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Cited by 303Psychosomatic Disorders and Their TreatmentsPain Management and Placebo EffectFibromyalgia and Chronic Fatigue Syndrome Research

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Non-pharmacological interventions for somatoform disorders and medically unexplained physical symptoms (MUPS) in adults

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van Dessel, Nikki, den Boeft, Madelon, van der Wouden, Johannes C, Kleinstäuber, Maria, Leone, Stephanie S, Terluin, Berend, Numans, Mattijs E, van der Horst, Henriëtte E, van Marwijk, Harm·2014·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd011142.pub2PMC PMC10984143
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Abstract

BACKGROUND: Medically unexplained physical symptoms (MUPS) are physical symptoms for which no adequate medical explanation can be found after proper examination. The presence of MUPS is the key feature of conditions known as 'somatoform disorders'. Various psychological and physical therapies have been developed to treat somatoform disorders and MUPS. Although there are several reviews on non-pharmacological interventions for somatoform disorders and MUPS, a complete overview of the whole spectrum is missing. OBJECTIVES: To assess the effects of non-pharmacological interventions for somatoform disorders (specifically somatisation disorder, undifferentiated somatoform disorder, somatoform disorders unspecified, somatoform autonomic dysfunction, pain disorder, and alternative somatoform diagnoses proposed in the literature) and MUPS in adults, in comparison with treatment as usual, waiting list controls, attention placebo, psychological placebo, enhanced or structured care, and other psychological or physical therapies. SEARCH METHODS: We searched the Cochrane Depression, Anxiety and Neurosis Review Group's Specialised Register (CCDANCTR) to November 2013. This register includes relevant randomised controlled trials (RCTs) from The Cochrane Library, EMBASE, MEDLINE, and PsycINFO. We ran an additional search on the Cochrane Central Register of Controlled Trials and a cited reference search on the Web of Science. We also searched grey literature, conference proceedings, international trial registers, and relevant systematic reviews. SELECTION CRITERIA: We included RCTs and cluster randomised controlled trials which involved adults primarily diagnosed with a somatoform disorder or an alternative diagnostic concept of MUPS, who were assigned to a non-pharmacological intervention compared with usual care, waiting list controls, attention or psychological placebo, enhanced care, or another psychological or physical therapy intervention, alone or in combination. DATA COLLECTION AND ANALYSIS: Four review authors, working in pairs, conducted data extraction and assessment of risk of bias. We resolved disagreements through discussion or consultation with another review author. We pooled data from studies addressing the same comparison using standardised mean differences (SMD) or risk ratios (RR) and a random-effects model. Primary outcomes were severity of somatic symptoms and acceptability of treatment. MAIN RESULTS: We included 21 studies with 2658 randomised participants. All studies assessed the effectiveness of some form of psychological therapy. We found no studies that included physical therapy.Fourteen studies evaluated forms of cognitive behavioural therapy (CBT); the remainder evaluated behaviour therapies, third-wave CBT (mindfulness), psychodynamic therapies, and integrative therapy. Fifteen included studies compared the studied psychological therapy with usual care or a waiting list. Five studies compared the intervention to enhanced or structured care. Only one study compared cognitive behavioural therapy with behaviour therapy.Across the 21 studies, the mean number of sessions ranged from one to 13, over a period of one day to nine months. Duration of follow-up varied between two weeks and 24 months. Participants were recruited from various healthcare settings and the open population. Duration of symptoms, reported by nine studies, was at least several years, suggesting most participants had chronic symptoms at baseline.Due to the nature of the intervention, lack of blinding of participants, therapists, and outcome assessors resulted in a high risk of bias on these items for most studies. Eleven studies (52% of studies) reported a loss to follow-up of more than 20%. For other items, most studies were at low risk of bias. Adverse events were seldom reported.For all studies comparing some form of psychological therapy with usual care or a waiting list that could be included in the meta-analysis, the psychological therapy resulted in less severe symptoms at end of treatment (SMD -0.34; 95% confidence interval (CI) -0.53 to -0.16; 10 studies, 1081 analysed participants). This effect was considered small to medium; heterogeneity was moderate and overall quality of the evidence was low. Compared with usual care, psychological therapies resulted in a 7% higher proportion of drop-outs during treatment (RR acceptability 0.93; 95% CI 0.88 to 0.99; 14 studies, 1644 participants; moderate-quality evidence). Removing one outlier study reduced the difference to 5%. Results for the subgroup of studies comparing CBT with usual care were similar to those in the whole group.Five studies (624 analysed participants) assessed symptom severity comparing some psychological therapy with enhanced care, and found no clear evidence of a difference at end of treatment (pooled SMD -0.19; 95% CI -0.43 to 0.04; considerable heterogeneity; low-quality evidence). Five studies (679 participants) showed that psychological therapies were s

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Authors
van Dessel, N., den Boeft, M., van der Wouden, J. C., Kleinstäuber, M., Leone, S. S., Terluin, B., Numans, M. E., van der Horst, H. E., & van Marwijk, H.
Affiliations
  • EMGO Institute for Health and Care Research, VU University Medical Center; Department of General Practice and Elderly Care Medicine; Van der Boechorststraat 7, room D-550 Amsterdam Netherlands 1081 BT
  • VU University Medical Center; Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research; PO Box 7057 Amsterdam Netherlands 1007 MB
  • Philipps University of Marburg (DE)
  • Trimbos Institute (NL)
  • Amsterdam Public Health (NL)
  • Leiden University Medical Center (NL)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2014-11-01
Volume
2014
Issue
11
Pages
CD011142-CD011142
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd011142.pub2
PMC
PMC10984143
OpenAlex
W1603996513
Cited by
302
References
199
Citations by year
2026: 9 · 2025: 22 · 2024: 19 · 2023: 24 · 2022: 18 · 2021: 35 · 2020: 23 · 2019: 41 · 2018: 32 · 2017: 36 · 2016: 23 · 2015: 18 · 2014: 1
FWCI
3.58
Type
journal article
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
  • Digital Commons - USU (Utah State University) (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
  • Leiden Repository (Leiden University) (submittedVersion)
  • Pure Amsterdam UMC (submittedVersion)
  • Research Explorer (The University of Manchester) (submittedVersion)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
  • Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
Keywords
somatoform disorders, medically unexplained physical symptoms, non-pharmacological treatment, psychotherapy, cognitive behavioral therapy, mindfulness-based interventions, psychodynamic psychotherapy, integrative therapy, somatization disorder, undifferentiated somatoform disorder, pain disorders, treatment acceptability, somatic symptom severity, adults, third-wave CBT, behavior therapy
MeSH terms
Adult, Humans, Psychotherapy, Somatoform Disorders, Waiting Lists, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic

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