Internet-based emotional awareness and expression therapy for somatic symptom disorder: A randomized controlled trial

Daniel Maroti; Mark A Lumley; Howard Schubiner; Peter Lilliengren; Indre Bileviciute-Ljungar; Brjánn Ljótsson; Robert Johansson

doi:10.1016/j.jpsychores.2022.111068

Internet-based emotional awareness and expression therapy for somatic symptom disorder: A randomized controlled trial

J Psychosom Res. 2022 Dec:163:111068. doi: 10.1016/j.jpsychores.2022.111068. Epub 2022 Oct 22.

Authors

Daniel Maroti¹, Mark A Lumley², Howard Schubiner³, Peter Lilliengren⁴, Indre Bileviciute-Ljungar⁵, Brjánn Ljótsson⁶, Robert Johansson⁷

Affiliations

¹ Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden. Electronic address: Daniel.maroti@ki.se.
² Department of Psychology, Wayne State University, Detroit, MI, USA.. Electronic address: mlumley@wayne.edu.
³ Department of Internal Medicine, Ascension Providence-Providence Hospital, Michigan State University College of Human Medicine, Southfield, MI, USA.
⁴ Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden.. Electronic address: peter.lilliengren@esh.se.
⁵ Department of Clinical Sciences, Karolinska Institute and Department of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden.. Electronic address: indre.ljungar@ki.se.
⁶ Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden. Electronic address: brjann.ljotsson@ki.se.
⁷ Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden; Department of Psychology, Stockholm University, Stockholm, Sweden.. Electronic address: robert.johansson@psychology.su.se.

PMID: 36327532
DOI: 10.1016/j.jpsychores.2022.111068

Abstract

Objective: Somatic symptom disorder (SSD) is commonly encountered in health care settings. Cognitive-behavioural treatments have been most extensively studied, but they tend to have small effects of temporary duration. Emotional awareness and expression therapy (EAET) is a newly developed treatment for SSD, targeting emotional processing of trauma and conflict as a mechanism of symptom change. In an earlier uncontrolled study of self-guided, internet-administrated EAET (I-EAET), we found substantial reductions in somatic symptoms, prompting the need for a randomized controlled trial of I-EAET.

Methods: We conducted a 2-arm RCT, comparing 10-week I-EAET (n = 37) to a waitlist control (WL; n = 37). Primary outcomes were reductions of somatic symptoms (PHQ-15) and pain intensity (BPI-4) at post-treatment, with a 4-month evaluation of effect duration. We also analysed emotional processing (EPS-25) and depression (PHQ-9) as possible mediators of I-EAET's effects.

Results: Compared to controls, I-EAET significantly reduced somatic symptoms at both post-treatment and follow-up. I-EAET also reduced pain, depression, insomnia, and anxiety at post-treatment, but these effects were not retained at follow-up. As hypothesized, a facet of emotional processing partially mediated the treatment effect on somatic symptoms, even when controlling for depression.

Conclusions: Although treatment effects were smaller than in the previous uncontrolled trial, I-EAET is a promising treatment for SSD, with a minority of patients (around 20%) experiencing substantial clinical improvement. The benefits of I-EAET are partially mediated by improved emotional processing. Future research should identify and target patients who respond best to I-EAET and develop tailored treatment to enhance treatment effects. (Preregistered at clinicaltrials.gov: NCT04751825.).

Keywords: emotional awareness and expression therapy; emotional processing; functional somatic syndromes; randomized controlled trial; self-guided treatment; somatic symptom disorder.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Anxiety / therapy
Cognitive Behavioral Therapy*
Emotions
Humans
Internet
Medically Unexplained Symptoms*
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT04751825