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Emotional Disorder in Chronic Illness: Psychotherapeutic Interventions

Published online by Cambridge University Press:  02 January 2018

Elspeth Guthrie*
Affiliation:
Department of Psychiatry, University of Manchester
*
Dr E. Guthrie, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9BX

Abstract

Background

Emotional disorder associated with physical illness falls into two main groups: ‘psychological reaction to physical illness’ and ‘somatic presentation of psychological disorder’. Psychological treatments are becoming more widespread in the general hospital setting, but there are few systematic evaluations.

Method

A manual and computer (MEDLINE) literature search was performed. Studies which provided insight into clinical practice were selected for discussion, and randomised controlled trials of at least 6 weeks duration and inclusion of 30 or more subjects were selected for review.

Results

Fourteen empirical studies were found: six involving patients with chronic organic disorder and eight involving patients with somatisation.

Conclusions

There is little empirical evidence that psychotherapeutic interventions are of benefit when applied indiscriminately to patients with organic disease. Further work is required to delineate subgroups of patients who may be responsive. There is mounting evidence that psychotherapy is beneficial in patients with somatisation disorders. Patients with very chronic symptoms may require intensive treatment approaches.

Type
Review Article
Copyright
Copyright © 1996 The Royal College of Psychiatrists 

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References

Bassett, D. & Pilowsky, I. (1985) A study of brief psychotherapy for chronic pain. Journal of Psychosomatic Research, 29, 259264.Google Scholar
Benjamin, S. (1989) Psychological treatment of chronic pain: a selective review. Journal of Psychosomatic Research, 33, 121131.Google Scholar
Bennett, P. & Wilkinson, S. (1985) A comparison of psychological and medical treatment of the irritable bowel syndrome. British Journal of Clinical Psychology, 24, 215216.CrossRefGoogle ScholarPubMed
Burton, M. V., Parker, R. W. & Wollner, J. M. (1991) The psychotherapeutic value of a “chat”: a verbal response modes study of a placebo attention control with breast cancer patients. Psychotherapy Research, 1, 3961.Google Scholar
Corney, R. H., Stanton, R., Newe, R., et al (1991) Behavioural psychotherapy in the treatment of irritable bowel syndrome. Journal of Psychosomatic Research, 35, 461469.Google Scholar
Ewer, T. C. & Stewart, D. E. (1986) Improvement in bronchial hyper-responsiveness in patients with moderate asthma after treatment with a hypnotic technique: a randomised controlled trial. British Medical Journal, 293, 11291132.CrossRefGoogle ScholarPubMed
Greer, S., Moorey, S., Baruch, J. D., et al (1992) Adjuvant psychological therapy for patients with cancer: a prospective randomised trial. British Medical Journal, 304, 675680.Google Scholar
Guthrie, E. A., Creed, F. H., Dawson, D., et al (1991) A controlled trial of psychological treatment for the irritable bowel syndrome. Gastroenterology, 100, 450457.Google Scholar
Harvey, R. F., Hinton, R. A., Gunary, R. M., et al (1989) Individual and group hypnotherapy in treatment of refractory irritable bowel syndrome. Lancet, i, 424425.CrossRefGoogle Scholar
Johnston, D. W., Gold, A., Kentish, J., et al (1993) Effect of stress management on blood pressure in mild primary hypertension. British Medical Journal, 306, 963966.Google Scholar
Klimes, I., Mayou, R. A., Pearce, M. J., et al (1990) Psychological treatment for atypical non-cardiac chest pain: a controlled evaluation. Psychological Medicine, 20, 605611.Google Scholar
Lammers, C. A., Naliboff, B. D. & Straatneyer, A. J. (1984) The effects of progressive relaxation on stress and diabetic control. Behaviour Research and Therapy, 8, 641650.Google Scholar
Landis, B., Jovanovic, L., Landis, E., et al (1985) Effect of stress reduction on daily glucose range in previously stabilized insulin-dependent diabetic patients. Diabetes Care, 8, 624626.Google Scholar
Maguire, P., Pentol, A., Allen, D., et al (1982) Cost of counselling women who undergo mastectomy. British Medical Journal, 284, 19331935.Google Scholar
Malone, M. D., Struse, M. J. & Svogin, F. K. (1988) Metaanalysis of non-medical treatment for chronic pain. Pain, 34, 231244.Google Scholar
Minuchin, S., Baker, L. & Rosman, B. (1975) A conceptual model of psychosomatic illness in children. Archives of General Psychiatry, 32, 10311038.Google Scholar
Moore, J. E. & Chaney, E. F. (1985) Outpatient group treatment of chronic pain. Effects of spouse involvement. Journal of Cousulting Clinical Psychology, 53, 326334.Google Scholar
Moran, G. S. & Fonagy, P. (1995) A psychoanalytic approach to the treatment of brittle diabetes in children and adolescents. In Psychological Treatment in Disease and Illness (eds Hodes, M. & Moorey, S.), pp. 166192. London: The Royal College of Psychiatrists & The Society for Psychosomatic Research.Google Scholar
Oldenburg, B., Perkins, R. J. & Andrews, G. (1985) Controlled trial of psychological intervention in myocardial infarction. Journal of Consulting and Clinical Psychology, 53, 852859.Google Scholar
Peveler, R. C. & Fairburn, C. G. (1989) Anorexia nervosa in association with diabetes mellitus: a cognitive–behavioural approach to treatment. Behaviour Research and Therapy, 27, 9599.CrossRefGoogle ScholarPubMed
Pilowsky, I. & Barrow, C. G. (1990) A controlled study of psychotherapy and amitriptyline used individually and in combination in the treatment of chronic intractable ‘psychogenic pain’ pain. Pain, 40, 319.Google Scholar
Rosser, R., Denford, J., Heslop, A., et al (1983) Breathlessness and psychiatric morbidity in chronic bronchitis and emphysema: a study of psychotherapeutic management. Psychological Medicine, 13, 93100.CrossRefGoogle ScholarPubMed
Ryle, A., Boa, C. & Fosbury, J. (1993) Identifying the causes of poor-management in insulin dependent diabetics: the use of cognitive-analytic therapy techniques. In Psychological Treatment in Disease and Illness (eds Hodes, M., Moorey, S.), pp. 157165. London: The Royal College of Psychiatrists and the Society for Psychosomatic Research.Google Scholar
Saarijarvi, S., Alanen, E., Rytokoski, U., et al (1992) Couple therapy improved mental well-being in chronic low back pain patients. A controlled, five year follow-up study. Journal of Psychosomatic Research, 36, 651656.Google Scholar
Sjodin, I. (1983) Psychotherapy in peptic ulcer disease: a controlled outcome study. Acta Psychiatrica Scandinavica, 67 (suppl. 307).Google Scholar
Skinner, J. B. Erskine, A., Pearce, S., et al (1990) The evaluation of a cognitive behavioural programme in outpatients with chronic pain. Journal of Psychosomatic Research, 34, 1319.Google Scholar
Svedlund, J. (1983) Psychotherapy in irritable bowel syndrome. A controlled outcome study. Acta Psychiatrica Scandinavica, 67 (suppl. 306).Google Scholar
Taug, T. T., Svebak, S., Wilhelmsen, I., et al (1994) Psychological factors and somatic symptoms in functional dyspepsia. A comparison with duodenal ulcer and healthy controls. Journal of Psychosomatic Research, 38, 281292.Google Scholar
Thompson, D. R. & Meddis, R. (1990) A prospective evaluation of in-hospital counselling for first time myocardial infarction men. Journal of Psychosomatic Research, 34, 237248.Google Scholar
Van Montfrans, G. A., Karemaker, J. M., Wieling, W., et al (1990) Relaxation therapy and continuous ambulatory blood pressure in mild hypertension: a controlled study. British Medical Journal, 300, 13681372.Google Scholar
Whorwell, P. J., Prior, A. & Faragher, E. B. (1984) Controlled trial of hypnotherapy in the treatment of severe intractable bowel syndrome. Lancet, ii, 12321234.Google Scholar
Zigmond, A. S. & Snaith, R. P. (1983) The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67, 361370.Google Scholar
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