Extension of Cognitive Behavioral Therapy by emotion regulation training in patients with multiple somatoform symptoms: Results of a controlled pilot study [Erweiterung der kognitiven Verhaltenstherapie um Emotionsregulationstraining bei Patienten mit multiplen somatoformen Symptomen: Ergebnisse einer kontrollierten Pilotstudie]

Abstract

Background: Studies demonstrate that CBT is effective in treating patients with multiple somatoform symptoms (MSS), but by now, the interventions consistently did not exceed medium effect sizes. Since many MSS patients seem to lack emotional awareness, the integration of emotion regulation training could enhance the effects of common psychological interventions. The management of feelings should be enhanced by enriching CBT with emotion regulation strategies like non-judgmental perception, acceptance, and mindfulness. The objective of this study was to validate the ENCERT (Enriching CBT with Emotion Regulation Training) manual, to demonstrate its feasibility and to compare the changes over time with CBT and ENCERT. Patients and Methods: In a non-randomized group study, 20 patients in ENCERT and 22 in CBT (≥3 medically unexplained somatic symptoms, ≥6 months) attended 20 weekly sessions of individual psychotherapy in an outpatient setting. Assessments took place before beginning and after completion of therapy. Primary outcomes were the Screening of Somatization Disorder (SOMS-7T), emotion regulation skills, and visual analogue scales (VAS) assessing symptom intensity and subjective impairment. Results: Both groups showed significant improvement in the somatization severity index (CBT d = 0.46; ENCERT d = 0.70), as well as in the somatization symptom count (CBT d = 0.50; ENCERT d = 0.72). There were no significant group differences after completion of therapy: Controlling for baseline variables, there was an indication for significant difference between groups in favor of ENCERT in the somatization severity index after completion of therapy (ANCOVA: F (1.37) = 4.058, p = 0.051). Additionally, patients significantly improved during ENCERT in intensity (d = 0.59) and in impairment (d = 1.25) of symptoms, and they reported to acquire greater emotion regulation competence (d = 1.14). Conclusion: Patients with MSS improved during ENCERT and CBT with tendentially larger effect sizes for ENCERT but higher baseline value in depression and anxiety. However, we were not able to find group differences. This might be due to a lack of statistical power. Therefore, our next step is the implementation of a large randomized, controlled multicenter trial.