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"Mindfulness therapy for somatization disorder and functional somatic syndromes" (Fjorback et al)

Dolphin

Senior Member
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17,567
Full text is available for free here: http://funktionellelidelser.dk/file...atization_disorder_and_functional_somatic.pdf

Mindfulness therapy for somatization disorder and functional somatic syndromes: randomized trial with one-year follow-up.

J Psychosom Res. 2013 Jan;74(1):31-40. doi: 10.1016/j.jpsychores.2012.09.006. Epub 2012 Oct 1.

Fjorback LO1, Arendt M, Ornbøl E, Walach H, Rehfeld E, Schröder A, Fink P.

Author information

Abstract

OBJECTIVE:

To conduct a feasibility and efficacy trial of mindfulness therapy in somatization disorder and functional somatic syndromes such as fibromyalgia, irritable bowel syndrome, and chronic fatigue syndrome, defined as bodily distress syndrome (BDS).

METHODS:

We randomized 119 patients to either mindfulness therapy (mindfulness-based stress reduction and some cognitive behavioral therapy elements for BDS) or to enhanced treatment as usual (2-hour specialist medical care and brief cognitive behavioral therapy for BDS).

The primary outcome measure was change in physical health (SF-36 Physical Component Summary) from baseline to 15-month follow-up.

RESULTS:

The study is negative as we could not demonstrate a different development over time for the two groups (F(3,2674)=1.51, P=.21).

However, in the mindfulness therapy group, improvement was obtained toward the end of treatment and it remained present at the 15-month follow-up, whereas the enhanced treatment as usual group achieved no significant change until 15-month follow-up.

The change scores averaged half a standard deviation which amounts to a clinically significant change, 29% changed more than 1 standard deviation.

Significant between-group differences were observed at treatment cessation.

CONCLUSION:

Mindfulness therapy is a feasible and acceptable treatment.

The study showed that mindfulness therapy was comparable to enhanced treatment as usual in improving quality of life and symptoms.

Nevertheless, considering the more rapid improvement followingmindfulness, mindfulness therapy may be a potentially useful intervention in BDS patients.

Clinically important changes that seem to be comparable to a CBT treatment approach were obtained.
Further research is needed to replicate or even expand these findings.

PMID: 23272986 [PubMed - indexed for MEDLINE]
 
Last edited:

Dolphin

Senior Member
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17,567
The two groups:
Mindfulness therapy

The manualized mindfulness therapy features eight weekly 3 1/2 h sessions and one follow-up session, involving 12 patients per group. We included psychoeducation, symptom registration, and a model for graded exercise from the STreSS-1 manual. We excluded individual treatment goals and the use of individual treatment plans. We closely followed the MBSR manual developed by Jon Kabat-Zinn, Center For Mindfulness [22,36,37], except the all-day retreat which lasted only 3 1/2 h. All five groups were lead by two psychiatrists, one had developed the STreSS-1 manual and had 20 years of psychotherapy experience, the other had 20 years of meditation practice. Mindfulness is based upon concepts of mental training that propose that non-judgemental awareness of moment-to-moment experience (i.e. mindfulness) may positively affect accuracy of perception, acceptance of intractable health-related changes, realistic sense of control, and appreciation of available life experiences [22,38]. The mindfulness therapy applied these concepts to a multifactorial illness model. Details about the MBSR and the STreSS treatment modules are given in Table 1 [39]. Two treatment groups were videotaped for therapist supervision, and checks on treatment manual adherence. Two therapists independent of the trial made an overall judgment and found that the treatment was in accordance with the manual.

Enhanced treatment as usual

Within the first month after the assessment, the patients were offered a two-hour individual consultation by the psychiatrist who had performed the assessment. The multifactorial illness model was individualized (as a CBT case formulation), and an individual treatment plan was drawn up, including the definition of individual treatment goals, and identification of perpetuating factors. Advice was given on general lifestyle changes (exercise, nutrition, meditation, network, etc.).
 

Dolphin

Senior Member
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17,567
Most had CFS:
71% in the mindfulness group
and
77% in the Enhanced treatment as usual group
 

Dolphin

Senior Member
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17,567
The results were not that impressive. The smallest change was for SF-36 physical functioning:
Mindfulness:
Baseline (mean (SD)): 60.14 (20.9)
15 month: 63.1 (22.6)

Enhanced treatment as usual
Baseline (mean (SD)): 57.1 (22.2)
15 month: 66.8 (19.4)

They make all sorts of excuses

The physical functioning subscale of the SF-36, which measures impairments in physical activities such as climbing stairs, changed very little in themindfulness therapy group. To understand this,we tested the baseline physical functioning among the responders (change in PCS>1/2 SD) and non-responders in the two groups. At baseline, the mean physical functioning subscale was lower both in the enhanced treatment as usual group when compared to the mindfulness therapy group and among responders compared with the non-responders; the non-responders had physical functioning scores close to or within the normal range. When physical functioning scores fall within the normal range, there may be less room for improvement. A recent study [9] on chronic fatigue syndrome excluded patients with a physical functioning> 60; in our mindfulness therapy group the mean physical functioning was 60.4 at baseline. Also, the non-responders on the primary outcome had significantly more health anxiety (Whiteley 8) and more severe anxiety and depression (Scl-8) than the responders, and they improved on these scales. These improvements may have been necessary before they were able to improve in physical function, and these patients may have needed longer treatment time in order to do so.

These were a group of people aged 20-50. If one had a physical illness, one was generally excluded from taking part. So there was a lot of scope to score more than 63.1 (most people of working age score 90-100).

They make an error with regard to the PACE Trial:
A recent study [9] on chronic fatigue syndrome excluded patients with a physical functioning> 60
That was the initial position of the trial, but for most of the trial it was >65.

---
Another excuse:
Another explanation of the low response on the physical functioning scale could be that the strong focus on the observation of the body in the mindfulness therapy group made some patients realize that they were actually worse than they thought.
 

Dolphin

Senior Member
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17,567
More spinning:
Many patients described positive experiences from participating in the mindfulness intervention. The fact that this is not reflected more in the quantitative data may be ascribed to measurement problems, as the SF-36 is known to be not very sensitive to change, and mindfulness studies generally use other scales.
I'm not sure it's true at all that the SF-36 is not very sensitive to change particularly if one has fairly low scores starting off.
 

Dolphin

Senior Member
Messages
17,567
They don't really discuss the negative result much in terms of it possibly being accurate or valid:
e.g.
The negative trial may speak against mindfulness therapy, but on the other hand, mindfulness training may improve stress and emotion regulation and among other factors, bodily symptoms may be experienced due to destructive emotions as a result of distress and/or impaired regulation of emotions, symptoms, and pain. Thus, as a theoretical model mindfulness training in the form of mindfulness therapy may gain health.

and
We might have been too optimistic about the specific benefit of meditation and the nonspecific group effect.
 
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Location
Oregon
Mindfulness meditation is certainly feasible, but I think they are wrong to imply it is a treatment. It can be extremely useful in terms of helping the suffering patient recognize and better cope with the reality of their illness, but it in itself is not a treatment.
 

Cheshire

Senior Member
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1,129
Another excuse:
Another explanation of the low response on the physical functioning scale could be that the strong focus on the observation of the body in the mindfulness therapy group made some patients realize that they were actually worse than they thought.

In terms of poor justifications, it reminds me of the introduction for health professionals at King's college London

Much has been made of the fact that when badly "administered", Cognitive Behavioural Therapy can be less than helpful in the management of Chronic Fatigue Syndrome. Indeed, despite now very strong evidence (see the recent JAMA review) that CBT is an effective intervention, there was a recent patient conducted survey which showed a high degree of dissatisfaction with implementation of this treatment.

However, we professionals would like to minimise this finding, we cannot ignore the fact that there is a very real problem. It would seem that for some sufferers, the key ingredient of best practice CBT - collaboration - is missing. The experience of this group of dissatisfied customers is that of treatment as rote prescription uniformly administered, a one sided exhortation to do more, exercise, sleep less. Coupled with this is the perception of a lack of empathy for very real pain, distress and disability.

The problem may well be that some of our treatments are too evidence based. Thoroughly convinced as were are by the evidence, we all too easily fall into a repetitive giving of advice, encouraging the patient to do the right, evidence based thing - do more, exercise, sleep less. What this fails to address as an approach, are the very real reasons why a client may be sceptical or anxious; their wariness of yet more professional advice; the complex reasons why the imposition of a routine on their current life feels nigh on impossible.

http://www.kcl.ac.uk/innovation/groups/projects/cfs/health/index.aspx

Yes it doesn't function because we are too good.... :bang-head:


And by the way, how do you quote someone from the forum?
 

N.A.Wright

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And by the way, how do you quote someone from the forum?
Just click the Reply tag in the bottom right hand corner of the post. If you want to get clever and include multiple quotes fom different posters you'll need to copy and past the quote codes from an open window - looks like this : [quote ="Cheshire, post: 452813, member: 12860" -[/quote]