Centre for Emotions and Health, Dalhousie University, Halifax, Canada.
Department of Psychology, Wayne State University, Detroit, USA.
J Psychosom Res. 2021 Jun;145:110473. doi: 10.1016/j.jpsychores.2021.110473. Epub 2021 Mar 26.
A recent meta-analysis of 17 randomized, controlled trials (RCTs) showed that Short-term Psychodynamic Psychotherapy (STPP) for functional somatic disorders (FSD) reduced somatic symptoms compared to wait list, minimal treatment, and treatment-as-usual controls. A clinically important yet unanswered question is how much improvement patients experience within STPP treatment.
Following a systematic search, we identified STPP trials presenting data at baseline and post-treatment/follow-up. Meta-analyses determined the magnitude of changes in somatic symptoms and other outcomes from before to after STPP, and analyses examined effect sizes as a function of study, therapy, and patient variables.
We identified 37 trials (22 pre-post studies and 15 RCTs) totaling 2094 patients treated an average of 13.34 sessions for a range of FSD. Across all studies, somatic symptoms improved significantly from pre-treatment to short-term follow-up with a large effect size (SMD = -1.07), which was maintained at long-term follow-up (SMD = -0.90). After excluding two outlier studies, effects at short- and medium-term follow-up remained significant but were somewhat reduced in magnitude (e.g., short-term SMD = -0.73). Secondary outcomes including anxiety, depression, disability, and interpersonal problems had medium to large effects. Effects were larger for studies of STPP that were longer than 12 sessions or used an emotion-focused type of STPP, and for chronic pain or gastrointestinal conditions than for functional neurological disorders.
STPP results in moderate to large improvements in multiple outcome domains that are sustained in long-term follow-up. STPP is an effective treatment option for FSD and should be included in treatment guidelines.
最近一项针对 17 项随机对照试验（RCT）的荟萃分析显示，短期心理动力学心理治疗（STPP）治疗功能性躯体障碍（FSD）可减少躯体症状，与等待名单、最低治疗和常规治疗相比。一个具有临床意义但尚未得到解答的问题是，患者在 STPP 治疗中经历了多少改善。
我们进行了系统检索，确定了报告基线和治疗后/随访时数据的 STPP 试验。荟萃分析确定了从 STPP 治疗前到治疗后的躯体症状和其他结果的变化幅度，并分析了研究、治疗和患者变量对效应大小的影响。
我们确定了 37 项试验（22 项前后研究和 15 项 RCT），共纳入 2094 名患者，平均接受 13.34 次治疗，治疗各种 FSD。所有研究中，躯体症状从治疗前到短期随访均有显著改善，效应量较大（SMD=-1.07），在长期随访中仍保持（SMD=-0.90）。排除两项异常值研究后，短期和中期随访的效果仍然显著，但幅度有所降低（例如，短期 SMD=-0.73）。包括焦虑、抑郁、残疾和人际关系问题在内的次要结局均有中等至较大效应。STPP 研究持续时间超过 12 次或使用情绪聚焦型 STPP，或针对慢性疼痛或胃肠道疾病的研究，其效果大于针对功能性神经障碍的研究。
STPP 可使多个领域的结局得到中等至较大程度的改善，并在长期随访中持续存在。STPP 是 FSD 的有效治疗选择，应纳入治疗指南。
