Kolk A M M, Schagen S, Hanewald G J F P
Department of Clinical Psychology, University of Amsterdam, Roetersstraat 15, 1018 WB Amsterdam, The Netherlands.
J Psychosom Res. 2004 Oct;57(4):379-89. doi: 10.1016/j.jpsychores.2004.02.012.
To test the effect of psychological intervention on multiple medically unexplained physical symptoms, psychological symptoms, and health care utilization in addition to medical care as usual. To identify patient-related predictors of change in symptoms and care utilization.
In a randomized controlled trial, subjects were assigned to one of two conditions: psychological intervention by a qualified therapist plus care as usual by a general practitioner (GP) or care as usual only. Participants (N=98) were administered a standardized interview and several outcome measures at intake and after 6 months and 12 months after intake. GPs rated medically unexplained and explained symptoms and consultations over a period of 1 1/2 years.
ANOVAs for repeated measures showed that self-reported and GP-registered unexplained physical symptoms decreased from pretest to posttest to follow-up. Psychological symptoms and consultations decreased from pretest to posttest. GP-registered explained symptoms did not decrease. However, intervention and control groups did not differ in symptom reduction. Path analysis revealed two paths to a decrease in self-reported unexplained physical symptoms: from more negative affectivity via more psychological attribution and more pretreatment anxiety, and from more somatic attribution via more psychological attribution and more pretreatment anxiety.
Intervention and control groups did not differ in symptom reduction. Reduction of self-reported medically unexplained symptoms was well predicted by patient-related symptom perception variables, whereas the prediction of change in registered symptoms and consultations requires a different model.
除常规医疗护理外，测试心理干预对多种医学上无法解释的身体症状、心理症状以及医疗保健利用情况的影响。识别与患者相关的症状和护理利用变化的预测因素。
在一项随机对照试验中，受试者被分配到两种情况之一：由合格治疗师进行心理干预加全科医生（GP）的常规护理，或仅接受常规护理。参与者（N = 98）在入组时、入组后6个月和12个月接受标准化访谈和多项结局测量。全科医生对1年半时间内医学上无法解释和已解释的症状及会诊进行评分。
重复测量方差分析表明，自我报告和全科医生记录的无法解释的身体症状从预测试到后测试再到随访有所减少。心理症状和会诊从预测试到后测试有所减少。全科医生记录的已解释症状没有减少。然而，干预组和对照组在症状减轻方面没有差异。路径分析揭示了自我报告的无法解释的身体症状减少的两条途径：从更多的消极情感性通过更多的心理归因和更多的治疗前焦虑，以及从更多的躯体归因通过更多的心理归因和更多的治疗前焦虑。
干预组和对照组在症状减轻方面没有差异。与患者相关的症状感知变量能很好地预测自我报告的医学上无法解释的症状的减少，而对记录症状和会诊变化的预测则需要不同的模型。
