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Changes in illness perceptions mediated the effect of cognitive behavioural therapy in severe functional somatic syndromes
Abstract
Objective Although there is substantial evidence that cognitive behavioural therapy alleviates symptoms in functional somatic syndromes, the mechanisms of change are less investigated. This study examined whether changes in illness perceptions mediated the effect of cognitive behavioural therapy.Methods We analysed additional data from a randomised controlled trial comparing completers of cognitive behavioural group therapy (46 patients) to an enhanced usual care group (66 patients). Proposed mediators (illness perceptions) and primary (physical health) and secondary (somatic symptoms and illness worry) outcomes were assessed by means of questionnaires at referral, baseline, end of treatment, and 10 and 16 months after randomisation. Multiple mediation analysis determined whether (1) changes in specific illness perceptions during treatment mediated the effect of cognitive behavioural therapy (primary analysis), and (2) whether changes in illness perceptions during the whole trial period were associated with improved outcome (secondary analysis).Results Improvements in illness perceptions during treatment partially mediated the effect of cognitive behavioural therapy on physical health one year after treatment (sum of indirect effects 1.556, BCa 95% CI (0.006; 3.620)). Improving perceived control was particularly important. Changes in illness perceptions from baseline to 16 months after randomisation were associated with clinically meaningful improvements in physical health, somatic symptoms and illness worry during the same period.Conclusion Our results suggest that changing patients' illness perceptions is an important process in cognitive behavioural therapy for functional somatic syndromes. Challenging patients' own understanding of their illness may hence be a key element of successful treatment.
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“In a comparable study with adults, changes in illness perceptions partly mediated the effect of treatment on outcome.76”
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Metadata
- Authors
- Christensen, S. S., Frostholm, L., Ørnbøl, E., & Schröder, A.
- Affiliations
- Aarhus University Hospital (DK)
- Corresponding author
- Schröder, Andreas
- Venue
- Journal of Psychosomatic Research
- Publisher
- Elsevier BV
- Published
- 2015-04
- Volume
- 78
- Issue
- 4
- Pages
- 363-370
- ISSN
- 0022-3999 (ISSN-L)
- OpenAlex
- W2138752739
- Cited by
- 111
- References
- 44
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 1 · 2023: 3 · 2022: 4 · 2021: 8 · 2020: 59 · 2019: 8 · 2018: 10 · 2017: 5 · 2016: 6 · 2015: 2
- FWCI
- 3.31
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Psychosomatic Research (publishedVersion)
- PubMed (publishedVersion)
- Funders
- TrygFonden (7-12-1039)
- Torkil Steenbeck's Legat; LundbeckFonden (R129-A11720)
- Foreningen Østifterne (12-081)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- cognitive behavioral therapy, functional somatic syndromes, illness perception, perceived control, mechanisms of change, somatic symptoms, physical health outcomes, group therapy
- MeSH terms
- Adult, Anxiety, Female, Humans, Male, Middle Aged, Psychophysiologic Disorders, Surveys and Questionnaires, Social Perception, Syndrome, Cognitive Behavioral Therapy, Treatment Outcome
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