Psychotherapies for Somatoform Disorders

Summary: Summary Somatoform disorders are characterized by the chronic presence of physical symptoms, which are not explained by any physical disease. Patients with these conditions often consult multiple physicians/specialists. Limited understanding of the somatoform disorder and its management among general physicians often results in repeated unnecessary investigations and polypharmacy. Illness severity, quality and quantity of psychological treatment are important moderators of treatment efficacy. The distinction between mild, moderate, and severe symptom intensity is essentially based on clinician judgment which takes into account somatic and psychological extent of symptoms, loss of sociooccupational functioning, dysfunctional expectations, and abnormal illness behavior. Evidence supports the role of cognitive behavior therapy (CBT), mindfulness-based interventions, acceptance and commitment therapy, and relaxation therapy in the management of individual subtypes of somatoform disorders Nearly one-fourth of the patients undergoing psychotherapy report improvement after single session, and nearly half of the patients report improvement by the end of eight sessions. The aspects of treatment covered in this guideline include: 1. The assessment of suitability for specific psychotherapy focussing on the factors to consider during pretherapy assessment 2. The specific techniques that may be used, including: Positive suggestion, biomedical explanations, Reattribution, Problem-solving approach, Guided imagery and Combined consultation. Features suggestive of dependence on the therapist are also discussed. 3. Rating instruments available for the assessment of severity and improvement 4. The evidence base for various psychotherapeutic techniques, 5. A stepped care model based on symptom severity 6. Situations where in-patient care should be considered

Authors: Vivek Agarwal, Anil Nischal, Samir Kumar Praharaj, Vikas Menon, Sujita Kumar Kar

Year of Publication: January-2020