Podcast
Questions and Answers
What was the significant effect size for the severity of somatic symptoms posttreatment in the Cochrane review on CBT for somatoform disorders?
What was the significant effect size for the severity of somatic symptoms posttreatment in the Cochrane review on CBT for somatoform disorders?
Which therapy was found to be more effective than graded physical activity at posttreatment and 6 months after therapy?
Which therapy was found to be more effective than graded physical activity at posttreatment and 6 months after therapy?
What was the dropout rate reported in Woods and Asmundson's study?
What was the dropout rate reported in Woods and Asmundson's study?
Which of the following factors did cognitive behavioral interventions target in the etiology of somatoform disorders?
Which of the following factors did cognitive behavioral interventions target in the etiology of somatoform disorders?
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What were the effects of CBT reported for secondary outcomes like quality of life and depressive symptoms?
What were the effects of CBT reported for secondary outcomes like quality of life and depressive symptoms?
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What is a potential explanation for the low efficacy of CBT in somatoform disorders compared to anxiety disorders and depression?
What is a potential explanation for the low efficacy of CBT in somatoform disorders compared to anxiety disorders and depression?
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What was the reported effect size for anxiety in the systematic review and meta-analysis conducted by Veehof et al.?
What was the reported effect size for anxiety in the systematic review and meta-analysis conducted by Veehof et al.?
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Which of the following describes kinesiophobia as it relates to chronic pain?
Which of the following describes kinesiophobia as it relates to chronic pain?
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What might be a common cognitive distortion observed in Deborah regarding her symptoms?
What might be a common cognitive distortion observed in Deborah regarding her symptoms?
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Which of the following behaviors refers to Deborah's tendency to repeatedly seek medical advice?
Which of the following behaviors refers to Deborah's tendency to repeatedly seek medical advice?
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Why do practitioners often find it challenging to treat patients with MUPS?
Why do practitioners often find it challenging to treat patients with MUPS?
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What psychological intervention could help patients like Deborah understand their symptoms better?
What psychological intervention could help patients like Deborah understand their symptoms better?
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What is a common misconception patients with MUPS might have about psychological interventions?
What is a common misconception patients with MUPS might have about psychological interventions?
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What effect does kinesiophobia have on individuals like Deborah?
What effect does kinesiophobia have on individuals like Deborah?
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What behavior might involve Deborah frequently checking her body for signs of illness?
What behavior might involve Deborah frequently checking her body for signs of illness?
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What often hinders patients with MUPS from engaging in effective treatments?
What often hinders patients with MUPS from engaging in effective treatments?
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What is a key component in the treatment of kinesiophobia within CBT?
What is a key component in the treatment of kinesiophobia within CBT?
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Which intervention combines traditional CBT with mindfulness strategies for patients with MUPS?
Which intervention combines traditional CBT with mindfulness strategies for patients with MUPS?
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What does imaginal exposure in CBT for illness anxiety disorder involve?
What does imaginal exposure in CBT for illness anxiety disorder involve?
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What is the focus of the mindfulness and acceptance-based interventions in the third wave CBT?
What is the focus of the mindfulness and acceptance-based interventions in the third wave CBT?
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What common issue do patients with chronic pain often experience according to CBT principles?
What common issue do patients with chronic pain often experience according to CBT principles?
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What issue is primarily addressed through exposure therapy for chronic pain patients?
What issue is primarily addressed through exposure therapy for chronic pain patients?
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What might be a consequence of not addressing fear of movement in patients with chronic pain?
What might be a consequence of not addressing fear of movement in patients with chronic pain?
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What is a potential benefit of utilizing ACT in health anxiety treatment?
What is a potential benefit of utilizing ACT in health anxiety treatment?
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Study Notes
Introduction to Somatic Symptom and Related Disorders
- People experience somatic symptoms, and most cope effectively
- However some people's lives are overwhelmed by somatic concerns
- Somatic concerns can stem from well-established medical illnesses or have unclear origins
- A pervasive and overwhelming focus on these sensations is common in both situations
Somatic Symptom Disorder
- Patients believe they have a severe, undetected disease
- Evidence against disease does not sway their beliefs
- Patients fixate on one or more somatic symptoms that they believe indicate illness
- Patients often experience depression and anxiety alongside their somatic symptoms
- Patients may stick to one diagnosis or switch between diagnoses over time
Illness Anxiety Disorder
- Patients believe they have a serious, undiagnosed disease
- Evidence against the disease does not sway their beliefs
- Beliefs can shift to another disease over time
- This interferes with family, friends, and daily life
- The disorder includes preoccupation with illness, and often internet searching for information which fuels the concern
Conversion Disorder (Functional Neurologic Symptom Disorder)
- Patients experience neurologic symptoms that aren't consistent with known neurological conditions
- These symptoms can be motor or sensory
- The symptoms may be related to psychological stress
- The disorders are not intentionally produced by the patient
Psychological Factors Affecting Other Medical Conditions
- Patients experience physical disorders impacted by psychological or emotional factors
- A physical condition must already be present to diagnose this disorder
- This includes denial of treatment, asthma exacerbation, or diabetes insulin manipulation, among other scenarios
Factitious Disorder
- Patients feign, misrepresent, simulate, cause, or exacerbate their illness to take on a patient role
- It is not about financial or personal gain or the avoidance of duties
- This can involve inflicting pain on themselves or dependents
Management of Somatoform Pain Disorders
- Somatization, the experience of physical symptoms in the absence of a medical cause, is common
- The tendency to portray psychological distress as physical symptoms, and to seek help for those symptoms, is a widespread phenomenon
- Physical symptoms may remain poorly explained, with increased medical visits, tests, and procedures with potential complications
Overview
- One or more persistent physical symptoms with excessive thoughts, feelings, and behaviors concerning the symptoms
- This is a primary care concern for over 25% of patients
- These patients tend to extensively utilize healthcare services and experience little benefit and protracted impairments.
DSM-5 Disorders
- Somatic Symptom Disorder
- Illness Anxiety Disorder
- Conversion Disorder
- Psychological Factors Affecting Another Medical Condition
- Factitious Disorder
- Other Specified Somatic Symptom and Related Disorders
- Unspecified Somatic Symptom and Related Disorders
Deborah and Her Multiple Somatic Symptoms
- A 24-year-old student with fluctuating physical symptoms for 2 years
- Symptoms include breathlessness, pressure in the chest, and nausea/ vomiting, which may be triggered by exercise or alcohol consumption
- She sought medical attention and received contradictory information on treatments from multiple specialists, yet no lasting relief was found
Targets of CBT for Somatoform Disorders
- Attention bias toward somatic stimuli
- Patients focus more attention to bodily sensations, which are amplified more
- Symptom-related catastrophizing thoughts
- Patients misinterpret illness
- Illness worries,
- Cognitive beliefs about their body image affect how they perceive their symptoms
Dysfunctional Cognitions
- Patients have catastrophizing thoughts and misjudgment of potential risks
- Patients express perceived loss of control over somatic sensations
- Patients are self-blaming due to their perceived failures to receive better care
- Biased beliefs about their body and associated symptoms
Cognitive Restructuring
- Somatoform patients may have self-fulfilling prophecies that their symptoms will worsen when interacting, or engaging in other scenarios
- Identifying and questioning dysfunctional cognitions (e.g., catastrophizing) and modifying them through cognitive restructuring
- Implementing behavioral experiments to test beliefs about symptoms
- Working to help patients experience control
Stress Management and Biofeedback
- Educating patients on the relationship between stress, physical symptoms, and physiological processes
- Using relaxation techniques (like progressive muscle relaxation) to help control bodily responses
- Employing biofeedback as a complementary tool to aid in relaxation and understand bodily functions
Refocusing Attention
- Exercises to shift attention to different body regions
- The process of consciously shifting attention to different body parts
- Distraction strategies to reduce focus on somatic sensations
Cognitive Restructuring
- Identifying and challenging dysfunctional thoughts
- Challenging and modifying the belief surrounding loss of control over the symptoms
- Exploring and reorienting thoughts related to illness beliefs
- Addressing the patient’s distorted image of their physical and mental body
Reducing Illness Behaviors
- Addressing avoidance behaviors relating to illness
- Evaluating the need to scan the body
- Assessing the cost-benefit of avoiding activities
Reducing Extensive Health Care Utilizing Behaviors
- Exploring underlying motives of "doctor shopping"
- Realizing that clinicians might not take their concerns seriously due to repeated visits
- Establishing fewer appointments with more time between them
Specific Issues in CBT for Pain
- Catastrophizing thoughts and fear of movement
- Fear of movements escalating pain
- Disability, de-conditioning, and depressive mood
- Using exposure therapy for patients to gently confront their fear of movement, and escalating the levels of physical activities
Specific Issues in CBT for Illness Anxiety Disorder
- Imaginal exposure to help patients address their fear of imagined illness
- Addressing patients' worries and fears of physical health concerns
Developments of CBT
- Mindfulness-based interventions are combined with CBT to help patients accept their symptoms
- Acceptance and Commitment Therapy focuses on accepting symptoms, as well as setting values and committing to actions that align
Empirical Evidence for CBT
- CBT shows moderate effects in reducing somatic symptoms
- CBT has shown positive results in terms of improving daily functioning but other outcomes such as anxiety and depression display little benefit
Summary
- CBT targets factors associated with somatoform disorders
- Examining the effectiveness showing moderate results
- Methodological challenges to effectiveness
Models of Somatization
- There is no single adequate model of somatization
- "Emotional distress" is often expressed as physical symptoms
Somatic Symptom Disorder (DSM-5)
- Patients experience one or more somatic symptoms that disrupt their daily life, accompanied by excessive concern, thoughts, feelings, or behaviors related to the symptoms.
- The symptoms and concerns must persist for at least 6 months
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Description
This quiz covers the critical concepts of somatic symptom and related disorders, including Somatic Symptom Disorder and Illness Anxiety Disorder. It explores how these disorders can greatly impact individuals' lives through overwhelming concerns about health, even in the absence of significant medical findings. Test your understanding of these mental health conditions and their implications.
