Group Analysis in Patients with Somatoform Disorders: Clinical Effectiveness, the Dynamics of Quality of Life and Attitude Towards Disease and Treatment

Background: the application of group analysis for the treatment of somatoform disorders requires the substantiation of its clinical and psychological effectiveness in various differential diagnostic groups.

Aim: the investigation of the dynamics of pathological bodily sensations, concomitant psychopathological symptoms, quality of life as well as beliefs about the disease and treatment in patients with somatoform disorders undergoing group analysis, in comparison with patients in the psychoeducation program.

Patients and methods: 100 patients with somatoform disorders were randomized to group-analysis or psychoeducation. Before and after treatment, they filled Screening for Somatoform Symptoms, the Toronto Alexithymia Scale, the Illness Perception Questionnairie revised, Cognitions about Body and Health Questionnaire, Scale for the Assessment of Illness Behaviour, and Quality of Life Enjoyment and Satisfaction Questionnairie-18.

Results: all patients demonstrated a decrease in the severity of somatoform symptoms and an improvement in the quality of life in various spheres of life, which is significantly more pronounced in patients receiving group-analysis compared to psychoeducation. The improvement of subjective state of patients having undergone psychotherapy during treatment was highly associated with a decrease in the severity of the emotional reaction to the disease, somatosensory amplification, beliefs in bodily weakness and intolerance to bodily sensations. The patients of the main group solely demonstrated a decrease in patterns of hypochondriacal behavior such as catastrophization regarding bodily sensations, revisiting general practitioners, and simultaneous distrust of the results of medical tests and prescriptions. When comparatively analyzing the separate diagnostic groups, patients with polymorphic somatoform disorder displayed the most pronounced clinical effect (a decrease in the severity of complaints) in the process of group analysis, and patients with somatized disorder showed the most pronounced psychological effect (an improvement in the quality of life, a decrease in the dramatization of bodily sensations, a decrease in medical retesting and diagnosis verification, the optimization of beliefs about health).

Conclusions: group analysis demonstrated greater clinical and psychological effectiveness, in comparison with psychoeducation, in patients with somatoform disorders.

1. Brown RJ. Psychological mechanisms of medically unexplained symptoms: an integrative conceptual model. Psychol Bull. 2004;130(5):793– 812. DOI: 10.1037/0033-2909.130.5.793. PMID: 15367081.

2. Rasskazova EI. The role of cognitive and emotional regulation disorders in emergence of somatic symptoms. Voprosy psihologii. 2013;6:87–97. (In Russ.). eLIBRARY ID: 21202904

3. Ivanov SV. Terapiya psihosomaticheskih rasstrojstv. V kn.: Psihosomaticheskie rasstrojstva v klinicheskoj praktike. Pod red. akad. RAN A.B. Smulevicha. 2-e izd. M.: MEDpress-inform, 2019. (In Russ.).

4. Hiller W, Janca A. Assessment of somatoform disorders: a review of strategies and instruments. Acta Neuropsychiatr. 2003;15(4):167–179. DOI: 10.1034/j.1601-5215.2003.00031.x PMID: 26983564

5. Rasskazova EI. Clinical-psychological approach to the diagnostics of difficultly qualified symptoms of somatoform disorders. V.M. Bekhterev review of psychiatry and medical psychology. 2013;3:25–32. (In Russ.). eLIBRARY ID: 20401792

6. Piontek K, Shedden-Mora MC, Gladigau M, Kuby A, Löwe B. Diagnosis of somatoform disorders in primary care: diagnostic agreement, predictors, and comparisons with depression and anxiety. BMC Psychiatry. 2018;18:361. DOI: 10.1186/s12888-018-1940-3

7. Dehoust MC, Schulz H, Härter M, Volkert J, Sehner S, Drabik A, Wegscheider K, Canuto A, Weber K, Crawford M, Quirk A, Grassi L, DaRonch C, Munoz M, Ausin B, Santos-Olmo A, Shalev A, Rotenstein O, Hershkowitz Y, Strehle J, Wittchen H-U, Andreas S. Prevalence and correlates of somatoform disorders in the elderly: Results of a European study. Int J Methods Psychiatr Res. 2017;26(1):e1550. DOI: 10.1002/mpr.1550

8. Liu J, Gill NS, Teodorczuk A, Li ZJ, Sun J. The efficacy of cognitive behavioural therapy in somatoform disorders and medically unexplained physical symptoms: A meta-analysis of randomized controlled trials. J Affect Disord. 2019;245:98–112. DOI: 10.1016/j.jad.2018.10.114 Epub 2018 Oct 22. PMID: 30368076

9. Leichsenring F, Luyten P, Hilsenroth MJ, Abbass A, Barber JP, Keefe JR, Leweke F, Sven Rabung S, Christiane Steinert Ch. Psychodynamic therapy meets evidence-based medicine: a systematic review using updated criteria. Lancet Psychiatry. 2015;2(7):648–660. PMID: 26303562. DOI: 10.1016/S2215-0366(15)00155-8

10. Beutel ME, Michal M, Subic-Wrana C. Psychoanalytically-oriented inpatient psychotherapy of somatoform disorders. J Am Acad Psychoanal Dyn Psychiatry. 2008;36(1):125–142. DOI: 10.1521/jaap.2008.36.1.125 PMID: 18399750

11. Wittich GH. Der hysterische Patient im sozialen Feld und in der therapeutischen Gruppe. Praxis d. Psychother. 1974;19:274–280.

12. Schaefer M, Egloff B, Witthöft M. Is interoceptive awareness really altered in somatoform disorders? Testing competing theories with two paradigms of heartbeat perception. J Abnorm Psychol. 2012; 121(3):719–724. DOI: 10.1037/a0028509 Epub 2012 May 28. PMID: 22642840

13. Flasinski T, Dierolf AM, Rost S, Lutz A, Voderholzer U, Koch S, Bach M, Asenstorfer C, Münch EE, Mertens V-C, Vögele C, Shulz A. Altered Interoceptive Awareness in High Habitual Symptom Reporters and Patients With Somatoform Disorder. Front Psychol. 2020;11:1859. DOI: 10.3389/fpsyg.2020.01859

14. Waller E, Scheidt CE. Somatoform disorders as disorders of affect regulation: a development perspective. Int Rev Psychiatry. 2006;18(1):13–24. DOI: 10.1080/09540260500466774 PMID: 16451876

15. Taylor GJ, Bagby RM, Parker JD. Disorders of affect regulation: Alexithymia in medical and psychiatric illness. Cambridge: Cambridge University Press, 1997.

16. Mora PA, Robitaille C, Leventhal H, Swigar M, Leventhal EA. Trait negative affect relates to prior-week symptoms, but not to reports of illness episodes, illness symptoms, and care seeking among older persons. Psychosom Med. 2002;64(3):436–449. DOI: 10.1097/00006842-200205000-00007 PMID: 12021417

17. Drahovzal DN, Stewart SH, Sullivan MJ. Tendency to catastrophize somatic sensations: pain catastrophizing and anxiety sensitivity in predicting headache. Cogn Behav Ther. 2006;35(4):226–235. DOI: 10.1080/16506070600898397 PMID: 17189240

18. Rief W, Hiller W, Margraf J. Cognitive aspects of hypochondriasis and the somatization syndrome. Journal of Abnormal Psychology [serial online]. 1998;107(4):587–595.

19. Barsky AJ, Wyshak G. Hypochondriasis and somatosensory amplifi cation. Br J Psychiatry. 1990;157:404– 409. DOI: 10.1192/bjp.157.3.404 PMID: 2245272

20. Martinez MP, Belloch A, Botella C. Somatosensory amplification in hypochondriasis and panic disorder. Clin Psychol and Psyhotherapy. 1999;6:46–53.

21. Rief W, Ihle D, Pilger F. A new approach to assess illness behaviour. J Psychosom Res. 2003;54(5):405– 414. DOI: 10.1016/s0022-3999(02)00401-4 PMID: 12726894

22. Reed GM, First MB, Kogan CS, Hyman SE, Gureje O, Gaebel W, Maj M, Stein DJ, Maercker A, Tyrer P, Claudino A, Garralda E, Salvador-Carulla L, Ray R, Saunders JB, Dua T, Poznyak V, Medina-Mora ME, Pike KM, Ayuso-Mateos JL, Kanba S, Keeley JW, Khoury B, Krasnov VN, Kulygina M, Lovell AM, de Jesus Mari J, Maruta T, Matsumoto C, Rebello TJ, Roberts MC, Robles R, Sharan P, Zhao M, Jablensky A, Udomratn P, Rahimi-Movaghar A, Rydelius PA, Bährer-Kohler S, Watts AD, Saxena S. Innovations and changes in the ICD-11 classification of mental, behavioural and neurodevelopmental disorders. World Psychiatry. 2019;18(1):3–19. DOI: 10.1002/wps.20611 PMID: 30600616; PMCID: PMC6313247

23. Belokrylov IV. Sovremennye problemy psihoterapii zavisimosti ot psihoaktivnyh veshchestv. Voprosy narkologii. 2010;6:60–68. (In Russ.).

24. Rief W, Hiller W. A new approach to the assessment of the treatment effects of somatoform disorders. Psychosomatics. 2003;44(6):492–498. DOI: 10.1176/appi.psy.44.6.492 PMID: 14597684

25. Ritsner M, Kurs R, Gibel A, Ratner Y, Endicott J. Validity of an abbreviated quality of life enjoyment and satisfaction questionnaire (Q-LES-Q-18) for schizophrenia, schizoaffective, and mood disorder patients. Qual Life Res. 2005;14(7):1693–1703. DOI: 10.1007/s11136-005-2816-9 PMID: 16119181

26. Rasskazova EI. Metodika ocenki kachestva zhizni i udovletvorennosti: psihometricheskie harakteristiki russkoyazychnoj versii. Psihologiya. Zhurnal Vysshej shkoly ekonomiki. 2012;9(4):81–90. (In Russ.).

27. Taylor GJ, Ryan D, Bagby RM. Toward the development of a new self-report alexithymia scale. Psychother Psychosom. 1985;44(4):191–199. DOI: 10.1159/000287912 PMID: 3837277

28. Starostina EG, Teilor GD, Kvilti LK, Bobrov AE, Moshnyaga EN, Puzyreva NV, Bobrova MA, Ivashkina MG, Krivchikova MN, Shavrikova EP, Begbi RM. Nadezhnost’ i faktorial’naya validnost’ russkoi versii 20-punktovoi Torontskoi shkaly aleksitimii. Sotsial’naya i klinicheskaya psikhiatriya. 2012;20(3):20– 25. (In Russ.).

29. Moss-Morris R, Weinman J, Petrie K, Horne R, Cameron L, Buick D. The Illness-Revised Perception Questionnaire (IPQ-R). Psychology and Health. 2002;17(1):1–16.

30. Rasskazova EI. Russkoyazychnaya aprobaciya oprosnika vospriyatiya bolezni R. Moss-Morris i dr.: aprobaciya na vyborke bol’nyh s nepsihoticheskimi depressiyami. Vestnik Moskovskogo universiteta. Seriya 14. Psihologiya. 2016;1:123–142. (In Russ.).

31. Rasskazova EI, Thostov ASh. Psihologicheskie faktory effektivnosti lechebnogo processa. V kn.: Rukovodstvo po psihologii zdorov’ya. Pod red. ASh Thostova, EI Rasskazovoj. M.: Izdatel’stvo MGU, 2019;691–752. (In Russ.).

32. Belokrylov IV, Semikov SV, Tkhostov ASh, Rasskazova E. Hypochondriac Beliefs and Behavior in Patientswith Somatoform Disorders: Relationship to Somatic Complaints and Subjective Well-Being. Psychiatry (Moscow) (Psikhiatriya). 2021;19(3):58–67. DOI: 10.30629/2618-6667-2021-19-3-58-67