Short-term psychodynamic psychotherapy for functional somatic disorders: A systematic review and meta-analysis of within-treatment effects

Allan Abbass; Mark A Lumley; Joel Town; Hannah Holmes; Patrick Luyten; Angela Cooper; Leo Russell; Howard Schubiner; Celine De Meulemeester; Steve Kisely

doi:10.1016/j.jpsychores.2021.110473

Short-term psychodynamic psychotherapy for functional somatic disorders: A systematic review and meta-analysis of within-treatment effects

J Psychosom Res. 2021 Jun:145:110473. doi: 10.1016/j.jpsychores.2021.110473. Epub 2021 Mar 26.

Authors

Affiliations

¹ Centre for Emotions and Health, Dalhousie University, Halifax, Canada. Electronic address: allan.abbass@dal.ca.
² Department of Psychology, Wayne State University, Detroit, USA.
³ Centre for Emotions and Health, Dalhousie University, Halifax, Canada.
⁴ Department of Psychology, Wayne State University, Detroit, USA; Department of Psychology, Appalachian State University, Boone, NC, USA.
⁵ University Leuven, Belgium; University College London, UK.
⁶ Devon Partnership NHS Trust, UK.
⁷ Ascension Providence Hospital and Michigan State University College of Human Medicine, Southfield, MI, USA.
⁸ Department of Psychology, Appalachian State University, Boone, NC, USA.
⁹ Centre for Emotions and Health, Dalhousie University, Halifax, Canada; University of Queensland, Australia.

PMID: 33814192
DOI: 10.1016/j.jpsychores.2021.110473

Abstract

Objective: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Functional somatic disorders; Medically unexplained symptoms; Meta-analysis; Short-term psychodynamic psychotherapy; Somatic symptom disorders; Somatization; Somatoform disorders; Systematic review; Within-treatment effects.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Anxiety Disorders
Humans
Medically Unexplained Symptoms*
Psychotherapy
Psychotherapy, Brief*
Psychotherapy, Psychodynamic*
Treatment Outcome