Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-31T23:36:31.410Z Has data issue: false hasContentIssue false
  • English
  • Français

Acceptance and Commitment group Therapy for patients with multiple functional somatic syndromes: a three-armed trial comparing ACT in a brief and extended version with enhanced care

Published online by Cambridge University Press:  26 June 2018

Heidi Frølund Pedersen Open the ORCID record for Heidi Frølund Pedersen [Opens in a new window] ,
Johanne L. Agger ,
Lisbeth Frostholm ,
Jens S. Jensen ,
Eva Ørnbøl ,
Per Fink  and
Andreas Schröder
Heidi Frølund Pedersen*
Affiliation:
The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Noerrebrogade 44, 8000 Aarhus C., Denmark
Johanne L. Agger
Affiliation:
The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Noerrebrogade 44, 8000 Aarhus C., Denmark
Lisbeth Frostholm
Affiliation:
The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Noerrebrogade 44, 8000 Aarhus C., Denmark
Jens S. Jensen
Affiliation:
The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Noerrebrogade 44, 8000 Aarhus C., Denmark
Eva Ørnbøl
Affiliation:
The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Noerrebrogade 44, 8000 Aarhus C., Denmark
Per Fink
Affiliation:
The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Noerrebrogade 44, 8000 Aarhus C., Denmark
Andreas Schröder
Affiliation:
The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Noerrebrogade 44, 8000 Aarhus C., Denmark
*
Author for correspondence: Heidi Frølund Pedersen, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Psychological treatment for functional somatic syndromes (FSS) has been found moderately effective. Information on how much treatment is needed to obtain improvement is sparse. We assessed the efficacy of a brief and extended version of group-based Acceptance and Commitment Therapy (ACT) v. enhanced care (EC) for patients with multiple FSS operationalised as Bodily Distress Syndrome multi-organ type.

Methods

In a randomised controlled three-armed trial, consecutively referred patients aged 20–50 with multiple FSS were randomly assigned to either (1) EC; (2) Brief ACT: EC plus 1-day workshop and one individual consultation; or (3) Extended ACT: EC plus nine 3-h group-based sessions. Primary outcome was patient-rated overall health improvement on the five-point clinical global improvement scale 14 months after randomisation. A proportional odds model was used for the analyses.

Results

A total of 180 patients were randomised; 60 to EC, 61 to Brief ACT, and 59 to Extended ACT. Improvement on the primary outcome after Extended ACT was significantly greater than after EC with an unadjusted OR of 2.9 [95% CI (1.4–6.2), p = 0.006]. No significant differences were found between Brief ACT and EC. Of the 18 secondary outcomes, the only significant difference found was for physical functioning in the comparison of Extended ACT with EC.

Conclusions

Patients rated their overall health status as more improved after Extensive ACT than after EC; however, clinically relevant secondary outcome measures did not support this finding. Discrepancies between primary and secondary outcomes in this trial are discussed.

Keywords

Acceptance and Commitment Therapyfunctional somatic syndromespsychological treatmentRCTsomatoform disorders
Type
Original Articles
Information
Psychological Medicine , Volume 49 , Issue 6 , April 2019 , pp. 1005 - 1014
Copyright
Copyright © Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

These authors have contributed equally to this paper.

References

Agger, JL, Schroder, A, Gormsen, LK, Jensen, JS, Jensen, TS and Fink, PK (2017) Imipramine versus placebo for multiple functional somatic syndromes (STreSS-3): a double-blind, randomised study. The Lancet Psychiatry 4, 378–388.Google Scholar
Budtz-Lilly, A, Vestergaard, M, Fink, P, Carlsen, AH and Rosendal, M (2015) The prognosis of bodily distress syndrome: a cohort study in primary care. General Hospital Psychiatry 37, 560.Google Scholar
Busch, AJ, Schachter, CL, Overend, TJ, Peloso, PM and Barber, KA (2008) Exercise for fibromyalgia: a systematic review. The Journal of Rheumatology 35, 1130–1144.Google Scholar
Christensen, SS, Frostholm, L, Ørnbøl, E and Schröder, A (2015) Changes in illness perceptions mediated the effect of cognitive behavioural therapy in severe functional somatic syndromes. Journal of Psychosomatic Research 78, 363–370.Google Scholar
Creed, F, Henningsen, P and Fink, P (eds) (2011) Medically Unexplained Symptoms, Somatisation and Bodily Distress. Developing Better Clinical Services. New York: Cambridge University Press.Google Scholar
Dahl, J and Lundgren, T (2006) Acceptance and commitment therapy (ACT) in the treatment of chronic pain. In Mindfulness-Based Treatment Approaches. San Diego, CA: Academic Press, pp. 285–306.Google Scholar
Dworkin, RH, Turk, DC, Wyrwich, KW, Beaton, D, Cleeland, CS, Farrar, JT, Haythornthwaite, JA, Jensen, MP, Kerns, RD, Ader, DN, Brandenburg, N, Burke, LB, Cella, D, Chandler, J, Cowan, P, Dimitrova, R, Dionne, R, Hertz, S, Jadad, AR, Katz, NP, Kehlet, H, Kramer, LD, Manning, DC, McCormick, C, McDermott, MP, McQuay, HJ, Patel, S, Porter, L, Quessy, S, Rappaport, BA, Rauschkolb, C, Revicki, DA, Rothman, M, Schmader, KE, Stacey, BR, Stauffer, JW, von Stein, T, White, RE, Witter, J and Zavisic, S (2008) Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations. The Journal of Pain 9, 105–121.Google Scholar
Eilenberg, T, Fink, P, Jensen, JS, Rief, W and Frostholm, L (2016) Acceptance and commitment group therapy (ACT-G) for health anxiety: a randomized controlled trial. Psychological Medicine 46, 103–115.Google Scholar
Fink, P and Schröder, (2010) One single diagnosis, bodily distress syndrome, succeeded to capture 10 diagnostic categories of functional somatic syndromes and somatoform disorders. Journal of Psychosomatic Research 68, 415–426.Google Scholar
Fink, P, Toft, T, Hansen, MS, Ørnbøl, E and Olesen, F (2007) Symptoms and syndromes of bodily distress: an exploratory study of 978 internal medical, neurological, and primary care patients. Psychosomatic Medicine 69, 30–39.Google Scholar
Fjorback, LO, Arendt, M, Ørnbøl, E, Walach, H, Rehfeld, E, Schröder, A and Fink, P (2013) Mindfulness therapy for somatization disorder and functional somatic syndromes – randomized trial with one-year follow-up. Psychosomatic Research 74, 31.Google Scholar
Frolund Pedersen, H, Frostholm, L, Sondergaard Jensen, J, Ornbol, E and Schroder, A (2016) Neuroticism and maladaptive coping in patients with functional somatic syndromes. British Journal of Health Psychology 21, 917–936.Google Scholar
Glombiewski, JA, Sawyer, AT, Gutermann, J, Koenig, K, Rief, W and Hofmann, SG (2010) Psychological treatments for fibromyalgia: a meta-analysis. Pain 151, 280.Google Scholar
Hayes, SC, Luoma, JB, Bond, FW, Masuda, A and Lillis, J (2006) Acceptance and commitment therapy: model, processes and outcomes. Behaviour Research and Therapy 44, 1–25.Google Scholar
Hayes, SC, Strosahl, KD and Wilson, KG (1999) Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change. New York: Guilford Press.Google Scholar
Henningsen, P, Zipfel, S and Herzog, W (2007) Management of functional somatic syndromes. The Lancet 369, 946.Google Scholar
Hughes, LS, Clark, J, Colclough, JA, Dale, E and McMillan, D (2016) Acceptance and commitment therapy (ACT) for chronic pain: a systematic review and meta-analyses. The Clinical Journal of Pain 33, 552–568.Google Scholar
Jones, GT, Atzeni, F, Beasley, M, Fluss, E, Sarzi-Puttini, P and Macfarlane, GJ (2015) The prevalence of fibromyalgia in the general population: a comparison of the American College of Rheumatology 1990, 2010, and modified 2010 classification criteria. Arthritis & Rheumatology (Hoboken, NJ) 67, 568–575.Google Scholar
Kohl, A, Rief, W and Glombiewski, JA (2012) How effective are acceptance strategies? A meta-analytic review of experimental results. Journal of Behavior Therapy and Experimental Psychiatry 43, 988–1001.Google Scholar
Levin, ME, Hildebrandt, MJ, Lillis, J and Hayes, SC (2012) The impact of treatment components suggested by the psychological flexibility model: a meta-analysis of laboratory-based component studies. Behavior Therapy 43, 741.Google Scholar
Luciano, JV, Guallar, JA, Aguado, J, Lopez-Del-Hoyo, Y, Olivan, B, Magallon, R, Alda, M, Serrano-Blanco, A, Gili, M and Garcia-Campayo, J (2014) Effectiveness of group acceptance and commitment therapy for fibromyalgia: a 6-month randomized controlled trial (EFFIGACT study). Pain 155, 693–702.Google Scholar
Moore, RA, Straube, S and Aldington, D (2013) Pain measures and cut-offs – ‘no worse than mild pain’ as a simple, universal outcome. Anaesthesia 68, 400–412.Google Scholar
Öst, L (2014) The efficacy of acceptance and commitment therapy: an updated systematic review and meta-analysis. Behaviour Research and Therapy 61, 105–121.Google Scholar
Rask, MT, Ornbol, E, Rosendal, M and Fink, P (2017) Long-term outcome of bodily distress syndrome in primary care: a follow-up study on health care costs, work disability, and self-rated health. Psychosomatic Medicine 79, 345–357.Google Scholar
Rief, W, Burton, C, Frostholm, L, Henningsen, P, Kleinstäuber, M, Kop, WJ, Löwe, B, Martin, A, Malt, U, Rosmalen, J, Schröder, A, Shedden-Mora, M, Toussaint, A and van der Feltz-Cornelis, C (2017) Core outcome domains for clinical trials on somatic symptom disorder, bodily distress disorder, and functional somatic syndromes: EURONET-SOMA recommendations. Psychosomatic Medicine 79, 1008–1015.Google Scholar
Schröder, A, Ørnbøl, E, Jensen, JS, Sharpe, M and Fink, P (2017) Long-term economic evaluation of cognitive-behavioural group treatment versus enhanced usual care for functional somatic syndromes. Journal of Psychosomatic Research 94, 73.Google Scholar
Schröder, A, Rehfeld, E, Ornbøl, E, Sharpe, M, Licht, RW and Fink, P (2012) Cognitive-behavioural group treatment for a range of functional somatic syndromes: randomised trial. The British Journal of Psychiatry: The Journal of Mental Science 200, 499.Google Scholar
Schröder, A, Sharpe, M and Fink, P (2015) Medically unexplained symptom management. The Lancet Psychiatry 2, 587.Google Scholar
Trompetter, HR, Bohlmeijer, ET, Veehof, MM and Schreurs, KM (2015) Internet-based guided self-help intervention for chronic pain based on Acceptance and Commitment Therapy: a randomized controlled trial. Journal of Behavioral Medicine 38, 66–80.Google Scholar
Veehof, MM, Trompetter, HR, Bohlmeijer, ET and Schreurs, KM (2016) Acceptance- and mindfulness-based interventions for the treatment of chronic pain: a meta-analytic review. Cognitive Behaviour Therapy 45, 5–31.Google Scholar
Wetherell, JL, Afari, N, Rutledge, T, Sorrell, JT, Stoddard, JA, Petkus, AJ and Atkinson, JH (2011) A randomized, controlled trial of acceptance and commitment therapy and cognitive-behavioral therapy for chronic pain. Pain (Amsterdam) 152, 2098–2107.Google Scholar
White, PD, Goldsmith, KA, Johnson, AL, Potts, L, Walwyn, R, DeCesare, JC, Baber, HL, Burgess, M, Clark, LV, Cox, DL, Bavinton, J, Angus, BJ, Murphy, G, Murphy, M, O'Dowd, H, Wilks, D, McCrone, P, Chalder, T, Sharpe, M and PACE trial management group (2011) Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. Lancet (London, England) 377, 823–836.Google Scholar
Wing, JK, Babor, T, Brugha, T, Burke, J, Cooper, JE, Giel, R, Jablenski, A, Regier, D and Sartorius, N (1990) SCAN: Schedules for Clinical Assessment in Neuropsychiatry. Archives of General Psychiatry 47, 589–593.Google Scholar
Supplementary material: File

Pedersen et al. supplementary material

Pedersen et al. supplementary material 1

Download Pedersen et al. supplementary material(File)
File 303.6 KB
Supplementary material: File

Pedersen et al. supplementary material

Pedersen et al. supplementary material 2

Download Pedersen et al. supplementary material(File)
File 36.4 KB
Supplementary material: File

Pedersen et al. supplementary material

Pedersen et al. supplementary material 3

Download Pedersen et al. supplementary material(File)
File 3.6 MB
Supplementary material: File

Pedersen et al. supplementary material

Pedersen et al. supplementary material 4

Download Pedersen et al. supplementary material(File)
File 37.4 KB