Von Hiller Wolfgang
Johannes Gutenberg University Mainz, Department of Psychology, Staudingerweg 9, D-55099 Mainz, Germany.
Z Psychosom Med Psychother. 2005;51(1):4-22. doi: 10.13109/zptm.2005.51.1.4.
Modern cognitive behavioral approaches for the treatment of patients with medically unexplained somatic symptoms have been developed on the basis of the classification systems DSM-IV and ICD-10. These systems define somatoform disorders as a homogeneous clinical group. Behavior therapy has additionally developed vicious circle models specifying etiological, triggering and maintaining factors. Treatment goals and strategies can be derived directly from these models. The main components are: (1) motivation of patients to accept the psychotherapeutic approach; (2) introduction of alternative explanations of the symptoms on the basis of both biomedical as well as psychosocial mechanisms; (3) evaluation of the new explanations by patient and therapist; (4) reduction of avoidance and inadequate illness behaviour. Health economical aspects are particularly important because patients with somatoform disorders tend to overuse medical services and are thus considered an expensive problem group for the health system.
现代针对患有医学上无法解释的躯体症状患者的认知行为治疗方法是在《精神疾病诊断与统计手册》第四版（DSM-IV）和《国际疾病分类》第十版（ICD-10）分类系统的基础上发展而来的。这些系统将躯体形式障碍定义为一个同质的临床组。行为疗法还开发了恶性循环模型，明确了病因、触发因素和维持因素。治疗目标和策略可直接从这些模型中推导出来。主要组成部分包括：（1）促使患者接受心理治疗方法；（2）基于生物医学和心理社会机制对症状引入替代性解释；（3）患者和治疗师对新解释进行评估；（4）减少回避行为和不适当的疾病行为。健康经济学方面尤为重要，因为躯体形式障碍患者往往过度使用医疗服务，因此被视为卫生系统中一个成本高昂的问题群体。
