Maroti Daniel, Ek Josefine, Widlund Rose-Marie, Schubiner Howard, Lumley Mark A, Lilliengren Peter, Bileviciute-Ljungar Indre, Ljótsson Brjánn, Johansson Robert
Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
Department of Psychology, Uppsala University, Uppsala, Sweden.
Front Psychiatry. 2021 Feb 12;12:620359. doi: 10.3389/fpsyt.2021.620359. eCollection 2021.
There is growing evidence that trauma, psychosocial conflict, and difficulties with emotional processing contribute to centralized somatic symptoms. Emotional Awareness and Expression Therapy (EAET) was developed to address these factors and reduce symptoms, and EAET has shown efficacy in face-to-face formats. No trial of an internet-delivered EAET (I-EAET) exists, however, so we developed such an intervention and conducted an uncontrolled feasibility and potential efficacy trial of I-EAET for patients with Somatic Symptom Disorder (SSD) with centralized symptoms (SSD-CS). After screening potential participants, a sample of 52 patients (50 women, two men; age = 49.6, = 11.9) diagnosed with SSD-CS initiated treatment. I-EAET consisted of nine weekly modules focused on psychoeducation, emotional awareness and exposure, and anxiety regulation with self-compassion. Therapists communicated with each patient by email for about 20 min per week during treatment, answering questions and giving feedback on homework assignments. Patients completed measures of somatic symptoms, depression, anxiety, trauma-related symptoms, and functional disability before treatment and again at post-treatment and 4-month follow-up. A large reduction in somatic symptoms (PHQ-15) occurred pre-to post-treatment ( = 1.13; 95% CI: 0.84-1.47) which was fully maintained at 4-month follow-up ( = 1.19; 95% CI: 0.88-1.56). Twenty-three percent of the patients at post-treatment and 27% at follow-up achieved a 50% or greater reduction in somatic symptoms, and about 70% achieved a minimally important clinical difference. In addition, at post-treatment, there were small to medium reductions ('s from 0.33 to 0.72) in anxiety (GAD-7), depression (PHQ-9), trauma-related symptoms (PCL-5), and functional disability (Sheehan Disability Scale). For all of these secondary outcomes, improvements were slightly to substantially larger at follow-up than at post-treatment ('s from 0.46 to 0.80). I-EAET appears to be a feasible treatment for adults with SSD and centralized symptoms, resulting in substantial and durable improvement not only in somatic symptoms but in other psychiatric symptoms and functioning. Controlled trials are needed determine the effects of I-EAET specifically and how this approach compares to face-to-face EAET and to other internet-delivered treatments, such as cognitive-behavioral interventions. Research should also identify treatment responders and mechanisms of change in EAET. www.ClinicalTrials.gov, identifier: NCT04122846.
越来越多的证据表明，创伤、心理社会冲突以及情绪处理困难会导致躯体症状集中化。情绪意识与表达疗法（EAET）旨在解决这些因素并减轻症状，且EAET已在面对面治疗形式中显示出疗效。然而，目前尚无关于互联网提供的EAET（I-EAET）的试验，因此我们开发了这样一种干预措施，并对患有集中性症状的躯体症状障碍（SSD-CS）患者进行了I-EAET的非对照可行性和潜在疗效试验。在筛选潜在参与者后，52名被诊断为SSD-CS的患者（50名女性，2名男性；年龄 = 49.6，标准差 = 11.9）开始接受治疗。I-EAET包括九个每周一次的模块，重点是心理教育、情绪意识与暴露以及通过自我同情进行焦虑调节。在治疗期间，治疗师每周通过电子邮件与每位患者沟通约20分钟，回答问题并对家庭作业给予反馈。患者在治疗前、治疗后以及4个月随访时完成了躯体症状、抑郁、焦虑、创伤相关症状和功能残疾的测量。治疗前到治疗后躯体症状（PHQ-15）大幅减少（均值差 = 1.13；95%置信区间：0.84 - 1.47），在4个月随访时完全维持（均值差 = 1.19；95%置信区间：0.88 - 1.56）。治疗后23%的患者以及随访时27%的患者躯体症状减少了50%或更多，约70%的患者实现了最小临床重要差异。此外，在治疗后，焦虑（GAD-7）、抑郁（PHQ-9）、创伤相关症状（PCL-5）和功能残疾（希恩残疾量表）有小到中等程度的减少（均值差从0.33到0.72）。对于所有这些次要结果，随访时的改善比治疗后略大到显著更大（均值差从0.46到0.80）。I-EAET似乎是一种针对患有SSD和集中性症状的成年人的可行治疗方法，不仅能使躯体症状得到显著且持久的改善，还能改善其他精神症状和功能。需要进行对照试验来具体确定I-EAET的效果，以及这种方法与面对面EAET以及其他互联网提供的治疗方法（如认知行为干预）相比如何。研究还应确定EAET的治疗反应者和变化机制。ClinicalTrials.gov网站，标识符：NCT04122846。
