Krempel Laura, Martin Alexandra
From the Department of Clinical Psychology and Psychotherapy, Institute of Psychology, School of Human and Social Sciences, University of Wuppertal, Wuppertal, Germany.
Psychosom Med. 2023 Jan 1;85(1):61-70. doi: 10.1097/PSY.0000000000001143. Epub 2022 Oct 3.
Patients with somatic symptom disorder (SSD) often receive targeted intervention only after a long duration of illness. Moreover, the reported effect sizes of interventions for SSD are small. Therefore, improvement and evaluation of interventions are needed. Preliminary evidence suggests autonomic imbalance, for example, lower heart rate variability (HRV) in SSD. HRV biofeedback (HRV-BF) as a method for self-regulation shows initial positive effects in chronic pain and functional syndromes. The aim of this study was to evaluate the efficacy of a brief HRV-BF intervention for SSD.
Of a total of 50 participants with SSD ( Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition ) who were recruited and randomly assigned to four sessions of HRV-BF ( n = 25) or autogenic training (AT; n = 25), 49 participants were analyzed (female, 77.6%; mean [standard deviation] age = 45.3 [14.4] years). The primary outcomes were somatic symptom severity (Screening for Somatoform Disorders, numeric rating scale) and HRV. Secondary outcomes were psychological characteristics of SSD (e.g., the Somatic Symptom Disorder 12 scale, health concerns, emotion regulation). The data were collected before and after intervention and were analyzed with repeated-measures analyses of variance and post hoc t tests.
Symptom severity improved after both, HRV-BF and AT. Standard Deviation of the NN Interval and psychological symptoms improved significantly more strongly in the HRV-BF than in the AT group (e.g., Standard Deviation of the NN Interval: ηp2 interaction = 0.10, p = .047).
The improvements in somatic symptoms, but specifically in cognitive-affective symptoms and autonomic regulation, suggest that HRV-BF with only four sessions is a potentially useful intervention option for SSD. Thus, adding this short HRV-BF intervention to existing psychological treatments for SSD may be promising.Trial Registration : German Clinical Trial Register identifier DRKS00017099 ( https://www.drks.de ).
躯体症状障碍（SSD）患者通常在患病很长时间后才接受针对性干预。此外，报告的针对SSD的干预效应量较小。因此，需要改进和评估干预措施。初步证据表明存在自主神经失衡，例如SSD患者心率变异性（HRV）较低。HRV生物反馈（HRV-BF）作为一种自我调节方法，在慢性疼痛和功能综合征中显示出初步的积极效果。本研究的目的是评估简短的HRV-BF干预对SSD的疗效。
共招募了50名符合《精神疾病诊断与统计手册》第五版的SSD患者，随机分为四节HRV-BF组（n = 25）或自生训练（AT；n = 25）组，对49名参与者进行分析（女性，77.6%；平均[标准差]年龄 = 45.3 [14.4]岁）。主要结局指标为躯体症状严重程度（躯体形式障碍筛查，数字评定量表）和HRV。次要结局指标为SSD的心理特征（例如，躯体症状障碍12项量表、健康担忧、情绪调节）。在干预前后收集数据，并采用重复测量方差分析和事后t检验进行分析。
HRV-BF组和AT组干预后症状严重程度均有所改善。HRV-BF组的NN间期标准差和心理症状改善明显强于AT组（例如，NN间期标准差：ηp2交互作用 = 0.10，p = .047）。
躯体症状的改善，尤其是认知情感症状和自主神经调节方面的改善，表明仅四节的HRV-BF是SSD一种潜在有用的干预选择。因此，将这种简短的HRV-BF干预添加到现有的SSD心理治疗中可能很有前景。试验注册：德国临床试验注册标识符DRKS00017099（https://www.drks.de）
