Philipps-University Marburg, Department of Clinical Psychology and Psychotherapy, Marburg, Germany.
University Koblenz-Landau, Department of Clinical Psychology and Psychotherapy, Landau, Germany.
J Psychosom Res. 2021 Jul;146:110486. doi: 10.1016/j.jpsychores.2021.110486. Epub 2021 Apr 7.
Cognitive behavior therapy (CBT) is the best-evaluated psychological approach to treat patients with medically unexplained symptoms (MUS). We still need a better understanding of what characterizes patients with MUS who benefit more or less from CBT. This systematic review aimed to identify patients' cognitive-emotional characteristics predicting the outcome of CBT for MUS.
A systematic literature search (PubMed, PsycINFO, Web of Science) revealed 37 eligible studies, 23 of these provided data for meta-analyses. Mean correlation coefficients between predictor variables and the outcomes (symptom intensity, physical or social-emotional functioning) were calculated using a random-effects model. Differences between syndromes of MUS were investigated with moderator analyses.
Meta-analyses showed that patients with a comorbid mood disorder (r = 0.32, p < .01) or anxiety disorder (r = 0.18, p < .01), symptom catastrophizing and worries (r = 0.34, p < .01), tendencies of somatosensory amplification (r = 0.46, p = .04), and low symptom acceptance or self-efficacy (r = 0.25, p < .01) have a less favorable CBT outcome. Moderator analyses revealed that these associations between predictors and treatment outcome are pronounced in patients with chronic fatigue syndrome and irritable bowel syndrome.
Our results show that pre-treatment differences in patients' cognitive-emotional characteristics predict patients' outcome in CBT. Patient-tailored CBT could be a promising approach to address MUS patients' widely varying needs more effectively.
The protocol of this systematic review and meta-analysis was registered in the PROSPERO registry (CRD 42018098649).
认知行为疗法（CBT）是治疗原因不明的躯体症状（MUS）患者的最佳评估心理方法。我们仍需要更好地了解从 CBT 中获益更多或更少的 MUS 患者的特征。本系统评价旨在确定预测 MUS 患者 CBT 结果的患者认知-情绪特征。
系统文献检索（PubMed、PsycINFO、Web of Science）共检索到 37 项符合条件的研究，其中 23 项研究提供了可用于荟萃分析的数据。使用随机效应模型计算预测变量与结局（症状强度、身体或社会情感功能）之间的平均相关系数。使用调节分析研究 MUS 综合征之间的差异。
荟萃分析显示，合并心境障碍（r=0.32，p<0.01）或焦虑障碍（r=0.18，p<0.01）、症状灾难化和担忧（r=0.34，p<0.01）、躯体感觉放大倾向（r=0.46，p=0.04）和低症状接受度或自我效能感（r=0.25，p<0.01）的患者 CBT 结局较差。调节分析显示，这些预测因素与治疗结果之间的关联在慢性疲劳综合征和肠易激综合征患者中更为显著。
我们的研究结果表明，患者认知-情绪特征的治疗前差异预测了患者在 CBT 中的结局。针对患者的 CBT 可能是一种很有前途的方法，可以更有效地满足 MUS 患者广泛不同的需求。
本系统评价和荟萃分析的方案在 PROSPERO 注册库（CRD42018098649）中进行了注册。
