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
Highlights
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
To find predictors that consistently predict CBT outcome over time, we explored whether psychological symptoms, personality-disorder characteristics, psychiatric history, and health-related quality of life in the mental domain assessed at baseline predicted CBT outcome on the primary outcome measure at the end of CBT, three months after CBT, and one year after CBT, all after control for pretreatment scores on the outcome measure and for socio-demographic variables
The 59 patients who had dropped out of the study did not differ from the study completers with regard to their available scores for CBT outcome, control variables, and predictors, with the exception of a difference in the ‘age’ control variable
Summary
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. Cognitive-Behavioral Therapy (CBT) is effective for Unexplained Physical Symptoms (UPS) [1,2,3,4,5,6], some therapists in clinical practice seem to believe that it is not effective for all patients with UPS Instead, they assume that outcome will be poorer in patients whose quality of life may have been affected by a psychiatric comorbidity such as depression, anxiety disorder, personality-disorder, or their psychiatric history. Some studies showed that poor treatment outcome for UPS was predicted by concurrent depressive symptoms [9], anxiety symptoms [10], personality-disorder characteristics [11], a psychiatric history [12,21] or poor health-related quality of life [12]. One study [12] found that depressive symptoms did not predict post-treatment outcome, but did predict better three-month follow-up outcome
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