effectiveness of this approach.
Treatment of Functional Impairment in Severe Somatoform Pain Disorder: A Case Example
Journal of Pediatric Psychology, 2001
Somatic symptoms are common in children but diagnosable conditions are rare. In a community sample of 540 school-age children, Garber, Walker, and Zeman (1991) found that only 1.1% of children met full diagnostic criteria for somatization disorder according to DSM-III-R criteria. Similarly, the estimated rate of conversion disorders is described as less than 1% of the general population (APA, 1994). Although there have been no controlled treatment outcome studies of somatoform disorder in children, case reports and case series have been published that describe treatment of such problems as persistent somatoform pain disorder (e.g., Lock & Giammona, 1999) and conversion reactions (e.g.
Children
(1) Background: Chronic musculoskeletal pain (CMP) in adolescents can negatively affect physical, psychological, and social functioning, resulting in functional disability. This randomized controlled trial (RCT) aimed to evaluate the effectiveness of an outpatient rehabilitation program based on graded exposure in vivo (EP) compared with care as usual (CAU: interdisciplinary outpatient rehabilitation care). Both EP and CAU aim to improve functional ability in adolescents with CMP. (2) Methods: Pragmatic multicenter RCT with 12-month follow-up. Adolescents (12-21 years) with CMP were invited to participate. Primary outcome: functional disability; secondary outcomes: perceived harmfulness; pain catastrophizing; pain intensity. Data analysis: intention-to-treat linear mixed model. (3) Results: Sixty adolescents (mean 16 years) were randomized; data for 53 were analyzed. Adolescents in EP showed relevant and significant decreases in functional disability (estimated mean difference at least −8.81, p ≤ 0.01) compared with CAU at all times. Significant differences in favor of EP were found for perceived harmfulness at all times (p ≤ 0.002), for pain catastrophizing at 2 months (p = 0.039) and for pain intensity at 4 and 10 months (p ≤ 0.028). (4) Conclusion: EP leads to a significant and clinically relevant decrease in functional disability compared with usual care.