Kallesøe, Schröder, Fink: Comparing group-based ACT with enhanced usual care for adolescents w/ FSS

[mango]

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

Karen Hansen Kallesøe1, Andreas Schröder1, Rikard K Wicksell2, Per Fink1, Eva Ørnbøl1, Charlotte Ulrikka Rask1,3

Author Affiliations

1. Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
2. Behavior Medicine Pain Treatment Services, Karolinska, Stockholm, Sweden
3. Regional Centre for Child and Adolescent Psychiatry, Risskov, Aarhus University Hospital, Aarhus, Denmark

Published 15 September 2016

Abstract
Introduction Functional somatic syndromes (FSS) are common in adolescents, characterised by severe disability and reduced quality of life. Behavioural treatments such as acceptance and commitment therapy (ACT) has shown promising results in children and adolescents with FSS, but has focused on specific syndromes such as functional pain. The current study will compare the efficacy of group-based ACT with that of enhanced usual care (EUC) in adolescents with a range of FSS operationalised by the unifying construct of multiorgan bodily distress syndrome (BDS).

Methods and analysis A total of 120 adolescents aged 15–19 and diagnosed with multiorgan BDS, of at least 12 months duration, will be assessed and randomised to either: (1) EUC: a manualised consultation with a child and adolescent psychiatrist and individualised treatment plan or (2) manualised ACT-based group therapy plus EUC. The ACT programme consists of 9 modules (ie, 27 hours) and 1 follow-up meeting (3 hours).

The primary outcome is physical health, assessed by an Short Form Health Survey (SF-36) aggregate score 12 months after randomisation. Secondary outcomes include self-reported symptom severity, symptom interference, depression and anxiety, illness worry, perceived stress and global improvement; as well as objective physical activity and bodily stress response measured by heart rate variability, hair cortisol and inflammatory biomarkers. Process measures are illness perception, illness-related behaviour and psychological flexibility.

Ethics and dissemination The study is conducted in accordance with Helsinki Declaration II. Approval has been obtained from the Science Ethics Committee of the Central Denmark Region and the Danish Data Protection. The results will be sought to be published according to the CONSORT statement in peer-reviewed journals.

Discussion This is one of the first larger randomised clinical trials evaluating the effect of a group-based intervention for adolescents with a range of severe FSS.

Trial registration number NCT02346071; Pre-results.

Strengths and limitations of this study

• Large-scale study in an area with limited knowledge.
• Evaluation of psychosocial and biological predictors and moderators of outcomes.
• Thorough assessment of all patients providing them with evidence-based understanding of their illness.
• Assessment and treatment are carried out in a specialised setting which might affect generalisation.
• Results not automatically applicable to younger adolescents given the developmental perspective, with multiple symptoms being less common in children and younger adolescents.

Background
Functional somatic syndromes (FSS), including chronic fatigue syndrome, juvenile fibromyalgia, functional gastrointestinal disorders and idiopathic pain syndromes, are well-known conditions in adolescents. FSS are diagnostic unities representing clusters of related functional somatic symptoms. [...]

http://bmjopen.bmj.com/content/6/9/e012743.full

 

[mango]

There's a similar ME/CFS study happening in Sweden too, where Wicksell is also involved:

The prevalence and impact of psychoneuroimmunologial factors in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: treatment effects and mechanism of action of Acceptance and Commitment Therapy

Gunnar Olsson, Martin Jonsjö, Rikard Wicksell, Indre Ljungar, Linda Holmström, Anna Andreasson.

Behavioral Medicine and Pain Treatment Center, Karolinska University Hospital

http://forums.phoenixrising.me/index.php?threads/problematic-me-cfs-research-on-act-get-in-sweden.37482/

 

[sarah darwins]

Thorough assessment of all patients providing them with evidence-based understanding of their illness.

They seem to be listing that as a 'strength' of the study. Presumably that actually means showing participants test results and 'evidence' (from other bps researchers, no doubt) to 'show' them that they're not really ill before proceeding with the babble.

 

[Hugo]

Insane, and it shows what kind of circle reasoning that sometimes dominate the psychiatric field. Just look at the some of the bullcrap of attachment theory (Im not disgarding the theory as a whole but its just a lot of circle reasoning in that kind of research). Sad that karolinska is wasting research on this.

 

[alex3619]

FSS do not exist except by dogmatic diagnostic fiat. They basically assert it exists without evidence. So how can everything after that be evidence-based? This is so very much like how comedians treat the Spanish Inquisition, sans comfy chair.

Let them do the actual science, and provide biomarkers (which HAVE to exist or the entire thing is utter babble), before they proceed on treating patients using experimental unproven diagnoses and therapies.

Now I anticipate some may claim I am a dualist, even though I am a monist on theory of mind. Let me remind them that under a lot of BPS doctrine the mind and body are interlocked, so physical evidence pertaining to any specific syndrome should exist. Otherwise its a bogus syndrome.